Podcast
Questions and Answers
Which of the following topical medications is generally considered best for dry, scaly lesions?
Which of the following topical medications is generally considered best for dry, scaly lesions?
Which type of topical medication is typically best suited for areas with hair?
Which type of topical medication is typically best suited for areas with hair?
What is the recommended treatment approach for weeping lesions?
What is the recommended treatment approach for weeping lesions?
What is the primary mechanism of action for topical corticosteroids?
What is the primary mechanism of action for topical corticosteroids?
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What is a potential concern when using occlusive dressings with topical corticosteroids?
What is a potential concern when using occlusive dressings with topical corticosteroids?
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Which of the following topical acne medication products contains erythromycin?
Which of the following topical acne medication products contains erythromycin?
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Which of the following topical acne medications is an androgen receptor inhibitor?
Which of the following topical acne medications is an androgen receptor inhibitor?
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Which of the following topical acne medications is available in gel, lotion, foam, and solution forms?
Which of the following topical acne medications is available in gel, lotion, foam, and solution forms?
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Which of the following medications is a topical antibiotic used to treat acne and rosacea?
Which of the following medications is a topical antibiotic used to treat acne and rosacea?
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Which of the following topical acne medications contains benzoyl peroxide?
Which of the following topical acne medications contains benzoyl peroxide?
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Which of the following medications is an androgen receptor inhibitor that is used to treat acne?
Which of the following medications is an androgen receptor inhibitor that is used to treat acne?
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Which of the following topical acne medication products contains clindamycin?
Which of the following topical acne medication products contains clindamycin?
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Which of the following topical acne medications contains adapalene?
Which of the following topical acne medications contains adapalene?
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Which of the following medications is used to treat candidiasis infections and cryptococcal meningitis?
Which of the following medications is used to treat candidiasis infections and cryptococcal meningitis?
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Which medication is used for both cutaneous candida infections and tinea versicolor?
Which medication is used for both cutaneous candida infections and tinea versicolor?
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Which of the following is NOT an effective treatment for HSV infections?
Which of the following is NOT an effective treatment for HSV infections?
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Which of the following medications is used to treat nail infections?
Which of the following medications is used to treat nail infections?
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Which of the following medications is a topical antifungal used to treat cutaneous candida infections and tinea versicolor?
Which of the following medications is a topical antifungal used to treat cutaneous candida infections and tinea versicolor?
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Which of the following medications is an antibiotic that may cause local skin reactions?
Which of the following medications is an antibiotic that may cause local skin reactions?
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Which of the following medications is used to treat 2nd and 3rd-degree burns?
Which of the following medications is used to treat 2nd and 3rd-degree burns?
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Which medication is part of the triple antibiotic ointment Neosporin®?
Which medication is part of the triple antibiotic ointment Neosporin®?
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Which of the following is a topical antiviral medication used to treat HSV infections?
Which of the following is a topical antiviral medication used to treat HSV infections?
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Which medication, when given with a high-fat meal, increases serum levels?
Which medication, when given with a high-fat meal, increases serum levels?
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Study Notes
Pharmacology in Dermatology
- Presented by Martha L. Sikes, DMSC, RPh, PA-C
Topical Medications
- Ointments: Petrolatum base (e.g., Vaseline)
- Gels/solutions: Higher alcohol content, oil-free
- Creams/lotions: Suitable for dry skin, non-irritating formulations
- Lotions/foams: Can be applied to areas with hair
- Occlusion order: Ointment > cream > lotion > gel > solution
Topical Corticosteroids
- MOA: Decrease cell proliferation, inhibit inflammatory mediators, cause local vasoconstriction
- Dosage: Dependent on affected area
- Formulations:
- Areas with hair: lotions, gels, aerosols, solutions, foams
- Weeping lesions: lotions, gels, creams
- Dry, scaly lesions: ointments
- Usage: Can be used on many skin areas
- Vehicle choice: Important for minimizing adverse effects (AEs)
Topical Corticosteroids: Occlusive Dressings
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Increased skin penetration
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Increased systemic effects
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Increased secondary bacterial/fungal infections
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Do not use with very high/ultra high potency (except lichenified lesions)
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Do not leave on for more than 12 hours
Topical Corticosteroids: Adverse Effects (AEs)
- Local AEs:
- Drying/cracking of skin
- Thinning of epidermis
- Atrophic striae (possibly permanent)
- Hypopigmentation
- Systemic AEs:
- Usually with large areas, prolonged use, occlusive dressings
- HPA suppression (especially in pediatrics)
Topical Corticosteroids: Potency
- Medications have varying potency based on strength/dosage form (I-VII)
- USP potency ratings: Low, Medium, High, Very High
- Low Potency: Face, genitals, axilla, skin folds
- Medium Potency: Trunk, arms, legs
- Limit weekly dose to 90-100 grams (Medium potency)
- Very High Potency: Palms, soles, resistant conditions
- Limit weekly dose to 50 grams (Very high potency)
- Treatment duration generally does not exceed 2 weeks
Topical Calcineurin Inhibitors (Topical Immunomodulators)
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MOA: Blocks inflammatory mediators by modulating T-cell function and depressing cell-mediated immune responses
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Indications:
- Second-line therapy for atopic dermatitis (intermittent use)
- Off-label use: psoriasis, seborrheic dermatitis, rosacea, vitiligo
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AEs: Temporary stinging, burning, pruritus
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Precautions: Based on animal studies, risk of skin cancer and lymphomas
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Precaution: Do not use on pre-malignant/malignant lesions
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Precaution: resolve cutaneous bacterial/viral infections before use
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Precaution: avoid sun exposure, use with occlusive dressing (unknown effects)
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Precaution: avoid use in immunocompromised patients
Topical Calcineurin Inhibitors (Specifics)
- Pimecrolimus 1% (Elidel): Cream, for adults and children >2 years old
- Tacrolimus 0.03%, 0.1% (Protopic): BID application
PDE-4 Inhibitor
- MOA: Results in increased intracellular cAMP levels to decrease proinflammatory response
- AEs: Application site pain, burning, or stinging (4%)
- Specifics
- Crisaborole (Eucrisa) 2% ointment: For mild-to-moderate atopic dermatitis in patients 2 years of age and older
- Roflumilast (Zoryve):
- Psoriasis (0.3% cream)
- Seborrheic dermatitis (0.3% foam)
- Atopic dermatitis (0.15% cream)
Miscellaneous Topical Agents
- Tazarotene (Tazorac®): Gel 0.05% or 0.1% for mild-to-moderate psoriasis, acne
- Calcipotriene (Dovonex®), calcitriol (Vectical®): Topical synthetic vitamin D analogs for mild-to-moderate psoriasis
- Coal Tar: Keratolytic and may have antiproliferative/anti-inflammatory effects, for psoriasis
- Salicylic acid in shampoos (typically 3-4% strength) can help with scalp psoriasis and dandruff
- Removal and smoothing of scale, treating hyperkeratosis, enhancing steroid penetration
JAK Inhibitors
- MOA: Inhibit JAK, a group of intracellular tyrosine kinases that influence cellular processes including inflammation
- AEs: Nasopharyngitis, bronchitis, increased eosinophils, diarrhea, folliculitis, tonsillitis
- Box warning: Serious infection, sudden cardiovascular death, malignancies, MACE (major adverse cardiovascular events), thrombosis
- Indications: Atopic dermatitis
AhR Agonist
- MOA: Aryl hydrocarbon receptor (AhR) agonist
- AEs: Folliculitis, nasopharyngitis, contact dermatitis, headache, pruritus
- Use: Atopic dermatitis, psoriasis
Systemic Corticosteroids
- Dermatologic uses: Contact dermatitis, atopic dermatitis, other
- Use: Short courses for acute exacerbations of chronic atopic dermatitis (eg., prednisone 40-60 mg/day for 3-4 days, then 20-30 mg/day for 3-4 days).
- Prednisone (Deltasone)
- Dexamethasone (Decadron)
Systemic Agents - Psoriasis
- Acitretin (Soriatane®): Oral retinoid
- Methotrexate: Oral/IM treatment
- Cyclosporine (Neoral or Sandimmune®): Suppresses T-cell activation
- Biologic Response Modifiers (BRMs): Newer therapies
TNF-a Inhibitors
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MOA: Inhibit TNF-alpha or its receptor
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Adverse Effects:
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Increased risk of infections (TB, hepatitis B, sepsis)
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Increased risk of fungal opportunistic infections
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Increased risk of pancytopenia
-Injection site reaction(s)
-Increased respiratory tract infections
-GI symptoms
-worsening of CHF (or new onset CHF)
-Need to do initial PPD, Hep B & C serologies, CBC, CMP
-Yearly PPD, Every 3 months CBC, CMP,
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TNF-a Inhibitors (Specific Examples)
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Adalimumab (Humira®): Chimeric/human MAB- 80mg SQ x 1st week then 40mg SQ weekly
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Etanercept (Enbrel®): Fully humanized MAB
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Infliximab (Remicade®): Chimeric MAB, 5mg/kg IV at 0,2,6 weeks then q8 weeks
Golimumab (Simponi®): Given SQ monthly
IL-12/23 Inhibitor
- Stelara (ustekinumab): Targets IL-12 & IL-23
- AE; URI, nasopharyngitis, back pain, injection-site erythema, diarrhea, fatigue, headache, myalgia
- Given every 3 months
IL-17 Inhibitors
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Cosentyx (Secukinumab): Inhibits IL-17A
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Taltz (ixekizumab): Inhibits IL-17A
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Bimzekizumab (Bimzelx): Inhibits IL-17A, IL-17F
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Siliq (brodalumab): Inhibits IL-17A receptor
IL-23 Inhibitors
- Guselkumab (Tremfya®): Inhibits IL-23
- Risankizumab (Skyrizi): Inhibits IL-23
- Tildrakizumab (Ilumya): Inhibits IL-23
PDE-4 Inhibitor
- Apremilast (Otezla®)
- Indications; Plaque psoriasis, psoriatic arthritis, Bechet disease
IL-4/13 Inhibitor
- Dupilumab (Dupixent): Monoclonal antibody inhibits IL-4 and IL-13
IL-13 Inhibitor
- Indications: Moderate to severe atopic dermatitis in adults not controlled on topical therapy
TYK2 Inhibitor
- Deucravacitinib (Tofyktu): Inhibits TYK2
- Indications; Plaque psoriasis
Phototherapy
- UVB radiation for psoriasis
- PUVA (psoralen plus UVA) for psoriasis
Acne Treatment
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Topical Treatments (examples): Benzoyl peroxide, Topical antibiotics, Isotretinoin, Topical retinoids, Combination products, Topical androgen receptor inhibitor
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Systemic Treatments (examples): Antibiotics, Isotretinoin
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Oral contraceptives
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Aldosterone Antagonist
Topical Rosacea Agents
- Oxymetazoline (Rhofae): Alpha-1 agonist eliciting vasoconstriction
- Brimonidine (Mirvaso): Alpha-2 agonist decreasing vasculature dilation
Bacterial, Viral, Parasitic Infection Treatments
- Topical Antibiotics (examples): Mupirocin, Retapamulin, Silver Sulfadiazine, Bacitracin, Bacitracin & Polymixin B, Triple Antibiotic Ointment
- Antifungals (examples): Azoles (Clotrimazole, Miconazole, Ketoconazole, Econazole), Terbinafine, Ciclopirox,
- Antivirals (examples): Acyclovir, Penciclovir
Parasitic Infections - Scabies
- Permethrin 5% (Elimite®): Acts as a neurotoxin, depolarizing parasite nerve cells and causing muscle paralysis.
- Ivermectin (Stromectol®): Binds to glutamate-gated Cl ion channels, resulting in paralysis and death of parasites.
Parasitic Infections - Lice
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Permethrin 1% (Nix®): Saturates treatment area and washed off after 10 minutes.
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Malathion (Ovide®): Applied to dry hair, allowed to dry naturally, then washed with soap after 8–12 hours
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Lindane (Kwell®): Applied to dry hair/pubic, then washed off after 4–12 hours
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Ivermectin (Stromectol®): 200mcg/kg PO q week x 3 doses
Additional Information
- References provided at the end
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Description
Test your knowledge on topical medications used for various skin conditions, including acne, dry lesions, and weeping lesions. This quiz will cover mechanisms of action, concerns with usage, and specific product knowledge related to topical treatments. Perfect for students in dermatology or pharmacy courses!
