skin drugs

pharmacology

salicylic acid

topical acne tx

many OTC preparations, well tolerated keratolytic (a drug that dissolves the keratin layer; helps to clear lesions more quickly)

benzoyl peroxide

• topical acne tx

• OTC and Rx.

• Efficacy due to its bactericidal activity against P.acnes

• Best for mild to moderate acne

antibiotics

• topical acne tx

• topical clindamycin and erythromycin are often used for mild/mod acne

• both also have anti-inflammatory properties

Retinoids

• topical acne tx

• Retin A; useful for both inflamed and non inflamed lesions (new product is a combo retinoid and clindamycin)

• common retinoid used is Tretinoin

Retinoids SE

• dry skin

• scaling, photo-irritation , redness burning and itching

• excessive dryness

• Vitamin A derivative; needs to be avoided during pregnancy!!

• takes a little bit of time for Retin-A to work and up to 5 months to get max therapy

• have to be cautious going out in the sun UV light or UV lamps

oral antibiotics

• systemic acne tx

• second most effective tx for inflammatory acne

  • superinfection, resistance is a concern

  • decreases effectiveness of oral contraceptives

Isotretinoin

• most effective drug for severe acne

• reduces sebum production, keratinolytic and anti inflammatory effects

Isotretinoin SE

• dry skin

• alopecia, eczema, skin fragility, photosensitivity, myalgias, increased triglycerides, hepatitis, pancreatitis, linked to IBS

• C/I in pregnancy, depression or suicidal ideation!

  • potent teratogen regulated by iPLEDGE a risk management program to prevent fetal exposure

  • consent must be sign and acknowledging you cant get pregnant!

oral contraceptives

• systemic acne tx

• raise sex hormone binding globulin and decrease free testosterone

  • if pt is on oral contraception for pregnancy prevention and oral abx for acne; The oral abx will render the oral contraceptives less effective or not effective

rosacea

inflammatory skin disorder

onset between 30 and 50 yrs of age

rosacea characteristic sx

• small papules without pus

• flushed face around nose and cheeks

• soft tissues of nose may swell- rhinophyma

rosacea tx

• Retinoids

  • reduce oil production and clogged pores

  • do not use if patient is pregnant

  • common reaction is sensitivity to sunlight

• oral contraceptives

• antibiotics

dermatitis

• inflammatory skin disorder- pain redness, and pruritis

  • excoriation- scratches that break the skin surface and fill with blood or serous fluid to form crusty scales

atopic dermatitis or eczema

chronic; genetic predisposition

contact dermatitis

hypersensitivity response

immunologically mediated

seborrheic dermatitis (on scalp)

seen in newborns and teenagers after puberty

stasis dermatitis

sign of poor venous circulation

pharmacotherapy of Dermatitis

• Topical glucocorticoids most effective tx

  • releive local inflammation and itching

  • adverse effects w/long term use

    • irritation, redness, thinning of skin

  • available in creams, lotions, solutions, gels, pads,

    • topical corticosteroids most common

  • Dupilumab- monoclonal ab that blocks interleukin-4 form binding to its receptor, preventing inflammation

psoriasis

chronic inflammatory skin disorder

etiology- may be genetic immune reaction

psoriasis sx

• red patches of skin covered with flaky, silvered colored scales (plaques)

psoriasis topical therapies

• topical corticosteroids

• topical immunomodulators (TMIs) suppress immune system

• Retinoid like compounds

psoriasis systemic drugs

• biologic therapies

  • alefacept (Amevive), adalimumab (Humira)