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Published byKathleen Barber Modified over 9 years ago
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Dermatopharmacology Prof Werner Sinclair Department of Dermatology
University of the Free State
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Outcomes for this Lecture
After this lecture the student should be able to: Name the most important characteristics and uses of the following antifungals: Griseofulvin Terbinafine Ketoconazole Fluconazole Itraconazole Topical imidazole creams Discuss the characteristics and uses of the different strengths and formulations of topical steroids Name the indications for and most important side-effects of chloroquine Discuss the indications and use of topical retinoids Discuss the origin, characteristics of and indications for mupirocin Discuss the use of tetracyclines in dermatology Name the uses of the different types of antihistamines (sedating vs non-sedating) in dermatology Name the indications for and side-effects of anti-androgens and imiquimod
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Drugs To Be Discussed1 Antifungals: Griseofulvin Terbinafin
Fluconazole Itraconazole Ketoconazole Corticosteroids: Topical Systemic Chloroquine
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Drugs To Be Discussed2 Retinoids: Topical Systemic Benzoyl peroxide
Shampoos Barriers Antibiotics: Topical Antivirals: Acyclovir Podophyllin Antiscabies: Benzoyl benzoate
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Drugs To Be Discussed3 Antihistamines Anti-androgens Imiquimod
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Antifungals Griseofulvin Terbinafin Fluconazole Itraconazole
Ketoconazole
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Griseofulvin Only active against dermatophytes (keratolytic fungi)
Fungistatic Absorbed with fatty food (milk) Very safe in children 10 – 20 mg per kg per day
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Terbinafin Only active against dermatophytes Fungicidal
Tablets and cream Some severe immunological side-effects
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Fluconazole Broad spectrum Fungistatic Convenient once per week dosage
Can be used in neonates Used for: Candida Cryptococcus
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Itraconazole Very broad spectrum Fungistatic To be taken with meals
Capsules and suspension available Used for: Any fungal infection Not better than terbinafin for dermatophytes
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Ketoconazole Broad spectrum Fungistatic To be taken with meals
Tablets, cream and shampoo available Used for: Seborrheic dermatitis Pityriasis versicolor Candidiasis Side-effects: Liver toxicity P450 inducer
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Imidazole Creams Variety available Similar spectra Little to choose
Price deciding factor E.g.. Ketoconazole, econazole, clotrimazole
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Corticosteroids Topical Systemic
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Topical Corticosteroids
3 Strengths Fluorinated vs Non-fluorinated Ointments, Creams, Lotions, Shampoos
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Topical Corticosteroids
Ointments: More potent Penetrates deeper More atrophy Used for: Dry lesions Thick lesions Thick skin
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Topical Corticosteroids
Creams: Less potent Penetrates less Less atrophy Used for: Acute, thin lesions Moist lesions Thin skin (Face, skin folds)
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Topical Corticosteroids
Lotions: Least potent, least atrophy Used for: Hairy areas (scalp) Wet lesions (Watery solutions)
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Topical Corticosteroids
Shampoos Clobetasol: Used for psoriasis of the scalp
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Systemic Corticosteroids
Prednisone / Prednisolone Potent, fast acting anti-inflammatory Cheap Side-effects: Short term: Almost none Long term: Severe Used once daily, in the morning
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Chloroquine Indications: Cutaneous lupus erythematosus
Porphyria cutanea tarda Side-effects: Corneal deposits (Temporary) Maculopathy (Permanent) Other
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Retinoids Topical: Tretinoin Adapalene Tazarotene
Comedolytic, anti-inflammatory Indications: Acne (All forms) Anti-aging Other
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Retinoids Systemic: Isotretinoin Acitretin Indications: Acne Psoriasis
Lymphomas Many others Side-effects, etc: See acne lecture
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Benzoyl peroxide Comedolytic, antiseptic Gel / Cream
Superficial, inflammatory acne vulgaris
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Shampoos Ketoconazole: Seborrheic dermatitis Pityriasis versicolor
(Not for tinea capitis) Coal tar (LPC): Psoriasis Povidone iodine (Betadine) Selenium sulfide (Selsun) Zinc pyrithione
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Barriers Zinc/Castor oil BP: Nappy rash
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Antibiotics Topical: Mupirocin Fucidic acid Gentamycin Erythromycin
Clindamycin Systemic: Tetracyclines (oxytetracycline, doxycycline, minocycline, lymecycline) Penicillins (amoxycillin, cloxacillin, amoxycillin-clavulanic acid
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Mupirocin Manufactured by Pseudomonas bacteria Broad spectrum
Esp effective against Staphylococci Ointment and cream No systemic use Reserved for short term use
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Tetracyclines Bacteriostatic antibiotics, potent anti-
inflammatory effects Used widely in acne, rosacea, bullous diseases Oxytetracycline: Rosacea Lymecycline: Drug of choice for acne Minocycline: Acne in white patients (pigmentation) Doxycycline: Acne in black patients (phototoxicity)
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Penicillins Cloxacillin, Flucloxacillin, Amoxycillin-Clavulanic acid: Staph infections Amoxycillin, erythromycin: Strep infections
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Antivirals Acyclovir: Cream, tablets and IV
Used for: Herpes simplex 1 and 2 Herpes zoster (Cream useless on skin) Side-effects: Practically none Podophyllin: 25% in TBCo: Used for condylomata acuminata and verrucae
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Antiscabies Benzoyl benzoate Only effective treatment for scabies
Method of use: See lecture on skin infections
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Antihistamines Sedating: Promethazine Chlorpheniramine
Hydroxyzine (Aterax®)
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Antihistamines Sedating: Promethasine Chlorpheniramine
Hydroxyzine (Aterax®) Used for: Atopic dermatitis Acute urticaria Other forms of night-time pruritus
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Antihistamines Sedating: Promethasine Chlorpheniramine
Hydroxyzine (Aterax®) Used for: Atopic dermatitis Acute urticaria Other forms of night-time pruritus Side-effects: Sedation (NB: Driving) Photo-allergy (not hydroxyzine) Dry mouth
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Antihistamines Non-sedating: Loratidine Cetirizine Desloratidine
Levocetirizine Used for: Acute and chronic urticaria Allergic rhinitis Side-effects: Almost none
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Anti-androgens Cyproterone acetate Progestogen, blocks 5α-reductase
2mg in Diane-35® 10mg in Androcur Used mostly for acne Side-effects: Depression, weight gain Drosperinone Ingredient of Yasmin®
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Imiquimod (Aldara®) Topical immunostimulant
Used for condylomata acuminata Superficial spreading basal cell CA Side-effects: Severe local inflammation
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