pharm for dermatitis, psoriasis, acne, sunburn

for driest skin

hydrocarbon

for oiliest skin

solution

dry to oily skin topical choices

hydrocarbon, ointment, cream, lotion, gel, solution

primary tx for skin irritation

topical corticosteroids

properties of topical corticosteroids

anti-inflammatory, antipruritic, vasocontrictive

what is use to estimate amount of topical corticosteroids to use?

finger tip method

local SE of topical corticosteriods

skin thinning, pigment changes, telangiectasia, rosacea, delayed wound healing, irritation, burning, peeling

systemic SE of topical corticosteroids

HPA suppression, iatrogenic cushings syndrome, growth retardation in peds, glaucoma

highest potency to weakest

ointment, creams, lotions, solution, gels, sprays

highest potent topical corticosteroid

clobetasol prpionate, fluocinonide

weakest potent topical corticosteroids

hydrocortisone

ointment

mostly oil based, greasy/thicker, slower absorption, difficult to spread, for dry skin conditions

cream

less oil based, lighter texture, faster absorption, easier to apply, for wet/oozing skin conditions

nonpharm tx for dermatitis

avoid triggers, hydration

first line for atopic dermatitis

topical mid-high potent steroids + antihistamines PRN

second line for atopic dermatitis

topical calcineurin inhibitors, phosphodiesterase-4 inhibitor, aryl hydrocarbon receptor agonist

refractory tx for atopic dermatitis

oral immunosuppressants, IL4 antogonist, IL13 monoclonal ab, jak 1 inhibitors

MOA for topical calcineurin inhibitors

reduces inflammation by blocking cytokines

topical calcineurin inhibitor meds

tacromilus (ointment), pimecromilus (cream)

ADR topical calcineurin inhibitors

headache, burning, itching, cough, flu-like symptoms,

pt education for topical calcineurin inhibitors

takes weeks to work, only for short term

MOA topical PDE4 inhibitors

inhibits PDE4 increasing intracellular cAMP levels

topical PDE4 inhibitor meds

crisaborole (ointment), zoryve (cream/foam),

when is crisaborole used?

in mild-mod AD in adults and peds >3mo who cant use topical corticosteroids

ADR crisaborole

hypersensitivity rxns, application site pain

who can use zoryve?

older than 6

ADR zoryve

diarrhea, headache, insomnia, application site pain, URI, UTI

contraindication of zoryve

liver impairment

MOA of IL4 antagonist

Blocks inflammation by reducing the release of harmful substances like cytokines, chemokines, nitric oxide, and IgE

IL4 antagonist meds

dupilumab

ADR for dupilumab

injection site rxns, hypersensitivity rxns, conjunctivitis, arthralgia, rhinosinusitis

what do you avoid when on dupilumab?

live vaccines, pregnancy

Who can use IL4 antagonists?

older than 6 months with mod-severe AD

MOA IL13 monoclonal Ab

blocks IL13

IL13 monoclonal Ab meds

adbry (tralokinumab-ldrm)

ADR adbry (tralokinumab-ldrm)

URI, eye problems, injection site rxns, eosinophilia

what do you avoid in adbry?

live vaccines

who can use adbry?

those 12 and older

MOA of aryl hydrocarbon receptor agonist

decreases IL17

Aryl hydrocarbon receptor agonist meds

VTAMA (tapinarof) cream

ADR of tapinarof

folliculitis, nasopharyngitis, contact dermatitis, headache, pruritus, influenza

MOA oral jak1 inhibitors

blocks jak1

Oral JAK1 inhibitor meds

upadacitinib, abrocitinib

who can use upadacitinib?

12 and older

who can use abrocitinib?

adults only

contraindications of upadacitinib

do not use in pregnancy/lactation, hepatic impairment, GI perforations

BBW oral JAK1 inhibitors

retinal detachment, increased risk of mortality/cardiovascular deaths, malignancy, increased cholesterol levels

first line for psoriasis

moisterizers, nonpharm, topical steroids

ADR topical corticosteroids

skin atrophy, contact dermatitis, fungal skin infections, rosacea, striae

MOA topical vitamin D analogue

binds to vitamin D inhibiting keratinocyte proliferation

topical vitamin D analogue meds

calcipotriol

ADR caclipotriol

skin irritation, erythema, dryness, stinging or burning

MOA of topical retinoids (2nd line)

normalizes keratinocyte differentiation

topical retinoid meds

tazarotene

ADR tazarotene

skin irritation

When to avoid tazarotene?

pregnancy

what can you use for atopic dermatitis an psoriasis tx?

topical calcineurin inhibitors, PDE4 inhibitors, aryl carbon receptor agonist

BBW for topical calcineurin inhibitors

malignancy

2nd tx for psoriasis used in low doses in mod-severe

methotrexate

MOA methotrexate

suppresses T cell activation

contraindications of methotrexate

pregnancy/lactation, caution in pts with renal, hepatic disorders, leukopenia

ADR of methotrexate

N/V, mucosal ulceration, headaches, anemia, hepatotoxicity, pulmonary fibrosis, bone marrow toxicity, immunosuppressive

monitoring for methotrexate

digoxin bc can increase levels, CBC, renal function, hepatic function, pulm toxicity, pregnacy test (avoid in pregnancy)

what can methotrexate increase?

digoxin levels

what must you give with methotrexate?

folic acid

MOA cyclosporine for psoriasis

inhibits production/release of Il2 and inhibits IL2 activation

ADR cyclosporin

impaired renal function, HTN, hyperuricemia, etc

when should you avoid cyclosporin for the tx of psoriasis?

pregnancy

what class does apremilast belong to?

PDE4 inhibitors

ADR for apremilast

GI problems, dehydration, depression, weight loss

Selective TYK2 inhibitors MOA

TYK pairs with JAK1 or 2 to mediate cytokine pathway

Selective TYL3 inhibitor meds

deucravacitinib

ADR deucravacitinib

URI, blood creatine phosphokinase increased, herpes, mouth ulcers, folliculitits, acne

Biologic response modulators

TNF alpha inhibitors, IL12/IL23/IL17 inhibitors, T cell inhibitors

immunosuppressive effects for biologic response modulators

increased risk for infection and malignancies

TNF alpha inhibitors

etanercept

infliximab

adalimumab

certolizumab

hep B reactivation

etanercept

All IL inhibitors end in

umab

What is IL17 associated with?

exacerbating IBD

Non pharm tx for acne

Avoid aggravating factors, control stress, ensure appropriate cleansing, employ good shaving techniques. UV light, avoid hard drying cleansers

first line tx for mild acne

BPO and/or top retinoid

first line tx for mod acne

PO abx + BPO + top retinoid

first line tx for severe acne

Combo + PO abx or isotretinoin

hormonal acne

Spironolactone

MOA of benozyl peroxide

increases sloughing rate of epithelial cells to loosen the follicular plug

ADR BPO

drying, erythema, peeling, bleaching of hair/clothing, photosensitivity

MOA of salicylic acid

increases sloughing rate of epithelial cells to loosen the follicular plug

ADR salicylic acid

drying, erythema, peeling

MOA topical retinoids

reduce adherence of keratinocytes in oil gland

ADR topical retinoids

burning, stinging, dryness, scaling, photosensitivity

avoid in topical retinoids

salicylic scrubs while starting and pregnancy

education for topical retinoids

takes 4-12 weeks, acne may worsen

topical abx for acne

clindamycin and erythromycin

MOA of topical Abx

inhibition of bacterial protein synthesis

oral Abx

first line doxy, second line bactrim and erythromycin

MOA of oral abx

inhibits bacterial lipases, suppresses neutrophils (inflammation)

ADR of oral abx

diarrhea, rash, photosensitivity, dizziness

what can you not use oral abx as?

monotherapy

BBW isotretinoin

birth defects, increase in aggressive behavior

contraindications of isotretinoin

adolescents before cessation of growth, PREGNANCY