1. Drugs for the Skin

2.  Topical glucocorticoids (cream, ointment, or gel)  Uses  To relieve inflammation and itching  Drying agent  Adverse effects  Stretch marks  Purpura  Telangiectasia  Hypertrichosis  Possible systemic toxicity

3. Topical Glucocorticoids  Adverse effects  Local reactions Thinning of the skin Thinning of the skin Stretch marks Stretch marks Purpura Purpura Telangiectasia Telangiectasia Hypertrichosis Hypertrichosis Possible systemic toxicity Possible systemic toxicity

4. Topical Glucocorticoids  Adverse effects  Systemic toxicity More likely with higher doses and long-term therapy More likely with higher doses and long-term therapy Growth retardation in children Growth retardation in children Adrenal suppression Adrenal suppression  Administration  Apply in a thin film and gently rub into the skin  Do not use occlusive bandages (or tight-fitting diapers and plastic pants)

5. Keratolytic Agents  Promote shedding of horny layer of the skin  Primary agents and uses  Salicylic acid: warts, corns  Sulfur: acne, dandruff, psoriasis, seborrheic dermatitis  Benzoyl peroxide

6. Treatment for Acne  Nondrug therapy  Cleansing  Drug therapy  Benzoyl peroxide  Antibiotics Topical: clindamycin Topical: clindamycin Oral: tetracycline antibiotics, isotretinoin, hormonal agents Oral: tetracycline antibiotics, isotretinoin, hormonal agents  Retinoids Tretinoin (Retin-A) Tretinoin (Retin-A) Adapalene (Differin) Adapalene (Differin)

7. Topical Drugs for Acne  Benzoyl peroxide  Retinoids  Tretinoin  Adapalene  Tazarotene  Azelaic acid  Dapsone

8. Oral Drugs for Acne  Antibiotics  Agents of choice Doxycycline (Vibramycin), minocycline (Minocin) Doxycycline (Vibramycin), minocycline (Minocin)  Alternatives (resistance is common) Tetracycline (Sumycin), erythromycin (Ery-Tab) Tetracycline (Sumycin), erythromycin (Ery-Tab)  Isotretinoin (Accutane)  Teratogenic  Triglyceride levels must be monitored  Hormonal agents

9. Sunscreens  Sun exposure  Promote tanning  Ultraviolet (UV) radiation can cause burns, premature aging of the skin, skin cancer, and immunosuppression  Sunscreens impede the penetration of UV radiation to viable cells of the skin

10. Sunscreens  Organic screens  Also known as chemical screens  Absorb UV radiation and then dissipate it as heat  15 of approved sunscreens  Inorganic screens  Also known as physical screens  Scatter UV radiation  Titanium oxide and zinc oxide  Now micronized and clear for applying to skin

11. Sun Protection Factor (SPF)  SPF is an index of protection against ultraviolet B (UVB) radiation  SPF does not address ultraviolet A (UVA) protection  Methods for obtaining SPF are not precise  Relationship between SPF and protection against sunburn is not linear (SPF-30 is not twice as much protection as SPF-15)

12. Sunscreens  Water and sweat resistance  Adverse effects of sunscreens  Proposed changes regarding sunscreen testing and labeling  UVB rating and labeling  Using a sunscreen effectively

13. Treatment for Psoriasis  Psoriasis: red patches with silver scales  Common, chronic inflammatory disorder that follows an erratic course  Initial episode usually develops in early adulthood  Subsequent attacks may occur spontaneously or in response to triggers  Varying degrees of severity  Symptoms result from:  Accelerated maturation of epidermal cells  Excessive activity of inflammatory cells

14. Treatment for Psoriasis  Topical drugs  Glucocorticoids  Calcipotriene (Dovonex)  Tazarotene (Tazorac)  Anthralin  Tars  Biologic agents  Alefacept (Amevive)  Efalizumab (Raptiva)  Tumor necrosis factor inhibitors (Enbrel)

15. Treatment for Psoriasis  Systemic drugs (conventional agents)  Methotrexate  Acitretin (Soriatane)  Glucocorticoids  Cyclosporine (Neoral)  Procedures  Phototherapy  Coal tar plus ultraviolet B irradiation

16. Actinic Keratoses (AKs)  Rough, scaly, red or brown papules caused by chronic exposure to sunlight  Half of all skin cancers in United States begin as AKs  Drugs for AK  Fluorouracil  Diclofenac sodium  Imiquimod  Aminolevulinic acid plus blue light

17. Drugs for Atopic Dermatitis (Eczema)  Glucocorticoids  Topical immunosuppressants  May cause skin cancer or lymphoma  Tacrolimus  Pimecrolimus

18. Agents Used to Remove Venereal Warts  Physical measures  Cryotherapy, electrodesiccation, laser surgery, and conventional surgery  Topical drugs  Podophyllin (must be applied by physician)  Can be applied at home  Imiquimod  Podofilox  Kunecatechins

19. Miscellaneous Drugs for Skin  Agents to remove common warts  Antiperspirants  Deodorants  Drugs for seborrheic dermatitis and dandruff

20. Drugs for Hair  Treat hair loss  Topical minoxidil  Finasteride (Propecia)  Treat unwanted facial hair  Eflornithine (Vaniqa)

21. Impetigo  Most common bacterial infection of the skin: Staphylococcus aureus  Usually seen in children 2–5 years of age  Two forms  Bullous  Nonbullous  Drugs for impetigo (see Table 105–5)

22. Local Anesthetics  Can be applied topically to relieve pain and itching associated with skin disorders  Benzocaine  Lidocaine  Pramoxine