Derm Drugs

Glucocorticoids/Corticosteroids MOA

• bind to corticosteroid regions; regulate expression of corticosteroid-responsive genes

• decrease endogenous inflammatory mediators, decrease vascular permeability, decreased inflammation, decrease erythema, decrease pruritus

Retinoid MOA

• vitamin A analogue

• activate retinoic acid receptors (RAR): affect cell differentiation and proliferation

• activate retinoid x receptors (RXR): induce apoptosis

• keratolytic, comedolytic, anti-inflammatory

Anti-Malassezia agents

• pyrithione zinc

• selenium sulfide

• ketoconazole

Coal tar

• cytostatic agent, keratolytic

• MOA: decrease epidermal replication rate, decrease keratinocyte binding, increased removal of dead skin

Salicylic acid

• ketatolytic

• MOA: loosen and lyse keratin aggregates

Calcipotriene

• Dovonex

• MOA: vitamin D analogue

  • bind vitamin D receptor, alter keratinocyte proliferation/differentiation, alter T-cell development/activation, decrease inflammation

Calcitriol

• Vectical

• MOA: vitamin D analogue

  • bind vitamin D receptor, alter keratinocyte proliferation/differentiation, alter T-cell development/activation, decrease inflammation

Tacrolimus

• calcineurin inhibitor

• inhibit T cell activation, decrease mast cell/cytokine release

Pimecrolimus

• calcineurin inhibitor

• inhibit T cell activation, decrease mast cell/cytokine release

Methotrexate

• systemic antimetabolite

• MOA: inhibit enzymes needed to produce nuclic acids → decreased T cell activation → anti-inflammatory

• take with folic acid, monitor liver

Cyclosporine

• systemic calcinuerin inhibitor

• MOA: inhibit T cell activation, mast cell/cytokine release

• monitor kidney/liver

• strong CYP 3A4 inhibitor

Apremilast

• systemic PDE-4 inhibitor

• MOA: unknown, decrease cytokine production

Acitretin

• soriatane

• systemic retinoid

• MOA: normalize keratinocyte differentiation, proliferation

• for psoriasis

TNF-alpha inhibitors

• etarnercept (Enbrel)

• infliximab (remicade)

• adalimumab (humira)

• certrolizumab (cimzia)

• use for moderate-severe plaque psoriasis, PsA

IL-12/23 mAb

• ustekinumab

• use for moderate-severe plaque psoriasis, PsA

IL-17 inhibitor

• secukinumab (cosentyx)

• ixekizumab (taltz)

• brodalumab (siliq)

  • REMS for suicide; contraindicated with suicidal pts

• bimexizumab (bimzelx)

JAK inhibitors

• MOA: prevent cytokine or growth factor mediated gene expression and intracellular activity of immune cells → decrease inflammation

  • disease modifying

• Tofacitinib (Xeljanz)

• Upadacitinib (Rinvoq)

• Deucravacitinib (Sotyktu)

• Abrocitinib (cibinqo)

• baricitinib (oluminant)

• TOPICAL: ruxolitinib (opzelvra)

Ivyblock lotion

• 5% bentoquan (organoclay)

• prevention, apply before allergen exposure

Topical PDE-4 inhibitors

• MOA: decrease cytokine production

• Crisabole (Eucrisa)

  • BID

• Roflumilast (Zoryve)

  • QD

IL-4/IL-13 antagonists

• Dupilumab (Dupixent)

• Tralokinumab (Adbry)

Tapinarof

• Vtama

• MOA: aryl hydrocarbon receptor agonist

Lebrikizumab

• Ebglyss

• MOA: IL-13 mAb

Nemolizumab

• Nemluvio

• IL-31 mAb

Benzoyl peroxide

• MOA: keratolytic, comedolytic, antibacteria

• first-line for acne

Salicylic acid

• MOA: keratolytic (3-6%), comedolytic, anti-inflammatory

Azelaic acid

• MOA: comedolytic, antibacterial, anti-inflammatory, normalizes keratinization

Dapsone

• MOA: antibacterial (sulfone), anti-inflammatory

Topical retinoids

• adapalene

• tazartotene

• tretinoin

• trifarotene

Isotretinoin

• oral retinoid for acne

• MOA: decreases sebum production, normalizes keratinization, antibacterial, anti-inflammatory, comedolytic

Antibiotics for acne

• MOA: antibacterial, anti-inflammatory

• Tetracyclines:

  • Doxycycline (pref)

  • Sarecycline

  • minocycline

  • tetracycline

• Lincosamide:

  • clindamycin

• Macrolides:

  • erythromycin

  • azrithromycin

Combined Oral Contraceptives

MOA: decrease sebum production by reducing androgen production in ovaries, increasing binding of circulating testosterone, and blocking androgen receptor

Clascoterone

• Winlevi

• MOA: androgen receptor inhibitor, reduce sebum production and inflammation

Spironolactone

• aldactone

• antiandrogen

• decrease testosterone production and competitively inhibit testosterone/DHT binding to androgen receptors in skin

Minoxidil

• rogaine

• MOA: increases cutaneous blood flow to hair follicles resulting in hypertrophy and prolonged anagen phase

Finasteride

• propecia (1 mg)

• MOA: 5a-reductase inhibitor

  • block conversion of testosterone→ DHT

JAK inhibitors approved to treat alopecia areata

• Baricitinib (oluminant)

• Ritlecitinib (Litfulo)

  • only one approved for peds (12+)

• Deuruxolitinib (Leqselvi)

• MOA: inhibit JAK-STAT pathway, resulting in various immunologic changes (prolong anagen phase, angiogenesis, stimulating/activating proliferation of hair stem cells)

1st gen H1 antihistamine

• MOA: compete with histamine for H1 receptor sites on effector cells in GI, blood vessels, and respiratory tract

• OTC: diphenhydramine, chlorpheniramine (chlor-trimeton)

• Rx: hydroxyzine

2nd gen H1 antihistamine

• MOA: compete with histamine for H1-receptor sites on GI tract, blood vessels, respiratory tract ; more selective

• OTC: cetirizine, loratadine, fexofenadine, levocetirizine

• Rx: desloratadine (clarinex)

• PREF

Dimethyl ether and proprane spray

• DMEP

• Cryotherapy (OTC)

• MOA: freezing → irritation/tissue destruction, cells slough off

  • warts

Urea

• MOA: emollient + keratolytic

  • moisturizes and breaks down hyperkeratotic skin

• use for corns, callus

Skin protectants

• allantoin, cocoa butter, petrolatum, shark liver oil, white petrolatum

• MOA:

  • protect from mechanical irritation

  • prevent drying

  • reduce pain

  • prevent scarring

First-Aid antibiotics

• bacitracin, neomycin polymyxin B

• helps prevent infection

Topical anesthetics

• benzocaine, dibucaine, lidocaine, pramoxine, tetracaine

• inhibit transmission of pain signals from receptors

First-aid antiseptics

• hydrogen peroxide, ethyl alcohol, isopropyl alcohol, iodine, povidone/iodine, camphorated phenol, chlorhexidine

• prevent infection

Drugs with strong association with SJS

• allopurinol

• lamotrigine

• phenobarbital

• sulfamethoxazole

• sulfasalazine

• phenytoin

• nevirapine

• carbamazepine

• oxicam NSAIDs (piroxicam)

IVIG

• MOA: inhibit FAS-mediated keratinocyte apoptosis

• for SJS

Calendula

• pot marigold

• anti-inflammatory, antibacterial

Topical Silver Sulfadiazine

• 1%

• rx only

• sulfa-derived antibiotic

• prevent and treat 2nd-3rd degree burn

• first-line

Mafenide Acetate

• Sulfamylon

• 11.1% cream

• antibiotic

• best for heavily contaminated burn wounds or delayed tx

Meds that induce photosensitivity

• fluoroquinolones (cipro)

• tetracyclines (doxycycline)

• bactrim

• NSAIDs

• diuretics (furosemide, thiazide)

• antihistamine (promethazine)

• anti-arrhythmics (amiodarone, quinidine)

• acne meds (tretinoin, isotretinoin)

• tricyclic anti-depressants (amitriptyline, nortriptyline)

• methotrexate

• antimalarial (chloroquine)

• antifungals (griseofulvin)

• diabetes meds (glipizide, glyburide)

• hormonal meds (ethinyl estradiol, progesterone)

• benzoyl peroxide

Hydroquinolone

• only FDA approved non-Rx skin bleaching product for hyperpigmentation

Hydroxy acids

• AHA

  • lactic acid, glycolic acid, polyhydroxy acid

• BHA

  • salicylic acid

• improve skin elasticity

• increase skin collagen and elastin

Ascorbic acid

• vitamin C

• anti-oxidant, anti-inflammatory, skin lightening

Topical fluorouracil

• used in photoaging in pts with actinic keratoses

• MOA: epidermal injury, wound healing, and remodeling of dermal matrix

Inorganic sunscreens

• zinc oxides

• titanium dioxide

• broad-spectrum

PABA

• para-aminobenzoic acid

• can cause cross-sensitivity rxns with benzocaine, thaizides, sulfonamides, paraphenylenediamine

• cause contact or photocontact dermatitis

DEET

• N, N-didethyl-m-toluamide

• most efficacious bug repellant

Picaridin

• bug repellant

• shorter DOA, less odor, less irritating vs DEET

Oil of lemon eucalyptus

• shorter DOA vs DEET

• avoid in children under 3

Chikunyunya vaccine

• live, attenuated: IXCHIQ

  • 18+

• virus-like particle vaccine: VIMKUNYA

  • 12+

Dengue vaccine

• Dengvaxia

Yellow fever vaccine

• live vaccine

• 9 months +

Japanese Encephalitis vaccine

• IXIARO -inactivated virus

• 2 months+

Tickborne encephalitis vaccine

• TICOVAC - inactivated vaccine

• 1+

Topical antihistamines

• diphenhydramine, chloropyramine

• anesthetic effect by depressing cutaneous receptors

Camphor

• depress cutaneous receptors

• topical analgesic, anesthetic, antipruritic

• dangerous if ingested

Menthol

• depress cutaneous receptors

• analgesic effect

• antipruritic

NIX

• permethrin 1%

• pediculicidal: cause lice paralysis and death by blcoking nerve transmission

• only for 2 months +

RID

• pyrethrins 0.33%/piperonyl butoxide 4%

• pediculicidal: cause lice paralysis and death by blocking nerve transmission

• only for 2+

Sklice

• ivermectin lotion

• pediculicidal

• single dose

Spinosad

• natroba

• pediculicide (targets nervous system)

• ovicidal (kills lice eggs)

• 6 months +

Malathion

• ovide

• pediculicidal, partical ovicidal

• 6 years +

Scabies tx

• topical: RX permethrin cream/lotion

• oral: ivermectin single dose