Dermatology

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Anthracene Derivatives

anthralin: AVL: Topical (cream, ointment). IND: Psoriasis. ADM: Wash off 15min-hours after application depending on formulation.


 

Combination Topicals

Fucibet=fusidic acid2%+betamethasone valerate 0.1%: IND: Eczema w/ secondary bacterial infection. For flare-ups or short-term Tx (max=2 weeks). MOA: Betamethasone has anti-inflammatory, antipruritic and vasoconstrictive actions. Fusidic acid inhibits bacterial protein synthesis. Action is mainly bacteriostatic, but may be bactericidal at higher concentrations. EVD: Primarily active for gram (+) bacteria. Particullarly effective for (Staph aureus including MRSA). Also active against Streptococcus species, Corynebacterium minutissimum, some Neisseria species, and certain Clostridium species. ADM: Apply thin layer. AE: Pruritus and skin burning sensation, pain, irritation, swelling and vesicles at the application site, aggravated eczema, dry skin, erythema, urticaria, rash, contact dermatitis, skin atrophy, application site irritation, skin discolouration and striae. CI: <6yo. DI: None. DOS: Thin layer to affected area BID until cleared. Max=2 weeks. Children (6–18yo) should avoid large amounts and occlusion (more susceptibile to corticosteroid-induced AEs).

 

Immune Modulator

imiquimod=Aldara: AVL: Topical cream. IND: Genital warts. ADM: AAA qhs and remove in am. Rub in until clear. Wash hands before and after. AE: Site rxn30%, redness and peeling of skin, burning sensation15%, skin ulcer45%, flu like symptoms4% CI: Immunosuppressed/ transplant. OTH: Can make condoms ineffective.


 

Phosphodiesterase 4 (PDE-4) inhibitors

crisaborole=Eucrisa: AVL: 2% brand name ointment only2018 IND: Mild to mod atopic dermatitis in pts > 2yo. MOA: PDE-4 inhibition leads to less production of some inflammatory cytokines that are involved in atopic dermatitis. EVD: Pts treated w/ Eucrisa had ~20-30% higher reate of clear/almost clear dermatitis vs vehicle alone. ADM: Apply a thin layer then wash hands. AE: Application site pain/burning/stinging, dermatitis flare, skin infection, allergic rxn. DI: None. DOS: Thin layer BID. OTH: Manufactured by Pfizer.

 

Retinoids

Oral
isotretinoin=Accutane=Epuris: EVD: Takes up to 8w to show full effect. AE: Dry lips93%, dry mouth33%, dry eyes35%, dry nose80%, nose bleed20%, rare: depression, suicide (reported but not shown to increase risk), insomnia, mood swings, peeling of finger tips, dry skin, itching, hair loss rash. CI: Increased lipids, prg, LASIK surgery. PRG: Very contraindicated (Monthly HCG testing).


Topical
IND: Mild-mod comedonal acne. EVD: 12w for max response. AE: May worsen acne at 2-4w.


Adapalene (ADA)=Differin EVD: Least irritation vs TAZ and TRE.


Tazarotene (TAZ)=Tazorac: OTH: Rarely seen (most irritation vs TAZ and TRE.


Tretinoin (TRE)=Retin-A=Stevia-A: COS: Cheapest vs TAZ and ADA.


 

Topical Antibiotics

bacitricin: AVL: Only use topically cause can cause kidney damage. Also used for eyes. IND: Treats gram (+) and (–) organisms. MOA: Breaks the peptidoglycan cell wall. PK: Mixture of cyclic peptides



benzoyl peroxide (BPO)=Acetoxyl=Benzagel=Benoxyl=Benzac=Oxy 5=Panoxyl=Solugel: AVL: Water, alcohol, or acetone based. IND: Mild-mod acne. EVD: Takes 8-12w to work. Can worsen acne at 2-4w. ADM: Could apply q2-3d then increase to tolerance. Apply to entire effected area. AE: Dermatitis, dry skin. OTH: Can stain clothing. Use water base for sensitive skin.


fusidic acid=Fucidin: IND: Impetigo 1st line. MOA: Stops protein synthesis. Covers Gram (+) only. AE: Mild irritationrare, dermatitisrare. DOS: Impetigo: AAA BID or TID × 5d or until all lesions heal.


gramacidin: EVD: Active against some gram (+) and some gram (-). AE: Causes hemolysis (Only use topically).


mupirocin=Bactroban: IND: Gram (+) including MRSA. furuncles, Impetigo1st line, folliculitis, open wounds, nasal eradication therapy. MOA: Inhibits protein synthesis. EVD: More effective than fusidic acid but more expensive. ADM: AE: Burninginfrequent, stinginginfrequent, dermatitisrare. DOS: Impetigo: AAA BID or TID × 5d or until all lesions heal. OTH: Covers gram + only. Resistance does develop.


neomycin=Neosporin: AVL: Topical, ophthalmic. MOA: Inhibits protein synthesis. EVD: Active against gram (–) and partially for gram(+). OTH: Drug class aminoglycoside.


polymyxin b=Polysporin: AVL: Topical, opthalmic. IND: Used mainly for gram (-) resistant organisms, meningitis, UTIs, clears endotoxins. MOA: Makes outer cell membrane more susceptible to water uptake (Gram positive don’t have outside membrane).


 

Topical Corticosteroids

clobetasone: AVL: Topical (cream0.05%). IND: Eczema, psoriasis. DOS: AAA BID or TID x 2-3w. OTH:


hydrocortisone=Emo-Cort: IND: Dermatitis, psoriasis. AE: skin irritation, allergic rxnrare,
DOS: Dermatitis & psoriasis: Apply thin layer BID-TID prn.


 

AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:
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