Dermatology pharm

Question 1

Topical steroid side effects

Answer 1

Skin atrophy
Telangiectasias
Purpura
Acne
Glaucoma
Skin infections
HPA axis suppression

Question 2

Tacrolimus

Answer 2

Calcineurin inhibitor

MOA:
- Blocks translocation of DNA transcription factor that upregulates IL-2 (inflammatory factor)

Use:

• Stop topical steroid.
• Switch to calcineurin inhibitor to maintain remission.
• Can stop when completely clear.
• Restart topical steroid when reflare occurs.
• Repeat above steps.

Goal: maximize steroid-free intervals.

Question 3

Pimecrolimus

Answer 3

Calcineurin inhibitor

MOA:
- Blocks translocation of DNA transcription factor that upregulates IL-2 (inflammatory factor)

Use:

• Stop topical steroid.
• Switch to calcineurin inhibitor to maintain remission.
• Can stop when completely clear.
• Restart topical steroid when reflare occurs.
• Repeat above steps.

Goal: maximize steroid-free intervals.

Question 4

Retinoids

Answer 4

Tretinoin (topical medicine with limited systemic absorption)

Acitretin (Used for psoraisis, NOT in child-bearing women)

Isotretinoin (persistant, refractory acne vulgaris, scarring acne)

MOA: small molecule hormones which activate nuclear receptors and regulate gene transcription

Affect inflammation, cellular differentiation, apoptosis, and sebaceous gland activity.

Side effects:

• Cheilitis, dry skin, muscle enzyme abnormalities, elevated LFTS, triglycerides- need monthly labs
• Pseudotumor cerebri

Category X teratogen: need monthly pregnancy tests, 2 forms of birth control