DERM: Topical steroids scabies Acne alopecia Rosacea Antifungals Immunomodulators. Topical Corticosteroids . Nursing 7755 Fall 2010 Debkfp@hotmail.com. Topical corticosteroids. MOA: Vasoconstriction Anti-inflammation Decrease epidermal proliferation. Cell. Inhibit phospholipase
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Decrease epidermal proliferation
A2 which reduces skin
levels of pro-inflam kinines:
(Omega-6, ’s inflammation)
(’s vascular dilation)
lichen simplex chronicus
severe poison ivy
Steroid induced Acne
Long-term use :
basic cyclopentanophenanthrene nucleus .. three 6-carbon rings (A, B, C) + a single 5-carbon ring (D
Betamethasone dipropionate 0.05% AF cream, lotion (DiproleneAF)
Fluocinonide 0.05% gel, cream, oint, sol
Mometasone fuorate 0.1% lotion oint (Elecon)Potency: 7 groups-- I: High-> VII:low
I :Ultra High
Betamethasone dipropionate 0.05%Gel, oint (Diprolene)
Clobetasol propionate 0.05%cr, oint, sol, foam(Temovate, Olux)
Halobetasol propionate 0.05%cr, oint. (Ultravate)
III: Medium to high
Betamethasone dipropionate 0.05% cream
Betamethasone valerate 0.05% 0.1% lotion oint
Fluticasone propionate 0.05% oint
Triamcinolone acetonide 0.1% oint, 0.5%cream
Betamethasone benzoate 0.025% oint
Betamethasone valerate 0.12% Luxiq foam
Fluocinolone acetonide 0.025% oint
Fluticasone propionate 0.05% cream
Hydrocortisone valerate 0.2% oint
Triamcinolone acetonide 0.1 cream
Betamethasone dipropionate 0.05% lotion
Betamethasone valerate 0.01%0.05% 0.1% cream
Fluticasone acetonide 0.025% cream
Hydrocortisone valerate 0.2% cream
Triamcinolone acetonide 0.1% lotion
Fluticasone acetonide 0.01% cream/ solution
Triamcinolone acetonide 0.1% cream (Aristocort)
VII: Least potent
Hydrocortisone 1%, 2.5% cr, lotion, oint
Dexamethasone 0.1% gel, aerosol,cream
Methylprednisolone acetate0.25%, 1% cream oint
mucous membranes -> scrotum-> eyelids-> face-> torso-> extremities-> palm,soles, elbows, knees
2 FTU = 1gm
SE: initial dryness, irritation;
develops tolerance 1+wk;
Misc:Reduces anbx resistance if used w/anbx;
inhibits folate synthesis
SE: local irritation, burning, itching erythema, SJS
Avoid w/sulfa allergy
Apply thin film BID
found in wheat, rye, barley.
Naturally produced by Malassezia furfur (AKA Pityrosporum ovale), a normal skin yeast.
Antibacterial: (Propionibacterium acnes & Staphylococcus epi)
Keratolytic / comedolytic: Normalizes lining of hair follicle.
Reduces pigmentation: melasma, actinic lentigines.
>12yr, clean/dry skin BID
skin irritant, hypopigmentation
Facial edema, depression,
psychosis, tonic clonic sz,
sinusitis, Abd pain, pancreatitis,
pea-sized amt, thin layer BID;
reevaluate if no improvement
Yellow/orange color of skin &
hair w/ dapsone gel + top.BPO
*Use with BPO
or top anbx
Vitamin A derivative
’s cohesiveness of cells
’s stratum corneum cell layers from 14 to 5
use BPO qam/tretinoin HS, enhance efficacy w/ less irritation
*Erythema Burning *Photosensitivity
AGE: Not <12yr
Preg: C (po teratogenic)
DI:Substrate of minor:CYP2A6, 2B6, major 2C8,2C9
Inhibits weak CYP2C9
Induces weak CYP2E1
OCPs (’s progestin concentration)
Solution: (most irritation) 0.05% solution
Gels: 0.01% and 0.025% gels
Gel microsphere: 0.04%, 0.1%
Creams: (least irritation)
0.025% cream (mild, sensitive skin)
0.05% cream (mod, sensitive skin)
0.1% creams (mod, nonsensitive skin)
Black Box: teratogenicity
(2 forms of birth control)
SE: depression/ suicide etc
Chelitis, dry skin, pruritus
Check LFTs, trigs, Hcg qmo
Separate from dairy
Avoid <8yr; Preg D
Monitor CBC, LFT, BUN/CR
The disease is chronic; control rather than cure is the goal of therapy.
Topical antibiotics & BPO relieve inflammation
(eg, benzoyl peroxide + erythromycin “Benzamycin”
benzoyl peroxide + clindamycin) “Benzaclin” ”Duac”
Lotrimin ultra otc
Lamisil AT otc
USE: fungalinfections ie:
.. inhibit the enzyme lanosterol 14 α-demethylase; the enzyme necessary to convert lanosterol to ergosterol.
…inhibit squalene epoxidase, another enzyme required for ergosterol synthesis.
Griseofulvin binds to polymerizedmicrotubules and inhibits fungal mitosis
DI’s: CYP3A4, increased concentration w/ CCBs, immunosuppressants, chemo drugs, benzodiazepines, tricyclic antidepressants, macrolides, SSRIs.
Protopic0.03% or 0.1% ointment& Elidel1% cream
MOA: “Calcineurin” Inhibitor
Inhibits T-lymphocytes & pro- inflammatory cytokines in inflamed dermis
Protopic substrate of CYP3A4 (major)
inhibits CYP3A4 (weak), min. absorbed
Elidel:substrate of CYP3A4 (minor)
USE:Adult: Apply small amt 0.03% or 0.1% oint. BID
rub in gently & completely. Reeval 6 wk.
Child ≥2 years: use 0.03%
SE: HA, burning,
Black box warning ?malignancies
lymphoma and skin malignancy
activates the body's own immune system.
(cytokines, including interferon-alpha and others)
no direct antiviral activity not chemodestructive or cytotoxic.
USE: Perianal warts/condyloma acuminata:
Apply a thin layer 3 x/wk on alternative days @hs and leave on skin for 6-10 hours. Remove by washing with mild soap and water.x<16wk.
Actinic keratosis: Apply 2x/wk x 16 weeks); apply HS, leave on x8hr
Common warts (unlabeled use) Apply qhs.
Superficial basal cell carcinoma: Qhs 5d/wk x 6 wks. Treatment area should include a 1 cm margin of skin around the tumor. Leave on skin for 8 hours.
SCABIES:sx onset 2-6wk but contagious.
Rx all household members, sexual contacts, prolonged direct skin-to-skin contact within the preceding month
RX: scabicides kill mites; some kill mite eggs.
PYRETHROIDS (permethrin, pyrethrins), malathion, lindane, benzyl alcohol.
Benzyl alcohol 5% lotion
2009, FDA approved 6mo+
Lindane shampoo is not a drug of first choice because it has been associated with rare neurologic adverse effects and widespread resistance.
Spinosad fermentation product of the soil bacterium Saccharopolyspora spinosa, may be a promising future treatment. MOA: compromises the CNS of lice-> paralysis.
After treatment, lice free 85% spinosad, 44% permethrin.
Actinic Keratoses: clone of abnormal squamous cells caused by UV light-induced gene alteration.
carcinoma in situ, can develop into SCC (1:1000risk/yr) or BCC
Risk : age, skin color, sun exposure.
IDENTIFY: Small flat, rough papules, red, scaly patches, papules, or plaques, sun exposed areas.
Seborrheic kerotosis:common epidermal tumors, benign proliferation of immature keratinocytes
Age:50+,1-100s, autosomal dominant, sudden appearance of multiple seb k’sw/ skin tags & acanthosis nigricans=?malignancies;”stuck on”
AKs :erythematous base, hyperkeratotic, hard or spine-like, irregular vs
SebKs: smooth, sometimes soft hyperkeratosis, no erythematous base
Rx:Liquid nitrogen, destructive treatment of choice
topical 5-fluorouracil or imiquimod
Imiquimod/Aldara: topical immune response modifier stimulates local cytokine induction
Imiquimod 5% cream; 2-3x/wk x 12-16wk
complete resolution of AKs in 50% of pts, placebo 5%
AE: local erythema, scabbing, flaking.
Topical 5-fluorouracil: inhibits DNA synthesis, causes inflammation w/ destruction of lesion
APPLY: 1-2% face, 5% elsewhere; x 2-4wk
2wk for inflammation to subside after dc’d.
4-6wk for skin to progress through erythema, blistering, necrosis w/ erosion, re-epithelialization.
ALT: apply Bid until superficial ulceration occurs (2-3wk). Then:low potency topical corticosteroid cream BID to reduce inflammation until healed
EFFICACY: 50% for 100 % clearance of AKs
Vasodilator: speculated that dilating blood vessels & opening K+ channels-->
allows more O2, blood & nutrients to the follicle.
This causes follicles in the telogen phase to shed, usually soon to be replaced by new, thicker hairs (new anagen phase)
Anagen: growth phase
Catagen: regressing phase (2-3 wk)
Telogen: resting phase
One study: healthy males 18-50yr w/ androgenic alopecia..
5% sol. x 32wks: non-vellus hair counts avg 39 hairs/cm2
Placebo: 5 hairs/cm2
INDICATION: androgenic alopecia, indicated top of head only
effective w/ large area
effectiveness younger men (18-41yr)
When DC: changes disappear w/i months
eye burning/irritation itching
redness / irritation at treated area unwanted hair growth
Alcohol dries scalp--> dandruff
hair loss!! hairs already in telogen phase shed early, before beginning new anagen phase
Severe SE: Severe allergic rx:
rash hives itching SOB peripheral edema angioedema
tachycardia chest tightness /pain vertigo/syncope
unexplained wt gain
highly toxic to cats -> death
Maximum effect: solution contact w/ scalp 4hrs
min. 40”..less effective
Apply 1-2x/d for maintenance
Minoxidil vasodilates..does notreduceDHT or the enzyme responsible for its accumulation around the hair follicle, 5-alpha reductase, which are the main causes of male pattern baldness in genetically susceptible individuals.
Dihydrotestosterone (DHT) is an androgen, synthesized primarily in the prostate gland, testes, hair follicles, and adrenal glands by the enzyme 5α-reductase
There are 2 “5-alpha reductase inhibitors”
THUS.. When treatment is stopped, the DHT already accumulated around the follicle has its expected effect, and the follicle usually shrinks again and eventually dies.
(protein produced in liver, that transports testosterone in blood, prevents metabolism, & prolongs half-life)
Witch Hazel: astringent, vasoconstrictor
USE: contact dermatitis, hemorrhoids acne
Emollients: soften and soothe skin
3 basic properties:
▪Occlusion - provide a layer of oil on skin surface to slow water loss and thus the moisture content of the stratum corneum
▪Humectant - water-holding capacity of SC
▪Lubrication - add a slip or glide across the skin.
IE: mineral oil, lanolin, fatty acids, cholesterol, squalene, and structural lipids such as ceremides
Ceramides (1-7):barrier function of the skin.
Stratum Corneum has 3 types of lipids:ceramides,cholesterol, FFAs
Eczematous skin have fewer ceramides in SC.
Psoriatic skin: same # ceramides as nl skin but less 1,3,4,5,6, & more 2.
al lipids have to be replaced at a proper ratio to restore barrier function
Kelo-cote: topical silicone gel for mgmt & prevention of scars (keloids)
Lac-hydrin, Amlactin 12% lactic acid
Apply bid, solution/cream
Burow's solution: aluminium acetate dissolved in water.
invented mid-1800s by Karl August Burow, ophthalmologist.
MOA: astringent / antibacterial properties
USES: skin conditions: insect bites, rhus derm, swelling, allergies. bruises.
APPLY: cold compresses over the affected area.
AVAILABLE: OTC , Domeboro tablets to dissolve in water
Zovirax/acyclovir / 5% ointment,cream / Abreva 10% OTC
MOA: inhibits DNA synthesis and viral replication
Apply 5 times/day for 4 days
USE: Rx of herpes labialis (cold sores)