Usage
Liposomal dithranol is primarily prescribed for the treatment of chronic plaque psoriasis, a skin condition characterized by red, itchy, and scaly patches. It is classified as an antipsoriatic medication. The mechanism of action involves slowing down the excessive growth of skin cells, thereby reducing scaling and thickening of the skin.
Alternate Names
Liposomal dithranol is also known as liposomal anthralin. Brand names may vary depending on the region and manufacturer.
How It Works
Pharmacodynamics: Dithranol’s precise mechanism of action is not fully elucidated. However, it is believed to generate free radicals, which ultimately prevent nucleic protein synthesis by inhibiting DNA synthesis in the affected skin cells. This reduces the rapid proliferation of epidermal cells characteristic of psoriasis. It interacts with keratin, specifically type II cytoskeletal 2 epidermal and type I cytoskeletal 12, acting as an antagonist.
Pharmacokinetics: Liposomal encapsulation enhances dithranol’s skin penetration compared to conventional formulations, improving drug delivery to the targeted site. After topical application, the liposomes facilitate penetration through the stratum corneum, delivering dithranol to deeper skin layers. Maximum concentration in the skin is reached after 30-60 minutes of application when delivered through a cream. The elimination pathways of dithranol are not extensively studied.
Dosage
Standard Dosage
Adults:
A 0.5% liposomal dithranol cream or gel is applied to the affected area once daily, or as directed by the physician. Treatment duration is typically several weeks, depending on the clinical response. Short-contact therapy with application times of 30 minutes has demonstrated efficacy.
Children:
Dosing in pediatric patients should be determined by a doctor, considering the child’s age and weight.
Special Cases:
Dosage adjustments may be necessary for elderly patients and those with renal or hepatic impairment. The medication should be used with caution in these populations, and dosage should be individualized based on the patient’s specific condition and tolerance.
Clinical Use Cases
Liposomal dithranol is primarily indicated for chronic plaque psoriasis and is not typically used in the clinical settings mentioned (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations).
Dosage Adjustments
Dose modifications may be needed for patients with renal/hepatic dysfunction or other relevant comorbid conditions. These adjustments should be determined by a healthcare professional, considering the individual’s specific health status.
Side Effects
Common Side Effects:
Skin irritation, burning sensation, dryness, erythema (skin redness), peeling, and photosensitivity are common local side effects.
Rare but Serious Side Effects:
Although rare, allergic reactions may occur. Severe skin reactions warrant immediate medical attention.
Long-Term Effects:
Long-term use of high concentrations or overuse on extensive skin areas may lead to skin atrophy or other complications. Regular monitoring is advisable for prolonged use.
Adverse Drug Reactions (ADR):
Significant ADRs, such as severe allergic reactions, require immediate medical attention.
Contraindications
Liposomal dithranol is contraindicated in patients with acute pustular psoriasis, inflamed skin, and hypersensitivity to dithranol or any component of the formulation. Use with caution in patients with fair skin and those who have recently used potent corticosteroids.
Drug Interactions
May enhance the effects of photosensitizing drugs. Avoid concomitant use of topical irritating preparations. Propylene glycol may oxidize and inactivate dithranol.
Pregnancy and Breastfeeding
Liposomal dithranol should be used during pregnancy and breastfeeding only if the potential benefits outweigh the risks to the fetus or neonate. Consult a specialist for advice on appropriate treatment options during these periods. Topical dithranol is categorized as Pregnancy Category C.
Drug Profile Summary
- Mechanism of Action: Inhibits DNA synthesis and reduces epidermal cell proliferation.
- Side Effects: Skin irritation, burning, dryness, erythema, peeling. Rarely, allergic reactions.
- Contraindications: Acute pustular psoriasis, inflamed skin, hypersensitivity.
- Drug Interactions: Photosensitizing drugs, propylene glycol.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: 0.5% cream/gel applied once daily to affected areas.
- Monitoring Parameters: Monitor for skin irritation and allergic reactions.
Popular Combinations
Not commonly used in combination therapies, especially in liposomal form. Topical corticosteroids may be used cautiously on adjacent skin to reduce irritation.
Precautions
- General Precautions: Avoid contact with eyes and mucous membranes. Perform allergy testing if there’s a history of sensitivities.
- Specific Populations: Use cautiously in pregnant/breastfeeding women and children. Consult a specialist for guidance.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Liposomal Dithranol?
A: Typically, a 0.5% liposomal dithranol cream or gel is applied to affected areas once daily. A physician should determine the appropriate dosage and duration of treatment.
Q2: How long does it take to see results?
A: Improvement can be observed within a few weeks, but complete clearance may take several weeks or months, depending on the severity of the psoriasis.
Q3: What should I do if I miss a dose?
A: Apply the missed dose as soon as remembered, unless it’s close to the next scheduled dose. Avoid doubling the dose.
Q4: Can I use Liposomal Dithranol on my face?
A: Use with caution on the face and sensitive areas due to the increased risk of irritation.
Q5: What are the main side effects?
A: Common side effects include skin irritation, burning sensation, redness, dryness, and peeling at the application site.
Q6: Can I use this medication if I’m pregnant or breastfeeding?
A: Consult with a healthcare professional before using liposomal dithranol during pregnancy or while breastfeeding.
A: The liposomal formulation improves drug delivery and reduces skin irritation and staining compared to conventional dithranol creams or ointments.
Q8: Can I use other topical medications with Liposomal Dithranol?
A: Avoid using other potentially irritating topical medications concurrently, unless advised by a doctor. Some medications may interact with dithranol.
Q9: How should I store Liposomal Dithranol?
A: Store at room temperature away from heat, moisture, and direct sunlight. Keep the container tightly closed.
