Uses of Derobin Ointment

DEROBIN

Compound Dithranol Ointment 

Contains :

Dithranol IP .......................................... 1.15% w/w

Salicylic acid IP .................................... 1.15% w/w

Sodium of Coal Tar ............................... 5.3% w/w

White soft paraffin IP ............................ q.s.

Pharmacology

Dithranol : The exact mode of action of dithranol is unknown. It may affect DNA synthesis, which reduces cell turnover or various  system including those of polyamine and leukotriene synthesis or respiratory function. Recent studies show decreased TGF -alpha mRNA expression and decreased epidermal growth factor receptor binding in anthralin- treated keratinocytes indicating that anthralin alters some components of the epidermal growth factor receptor pathway. Anthralin is reported to inhibit the activity of protein kinase C.

Coal Tar : Tars have phototoxic and photodynamic activity with an action spectrum in the UV and visible spectrum. They may also have antimitotic effect on the skin, it suppresses the epidermal cell DNA synthesis and mitotic activity and restores the normal rate of proliferation. The addition of coal tar in DEROBIN have additional effect of minimising the irritation of the skin produced by dithranol.

Salicylic acid : Salicylic acid 1-5% is an antifungal agent. Salicylic acid is used as a keratolytic agent in the concentration of 2-5%. The addition of salicylic acid in DEROBIN ointment is to prevent the oxidation of dithranol to its inactive products.

Pharmacokinetics

The penetration of dithranol is found to be increased from the psoriatic skin rather than the normal skin. When applied, it can penetrate the full epidermal in 100 min or less, thus there is no need for allowing contact with dithranol for more time. Thus the notion of short contact therapy. This reduces irrarion and improves patient compliances. Dithranol therapy for as short as 10 min is effective.

Indications

DEROBIN is indicated for the management of chromic plaque psoriasis.

Method of uses

Dithranol can be used in different ways:

A. Ingram regimen :

First the patient is subjected to a tar bath, in which and the previous application are removed . Suberythema UVB is given and the lesion covered with dithranol pastes ( in Lassars paste ). The concentration is 0.05% or 0.1% increasing cautiously upto 4% according to the response. After 18-22 hrs the cycle is repeated. The lesions can clear within 3 weeks.

B. Short contact regimen :

Dithranol ( high or low concentrations ) is applied for 10-30 minutes and then washed with soap and hot water. Depending on the response, the contact time is increased. The lesions clear well with the short contact therapy, however for psoriasis of the soles and palms, overnight application may be required. It should be applied with the help of an applicator and application to the normal skin must be avoided.

Adverse Effects

Dithranol may cause a burning sensation when applied to normal skin or to lesion. It stains the skin and clothes reddish brown colors. Coal tar may produce folliculitis, phototoxicity, and allergic contact sensitivity.

To reduce the irritation caused by dithranol, several methods are suggested which include, use of low dose dithranol (DEROBIN can be diluted with soft paraffin base), reducing the contact time, use of antioxidents, use of triethanolamine (10%) solution, use of 1%  KOH solution, use of indomethacin, usage along with coal tar, and to avoid contact with normal skin.

Stained clothes can be rinsed with water and not to be washed with soap since alkaline soaps increase the staining.

Precautions

Dithranol is not suitable for head, neck, flexures or genitalia. Contact with eyes will cause conjunctivitis.

Contraindicators

It is contraindicated in renal disease and pregnancy.

Presentation

30 gm tube with applicator.

DEROBIN application instructions for scalp use

1.  Wet your scalp thoroughly, part off your hair one inch at a time to examine and treat each plaque.
2.  With the help of applicator apply the recommended quantity of DEROBIN directly to all     plaques.
3.  Avoid ears, eyes and neck and be careful not to smear on unaffected skin.
4. Tip: Petroleum jelly can be applied to ear folds and nech to minimize contact and avoid irritation.
5.  Cover scalp with shower cap to prevent staining and smearing. Line the edges of the cap with   cotton coil or folded tissues.
6.  Do not leave DEROBIN on any longer than directed by your dermatologist.
7. Remove immediately when time is up. Wipe off DEROBIN thoroughly with body, mineral or        Vegetable oil using an old cloth or disposable towel.
8. Note: Failure to completely remove remainig product may cause irritation, especially in body folds and skin creases.
9. Shampoo out thoroughly but gentle. Lean head back when rinsing to avoid DEROBIN contact with the face, rinse thoroughly and cell your dermatologist.
10. Dry off with an old towel as staining of fabrics is permanent.
11.  Immediately clean the shower or bathroom fixture, rinsing thoroughly. Dish washing detergent may helps to remove residue.

DEROBIN application instructions for body use

1. DEROBIN can be applied to clean dry or damp skin. Be sure to remove any other residual medication before each application.
2. With the help of applicator apply the recommended quantity of DEROBIN directly to all plaques.
3. Avoid ears. eyes and neck, and be careful not be smear DEROBIN on unaffected skin.
4. If irritation or smearing becomes a problems, use a cotton sweb to apply petroleum jelly to the edges of the plaque before applying DEROBIN.
5. Do not leave DEROBIN on any longer than directly by your dermatologist. Remove immediately when time is up. Note : since this product will permanently stain clothing, cover any furniture to be used with an old sheet.
6. Wipe off DEROBIN thoroughly with body, mineral or vegetable oil using an old cloth or disposable towel. Note : failure to completely remove remaining product may cause irritation, especially in body folds and skin creases.
7. Shower or bathe with your normal soap. Dry off an old towel as staining of fabrics is permanent.
8. Immediately clean the tub or shower, rinsing thoroughly. Dishwashing detergent may help to remove residue.
9. Apply oil or moisturizer to treated areas.
   

NOTE : If your doctor has recommended triethanolamine to minimize staining and irritation, please follow these steps.

Step 1. After the DEROBIN contact time is complete and immediately before medication wash-off, apply  triethanolamine over treated areas.

Step 2. Immediately after wash- off, apply triethanolamine lightly over treated areas again to help prevent irritation from any DEROBIN that may remain on the skin