NTA Level 4 • Semester 2 • PST04211

Description of Keratoplastic and Keratolytic

Basic Pharmacology • Source Session/Topic 17

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Session 17: Description of Keratoplastic and Keratolytic

Agents

Total Session Time: 60 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Outline indications of keratoplastic and keratolytic agents

• List contraindications of keratoplastic and keratolytic agents

• Describe dose, dosage and course of keratoplastic and keratolytic agents

• List side effects and adverse effects of keratoplastic and keratolytic agents

• Describe interactions and precautions of keratoplastic and keratolytic agents

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Overhead projector and computer

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning Objectives

Presentation/ Indications of Keratoplastic and Keratolytic

2 20 minutes

Buzzing Agents

Presentation/ Contraindications of Keratoplastic and

3 05 minutes

Brainstorming Keratolytic Agents

Dose, Dosage and Course of Keratoplastic and

4 05 minutes Presentation

Keratolytic Agents

Presentation/ Side effects and adverse effects of

5 05 minutes

Brainstorming Keratoplastic and Keratolytic Agents

Interactions and precautions Keratoplastic

6 10 minutes Presentation

and Keratolytic Agents

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Indications of Keratoplastic and Keratolytic Agents (20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the keratoplastic and keratolytic agents that are used in clinical practice?

What are indications of keratoplastic and keratolytic agents?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

• A keratolytics are agents that induces sloughing of cornified epithelium (horny or hard

layer of the skin)

• Keratolytic drugs act to damage the cornifled layer of skin that is then sloughed off to

whatever depth the agent has acted

• A keratoplastic (mild keratolytic) effect is seen when the drug does not produce a rapid

destruction and sloughing, thereby softening the keratin and loosening the cornified

epithelium

• Keratolytic agents are used to remove warts and corns. They are also used in the

treatment of severe acne

• Keratoplastic agents are used in the treatment of acne, eczema, psoriasis, and seborrheic

dermatitis

• Coal Tar (chemical name). This agent is used as a keratoplastic in the treatment of

eczema, psoriasis, and seborrheic dermatitis

• Salicylic Acid (chemical name). It is used as a keratolytic when present in concentrations

of from 5% to 20%. It is used as a kerato- plastic when present in concentrations of from

1% to 2%

• Sulfur (chemical name). Sulfur is used as a keratoplastic in the treatment of acne and

seborrheic dermatitis, it is used for the treatment of skin fungal infection

• Tretinoin (topical) (Retin A®). This agent is used in the treatment of severe acne. The

application of this agent to the skin will produce a horny layer of skin that is more easily

removed

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• Salicylic Acid 2% and Sulfur 2% (Fostex®). This preparation is available in cream or

soap. It is used to treat acne

• Salicylic Acid 2% and Sulfur 2% shampoo (Sebulex® or Sebra®). This shampoo is used

to treat dandruff

• Salicylic Acid 2%, Coal Tar 0.5%, and Sulfur 2% Shampoo (Sebutone® or Sebra T®).

This product is used to treat dandruff

STEP 3: Contraindications of Keratoplastic and Keratolytic Agents

(5 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

What are contraindications of keratoplastic and keratolytic agents?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Contraindicated in:

• Children

• Diabetic patients

• Patients with hypersensitivity to be to the drugs

• removal of birth marks, facial warts, warts on mucous membrane

• Infected skin

• Avoid on broken skin

• Not suitable for internal genital what should be avoided in uncircumcised males

STEP 4: Dose, Dosage and Course of Keratoplastic and Keratolytic Agents

(5 minutes)

• Podophyllotoxin

Apply twice daily for three consecutive days

• Silver nitrate

Apply moisture caustic pencil tip 1-2 minutes repeat after 24 hours up to maximum 3

application for warts and six application for verrucas, for umbilical granuloma apply 1-2

minutes while protecting skin with soft paraffin

• Retinoic acid topically 0.025-0.05% at night if unresponsive refer to specialist for oral

retinoids (isotretinoin 0.5 -1mg/kg)

• Crude Coal tar 5% in Vaseline in the morning (Acne)

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• Salicylic acid 5% in Vaseline to descale (Psoriasis)

STEP 5: Side Effects and Adverse Effects of Keratoplastic and Keratolytic

Agents (5 Minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

What are side effects and adverse effects of keratoplastic and keratolytic agents?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

• Topical use may be associated with:

o Local irritation,

o Acute inflammation

o Ulceration

• Chemical burns on surrounding skin

• Stain skin and fabric

STEP 6: Interactions and Precautions of Keratoplastic and Keratolytic

Agents (10minutes)

• Precautions

• Particular care must be exercised when using the drug on the extremities of diabetics or

patients with peripheral vascular disease.

• Silver nitrate is not suitable for application to face, ano-genital region, or large area

• Tretinion

o The medicine should not be applied to windburned or sunburned skin.

o It should not be applied to open wounds

o The medication should not be applied inside the nose, around the eyes, or around the

mouth

o While the patient is using the medication, he should avoid exposing the area being

treated to too much wind or sun (or sun lamp)

o When the patient begins using this product, he may find that he is more sensitive to

cold temperatures and to wind than before; therefore, protection should be worn until

the person sees how he reacts

• If you handle these chemicals, remember that they are irritating to the skin. You should

wash your hands immediately after working with them

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Step 7: Key Points (5 minutes)

• Indicated for removal of skin warts, acne and also in the cauterization

• Contraindicated in hypersensitivity, open wound and on facial warts

• Applied occlusive on the skin or by tip of pencil

• Topical use may be associated with:

o Local irritation

o Acute inflammation

o Ulceration

STEP 8: Evaluation (5 minutes)

• What is keratolytic and keratoplastic agent?

• What are the indications of keratolytic and keratoplastic agent?

• What are the contra indications of keratolytic and keratoplastic agent?

• What are side effects of keratolytic and keratoplastic agent?

• What are the cautions to be taken when handling or using keratolytic and keratoplastic

agent?

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References

Ministry of Health and Social Welfare. ( 2013). Standard Treatment Guidelines & National

Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania

government printers.

Robert L. T., Gary C. Y., Gary R. M., Barbara G. W., Michael, L.. (2014).

Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill

Education.

Sally S.R., Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York,

Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.).

Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale: the Extra

Pharmacopoeia (5TH ed). London, pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary

(59th ed). London, BMJ Group and RPS Publishing.

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