1. 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

2. 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 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.

3. 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

4. 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

5. 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

6. 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

7. 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