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Questions and Answers
Which of the following patients would be appropriate candidates for the use of topical antibiotics?
What is a possible complication of using topical acyclovir for treating HSV infections?
How does topical acyclovir primarily function as an antiviral medication?
In which situation would it not be beneficial to use topical acyclovir?
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Which of the following statements regarding the dosing of topical acyclovir for cold sores is accurate?
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What is a primary mechanism of action for Acyclovir in treating viral infections?
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What serious side effect should patients be aware of when taking Acyclovir?
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Which condition is treated by Acyclovir?
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When should Doconazole be used for treating skin infections?
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What is a common reaction to Acyclovir that patients might experience?
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In what situation should Acyclovir be reassessed for treatment?
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What is a misconception about using Doconazole?
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What criteria should be met to consider initiating Acyclovir treatment for genital HSV?
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What is the first sign of a cold sore or fever blister?
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When should a patient discontinue the use of a treatment for cold sores?
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Which of the following is an indication for prescribing oral antibiotics?
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What is a common complication associated with the use of antiviral treatments for herpes simplex virus (HSV)?
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In which situation is topical antibiotics recommended?
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What type of skin lesions are typically associated with carbuncles?
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What is the primary mechanism of action of treatments targeting cold sores?
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Which of the following is a general lifestyle measure to reduce the likelihood of skin infections?
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Study Notes
Dermatology Pharmacology I
- This class covers pharmacology related to dermatological conditions.
- The instructor is Dr. Lincoln McGinnis.
- The class is for the 2026 graduating class.
Instructional Objectives (General)
- Students will learn administration methods for dermatology medications.
- Students will recognize and categorize dermatology medications.
- Students will identify medications for common dermatological diseases.
- Students will determine the best route of administration for various medical conditions.
Instructional Objectives (Specific conditions)
- Students will be familiar with medications for pruritis (itching).
- Students will understand medications used to treat sunscreen application related conditions such as dermatitis.
- Students will learn the medication used to treat psoriasis.
- Students will learn the medication used to treat viral skin infections.
- Students will learn the medication used to treat bacterial skin infections.
- Students will learn the medication used to treat fungal skin infections.
- Students will learn the medication used to treat parasitic skin infections.
- Students will learn the use of medications for hair loss (Trichogenic).
- Students will learn the use of medications for acne.
- Students will learn the use of medications for dermatological antineoplastic agents (Actinic Keratosis)
Morphology, Diagnosis, Etiology and Treatment
- The presentation describes various skin conditions (pigmented, scaly, vesicular, etc.) and associated treatments and causes (infectious diseases, viral conditions, bacterial conditions, and more)
- The presentation details the different types of barriers against these dermatological conditions such as sunscreen agents and anti-inflammatory agents including topical corticosteroids and systemic steroids.
A General Pathway to Integrating Dermatology Pharmacology
- The presentation describes a learning pathway to integrate dermatologic pharmacology with clinical medicine.
- The learning path involves clinical medicine, pathophysiology, treatment and prognosis of disease, general principles of pharmacology, integration of specific block information, and PANCE master topics.
Medications by Categories
- The presentation lists many specific dermatological medications, categorized by the conditions they treat (e.g., acne, psoriasis).
KISS Principles of Dermatology
- If a skin condition is dry, wet it.
- If a skin condition is wet, dry it.
- If you think you know what it is, don't touch it.
- If you don't know what it is, biopsy it.
Principles of Dermatologic Therapy
- Bathing (soap use restricted to axillae, groin, and feet)
- Topical therapy (anti-infectives, corticosteroids, emollients, drying agents, topical antipruritics, and keratolytics)
- Systemic drugs (antihistamines, antidepressants, systemic corticosteroids, systemic immunomodulators, and systemic anti-infectives)
Vehicles of Administration
- Topical medications often use vehicles to facilitate application.
- Vehicle selection depends on factors such as active agent solubility, release rate, and stratum hydration.
Pharmacologic Response to Topical Medication
- Regional variation in drug penetration (scrotum, face, axilla, scalp are more permeable).
- Concentration gradients (drug transfer varies depending on concentration).
- Dosing schedule (skin acts as a reservoir, may allow once-daily application).
- Vehicles and occlusion (occlusion can maximize drug penetration).
Concentration Gradient, Dosing Schedule
- Increasing the concentration gradient increases the mass of drug transferred.
- Resistance to topical corticosteroids can be overcome by higher concentrations.
- Skin acts as a reservoir for many drugs, allowing once-daily application.
Vehicles of Administration for Topical Dermatology
- Gel: may contain alcohol; least occlusive.
- Foams: cosmetically elegant; spread readily/not occlusive
- Creams: can easily be rubbed in; can sting
- Oils: less stinging; commonly used on scalp
- Solution: less greasy/ less occlusive; may contain alcohol.
- Ointments: occlusive; greasy; good for dry or thick skin
Topical Antiviral Agents
- Acyclovir, valacyclovir, penciclovir, and famciclovir: synthetic guanine analogs that have inhibitory activity against Herpes simplex types 1 and 2.
- Comparative trials found these agents to be effective in treating Herpes simplex virus (HSV) infections by reducing symptom duration, time to lesion healing, and viral shedding time.
- Treatment of first-episode herpes simplex does not alter the recurrence rate of the condition
Acyclovir (Topical)
- Provides high concentrations for herpes lesions.
- Systemic concentrations are undetectable.
- Mechanism of action: Inhibits DNA polymerase; incorporates into viral DNA.
Acyclovir (Oral/Systemic)
- Treatment of HSV, orolabial HSV and HSV infections (immuno).
- Dosage forms include capsules and tablets
- Causes adverse reaction including, but not limited to, headache and neurotoxicity
Docosanol (Abreva)
- Appropriate for external use only
- Mechanism of action: Prevents viral entry and replication
Topical Antibacterial Agents
- Most commonly include bacitracin, mupirocin, retapamulin, polymyxin B sulfate, neomycin & gentamicin.
- These topical antibiotics are used to treat infections limited to smaller areas.
- Combined antibiotic products are often used (e.g., Neosporin).
Topical Antiviral Agents
- Often used for recurrent herpes labialis (cold sores, fever blisters)
- Effective in treating these conditions.
Antiseptics
- Povidone iodine
- Hydrogen peroxide
- Chlorhexidine
- Reduce bacterial load, but clinical significance is uncertain.
- Not typically associated with bacterial resistance.
- Used for wound care, handwashing, and surgical procedures.
Topical Antibacterial Preparations
- Used for prevention of infections in clean wounds.
- Combination therapy with corticosteroids may be effective in some cases.
Topical Antibiotics (Gram positive)
- Bacitracin, Gramicidin (peptide antibiotics)
- Mupirocin (pseudomonic acid A)
- Retapamulin (semisynthetic derivative)
Topical Antibiotics (Gram negative)
- Polymyxin B sulfate (peptide antibiotic)
- Neomycin & Gentamicin (aminoglycoside)
Topical Antibacterial Preparations
- Used to treat infections limited to small areas or to treat infections in combination with other medications.
- Combining antibiotics can improve efficacy for treating specific conditions like eczema, stasis dermatitis, and impetiginized eczema.
Bacitracin & Gramicidin (Topical)
- Poorly absorbed through skin.
- Systemic toxicity is rare.
- Used in combination with other medications in topical ointments.
Mupirocin (Topical)
- Used for localized impetigo.
- Effective in treating impetigo caused by Staphylococcus aureus or Streptococcus pyogenes.
Neosporin Ointment (Topical)
- Each gram contains polymyxin B sulfate, bacitracin zinc, and neomycin sulfate.
- Suitable for the treatment of certain infections, burns and minor wounds.
- Treatment for various superficial skin infections.
Impetigo
- Soaking and scrubbing can be beneficial (unroofing pus under the skin).
- Topical agents like bacitracin, mupirocin, & retapamulin are typically used.
- In widespread/immunocompromised cases, systemic antibiotics (e.g., Cephalexin) are recommended.
Seborrheic Dermatitis
- Often presents as an itchy, scaly rash commonly on the scalp, face, sides of the nose, eyebrows, ears, eyelids and chest.
- Topical therapies like Selenium sulfide (e.g. Selsun Blue).
Tinea Unguium (Onychomycosis)
- Trichophyton infection of fingernails or toenails (most frequently T rubrum).
- Nail onychomycosis is difficult to treat.
- Usually requires systemic therapy for effective treatment.
Topical Imidazoles & Triazoles
- Used for cutaneous infections, like ringworm, candidiasis.
- Commonly formulated as creams or solutions.
Imidazoles/Triazoles (Topical)
- Include clotrimazole and miconazole (e.g., lotrimin creams, monistat, micatin).
- Often used for treatment of superficial fungal infections.
- Mechanism of action involves damage to fungal cell wall via interference of ergosterol biosynthesis.
Ketoconazole (Topical)
- Effective for dermatophytosis, candidiasis, and seborrheic dermatitis.
- Formulation includes creams, solutions (e.g., topical nizoral).
- Mechanism of action involves damaging the fungal cell wall by inhibiting ergosterol biosynthesis.
Allylamines (Topical)
- Effective against dermatophytes.
- Include Terbinafine (Lamisil) and Naftifine HCL.
- Mechanism of action involves inhibiting squalene epoxidase.
Terbinafine (Oral)
- Used for onychomycosis (nail infections).
- Should generally be used only if topical therapies have not resolved the infection.
- Mechanism of action is to inhibit squalene epoxidase.
Butenafine(Topical)
- Used against dermatophytes.
- Topical applications are typically twice daily.
- Mechanism of action is to inhibit squalene epoxidase.
Selenium Sulfide (Selsun Blue)
- Used for dandruff, seborrheic dermatitis, and tinea versicolor.
- Lotion or shampoo, applied to the scalp.
Topical Anti-Infectives (General)
- Topical treatment is often successful for many superficial infections.
- In general for topical applications, topical medications are frequently more appropriate for smaller areas that don't warrant systemic treatment or for treating certain superficial conditions.
Ectoparasiticide (Topical)
- Includes Pyrethrins, Permethrin, Nix*, and Lindane.
- Used in the management of ectoparasitic infestations.
Ectoparasiticide (Topical)-Pyrethrins combined with piperonyl butoxide
- Safe and effective when used as directed
- Can only kill live lice, not unhatched eggs (nits).
Ectoparasiticide (Topical)-Permethrin
- Synthetic pyrethroid.
- Approved by the FDA for head lice treatment.
- May continue to kill newly hatched lice for several days after the initial treatment.
Ectoparasiticide (Topical) - Benzyl Alcohol
- Topical benzyl alcohol (e.g., Ulesfia lotion) is not ovicidal.
- Effective for treating lice but a second treatment is required after the initial treatment to kill newly hatched lice.
Ectoparasiticide (Topical)-Ivermectin
- Synthetic pyrethroid that is similar to naturally occurring pyrethrins.
- Approved by FDA
- Approved for children 6+ months.
Ectoparasiticide (Topical) - Malathion
- Organophosphate pediculicidal.
- Partially ovicidal
- Approved for children 6+ years.
Ectoparasiticide (Topical) - Spinosad
- Derived from soil bacteria.
- Effective against live lice and unhatched eggs.
- No need for further treatments to kill newly hatched.
Ectoparasiticide (Topical)-Lindane
- Organochloride that is no longer recommended as first-line treatment by the American Academy of Pediatrics.
- May be used for people who have failed first-line treatments
- Contraindicated, or should be avoided, in premature infants, individuals with other skin conditions (including atopic dermatitis and psoriasis), the elderly, and in those weighing less than 110 lbs (50 kg)
Topical Minoxidil (Rogaine)
- Used to treat androgenic alopecia.
- Dosing is frequently, but it isn't always, permanent, and cessation of treatment may cause hair loss.
Finasteride (Propecia)
- Promotes hair growth, prevents further hair loss.
- Treatment for 3-6 months may be necessary.
- Avoid use in pregnant women
Topical Retinoids
- Tretinoin, Tazarotene, Adapalene, and Alitretinoin
- Often prescribed for Acne, Acne vulgaris, and wrinkle reduction.
- Can be found in creams or gels.
Topical Vitamin A derivatives
- Mechanism of action is unknown, but it's presumed that they decrease cohesion between epidermal cells, leading to increased epidermal cell turnover.
- Retinoic acid, 13-cis-retinoic acid (isotretinoin, e.g., Accutane).
- Available in various formulations.
Systemic Retinoids (Oral)
- Include Isotretinoin, Etretinate, Acitretin, Bexarotene
- Often prescribed for severe recalcitrant nodular acne.
Calcipotriene
- Used topically in the treatment of psoriasis plaques.
- Applied twice daily to plaque psoriasis on the body, often in combination with topical corticosteroids.
Keratolytics (Salicylic Acid, Benzoyl Peroxide)
- Salicylic acid: Active metabolite of aspirin, frequently used for dermatologic therapy as a keratolytic agent.
- Effective against acne and warts. Often formulated as topical bars, creams, foams, washes, and pads.
- Topical application, with a limit of 2% for use on the face.
- Benzoyl peroxide: Penetrates the stratum corneum, and converts metabolically to benzoic acid within the skin.
- Effective for acne treatment.
- Can be highly concentrated and can lead to hyperpigmentation.
Topical Anti-Infectives
- Used in mild to moderate inflammatory acne treatment.
- Include Clindamycin, erythromycin, dapsone.
- More effective when combined with other drugs like topical benzoyl peroxide to reduce bacterial resistance.
Oral Antibiotics for Acne
- Used for moderate to severe acne.
- Include doxycycline, minocycline, tmp-smz, cephalosporin.
Rosacea
- Treatment for rosacea commonly involves a combination of good skin care and prescription drugs.
- Topical treatment such as brimonidine and oxymetazoline reduce flushing.
- Other topical treatments may include azelaic acid, metronidazole, and ivermectin, for treating lesions.
Imiquimod
- Immune response modifier that increases the body's immune system's activity.
- Used to treat genital and anal warts, actinic keratosis, and superficial basal cell carcinomas.
Tacrolimus & Pimecrolimus
- Employed for short-term, and long-term therapy for atopic dermatitis.
- Can be formulated as an ointment or cream.
Fluorouracil Topical
- Topical formulations like Carac, Efudex, and Fluoroplex.
- Can be formulated in different concentrations (0.5%, 1%, 2%, 4%, and 5%).
Diclofenac (Topical)
- Helps to treat actinic keratosis.
- Topical formulations of NSAIDs are frequently used.
- Can be formulated as a gel with variable concentrations (such as 3%).
Podophyllum Resin & Podofilox
- Used to treat condyloma acuminata (genital warts).
- In treating large condylomas, application should be restricted to sections of the affected area for minimizing systemic absorption to minimize systemic absorption.
- Wash off the preparation after 2-3 hours to reduce skin irritation.
Burns
- Initial treatment focus is on protecting the wound from desiccation and further injury/infection.
- Topical antibiotics like silver sulfadiazine (Silvadene), commonly used to prevent or treat infections in burns, burns, and other skin injuries.
Minor Skin Infections
- Treatment is not always necessary.
- Often topical antibiotics provide appropriate treatment in minor, localized scenarios such as impetigo.
Summary of Additional Topics
- Additional information on specific treatments for conditions such as acne (various topical and oral treatments and their formulations), psoriasis (various treatment options including topical and systemic treatments), and burns.
- Specific guidelines regarding appropriate use and considerations for pregnant women, pediatric patients, and patients with specific risk factors.
- Detailed instructions regarding dosages, frequency of application, and duration of treatment.
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Description
This quiz focuses on pharmacology related to dermatological conditions, designed for the 2026 graduating class. Students will test their knowledge of medication administration methods, treatment options for common skin diseases, and specific medications for conditions like pruritis and psoriasis.
