Therapies, Dermatology

Soriatane

• Dose: 25-50mg po OD, max 75mg/d
• Indications:severe psoriasis, hyperkeratinization (Darier's diease)
• Contraindication: Women childbearing potential
• Monitor: LFT, lipids q1-2wks til stable
• Interacts: systemic retinoids, MTX, tetracyclines, OCP
• S/E:

• Valtrex
• 1g po BID x 7-10days if first epidode genital herpes
• 500mg po BID x 5d for recurrent

• indications: chickenpox, herpes zoster, genital herpes, herpes labials
• Side effects: headache, N/D, abd pain

• Cyclosporin
• 2.5-4mg/kg/d po divided BID
• After 1 month may incr by 0.5mg/kg/day q2wks

Dose of Mg may protect kidney

Indications: psoriasis, lichen planus, DH, EM, urticaria, Atopic derm resistant

• Monitor: BP, Renal fn
• Contraindications: AbN RF, HTN uncontrolled, malignancy, infx, immunodeficiency

Ok to use for 2 yrs

Best to use for short term only

Avoid grapefruit juice

• Dapsone
• 500-100-150mg po OD tapering to 25-50mg po OD

Indications: Pemphigus vulgaris, Derm Herpetiformis

• Monitor: G6PD, thiopurine methyl transferase b/f start, q2ks = methemoglobin, CBC
• S/E: neuropathy, hemolysis

Isotretinoin 0.5-1mg/kg/day given OD to a total dose of 120mg/kg (ie 20wks)

• Indications: severe nodular / inflam acne
• Contra: teratogenic in f, need contraception x2
• S/E: night blindness, decr contact lenses tolerance, dry eyes/lips/nose, epistaxis, at start worsens acne, depression, incr TG, incr LFT

Drug interactions: tetracycline/minocycline, Vit A supplements

Itraconazole 100-400mg po OD depending on infx

• Toenails - 200mg po BID x7d per month, repeat 3
• Fingernails - 200mg BID po x7d per month, repeat 2

Indications: Tinea capitis, onychomycosis

• S/E: hepatotoxic
• Contraind: CHF

• Methotrexate
• 10-25mg qwks po, IM, or IV
• max = 30mg/qwk

Add Folic acid 1mg po OD on days not taking MTX

• Indications: psoriasis, Atopic derm, CTCL, Sezary
• Monitor: renal fn, liver fn, CBC
• Contra: preg, lactation, alcohol abuse. liver dysfn

• Minocycline
• 50-100mg po BID

Indications: Acne vulgaris, Rosacea

• Contra: decr renal or liver fn
• Drug interaction: don't use tih Accutane

S/E: extensive, CNS, teeth, bones, renal, photosensitive, blue pigment

• Terbinafine
• 250mg po OD x2wks
• fingernails - 6wks
• Toenails - 12wks

• 250-500mg po OD
• Take 1hr b/f meal or 2 hrs a/f meal

Indication: Acne, Rosacea, Bullous pemphigoid

• Indications
• -mod-severe psoriasis, failed systemic tx, contraindication or s/e from other po meds, concurrent P.arthritis, significant impact on QofL

• S/E
• -Administration rxn = hives, erythema, H/A, BP
• -Opportunistic infx = TB
• -Infx = cellulitis, HZV, fungal
• -Malignancy = lymphoma, leukemia, mal melanoma, solid organ tumors
• -Demylination = PML, MS, GBS, Sz
• -Hematologic AbN = pancytopenia
• -Hepatotoxicity
• -CHF

• Use:
• -Definite = psoriasis, PsA, RA, IBD

• Monitor:
• -Baseline: PPD, CBC, lytes, HBV, HCV, HIV
• -q3months = ROS, MS, CBC, lytes, infx s/s
• -q6months = CBC, lyes
• -qyr = PPD

• -cept = receptor drug, blocks binding of R to cell
• eg. Etanercept (enbrel)

• -ximab = chimeric monoclonal Ab
• eg Infiximab (Remicade)

• -mumab = monoclonal Ab
• eg new = Belimumab

Metabolism = renal

MofA = Needs to bind to specific R on target cell surface. Antivrial effects, Antiproliferation (affects all phases of cell cycle), Immunologic effect (incr NK cells)

• Uses = Genital warts (HPV 6,11)
• AIDS with Kaposi's sarcoma
• Chronic granulomatous disease
• Malignant melanoma* - esp stage 1,2

• Side effects
• -fatigue, neutropenia, fever, mylagia, anorexia, N/V, incr LFTs, Headaches

• Monitor
• -B/f, 2wks after, qmonthly - CBC, lytes, Cr, BUN, CK, LFT, TSH

• -visible light 400-770nm
• -UVA: 320 - 400nm (penetrates epi + dermis)
• UVA1 340-400nm
• UVA2 320-340nm
• -UVB: 290-320nm (penetrates epidermis)

MofA: immunosuppresion of CD4 T cells (direct DNA damage)

• Forms
• -systemic, topical, bath
• -use: Psoriasis, A derm, vitiligo, A Areta, CTCL, LS, GA, pruritis, mastocytosis
• -contraind: <10yo, preg, hx melanoma, XP, SLE

-indications: psoriasis, vitiligo, A derm, MF, PMLE, uremia prutisi, PPD, LP, PR, LS