General Secretary of the Dermatologic Society, Clinic for Dermatology, University Hospital, Charité, Berlin
Dermopharmacy in dermatologic science and practice
Ladies and Gentlemen,
with pleasure I have accepted the invitation to present some ideas concerning the position of dermopharmacy in science and practice. In this context I would like to express my sincerest thanks to the president of the 3rd meeting of the GD, Ms. Schäfer-Korting for the invitation and congrulate her to the successful meeting.
Science
The scientific position of dermopharmacy within the dermatology is determined in an exemplary manner by the program of the 3rd annual meeting of the Society of Dermopharmacy. Dermo-pharmaceutical chemistry, dermo-biopharmacy, dermo-pharmacokinetics, dermo-therapy and cosmetics are the major notions.
If one considers the fact that certainly over 90 % of the skin diseases are treated topically at present one may ask whether dermatopharmaceutical formulations of questions indeed occupy the importance within dermatological science they deserve. In my opinion, they do not. Even though methodical, technological and application-oriented know-how is made available from the pharmacy side, dermatological departments are lacking which offer their competent services in view of the multitude of questions dealt with. Fortunately, most of the active groups at the time being are represented in the course of this conference.
A large field of dermopharmacy lies in my opinion in the processing of pathophysiological features of varying skin diseases. Are there special characteristics which can be taken advantage of pharmaceutically for neutrophil- or lymphocytic-predominated inflammations for example? Do not different inflammatory mechanisms with differing pH levels, concentrations of lipase or esterase also entail direct consequences for the pharmaceutical preparationn? But do we have sufficient knowledge in order to intervene directly or to be able to react?
A further important requirement for research lies in our knowledge about the physiology of skin. At which point of time, however, a scientist has habilitated to physiological questions last? Is our state of knowledge concerning the penetration of molecules for example really sufficient, regarding the modulation of penetration, variations or micro-anatomical characteristics already complete?
Additional fields of professional dermatology will undoubtedly profit from the progress in these spheres. This also applies to the allergiological sector. Activities undertaken by the universities' dermatological clinics are asked for dealing with this field in a very professional manner which is of utmost importance on the one hand but also very exciting for science. The fact that this is still possible nowadays at difficult financial conditions shows the establishing of a sector of experimental and applied physiology of the skin at the Klinik für Dermatalogie, Venerologie und Allergologie mit Asthmapoliklinik (Clinic for Dermatology, Venereology and Allergiology and Asthma out-patient department) which comprises in the meantime 13 employees. Our experience shows that a commitment in this field pays, that this sector is apt for third-part capital placement and that scientific data can be proven by applying modern investigation techniques. This data will raise our understanding of the skin physiology to a level never achieved so far.
Practice
Most of the progress reached by dermopharmacy will probably remain unnoticed in practice. It is noticeable in a steadily increasing degree of tolerance, a wider applicability at very different skin conditions - often from the xerotic skin at old age to the weeping infantile eczema. Stability, esthetical appearance of ointment bases and release characteristics of the active substances are settled in such a way that the prescriptor does not think about such matters in general.
On the other hand the prescription attitude of practising dermatologists shows a constant tendency towards extemporaneous preparations caused by the unsupportable pressure from department-specific budgets, special funds and recourse threats. At present extemporaneous preparations form 50 % of dermatological prescriptions. By the way - extemporaneous preparations are not only prescribed by dermatologists: one third come from general practicians, pediatricians and ENT specialists. Every dermatologist makes out 3033 prescriptions on an average per year. This development gives rise to several problems. On the one hand the turnover of the pharmaceutical industry in this sector decreases. Indeed prescriptions of dermatics have reduced by almost 20 percent in 1997. This again results in a loss of standing of the dermatological market by the pharmaceutical industry as to its economical potential. This has alreadyled in some cases to a withdrawal of several important firms. Fortunately, other major companies have taken a contrary decision in favor of an intensified commitment in the dermatological field in the recent past.
Uncontested is furthermore that a large part of the extemporaneous preparations show lacks of quality. For this reason the Deutsche Dermatologische Gesellschaft (German Dermatological Society) continuously strives for a quality improvement of prescriptions and urges an exclusive use of NRF or comparable standards. By the way not all prescription recommendations given by the pharmaceutical industry regarding their own preparations come up to this quality criteria. Fortunately, a discussion process has come into being which will have a favorable impact.
The German Society of Dermopharmacy should contribute to this discussion. This also includes an actual manual reflecting the state of findings at the threshold to the millenium to come.
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