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February 19, 2014
Leonardo A. Torres, MD, FPSECP, FPSP, FPSA, RBA-ABI Dermatologic Pharmacology
"There is a face beneath this mask, but it isn't me. I'm no more that face than I am (Supplemental)
the muscles beneath it, or the bones beneath that." – Steve Moore, V for Vendetta

TRANSMASTER NOTE bactericidal activity

This mini-file containing notes from the lecture is intended as a o Neomycin: nephrotoxic and neurotoxic
supplement for those who have already printed the Katzung-based  ANTIBIOTICS + CORTICOSTEROIDS
dermatologic pharmacology transcription. For those who have not o For diaper dermatitis and otitis externa
printed yet, kindly use the integrated version instead.   MUPIROCIN AND RETAPAMULIN
o For impetigo contagiosa caused by staphylococci and GABHS
 Tincture o Mupirocin: inhibits isoleucyl t-RNA synthetase
o Contains alcohol o Retapamulin: ACD
o Water-soluble  METRONIDAZOLE
o Alcoholic or hydroalcoholic solution + chemical substances o Contraindicated in pregnancy (carcinogenic and teratogenic)
 Wet dressing  SULFACETAMIDE
o Cools and dries skin o Lotion-wash
o Softens dried blood and sera
o Stimulates drainage CICLOPROX OLAMINE
 Cream  For infections by Pityrosporum orbiculare
o Dry preparation for moist areas (e.g. wet, oozing lesion)
 Ointment TRIAZOLES
o Scaly skin (e.g. dry lesion)  ITRACONAZOLE
 Lotion o Longest t1/2
 Gel o For multiple fungal infection of nails
o Hairy areas
 Aerosol (oronasal) DRUG INTERACTIONS
o If with allergic rhinitis (nasal)  Triazoles + cardiovascular drugs  arrhythmia
 Emulsified vanishing cream  Triazoles + benzodiazepines  depression
o Intertriginous areas (e.g. armpit, inguinal area) without  Triazoles + statins  rhabdomyolysis
causing maceration
 Powder TOPICAL ANTIVIRALS
o Intertriginous areas  ACYCLOVIR
o Can also penetrate hairy areas o Precursor: valacyclovir (oral)
 Shampoo o For herpes simplex genitalis and herpes encephalitis
o Hairy areas  PENCICLOVIR
o Precursor: famciclovir (oral)
o For herpes simplex labialis
 DOCOSANOL
o 10% cream
o For herpes simplex labialis
 TRIFLURIDINE
o 1% ophthalmic
o For herpes keratitis

ECTOPARASITICIDES
 CROTAMITON
o Adverse effect: ACD
 SULFUR
o Scabicide of choice for pregnant women and infants
 LINDANE
o For pediculosis and scabies
o Wash after 12 hours
 PERMETHRIN
TOPICAL ANTIBACTERIALS o Wash after 14 hours
 BACITRACIN + NEOMYCIN + POLYMYXIN B  MALATHION
o Combination used to prevent infection of minor skin injuries o For pediculosis only
such as cuts, scrapes, and burns o Wash or combed after 6 hours
 GENTAMICIN + NEOMYCIN  BENZYL ALCOHOL
o Aminoglycosides with Gram-positive and Gram-negative o For head lice in patients >6 months old

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 Dermatologic Pharmacology (Supplemental)

o Applied on dry hair (before taking a bath)  ETANERCEPT SQ

o Adverse effects: ACD, eye irritations o For psoriatic arthritis
o Adverse effects: cancer, infection
REDUCING (DEPIGMENTING) AGENTS  INFLIXIMAB IV AND ADALIMUMAB SQ
 HYDROQUINONE o Adverse effects: sepsis, tuberculosis (latent TB reactivation)
o Adverse effect: ACD  USTEKINUMAB SQ
 MONOBENZONE AND MEQUINOL o Anti-IL-22/IL-23
o Combined with topical steroids and retinoic acid
 L-GLUTATHIONE RELATIVE EFFICACY OF CORTICOSTEROIDS
o Food supplement LOWEST  Hydrocortisone (lowest)
o Liver metabolizer (protects from paracetamol overdose)  Methylprednisolone
o No approved therapeutic claims  Dexamethasone
o Converts brown melanin to pallomelanin LOW  Triamcinolone
 Flumethasone
INTERMEDIATE  Hydrocortisone valerate
OXIDIZING (PIGMENTING) AGENTS
 Mometasone
 TRIOXSALEN
HIGH  Fluocinonide
o For vitiligo
 Diflorasone
o Requires exposure to ultraviolet A irradiation
HIGHEST  Betamethasone dipropionate
o Forms adducts by cross-linking with DNA  Halobetasol
o Adverse effects: melanoma, cataracts  Clobetasol
 METHOXSALEN
o For psoriasis

SUNSCREENS AND SUNBLOCKS

 ECAMSULE
o Greater UVA protection
o No photodegradation
 SUN PROTECTION FACTOR
o Measure of effectiveness
o Ratio of minimal erythema dose with sunscreen to minimal
erythema dose without sunscreen
o SPF 15-50: protect against sunburn, skin cancer, and aging

ANTI-ACNE
 VITAMIN A (RETINOIC ACID)
o Teratogenic
 BENZOYL PEROXIDE
o Comedolytic effect
o For pregnant and infants (if retinoic acid contraindicated)
 AZELAIC ACID
o For severe male acne

ANTI-PSORIASIS
RETINOIC ACID DERIVATIVES (contraindicated in pregnancy)
 ACITRETIN
o For pustular forms of psoriasis
o Adverse effect: hypervitaminosis A
 TAZAROTENE
o Contraindicated in pregnancy

VITAMIN D3 DERIVATIVES
 CALCIPOTRIENE
o For plaque-type psoriasis
o Safe for pregnancy
o Adverse effect: hypercalcemia

T CELL MODULATORS
 ALEFACEPT IV/IM
o Modulates CD2, CD4, and CD8
o Adverse effects: cancer, infection

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 Dermatologic Pharmacology (Supplemental)

ANTI-INFLAMMATORY AGENTS  EFLORNITHINE

TOPICAL CORTICOSTEROIDS can be given secondarily o Irreversible inhibitor of ornithine decarboxylase
 HYDROCORTISONE, FLUOCINOLONE, TRIAMCINOLONE, o PO bid for 6 months
BETAMETHASONE o Hair egrowth 8 weeks after discontinuation
o Most responsive and sensitive to topical corticosteroids: o DOC for advanced West African trypanosomiasis
psoriasis of genitals and face (less sensitive for palms and
soles; no response for other parts of the body) MISCELLANEOUS AGENTS WITH CLINICAL USES
o Combined with occlusive dressing ALITRETINOIN AIDS-related Kaposi's sarcoma
ANTHISTAMINES Pruritus (any cause), urticaria
COAL TAR PREPARATIONS ANTIMALARIALS Lupus erythematosus, photosensitization
 For hair and scalp psoriasis (HYDROXYCHLOROQUINE)
 Adverse effects: irritant folliculitis, ACD ANTIMETABOLITES Psoriasis, pemphigus, pemphigoid
(METHOTREXATE)
BECAPLERMIN Diabetic neuropathic ulcers
KERATOLYTICS BEXAROTENE Cutaneous T cell lymphoma
 SALICYLIC ACID CORTICOSTEROIDS Pemphigus, pemphigoid, lupus
o Adverse effects: salicylism, allergic reactions to salicylic acid erythematosus, allergic contact
 PROPYLENE GLYCOL dermatoses, other dermatoses
o Humectant (moisturizer) CYCLOSPORINE Psoriasis
 PODOPHYLLUM AND PODOFILOX DAPSONE Dermatitis herpetiformis, erythema
elevatum diutinum, pemphigus,
o Contraindicated in pregnancy
pemphigoid, bullous lupus erythematosus
 UREA DENILEUKIN DIFTITOX Cutaneous T cell lymphoma
o Best and safest keratolytic (Save urine, people. Hahaha.) DROSPERINONE AND Moderate female acne
o Humectant ETHINYL ESTRADIOL
o Removes excess stratum corneum through desquamation of INTERFERON ALFA Melanoma, viral warts
necrotic debris MYCOPHENOLATE MOFETIL Bullous disease
 SINECATHECINS ROMIDEPSIN Cutaneous T cell lymphoma
o Herbal drug from green tea leaves THALIDOMIDE Erythema nodosum leprosum
o For genital-anal warts in patients >18 years old VORINOSTAT Cutaneous T cell lymphoma
 5-FLUOROURACIL
o For actinic keratosis OTHER NOTES
o Inhibits thymidylate synthetase  inhibits DNA synthesis Koilocytosis
o Do not use vitamin A  Pathologic finding in genital warts
o Adverse effect: ACD  Treatment: imiquimod
 DICLOFENAC
o For actinic keratosis
 AMINOLEVULINIC ACID (ALA)
o Protoporphyrin IX  photodynamic illumination
o Combined with BLU-U after 18 hours
o Cytotoxic on sunlight exposure

ANTIPRURITIC AGENTS
 DOXEPIN
o Antidepressant
o For atopic dermatitis
o Adverse effect: ACD
 PRAMOXINE
o Topical anesthetic
o For eczematous dermatitis

TRICHOGENIC AND ANTITRICHOGENIC AGENTS

 MINOXIDIL
o For androgenic alopecia
o Antihypertensive (check for hypotension)
 FINASTERIDE
o Contraindicated in pregnancy (teratogenic and may cause
hypospadias in male fetus)
 BIMATOPROST
o For eyelash extension (also an adverse effect)
o Used in glaucoma
o PGF2A antagonist

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