There are many general classes, with no clear dividing line among similar formulations. Some physicians use a thick ointment to replace the waterproof barrier of the inflamed skin in the treatment of eczema, and a cream might not accomplish the same clinical intention. A pharmacist should not substitute an ointment for a cream, or vice versa, as the potency of the medication can change. It is extremely important to receive a medication in the correct base, before applying to the skin. In dermatology, the base of a topical medication is often as important as the medication itself. However, in a simple base like an ointment, much less variation between manufacturers is common. An example of this is the case of brand name Valisone cream and Kenalog cream in clinical studies have demonstrated significantly better vasoconstrictions than some forms of this drug produced by generic drug manufacturers. Studies have confirmed that the potency of some topical steroid products may differ according to manufacturer or brand. No comparative potency labeling exists to ensure equal efficacy between brands of topical steroids (percentage of oil vs water dramatically affect the potency of topical steroid). These variations can, on occasion, result in different clinical outcomes, even though the active ingredient is the same. For example, a vaginal formulation of miconazole antifungal cream might irritate the skin less than an athlete foot formulation of miconazole cream. Although containing the same active ingredients, one manufacturer's cream might be more acidic than the next, which could cause skin irritation or change its absorption rate. The manufacturer of each topical product has total control over the content of the base of a medication. As a rule of thumb, an ointment base is more occlusive and will drive the medication into the skin more rapidly than a solution or cream base. For example, some topical steroids will be classified one or two strengths higher when moving from cream to ointment. Choice of base formulation Ī medication's potency often is changed with its base. One poorly absorbable antibiotic is vancomycin, which is recommended by mouth as a treatment for severe Clostridium difficile colitis. If defined strictly as having local effect, the topical route of administration can also include enteral administration of medications that are poorly absorbable by the gastrointestinal tract. One example of an antibiotic that may be applied topically is chloramphenicol. Specific types include transdermal patches which have become a popular means of administering some drugs for birth control, hormone replacement therapy, and prevention of motion sickness. Such medications are generally hydrophobic chemicals, such as steroid hormones. By this definition, topical administration also includes transdermal application, where the substance is administered onto the skin but is absorbed into the body to attain systemic distribution. In other cases, topical is defined as applied to a localized area of the body or to the surface of a body part regardless of the location of the effect. The patch is labelled with the time and date of administration as well as the administrator's initials. A transdermal patch which delivers medication is applied to the skin.
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