Retinoids used in dermatology Tretinoin First generation Topically in acvne & anti-aging products Isotretinoin Systemically for acne & hidroadenitis suppurativa Alitretinoin Systemically for hand eczem Etretinate Second generation Systemically for psoriasis, now rarely used Acitretin Systemically for psoriasis, a metabolite for etretinate Tarazotene Third generation Topically for psoriasis & acne Bexarotene Systemically for cutaneous lymphoma Adapalene Topically for acne

Biological agents used in psoriasis Etanercept (Enbrel) Fully human , Anti-TNF monoclonal antibody 25 mg or 5O mg twice weekly or 5O mg once weekly Infliximab (Remicade) Chimeric (25% mouse, 75% human), anti-TNF monoclonal antibody. 5 mg/kg at baseline,2 weeks, 5 weeks then 8 -12 weekly. Adalimumab (Humira) Fully human, anti-TNF monoclonal antibody Ist dose 8O mg then 4O mg every 2 weeks Alefacept (Amevive) Fully human, inhibitor of CD2& LFA-3 15 mg weekly Efalizumab (Raptiva) Fully human, inhibitor of CDIIa 1 mg/kg weekly. Ustekinumab (Stelara) Fully human, inhibitor of IL-12 ^ IL-23 45 mg at baseline, week 4 & week 12 then 12 weekly.

Side effects of biological therapies @ Injection site reactions occur with all biologic agents are most commonly seen with etanercept. They are rarely serious. @ All biological agents carry a small increased risk of malignancy, especially lymphoma @ There is an increased risk of infection & serious infections with all biological agents, reactivation of latent tuberculosis is well recognized. @ Anti-TNF biological agents are associated with a new onset demyelinating disorders & exacerbation of pre-existing multiple sclerosis. @ Some patients develop ANA antibodies while on biological therapies, only rarely does this lead to a drug induced lupus which tends to resolve on stopping the medication. @ Patients may develop antibodies to the biological agents but this is only clinically relevant for infliximab where antibodies are associated with an increased risk of an infusion reactions & reduced efficacy

Side effects of biological therapies (continue) 2O% of patients on infliximab develop non serious infusion reactions such as headache, flushing & nauseas; 1%develop serious reactions such as anaphylaxis, hypotension & chest pain @ Adalimumab can be associated with leucopenia & thrombocytopenia, aleacept with lymphopenia & efalzumab with thrombocytopenia. ******************* Absolute contraindications include sensitivity to the drug, pregnancy & active or chronic infection Relative contraindications include a family or personal history of demyelinating diseases, history of malignancy & concomitant immunosuppressive treatment.. Congestive cardiac failure is a contraindication for infliximab & etanercept.. Thrombocytopenia is a contraindication for treatment with efalizumab & lymphopenia is a contraindication for using alefacept

Commercially available topical steroid preperations Hydrocortisone O.5% to 1% Mild Fluocinolone acetonide O.OO25% Synalar 1:1O Clobetasone butyrate O.O5% Eumovate, Trimovate Moderate Betasmethasone valerate O.O25% Betnovate Flucocinolone acetonide O.OO625% Synalar I:4 Betnovate valerate O.I% Potent Hydrocortisone butyrate O.I% Locoid Diflucortolone valerate O.I% Nerisone

Commercially available topical steroid preperations Mometasone furoate O.1% Elecone Moderate Triamcinolone acetonide O.1% Kenacort , cinolone Potent Clobetasol propionate O.O5% Dermovate Super potent Clovocort Betamethasone dipropionate O.O5% Diprosone ,Kerella Diflucortolone valerate O.3% Nerisone forte

If you are obliged to change from oral corticosteroid (e. g If you are obliged to change from oral corticosteroid (e.g. due to vomiting) to systemic corticosteroid; the equivalent doses of commonly used systemic steroids are: PREDNISOLONE 1O mg Hydrocortisone 4O mg Triamcinolone 8 mg Dexamethasone 1.5 mg If a patient is taking 8Omg/ day of predinosolone orally , this is equal to 12 mg dexamethasone systemically