Dermatology & Andrology TTT Flashcards
1
Q
what are the advantages of topical therapy in dermatology?
A
- Topical therapy plays a major role in dermatologic treatment.
- It has many advantages, the most important of which is that:
❶ The active agent reaches the lesion directly and in a sufficient concentration
❷ slight or no systemic side effects.
2
Q
Components of topical therapy
A
Any topical preparation consists of 2 components:
❶ Active agent: e.g., antibiotics, corticosteroids.
❷ Vehicle (base): Vehicles may have some therapeutic effects and sometimes may be used alone without the addition of active agent.
3
Q
Liquid Vehicles
A
- Example: water, alcohol, Ca hydroxide & glycerin. They are used in the preparation of solutions, lotions, tinctures, paints, creams
4
Q
Vehichles in topical therapy
A
- Ideally a vehicle should be: Non-toxic, non-irritant and non-allergic.
- Forms of Vehicles: Liquids, powders, creams or ointments.
5
Q
A
5
Q
Powder Vehicles
A
- Usually applied to normal skin folds to reduce friction.
6
Q
Creams
A
- Semisolid emulsion of oil in water.
- They are used in subacute condition
7
Q
Ointments
A
- Greasy base used for dry hyperkeratotic or lichenified skin disease
8
Q
Gels
A
- Non-greasy transparent, semisolid emulsions that liquefy on contact with the skin, drying as a thin greaseless, non-staining film.
- They are suitable for treating hairy areas
9
Q
Uses of Topical Corticosteroids (TCS)
A
Topical corticosteroids are commonly prescribed for treatment of many skin diseases including:
❶ Atopic dermatitis
❷ Discoid eczema
❸ Contact dermatitis, seborrheic dermatitis
❹ Psoriasis
❺ Lichen planus
❻ DLE (discoid lupus erythematous)
❼ Vitiligo
❽ Alopecia areata, and many others.
10
Q
Forms of Topical Corticosteroids (TCS)
A
Topical steroids are available in the form of:
- Creams
- Ointment
- Lotion
It can be mixed with salicylic acids, calcipotriene, antifungal, or antibiotics. Many OTC (over the counter preparations) are also available containing TCS, antifungal, and antibacterial.
11
Q
Classification of Topical Corticosteroids (TCS)
A
12
Q
Examples of Ultrapotent TCS
A
- Clobetasol propionate 0.05% [Dermovate ®]
13
Q
Examples of Highly potent TCS
A
- Mometasone furoate 0.1% (Elocon , Elica)
- Betamethasone dipropionate (Diprosone)
14
Q
Examples of Moderately potent TCS
A
- Betamethasone valerate (Betnovate, Betaderm, Betaval)
15
Q
Examples of Moderate/weekly potent TCS
A
- Hydrocortisone butyrate (Texacort)
- Prednicarbate (Dermatop)
- Alclometasone dipropionate 0.05% (perderm, weak)
- Hydrortisone acetate (the weakest TCS)
16
Q
Examples of Combination TCS
A
- Momenta (contain potent TCS)
- Kenacomb, quadriderm, pandermal (contain moderately potent TCS)
- Fucicort cream, Fusizon cream (contain moderately potent TCS)
- Daktacort (contain hydrocortisone)
17
Q
Side effects of TCS
A
18
Q
Systemic side effects of TCS
A
- Growth retardation in children
- Iatrogenic Cushing syndrome.
19
Q
what causes side effects by TCS?
A
- prolonged use of more potent steroids especially on: Delicate skin including child skin (any site), face, flexures, and genitalia.
- Even hydrocortisone acetate can produce skin atrophy with prolonged use especially on thin skin
20
Q
Prescription of TCS
A
- TCS are used once daily in most of cases.
- Ultrapotent TCS and potent CS should not be prescribed by general practitioner.
- Any type of TCS should not be prescribed without definite diagnosis.
21
Q
Treatment of impetigo
A
- Topical
- Systemic antibiotic
- Treatment of predisposing factors
22
Q
Topical treatment of impetigo
A
for mild and localized infection.
- Removal of the crust by olive oil.
- Antiseptic lotion, e.g., K. permenganate.
- Antibiotics, e.g., e.g., Mupirocin 2%, 2% fucidic acid, or neomycin- bacitracin,
23
Q
Systemic antibiotics for treatment of impetigo
A
-
B-lactamase-resistant penicillin
(e.g.or dicloxacillin or amoxicillin/clavulinic acid) or flucloxacillin 1-1.5gm/d (infant, children 25-50mg/d) - first-generation cephalosporin (e.g. cephalexin or cefadroxil).
- Clindamycin or Azithromycin if the patient is sensitive to penicillin. or erythromycin 1g/d (40mg/kg in infants and children)
24
Dose and indications of antibiotics in impetigo
- They are given for 7-10 days and are indicated in:
1. Extensive lesions.
2. Fever.
3. Regional lymphadenitis.
4. Bullous impetigo.
5. Nephrogenic strain of streptococcal impetigo
25
Treatment of predisposing factors in cases of impetigo
- When pediculosis is present, it should be treated topically after control of impetigo because pediculocidal drugs are toxic, so they are not applied on raw areas.
26
Treatment of Furunculosis
27
Treatment of carbuncle
- Penicillinase resistant penicillin.
- Surgical incision & drainage of pus.
28
Treatment of erysipelas and cellulitis
1. **Rest and antipyretic** (usually paracetamol) with leg elevation.
2. **Penicillin** for 10-14 days is the drug of choice.
- Aqueous penicilin C: for severe cases 600,000-2000,000 unt IV/6hr.
- Oral penicillin: for mild cases 250-500 mg/6hr. For 10days.
- Benzathine P: for rec. cases. 1,200,000 U. I.M/2-4ws for ms or ys
- Erythromycin: 1-2 gm/day for 10 days.
3. **Erythromycin:** is an alternative therapy for those who are allergic to penicillin.
4. **Antibiotics** that covers both strept and staph are recommended in cellulitis (e.g. dicloxacillin, cephalexin, clindamycin, or combinations).
29
Treatment of Streptococcal intertrigo
- Topical antiseptic.
- Topical & systemic antibiotic.
30
Etiology, predisposing factors & treatment of angular cheilitis
31
Treatment of erythrasma
32
Treatment of **Lupus vulgaris**
33
Treatment of leprosy
34
Antifungal drugs
35
Absorption of **Amphotericin B**
- poorly absorbed from the GIT and is usually administered IV
36
Category of **Amphotericin B**
B
37
MOA of **Amphotericin B**
- Amphotericin B binds ergosterol in fungal cell membrane >> form pores in cell membrane >>>cell content leak out>>> cell death
38
Pharmacokinetics of **Amphotericin B**
39
Side effects of **Amphotericin B**
40
Forms of **Nystatin**
available as suspension, ointment, cream, powder and tablet (tablet for local use)
41
Uses of **Nystatin**
- only topically in Candida infections.
42
Other Uses of **Nystatin**
43
Side effects of **Nystatin**
- They include nausea and bitter taste.
- Category A in pregnancy
44
Category of **Nystatin**
- Category A in pregnancy
45
Examples of Azoles
**Topical:**
- Miconazole
- Clotrimazole
**Systemic:**
- Ketoconazole
- Fluconazole
46
Uses of Miconazole & Clotirazole
They are used topically for
- Dermatophytic (tinea)
- Candida infections.
47
Forms of Miconazole & Clotirazole
They are available as
- cream, gel, lotion
- solution, spray
- vaginal pessary, etc.
- Clotrimazole lozenge is also available.
48
Characters of **Ketoconazole**
- It is orally effective
- Ketoconazole is the most toxic among azoles, but it is less toxic than amphotericin B.
49
Side effects of **Ketoconazole**
50
Administration of **Fluconazole**
For oral and i.v. administration
51
Indications for **Fluconazole**
Fluconazole is a drug of choice in
- esophageal and
- oropharyngeal candidiasis.
A single oral dose usually eradicates vaginal candidiasis.
52
Drug interactions of azoles
- All azoles inhibit the hepatic CYP450 3A4 isoenzyme to varying degrees.
- Patients on concomitant medications that are substrates for this isoenzyme may have increased concentrations and risk for toxicity (e.g warfarin).
53
Contraindications of azoles
- Azoles are considered teratogenic, and they should be avoided in pregnancy unless the potential benefit outweighs the risk to the fetus
54
Uses of **Terbinafine**
55
Side effects of **Terbinafine**
56
Side effects of **Griseofulvin**
disulfiram-like reaction
57
Uses of **Griseofulvin**
- Active only against dermatophytes (orally,not-topically)
- by depositing in newly formed keratin and disrupting microtubule structure
58
MOA of **Echinocandins** (Caspofungin & other fungins)
Inhibit the synthesis of beta-1,2 glucan
59
Uses of **Echinocandins**
- A critical component of fungal cell walls (not membrane)
- Back-up drugs given IV for disseminated and mucocutaneous Candida infections or invasive aspergillosis
- Monitor liver function
60
What are the most commonly used antifungal drugs for oral candidiasis?
- Clotrimazole, nystatin and fluconazole
61
Antifungal drugs used in pregnancy
- Nystatin and amphotericin B can be used in pregnancy but azoles are better avoided
62
What are antifungal drugs used in systemic fungal infections?
Azoles, amphotericin B and caspofungin
63
Indication of Topical azoles
dermatophytes and candida
64
Indication of Amphotericin B
systemic fungal infection
65
Indication of Fluconazole
- esophageal &oropharyngeal candidiasis
- vaginal candidiasis
66
Indication of Griseofulvin & Terbinafine
- dermatophytes only
67
Indication of Echinocandins
- Disseminated candidiasis
- mucocutaneous candidiasis
- Invasive aspergillosis
68
Indication of Nystatin
- candidal infection
69
Route of adminstration of Amphotericin B
IV infusion
70
Route of adminstration of Ketoconazole & griseofulvin
Oral
71
Route of adminstration of Fluconazole
Oral & IV
72
Route of adminstration of Echinocandins
IV
73
Treatment of **T.Capitis**
74
TTT of **T.Barbae**
Similar to tinea capitis.
75
TTT of **T.Corporis**
76
TTT of **T.Cruris**
Similar to T. Circinata
77
TTT of **T.Pedis**
78
TTT of **T.Manum**
Similar to T.Pedis
79
TTT of **Onchyomycosis (T.Unguium)**
80
Topical antifungals for dermatophyte infections
81
Systemic antifungals for dermatophyte infections
82
TTT of **Pityriasis Versicolor**
Topical & Systemic
83
Topical TTT of **Pityriasis Versicolor**
84
Systemic TTT of **Pityriasis Versicolor**
85
TTT of candida
- TTT of predisposing factors
- Topical
- Systemic
86
Topical TTT of Candida
87
Systemic TTT of Candida
88
TTT of Reactivated HS
89
TTT of **Chicken Pox (Varicella)**
symptomatic TTT & Systemic Anticirals
90
Symtomatic TTT of **Chicken Pox (Varicella)**
Required for most children (immunocompetent) (no specific treatment)
- Antipyretic for fever:(avoid salicylate).
- Antihistamine for itching.
- Antibiotic for secondary infection.
- Topical antiseptic.
91
Systemic TTT of **Chicken Pox (Varicella)**
- Acyclovir or Valacyclovir (which must be given within
24-72 hours of onset of lesion).
92
Indications of Systemic TTT in **Chicken Pox (Varicella)**
- Immunocompromised patients .
- Varicella in pregnant woman.
- Severe varicella in immunocompetent children
- Neonatal varicella (Acyclovir IV Infusion)
93
Prophylaxis from **Chicken Pox (Varicella)**
- Varicella-zoster immune globulin: immediate post exposure prophylaxis
- Live attenuated varicella vaccine (Varivax®): routine vaccination (active immunity).
94
TTT of pregnant woman with **Chicken Pox (Varicella)**
- **IV acyclovir**
* women who are not immune to varicella but are exposed may be treated with VZIG
95
Category of acyclovir
**Category B**
- Safe in pregnancy(category B) Fetal risk not demonstrated in animal studies but there are no controlled studies in pregnant women, or animal reproduction studies have shown an adverse effect that was not confirmed in controlled studies in women during first trimester and there is no evidence of risk in later trimesters)
96
TTT of infant with **Chicken Pox (Varicella)**
- Infants whose mothers develop varicella 5 d. before delivery or 2 d. following delivery should receive VZIG after birth.
- Infants who develop varicella during the first 2 w. of life should be treated with IV acyclovir.
97
Dose of VZIG in **Chicken Pox (Varicella)**
98
TTT of **Herpes Zoster (shingles)**
- Topical
- Systemic
- TTT of PHN
99
Topical TTT of **Herpes Zoster (shingles)**
- antiseptic, antibiotic.
100
Systemic TTT of **Herpes Zoster (shingles)**
- Must be given within 7 days after the onset of skin lesions.
- Acyclovir, Famciclovir and Valacyclovir
101
Indications of Systemic TTT of **Herpes Zoster (shingles)**
- Patient older than 50 years.
- Immunocompromised patients.
- Ophthalmic zoster.
- Ramsay Hunt syndrome.
- Antibiotic: For neuralgic pain: (Tegretol 200-800mg/d, tryptizol 25-100mg/d, neurosurgical advice)
102
TTT of PHN
- Gabapentin (Neurontin® or pregabalin)
- Tricyclic antidepressants (CA) as Amitriptyline (tryptizol 25-100mg/d) and nortriptyline.
- Carbamazepine(Tegretol 200-800mg/d)
- Other lines: lidocaine patches, narcotic analgesics, and nerve blocks + Neurosurgical advice
103
TTT of **Pityriasis Rosea**
- Reassurance.
- Avoid soap, hot bath and woolen clothing.
- Antihistamines for itching.
- Antipruritic topical agent or mild steroid for irritable lesions.
- UVR.
104
TTT of **Warts**
Because of the benign and self-limited nature of warts, aggressive treatments that cause scarring should be avoided especially in children
- Electrocautery
- Cryotherapy
- Chemicalcautery
- Others
105
Elctrocautery in **Warts**
- Used in painful and resistant warts, but carries risk of scarring.
- NOT used in
1. plantar wart
2. larger wart more than 1cm
3. warts on the small joints of toes and fingers
4. large periungual warts (nail dystrophy).
106
Cryotherapy in TTT of **Warts**
- Using coz snow or liquid nitrogen, cause destruction by freezing
107
Chemical Cautery in TTT of **warts**
108
Other methods used in TTT of warts
109
TTT of **Anogenital wart**
110
TTT of **Planter wart**
Salicylic acid, if multiple use formalin
111
TTT of **Common wart**
Salicylic acid, Imiquimod
112
TTT of **Condyloma Accuminata**
Podophyllin, if resistant use interferon
113
TTT of **Plane wart**
Retinoic topical, Imiquimod
114
TTT of **Resistant & Multiple warts**
Levimizole
115
TTT of **Anogenital wart**
Imiquimod
116
Prevention of **Warts**
proactive vaccine for genital HPV infection
117
TTT of **Mulluscum Contagiousm**
118
Classes of **Antiretroviral drugs**
- Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
- Non-nucleoside Reverse Transcriplase Inhibilors NNRTIs)
- Protease Inhibitors (Pls)
119
MOA of **Nucleoside Reverse Transcriptase Inhibitors (RTIs)**
120
Examples of Nucleoside Reverse Transcriptase Inhibitors (RTIs)
**Nucleoside Reverse Transcriptase Inhibitors (NRTIs):**
- Zidovudine [Azidothymidine (AZT)]
**Other Nucleoside Reverse Transcriptase Inhibitors (NRTIs):**
- Didanosine, Stavudine, Emtricitabine and Lamivudine
121
Uses of **Zidovudine [Azidothymidine (AZT)]**
122
AE of **Zidovudine [Azidothymidine (AZT)]**
**The common side effects:**
- Bone marrow suppression, anaemia and neutropenia.
**Initial stages of therapy commonly seen:**
- Nausea, vomiting, abdominal discomfort, headache, and insomnia
**Long-term therapy:**
- May cause hepatotoxicity, myopathy with fatigue and lactic acidosis.
123
Uses of **Didanosine, Stavudine, Emtricitabine and Lamivudine**
- They are effective orally.
- Lamivudine is a commonly used agent in antiretroviral therapy because of its efficacy and low toxicity.
124
AE of **Didanosine, Stavudine, Emtricitabine and Lamivudine**
1- peripheral neuritis
2- pancreatitis, gastrointestinal disturbances
3- lactic acidosis
4- skin rashes, etc.
125
Examples of **Non-nucleoside Reverse Transcriplase Inhibilors NNRTIs)**
Nevirapine & Efavirenz
126
MOA of **Non-nucleoside Reverse Transcriplase Inhibilors NNRTIs)**
127
AE of **Non-nucleoside Reverse Transcriplase Inhibilors NNRTIs)**
1- Skin rashes, pruritus.
2- Fever, nausea.
3- CNS disturbances like headache, confusion, insomnia, bad dreams, amnesia, etc.
128
Examples of **Protease Inhibitors (Pls)**
Lopinavir, Saquinavir, Ritonavir (navir)
129
MOA of **Protease Inhibitors (Pls)**
130
AE of **Protease Inhibitors (Pls)**
131
Drug interactions of **Protease Inhibitors (Pls)**
- Drug interactions are a common problem for PIs, because they potent inhibitors of CYP450 isoenzymes.
- Drugs that rely on metabolism for their termination of action on CYP450 isoenzymes, may accumulate to toxic levels.
**Examples of potentially dangerous interactions with PIs include excessive bleeding with warfarin**
132
Introduction to **Treatment of HIV Infection**
- Retroviruses contain RNA-dependent DNA polymerase (reverse transcriptase) enzyme.
- They cause selective depletion of CD4 cells leading to a profound decrease in cell-mediated immunity.
- Hence, the infected person is prone to severe opportunistic infections and lymphoid malignancies.
133
Objectives of anti-HIV therapy
134
Regimens in anti-HIV therapy
135
How require prophylactic therapy to HIV?
- Doctors, nurses, technicians and other healthcare workers who have had accidental exposure to HIV infection with surgical instruments, blood transfusion or needle-prick injury
136
Principles of anti-HIV therapy
137
The need of HIV PEP depens on ......
The need for postexposure prophylaxis (PEP) depends on
1. The degree of exposure to HIV (viral load)
2. The HIV status of the exposure source.
138
Basic & Expanded regimens in prophylaxis of HIV
139
Activity, Clinical Uses of **Acyclovir**
140
MOA of **Acyclovir**
- Monophosphorylated by viral thymidine kinase (K),
- Then further bioactivated by host-cell kinases to the triphosphate
- Acyclovir triphosphate is both a substrate for and inhibitor of viral polymerase when incorporated into the DNA molecule
141
AE of **Acyclovir**
- Minor with oral use
- More obvious with IV
- Crystalluria (maintain full hydration) and neurotoxicity (agitation, headache, confusion)
- Acyclovir is not hematotoxic
142
MOA of **Ganciclovir**
Similar to that of acyclovir First phosphorylation step is viral-specific; involves :
1. thymidine kinase in HSV
- phosphotransferase (UL97) in cytomegalovirus (CMV)
- Triphosphate form inhibits viral DNA polymerase and causes chain termination
143
Activity, Clinical Uses of **Ganciclovir**
Of Ganciclovir
- HSV, VZV, and CMV
- Mostly used in prophylaxis and treatment of CMV infections, including retinitis, in AIDS and transplant
144
AE of **Ganciclovir**
- Dose-limiting hematotoxicity (leukopenia, thrombocytopenia),
- Mucositis, fever, rash, crystalluria(maintain hydration);
- Seizures in overdose
145
TTT of **Scabies**
- General Treatments
- Topical Scabicides
- Systemic Scabicidies
146
Topical Scabicides in TTT of **Scabies**
147
Systemic TTT of **Scabies**
148
General Measures During TTT of Scabies
- Boiling of cloths, bed linens, towels.
- The mites cannot survive at temperature about 50°C for longer than 5min.
- It cannot survive at room temperature in blanket or clothing for more than 2w
- Treatment of all members of the family except in animal scabies.
- Treatment of infested animals.
149
TTT of Nodular Scabies
1- Intralesional injection of steroid
2- Surgical excision.
150
TTT of **Pediculosis**
151
TTT of **Urticaria**
152
TTT of **Atopic Dermatitis**
153
TTT of **Atopic Dermatitis**
- General Measures
- Regular Emollient therapy
- Topical Anti-inflammatory Therapy
- Systemic therapy
154
General Measures of **Atopic Dermatitis**
- Avoid exposure to irritants, wool, synthetic cloths or other rough fabrics, dust mites.
- Careful drug taking is advised particularly with penicillin, antitetantic serum and other drugs known to induce anaphylactic reaction.
155
Regular Emolient Therapy in **Atopic Dermatitis**
(ointment or water in oil creams): Basic line in treatment of all cases.
156
Systemic Therapy in **Atopic Dermatitis**
157
Topical Anti-Inflammatory therapy in **Atopic Dermatitis**
- Topical corticosteroids ointment: the main line
- Topical calcineurin inhibitors (CIs) : Tacrolimus 0.03% and 0.1% ointment and pimicrolimus 1% cream.
- Zinc oxid cream
158
Side effects of TCS
159
TTT of **Pompholyx**
**Topical:**
- Drying lotion.
- Topical steroid.
**Systemic:**
- Antibiotic.
- short course steroid.
160
TTT of Pityriasis Alba
topical emollient.
161
TTT of Infective Dermatitis
- Topical drying lotion: KMn04,saline.
- Topical Abic-steroid combination
- Systemic Abic.
162
TTT of **Contact Dermatitis**
163
TTT of **Erythema Multiforme**
1- Elimination of cause
2- Symptomatic and supportive
3- prevention (Recurrent cases):
Oral acyclovir (400 mg twice daily for 6 months) to prevent recurrence of herpes associated E.M
164
TTT of **Erythema Nodosum**
1- Treatment of the cause.
2- Bed rest and supportive bandages.
3- Non-steroidal anti-inflammatory drugs (NSAIDs)
4- potassium iodide for 2 weeks in severe cases
165
TTT of drug reactions
- Elimination of the offending drug
- Symptomatic treatment:
1. Antihistamines.
2. Topical steroid.
3. Systemic steroids in severe cases.
166
TTT of **Epidermal Necrolysis**
- Early(immediate) withdrawal of suspected drugs.
- Rapid initiation of supportive care in intensive care burn unit
167
TTT of **Pemphigus vulgaris**
- Refer to dermatologist
- Systemic steroids & immunosuppressive (cytotoxic) drugs.
168
TTT of **Psoriasis**
- Topical
- Phototherapy
- Systemic
169
Topical TTT of **Psoriasis**
- Steroids
- Salicylic Acid
- Tar
- Calcipotriol (vitamin D analogue)
170
when is Tar Contraindicated in **Psoriasis**?
- Application on face, flexures & genitals.
- Erythroderrnic and generalized pustular psoriasis.
- Severe acne & folliculitis.
171
Steroids In TTT of **Psoriasis**
- Antimitotic & anti-inflammatory. (Topical, intralesional)
- They are applied alone or in combination with salicylic acid.
- Intralesional injection of steroid is used in localized small resistant lesion.
- Also, it is used for nail psoriasis by injection in the nail fold. However.
172
Salicylic acid in TTT of **Psoriasis**
- Keratolytic agent which is used to remove the scales. It is usually used in combination with steroid, tar or anthralin.
173
Calcipotriol in TTT of **Psoriasis**
(vitamin D analogue)
- It inhibits proliferation of keratinocytes.
- It is applied twice daily with maximum dose of 100 gm weekly for 6 week
- This drug may increase serum calcium.
174
Tar in TTT of **Psoriasis**
Antimitotic 2-5% tar ointment is applied at night, and then removed in the next day by mineral oil before exposure to UVB. (goekerman technique)
175
Phototherapy in TTT of **Psoriasis**
- UVB (broad band or narrow band) exposure 3 times weekly in mildly erythemogenic dose.
176
Systemic Therapy in TTT of **Psoriasis**
- Methotrexate. (given once weekly, hepatotoxic and myelotoxic)
- PUVA (psoralen+ UVA).
- Retinoids (acitretin), etretinate: teratogenic.
- Cyclosporine: nephrotoxic.
- Biologic therapy as TNFa blockers (as adalimumab, etanercept) and IL-17 antagonists (as sekicinumab)
177
Indications of Systemic Therspy in TTT of **Psoriasis**
should be used only by specialist in:
- Extensive psoriasis vulgaris not responding to topical therapy.
- Erythrodermic psoriasis.
- Pustular psoriasis.
- Arthropathic psoriasis
178
Why are Systemic corticosteroids absolutely contraindicated in psoriasis vulgaris?
Cause flare at withdrawl
179
TTT of **Lichen Planus**
180
TTT of **Discoid lupus erythematosus (DLE)**
181
Systemic TTT of **Discoid lupus erythematosus (DLE)**
- Antimalarial drugs as hydroxychloroquine in cases not responding to topical steroid.
- Prednisone 15 mg/d.
- Etretinate
182
Introduction to TTT of SD
183
2 steps regimen in TTT of SD
184
TTT of **Infantile SD**
185
TTT of **Acne Vulgaris**
186
Topical in TTT of **Acne Vulgaris**
- Comedolytic agents
- Antibacterial agents
187
Comedolytic agents in TTT of **Acne Vulgaris**
188
what is cornerstone in acne ttt?
Topical retinoids
189
# AV = Acne Vulgaris
Topical retinoids in TTT of AV
Retinoic acid (0.05-0.1%) is used in gradually increasing concentration
190
SE of Topical retinoids in TTT of AV
It may cause dryness & irritant dermatitis. (Most common side effect)
191
what are examples of Topical Retinoids?
192
Antibacterial agents in TTT of AV
193
Characters of Benzoyl peroxide (BPO) (2.5, 5, 10)%
- no resistance has mild comedolytic effect.
- It may cause contact dermatitis.(irritant)
194
what are topical antibiotics used in TTT of AV?
erythromycin and clindamycin are effective in pustular lesions. (not alone)
195
Indication for topical TTT of AV
196
Systemic TTT of AV
- Antibiotics
- Antiandrogens
- Isotretinoin
- Dapsone
- Miscellanous therapy
- TTT of scars
197
what is the systemic antibiotic of choice in acne?
- Doxycycline: 100mg/day is the antibiotic of choice in acne.
- This dose is given until acne clears then dec. the dose gradually for 6 months
- Erythromycin and Azithromycin are good alternatives.
- clindamycin
198
MOA of antibiotics in systemic TTT of AV
- Reduce inflammation
- Reduce P: acne population> reducing bacterial production of inflammatory factors as FFA
- Intrinsic anti-inflammatory
- Reduce PMN (poly morphonuclear leukocytes) migration
199
Indication of using of antiandroges on TTT of AV
used only in females with severe nodulocystic acne
200
Examples of antiandroges used in TTT of AV
1- contraceptive as Yasmin
2- Cyproterone acetate (with OCPs diane)
3- Spironolactone (K sparing diuretic but has
antiandrogen effect)
201
Effects of isotretinoin used in systemic TTT of AV
- It decreases sebum secretion
- Decrease P. acne.
- Decrease follicular hyperkeratosis
- has anti-inflammatory effect
202
AE of isotretinoin used in systemic TTT of AV
It is teratogenic drug with serious side effects, so it should be used only in severe acne and by highly experienced dermatologists.
203
Dapsone **Systemic TTT of AV**
Anti-inflammatory drug used in severe acne with special precautions.
204
Miscellaneous therapy
**Systemic TTT of AV**
**Comedonae removal:**
- If comedones are resistant
**intralesional steroids:**
- Triamcinolone acetonide (2-5 mg/ml)
- Used for large inflammatory nodules/cysts
205
TTT of scars
**Systemic TTT of AV**
- Dermabrasion, laser resurfacing, deeper chemical peels
- Filler substances
- Punch excision (ice-pick) scar
206
Treatment according to the severity of acne can be given as follow (overview)
207
TTT of **Miliaria (Sweat rash)**
208
TTT of **Alopecia Areata**
209
TTT of **Vitiligo**
