Drugs for the Skin

Question 1

• Thick, greasy preparations with an oil or petroleum jelly base and little if any water
• Provide the highest medication absorption of all formulations
• Especially useful in the management of conditions with thickened skin (e.g., with lichenification secondary to prolonged scratching) or inflamed skin
• Not a good choice for weeping or oozing skin conditions or in areas prone to heavy perspiration

Answer 1

Ointment

Question 2

• An emulsion of oil and water
• They are not as thick as ointments but thicker than lotions
• Good for inflamed skin and dry, sensitive skin
• Tend to be more appropriate than ointments for intertriginous areas

Answer 2

Creams

Question 3

• Water-based
• They have little if any oil; as a result, they have a lighter feel than creams; nongreasy
• They are easy to spread, which makes them a good choice for large and/or hairy areas; also suitable for intertriginous areas
• They are suitable for oily skin and may even decrease oiliness depending on the ingredients

Answer 3

Lotions

Question 4

• Transparent preparations with a water or alcohol base that usually contain cellulose
• They liquefy on skin contact and often have a cooling effect as they dry
• They are nongreasy and tend to have drying effects, gels are good choices for oily skin

Answer 4

Gels

Question 5

• Aerated solutions
• Spread easily, dry quickly, leave neglible residue
• Good choices for oily skin and large and/or hairy areas

Answer 5

Foams

Question 6

Should be applied in a thin film and gently rubbed into the skin

• Employed to relieve itching and inflammation with a variety of dermatological conditions
• Can vary widely in potency
• Absorption is influenced by the vehicle and can be greatly increased by an occlusive dressing
• With prolonged use, can cause atrophy of the dermis and epidermis, resulting in thinning of the skin, striae, purpura, and telangiectasias

Answer 6

Topical glucocorticoids

Question 7

Keratolytic agent

• Promotes desquamation by dissolving the intracellular cement that binds scales to the stratum corneum
• Keratolytic effects are achieved with concentrations between 3% and 6%
• Low (3% to 6%) concentrations are used to treat dandruff, seborrheic dermatitis, acne, and psoriasis

Answer 7

Salicylic Acid

Question 8

Keratolytic Agent

• Promotes peeling and drying
• Has been used to treat acne, dandruff, psoriasis, and seborrheic dermatitis
• Commonly combined with salicylic acid for additive effects (e.g., Sebex shampoo)

Answer 8

Sulfur

Question 9

• A first-line drug for mild to moderate acne, is both an antibiotic and keratolytic
• Benefits derive primarily from suppressing the growth of P. acnes
• Can reduce inflammation and promote keratolysis
• Adverse effects: drying and peeling of skin

Answer 9

Benzoyl peroxide

Question 10

• Suppresses growth of P. acnes and reduces inflammation
• Often combined with benzoyl peroxide to combat resistance

Answer 10

Clindamycin, erythromycin

Question 11

• Used as oral therapy of leprosy
• In patients with acne, the drug yields a modest decrease in inflammation and number of lesions
• Most common side effects are oiliness, peeling, dryness, and erythema
• Poses a risk for hemolytic anemia in patients with G6PD deficiency

Answer 11

Dapsone

Question 12

Retinoid

• A derivative of vitamin A, is used for acne and to remove fine wrinkles
• Benefits derive from normalizing the hyperproliferation of epithelial cells within hair follicles
• Causes thinning of the stratum corneum and can thereby facilitate penetration of other drugs
• Therapeutic effects can be enhanced by combining tretinoin with benzoyl peroxide, topical antibiotics, and oral antibiotics

Answer 12

Topical tretinoin

Question 13

Retinoid

• Through actions in the cell nucleus, modulates inflammation, epithelial keratinization, and differentiation of follicular cells
• Drug reduces formation of comedones and inflammatory lesions
• May appear to exacerbate acne by affecting previously invisible lesions

Answer 13

Adalapene

Question 14

Retinoid

• Indicated for topical therapy of acne, wrinkles, and psoriasis

Answer 14

Tazarotene

Question 15

Keratolytic

• Topical keratolytic drug for the treatment of mild to moderate acne
• Commonly prescribed for rosacea, a condition with some similarities to acne
• Appears to work by suppressing the growth of P. acnes and decreasing the proliferation of keratinocytes, thereby decreasing the thickness of the stratum corneum
• Adverse effects: pruritus, burning, stinging, tingling, and erythema

Answer 15

Azelaic acid

Question 16

• Used to treat severe nodulocystic acne vulgaris
• Its use is restricted to patients with severe, disfiguring acne that has not responded to more conventional agents, including oral antibiotics
• The drug decreases sebum production, sebaceous gland size, inflammation, and keratinization. In addition, by decreasing the availability of sebum, a nutrient for P. acnes, isotretinoin lowers the skin population of this microbe

Answer 16

Isotretinoin

Question 17

Topical immunosuppressant

• Ointment for moderate to severe atopic dermatitis
• The drug inhibits calcineurin and thereby suppresses the activity of T cells and decreases the release of inflammatory mediators from cutaneous mast cells and basophils
• Most common side effects are erythema, pruritus, and a burning sensation at the application site

Answer 17

Tacrolimus

Question 18

Topical immunosuppressant

• Topical immunosuppressant approved for mild to moderate atopic dermatitis
• The drug is very similar to tacrolimus with regard to mechanism, therapeutic effects, and adverse effects

Answer 18

Pimecrolimus cream

Question 19

Phosphodiesterase 4 Inhibitor

• It inhibits phosphodiesterase type 4 (PDE4), which in turn leads to a reduction in cytokines and skin inflammation
• Patients should apply a thin layer of the ointment twice-daily to the affected areas

Answer 19

Crisaborole ointment

Question 20

Provider-applied drug

• Used primarily for perianal and venereal warts
• Active ingredient in the resin is podophyllotoxin, a compound that inhibits DNA synthesis and mitosis
• Eventually lead to cell death and erosion of warty tissue

Answer 20

Podophyllin

Question 21

Provider-applied drug

• Can destroy warts by chemical coagulation
• Solutions of these acids are very watery and hence can easily spread to and thereby injure surrounding tissue
• To minimize spread, the solution should be allowed to dry before the patient sits or stands
• If pain develops, BCA and TCA can be neutralized with liquid soap or sodium bicarbonate (baking soda)

Answer 21

Bichloroacetic acid and trichloroacetic acid

Question 22

Patient-applied Drug

• stimulates production of interferon alpha, tumor necrosis factor (TNF), and several interleukins and thereby intensifies immune responses to HPV, the virus that causes venereal warts
• Principal adverse effects are erythema, erosion, and flaking at the site of administration
• Both formulations are applied at bedtime and washed off in the morning

Answer 22

Imiquimod cream

Question 23

Patient-applied drug

• Inhibits mitosis
• Supplied as a 0.5% gel or 0.5% solution to be applied twice daily for 3 consecutive days followed by 4 days off
• Pattern is repeated four times or until the warts are gone, whichever comes first
• Does not need to be washed off

Answer 23

Podofilox

Question 24

• Made by extraction from the leaves of Camellia sinensis (green tea)
• Primary active component in this extract is epigallocatechin, a compound in the catechin family
• Although the mechanism of action has not been determined, possibilities include antioxidative effects, induction of apoptosis (programmed cell death), and inhibition of telomerase
• Supplied as a 15% ointment to be applied three times daily until all warts clear, or for 16 weeks, whichever comes first

Answer 24

Kunacatechins ointment