Drugs for the skin Flashcards
4 potency groups of topical glucocorticoids
low, medium, high and super high
Prolonged use can cause atrophy of the dermis and epidermis
topical glucocorticoids
can be absorbed in amounts sufficient to cause sytemic toxicity. Growth retardation and adrenal suppression
Use of topical steroids
Children 1 week Adults 2 weeks
Fluorintaed agents are stronger than non-fluorinated used to relieve itching and inflammation
If drying is needed
Use gels or lotions
If area is already dry
use ointments or creams
Occlusive dressings increase penetration
avoid permeable areas such as the face, groin, or axillae
apply topicals sparingly
Can lead to skin thinning and can casue straie and telangiectasia
First line treatment of Acne
wash face 2-3 times daily with mild soap.
Avoid oil-based facial products
change pillow cases regularly
Acne First line Tx
Topical treatment-benzoyl peroxide, clindamycin, erythromycin suppress growth of propionibacterium acnes
Topical retinoids-tretinoin, adapalene, and tazarotene- help clear mild acne by normalizing hyperproliferating of epithelial cells in hair follicles
These are not absorbed systemically
Acne first line-start low, go slow
Benzoyl peroxide needs to be used for 6 weeks to see if it is effective.
Moderate to severe acne
Initiate oral antx- Tetracyclines- Doxycycline (Vibramycine) and minocycline (minocin, Dynacin, Solodyn) are most common.
Erythromycin
used is tetracycline is ineffective or if pregnancy is a possibility. Tetracycline may cause discoloration of the teeth.
Retin A is used for moderate
Is not systemic
Isotretinoin (Accutane)
severe acne. adverse effects. nosebleeds, inflammation of the lips and eyes, pain, tenderness or stiffness in joints, bones, muscles
highly teratogenic. Providers of such must participate in risk-management program designed to ensure it is not used in pregnancy
Should be used under dermatologist referral
Second line acne tx can include combined oral contraceptives
YAZ, Estrostep, and Ortho-tri-cyclen have FDA approval, all COC formulations with imporve inflammatory and noninflammatory acne
second line oral contraceptives
estrogen and progesterone diminish testosterone and increase SHBG in the liver reducing sebum production. Takes 4-6 months to work
Acne Rosacea
Initially treat with metronidazole. It that fails, other topical or oral antbx can be included. No alcohol with oral Flagyl
Clindamycin safe “B” for pregnancy
Not safe during lactation.
Topical erythromycin
first line in pregnancy and lactation
Resesarch on Benzoyl and salcylic acid is limited
Systemic absorption is low so could be used in lactation.
Retin A (tretinoins)
risk for teratogenesis. Topical may have limited fetal exposure, but cannot exclude. Do not use in lactating mother
Tetracycline
discolors teeth in pregnancy and cause bone deformation and growth restriction
Not always contraindicated in lactating mother. Infant can be exposed if used longer than 3 weeks
Pruritus
local histamine reaction.
