Dr. Nicolet Dermatology

Macules

Non-palpable lesions <1 cm that vary in pigmentation from the surrounding skin

Patches:

Same as macules but > 1 cm

Wheals

Irregularly shaped, elevated, edamatous/erythematous

Papules

Palpable discreate lesions measuring <1 cm in diameter

Plaques

Elevated lesions athat are >1 cm in diameter that may be formed by grouped papules

Nodules

Palpable (solid or cystic) lesions measuring 1-2 cm in diameter

Vesicles and Bullae

Fluid-filled skin lesions that vary in size and appearance`

Topical Prescriptions for MILD acne

Tretinoin and Tazarotene, Clindamycin and Erythromycin, Dapsone, Clascoterone

Tretinoin and Tazarotene

RARi

Tretinoin and Tazarotene

Decreases microcomedone formation and modulates differentiation of epithelial tissues: Avoid use with salicylic acid and pregnant patients. May take 4-12 weeks to work

Clindamycin and Erythromycin

Topical abx

Clindamycin and Erythromycin

Bind to 50 s ribosomal subunits and inhibits bacterial protein synthesis, should not be used as monotherapy given concerns of developing resistanceD

Dapsone

Topical Abx

Dapsone

Antagonist of PABA preventing synthesis of folic acid, use in caution in pts with sulfa allergy and monitor for development of dermatologic reactions

Clascoterone

ARi

Clascoterone

Inhibits androgen receptor to decrease sebum production and inflammation. Adrenal suppression may occur and is reserved for patients who topical options fail or is moderate in severity

Systemic Prescriptions for mod to severe acne

Doxycycline, minocycline, sarecycline, estrogen + progestin, spironolactone, isotretinoin

Doxycycline, minocycline, sarecycline

Systemic ABXD

Doxycycline, minocycline, sarecycline

Binds to 30 S Possibly 50S ribosomal subunits and inhibits protein synthesis, avoid prolonged exposure to sunlight, pregnancy, or children <8 yo

Estrogen + Progestin

Decreases activation of androgen receptor by reducing free testosterone and androgen production, CI in CVD, cancer, ect.

Spironolactone

Decreases testosterone production and competitvely inhibits binding to androgen receptors on the skin, should not be used in pregnancy and may require potassium monitoring

Isotretinoin

RARiI

Isotretinoin

Decreases sebum production and sebaceous gland size, causes arthralgia and changes in LFTs, teratogenic

Risk factor for what: PSORS1 on chromosome 6p

Psoriasis

Topical Prescriptions for Mild to mod psoriasis

Corticosteroids, calcipotriene and calcitriol, tazarotene, anthralin

Potent anti-inflammactory, antiproliferative, immunosuppresive, and vasoconstrictive effects

Corticosteroids

Calcipotriene and calcitriol

Vitamin D3 analogs

Calcipotriene and calcitriol

Inhibits keratinocyte proliferation/differentiation and cytokine production, similar efficacy to high potency topical corticosteroids with good safety profile.

Tazarotene

RARiT

Tazarotene

Modulates keratinocyte differentiation of epithelial tissue and has anti-inflammatory properties, avoid use with salicylic acid and pregnant patients

Anthralin

Keratolytic

Anthralin

Prevents T-cell activation and has antipoliferative effect on keratinocytes, possibly d/t direct effect on mitochondria and epidermal cells, short-contact therapy recommended to minimize irritation

High potency

Betmethasone 0.05, clobetasol 0.05, halobetasol 0.05, desoximetasone 0.05 and 0.25, fluocinonice 0.05

Medium potency

Betamethasone valerate 0.1, triamcinolone 0.1 and 0.5, flurandrenolide 0.05, fluticasone 0.05Lo

Low potency

Desonide 0.05, hydrocortisone 0.5-2.5

Systemic Prescriptions for mod to severe psoriasis

Acitretin, cyclosporine, methotrexate, tofactinib, apremilast

Acitretin

RARi

Acitretin

Binds to retinoid receptors and inhibits hyperproliferation and expression of proinflammatory cytokines, avoid use with salicylic acid and pregnant patients. Efficacy is dose-dependent and is generally used in combo with vit d3 analog or phototherapy

Cyclosporine

Calcineurin

Cyclosporine

Inhibits production and release of IL2 disrupting activation of T-llymphocytes, may be used to bridge tehrapy with biologics. 3a4 substrate should be used in periods up to 12 weeks

Methotrexate

DMARD

Methotrexate

Binds to DHF and interferes with DNA synthesis, repair, adn cellular replication, may cause liver toxicity, CI in pregnancy and possesses serum albumin binding interactions

Tofactinib

JAKi

Tofacitinib

Kinase inhibitor of the JAK family (AK 1, 2, 3, and TyK2) that helps block cytokine signaling, indicated for psoriatic/RA, off-lable for psoriasis. Drug interactions with cyp450 substrates.

Apremilast

PDE4i

Apremilast

Inhibits PDE4 which increases cAMP levels which helps regulate inflammatory markers (TNF alpha, IL23), particularly effective in palmar-plantar, scalp psoriasis, and psoriatic arthritis

Systemic Biologics for mod to severe psoriasis

Adalimumab, etanercept, infliximab, certolizumab, ustekinumab, seecukinumab, ixekizumab, brodalumab, bimekizumab, guselkumab, tildrakizumab, risankizumab

Adalimumab

TNF-a inhibitor

Etanercept

TNF-a inhibitor

Infliximab

TNF-a inhibitor

Certolizumab

TNF-a inhibitor

Adalimumab

Interferes with TNF-alpha receptor sites and reduces epidermal thickness and inflammatory cell infiltration, may increase risk of opportunistic infections, development or worsening of autoimmune sz, malignancy, cutaneous effects, toxicity, and CVD. Safe in pregnancy, however infatns may need to avoid live vaccines temporarily.

Etanercept

Interferes with TNF-alpha receptor sites and reduces epidermal thickness and inflammatory cell infiltration, may increase risk of opportunistic infections, development or worsening of autoimmune sz, malignancy, cutaneous effects, toxicity, and CVD. Safe in pregnancy, however infatns may need to avoid live vaccines temporarily.

Infliximab

Interferes with TNF-alpha receptor sites and reduces epidermal thickness and inflammatory cell infiltration, may increase risk of opportunistic infections, development or worsening of autoimmune sz, malignancy, cutaneous effects, toxicity, and CVD. Safe in pregnancy, however infatns may need to avoid live vaccines temporarily.

Certolizumab

Interferes with TNF-alpha receptor sites and reduces epidermal thickness and inflammatory cell infiltration, may increase risk of opportunistic infections, development or worsening of autoimmune sz, malignancy, cutaneous effects, toxicity, and CVD. Safe in pregnancy, however infatns may need to avoid live vaccines temporarily.

Ustekinumab

IL12/IL23 i

Ustekinumab

Binds to IL-12 and IL-23, disrupting activation of NK and CD4+ T-cells. Also interferes with MCP-1, TNF-a, IP-10, and IL-8. Weight based dosing and achieves rapid response within 2 weeks. May also treat psA alone +/- methotrexate >18 yo

Secukinumab

IL-17i

Ixekizumab

IL-17i

Brodalumab

IL-17i

Bimekizumab

IL-17i

Secukinumab

Inhibits IL17a interaction with IL17 receptor, prohibiting release of proinflammatory cytokines and chemokines, increased risk of mucocuteaneous Candida infection, should be avoided in patients with IBD. Neutralizing antibiodies reported

Ixekizumab

Inhibits IL17a interaction with IL17 receptor, prohibiting release of proinflammatory cytokines and chemokines, increased risk of mucocuteaneous Candida infection, should be avoided in patients with IBD. Neutralizing antibiodies reported

Brodalumab

Inhibits IL17a interaction with IL17 receptor, prohibiting release of proinflammatory cytokines and chemokines, increased risk of mucocuteaneous Candida infection, should be avoided in patients with IBD. Neutralizing antibiodies reported

Bimekizumab

Inhibits IL17a interaction with IL17 receptor, prohibiting release of proinflammatory cytokines and chemokines, increased risk of mucocuteaneous Candida infection, should be avoided in patients with IBD. Neutralizing antibiodies reported

Guselkumab

IL-23i

Tildrakizumab

IL-23i

Risankizumab

IL-23i

Guselkumab

Selective inhibition of Il23 that reduced serum levels of il17a and il17f and il22 inhibiting release of proinflammatory cytokines and chemokines, dose-dependent effect, may require adjunctive therapy, neutralizing antibodies have been reported

Tildrakizumab

Selective inhibition of Il23 that reduced serum levels of il17a and il17f and il22 inhibiting release of proinflammatory cytokines and chemokines, dose-dependent effect, may require adjunctive therapy, neutralizing antibodies have been reported

Risankizumab

Selective inhibition of Il23 that reduced serum levels of il17a and il17f and il22 inhibiting release of proinflammatory cytokines and chemokines, dose-dependent effect, may require adjunctive therapy, neutralizing antibodies have been reported

Topical prescriptions for AD

Corticosteroids, tacrolimus and pimecrolimus, crisaborole and roflumilast, ruxolitnib, tapinarof

Systemic Prescriptions for AD

Dupliumab, tralokinumab and lebriikizumab, nemolizumab, upadacitibib, abrocitinib, baricitinib, methotrexate, azathioprine, cyclosporine, mycophenolate mofetil

Tacrolimus and Pimecrolimus

TCIs

Tacrolimus and Pimecrolimus

Penetrates inflamed epidermis to inhibit T cell activation by blocking transcription of proinflammatory cytokine genes such as IL02, interferon gamma, Th1-type, IL4, and IL10

Crisaborole and Roflumilast

PDE4i

Crisaborole and Roflumilast

Inhibits PDE4 which increases cAMP levels which helps regulate inflammatory markers, approved for children 2 years and older

Ruxolitinib

Inhibits JAKs, disrupting signaling of cytokines and growht factors responsible for immune function, some dosage forms may contain propylene glycol, increase cholesterol, cytopenias, and or infections

Tapinarof

AhRA

Tapinarof

Activates aryl hydrocarbon receptor (AhR), a transcription factor that regulates cytokine and skin-barrier protein expression, approved for children 2 and older, well tollerated, improvement seen in 8 weeks

What is ruxolitinib used for

Topical prescription for AD

What is Crisaborole and Roflumilast used for

Topical prescriptions for AD

What is tacrolimus and pimecrolimus used for

Topical prescriptions for AD

What is tapinarof used for

Topical prescription for AD

Dupilumab

IL4i

Dupilumab

IgG4 that bind to the IL4Ra subunit blocking IL4 and IL13 signaling necessary for cytokine induced inflammatory response, neutralizing antibody development occurs, ocular effects

What is dupilumab used for

Systemic prescription for AD

Tralokinumab, lebrikizumab

IL13is

Tralokinumab, lebrikizumab

IgG4 that binds to the IL13 blocking interaction with a1 and a2 subunits on the IL13 receptor preventing release of cytokines, chemokines, and IgE.

What are tralokinumab and lebrikizumab used for

Systemic prescriptions for AD

Nemolizumab

IL31ai

Nemolizumab

IgG2 antibody that binds to IL31RA, inhibiting IL-13 signaling that helps release cytokines and chemokines.

What is nemolizumab used for

Systemic prescription for AD

Upadacitinib

Inhibits JAKs, disruption signaling of cytokines and growht factors responsible for immune funciton, Increased CVD risk and opportunistic infection. Vaccinate with shingles in older patients before.

Abrocitinib

Inhibits JAKs, disruption signaling of cytokines and growht factors responsible for immune funciton, Increased CVD risk and opportunistic infection. Vaccinate with shingles in older patients before.

Baricitnib

Inhibits JAKs, disruption signaling of cytokines and growht factors responsible for immune funciton, Increased CVD risk and opportunistic infection. Vaccinate with shingles in older patients before.

What is upadacitinib used for

Systemic prescription for AD

What is abrocitinib used for

Systemic prescription for AD

What is baricitinib used for

Systemic prescription for AD

What is methotrexate, azathioprine, mycophenolate used for

Systemic prescriptions for AD