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Pharmacology-IMED4111 > Skin pharmacology 2 - Drugs for eczema, psoriasis and acne > Flashcards

Skin pharmacology 2 - Drugs for eczema, psoriasis and acne Flashcards

1
Q

What is the meaning of eczema/dermatitis?

A

Eczema and dermatitis are synonymous terms for a wide range of conditions characterised by SKIN INFLAMMATION

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2
Q

Name some of the characteristics of dermatitis?

A
  • erythematous (red)
  • papules
  • vesicles
  • mild scaling
  • lichenification (skin thickening) results in chronic conditions
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3
Q

A patient comes in with ITCHY skin. This is a common symptom of _________ .

A

Dermatitis

itch is the most common symptom

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4
Q

What is the most common type of dermatitis?

Outline the cause and common age of onset.

A

ATOPIC dermatitis

Cause:

  • Combination of genetic and environment factors.
  • Predisposed by a mutation in the gene for filaggrin (protein involved in keratinisation and therefore epidermal function)

Age of onset:
- usually infants/childhood (younger than 5yo)

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5
Q

Describe the management of dermatitis.

A

Divided into basic and directed drug therapy

Basic:

  1. Avoid irritants (eg abrasive clothing, abrasive surfaces, overheating and skin dryness)
  2. Moisturisers (2 types):
    a) Emollients (most common is 10% glycerine in sorbelene) - best applied after bathing
    b) Humectants

Directed:

  1. Topical corticosteroids (mainstay of therapy for dermatitis)
  2. Adjuvant treatment
    a) Tars
    b) Phototherapy (UVB, PUVA)
    c) Immunosuppressives (eg. steroids, cyclosporin)
  3. Secondary treatment for infection (eg. anti-staph drugs)
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6
Q

Briefly describe how emollients work. Give some examples of emollients.

A

They fill in the spaces between dry skin flakes with oil droplets and smooth rough surfaces of the stratum corneum. Some also reduce transepidermal water loss (occlusive effect).

eg. petrolatum, silicones, liquid paraffin, lanolin, other oils.
* uses OIL (vs water in humectants)

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7
Q

Briefly describe how humectants work. Give some examples of humectants.

A

They attract water to the stratum corneum where it is retained.

eg. glycerine, propylene glycol, polyethylene glycol, urea.
* uses WATER (vs oil in emollients)

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8
Q

Briefly describe how topical steroids work and how they are applied.

A

It acts via its anti-inflammatory, immunosuppressive and antimitotic activity against fibroblast and epidermal cells.

Applied usually once or twice daily using (preferably) an ointment base.
Can also use wet dressing or Gladwrap for better action. (Wet dressing is used for acute or weepy dermatitis, Gladwrap is used for areas of thick skin - palms, soles)

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9
Q

Describe the classes of topical steroids.

A

Classed according to potency (graded I to V)

Weakest:
Hydrocortisone (best treatment for facial dermatitis, also for flexural areas - armpits, groin folds, butt crack / gluteal cleft)

Moderate:
Betamethasone valerate 0.02%
Triamcinolone acetonide 0.02%
Desonide 0.05%
(best for mild/moderate dermatitis)
Strongest:
Betamethasone dipropionate 0.05%
Betamethosone valerate 0.1%
Triamcinolone acetonide 0.1%
Mometasone furoate 0.1%
Methylprednisolone aceponate 0.1%
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10
Q

Side effects of topical corticosteroids?

A
  • folliculitis
  • steroid induced rosacea
  • perioral dermatitis (looks like acne)
  • skin atrophy
  • delayed wound healing
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11
Q

Briefly describe how tars work and give some examples.

A

Exact mechanism is unknown but they suppress DNA synthesis, reduce epidermal thickness and have mild antipruritic (anti-itch), anti-inflammatory and antiseptic properties. They also have some adverse side effects.

eg. coal tar, ichthammol and wood tar

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12
Q

What is the action of steroid sparing agents and what are they used for? Give 2 examples.

A

These inhibit T cell activation. They are used to reduce the quantity of topical steroid use, although they are less effective.

eg. Tacrolimus and pimecrolimus

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13
Q

What are the topical and systemic treatments available for psoriasis?

A

Topical:

  • emollients
  • keratolytic agents
  • tars
  • dithranol
  • corticosteroids (most common topical treatment)
  • calcipotriol
  • retinoids

Systemic:

  • phototherapy
  • systemic drug therapy
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14
Q

Briefly describe how keratolytic agents work and give 1 example.

A

Acts by removing accumulated scale and improving penetration of other topical agents.

eg. salicylic acid (2-10% concentration)

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15
Q

Briefly describe how dithranol works.

A

Inhibits mitosis and has an anti-inflammatory effect.

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16
Q

You are taking a medical history from a patient and they mention that they suffer from psoriasis. They are using a product called “Daivobet”. What is it?

A

Daivobet is the brand name for a product containing:

Calcipotriol (a vitamin D analogue) + corticosteroids (betamethasone diprprionate).

It is available as an ointment or gel.

17
Q

Briefly explain the types and mechanism of phototherapy.

A

There are two types of UV light used in phototherapy - UVA and UVB.

UVA light is used with a drug called methoxsalen and this treatment is called PUVA phototherapy. PUVA works by intercalation of methoxsalen to DNA resulting in inter-strand cross links and inhibition of DNA synthesis. It can be used topically or systemically.

UVB light can be broad band or narrow band. Narrow band is used for psoriasis and is equally as efficacious as PUVA.

18
Q

What drug would you give to a patient to reverse epidermal proliferation and keratinisation seen in psoriasis?

A

Acitretin (a retinoid)

19
Q

A patient has widespread psoriasis. What are 3 systemic drug treatments you can recommend?

A

methotrexate, acitretin and cyclosporin

20
Q

Briefly describe how methotrexate works and what condition it is used to treat.

A
  • inhibits cell proliferation in rapidly dividing tissues and also has an immunosuppressive effect
  • used for widespread psoraisis
21
Q

Briefly describe how cyclosporin works and explain why this is suited to severe psoriasis.

A
  • achieves its immunosuppressive effect by decreasing production of IL-2 and inhibiting T helper cell activity.
  • suited to severe psoriasis because the condition is T-cell mediated
22
Q

Systemic treatments for psoriasis have adverse side effects. How do we overcome these?

A
  1. Rotation of therapies
  2. Combine therapies
  3. If side effects persist and the patient meets PBS criteria, switch to Biologics
23
Q

How do biologics work?

A

Inhibit T cells and pro-inflammatory cytokines

24
Q

What are the 4 main causes of acne?

A
  1. increased sebum production
  2. abnormal follicular keratinisation
  3. proliferation of propionebacterium acnes
  4. inflammation
25
Q

Describe the range of acne characteristics from mild - severe.

A

Mild: comedones, papules, pustules
Mod: comedones, widespread papules and pustules
Severe: cystic/nodular lesions

26
Q

What are some general measures in the treatment of acne? (Not including topicals)

A
  • gentle skin care
  • no picking/squeezing
  • balanced diet
  • possibly hormone evaluation (if females have signs of androgenisation)
27
Q

List the 4 topical agents used in acne treatment.

A
  1. retinoids
  2. benzoyl peroxide (comedolyic and antibacterial)
  3. azelaic acid (comedolyic and antibacterial)
  4. antibacterials (erythromycn, clindamycin)
28
Q

Give 2 examples of combined acne drugs.

A
  1. Duac gel (benzoyl peroxide + clindamycin)

2. Epiduo (benzoyl peroxide + retinoid)

29
Q

List the systemic treatments for acne.

A
  1. oral antibiotics eg. tetraycline, doxycycline, trimethoprim-sulphamethoxazole, erythromycin
  2. oral antiandrogens eg. oral contraceptives, oestrogens
  3. oral isotretinoin (Roaccutane)
30
Q

Briefly describe how isotretinoin works.

A

Inhibits sebaceous gland activity and is comedolytic and anti-inflammatory

Pharmacology-IMED4111 (13 decks)

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