Dermatopathology

Question 1

Class;Mechanism;Therapeutics;SideEffects

Hydrocortisone

Answer 1

Steroid — Dermatitis, psoriasis Atrophy/thinning of skin (collagen), stretch marks, talangiectasias, acne, cataract or glaucoma if applied near eye Systemically, affects hypothalamic-pituitary-adrenal axis –> growth retardation Seven classes, w/class I being the strongest and class VII being the weakest; side effects may be permanent

Question 2

Class;Mechanism;Therapeutics;SideEffects

Cyclosporine

Answer 2

Immunosuppressant — Inflammatory conditions (psoriasis) Raise blood pressure, damage kidneys if used long-term — —

Question 3

Class;Mechanism;Therapeutics;SideEffects

Methotrexate

Answer 3

Folate analog Inhibits DHFR Inflammatory conditions (psoriasis), conditions needing immunosuppression Hepatotoxicity (develops slowly, can give up to 4.5 g over life); pulmonary toxicity (develops quickly); leukopenia; rarely, renal toxicity Nausea, vomiting PO, IM (1/week); any drug increasing unbound protein may cause methotrexate toxicity (sulfa, salicylates, TCN, phenytoin)

Question 4

Class;Mechanism;Therapeutics;SideEffects

Biologics

Answer 4

— Block TNF-a Inflammatory conditions, arthritis Few (may unmask neurologic disease, latent infections (must do PPDs), malignancies) — Costly

Question 5

Class;Mechanism;Therapeutics;SideEffects

UV light therapy

Answer 5

UVA, UVB, UVC Immunosuppression of T-cells via type I or type II reactions –> mono- or bifunctional adducts in DNA Inflammatory conditions: atopic dermatitis, CTCL, lichen planus, psoriasis (not useful for non-inflammatory conditions) Skin cancer, thinning/leathering of skin — Usually used with psoralens (photosensitizing agents that increase efficacy); phenothiazines, thiazides, sulfonamides, NSAIDs, tetracycline, benzodiazapenes also sensitize skin to light therapy

Question 6

Class;Mechanism;Therapeutics;SideEffects

Isotretinoin (Accutane)

Answer 6

Retinoid Stimulate epithelial cell turnover; also anti-inflammatory Acne Teratogenic effects (washes out in three weeks) — Good as adjunct to other therapies

Question 7

Class;Mechanism;Therapeutics;SideEffects

Acitretin (Soriatane)

Answer 7

Retinoid Stimulate epithelial cell turnover; also anti-inflammatory Psoriasis Teratogenic effects (stays in fat stores for three years) — Good as adjunct to other therapies