Integumentary Therapeutics

Question 1

Topical Corticosteroids and Potency Class

Answer 1

Low-potency (Group 5 and 6)
- Desonide
- Hydrocortisone

Medium to High potency (Group 3 and 4)
- Fluocinolone
- Triamcinolone
- Betamethasone dipropionate

High to Super-high potency (Group 1 to 3)
- Betamethasone dipropionate
- Clobetasol propionate
- Fluticasone propionate
- Mometasone furoate
- Triamcinolone acetonide

Question 2

Calcineurin Inhibitors

Answer 2

Tacrolimus

Question 3

Topical Pharmacologicals for Acne Vulgaris

Answer 3

1. Adapalene [Differin] Lotion or hydroalcoholic gel (Retinoid) + Benzoyl Peroxide (Fixed-dose Combination Epiduo Topical Gel)
2. Benzoyl Peroxide (2.5%, 5%, 10%) Gel
3. Azelaic Acid 20% Cream or 15% Gel [Skinoren] — Pregnant women and younger children, skin sensitivity
4. Salicylic Acid 0.5%-2% [Comedone Lotion] (Exfoliant)
5. Clindamycin (Clindoxyl Once Daily Gel Topical Antibiotics) - Best used with BPO

Question 4

Oral Pharmacologicals for Acne Vulgaris

Answer 4

1. Tetracycline, Doxycycline (Oral Antibiotics) - Contraindicated in pregnancy or younger children age 9; gastric side effects
2. Combined Oral Contraceptives (Estelle-35
   Cyproterone acetate with Ethinyl estradiol)
3. Isotretinoin [Accutane]

Question 5

Topical Treatment of Mycotic Infections (Ringworm)

Answer 5

Tolnaftate [Tolnaderm Cream] (twice daily) - Tinea Pedis, Tinea Cruris, Tinea corporis

Topical Azole Cream:
1. Econazole (daily), Miconazole (twice daily), Ketoconazole (daily) - Tinea corporis

2. Clotrimazole (twice daily) - Tinea cruris
3. Sertaconazole (twice daily) - Tinea pedis

Allylamines Antifungal Cream (prevent recurrence) - Age > 12 y.o.
- Naftifine Cream (daily) - Tinea pedis, Tinea Cruris, Tinea corporis

Question 6

Oral Treatment of Mycotic Infections (Ringworm)

Answer 6

Oral Azole Tablets (when unresponsive to topical treatment)
1. Fluconazole 150mg/day for 1-4 weeks (Triazole) - Tinea pedis
2. Itraconazole 200-400mg/day for 1 week (Triazole) - Tinea cruris
3. Ketoconazole 200mg/day for 4 weeks (Imidazole) - Tinea manuum

Oral Allylamine: Terbinafine 250mg/day for 2 weeks - Tinea corporis

Question 7

Topical Treatment of Psoriasis

Answer 7

Calcipotriol 0.05% Cream [Dovonex] (Vitamin D3 Analogues) + Betamethasone valerate (optional)

Tazarotene 0.1% Cream (Retinoid) + Betamethasone (optional) O.N.

Topical Corticosteroids (Clobetasol Propionate 0.05% Cream - Most Potent)

Coal Tar

Salicylic Acid 2-3%, Betamethasone 0.05% Lotion [Diprosalic]

Question 8

Phototherapy for Psoriasis

Answer 8

UVB Broadband therapy
PUVA (Psoralen) therapy

Question 9

Systemic IV Treatment of Psoriasis

Answer 9

1. Acitretin
2. Cyclosporin
3. Methotrexate — Psoriatic Arthritis
4. Infliximab (Biologics, TNF-α inhibitors)
5. Adalimumab (Biologics, TNF-α inhibitors)