pharmacology: dermatology

the pharm lecture on some of the conventional drugs used to treat dermatologic conditions. there are a number of topical antimicrobials used to treat superficial skin infections; the most common might be neosporin, which is most effective against superficial bacterial infections, although has the potential to be ototoxic. muciprocin is used for impetigo as well as part of the treatment against MRSA-- in this treatment it is prophylactically applied to the nares to eradicate potential nasal infection from MRSA. ketoconazol is an antifungal that works by inhibiting sterol synthesis. glucocorticoids can be applied topically in cases of inflammation such as dermatitis, psoriasis, eczema, urticaria. application to the face should be avoided if possible, in particular because abruptly stopping could cause rosacea and perioral dermatitis.

treatment of acne involves drugs that reduce the hyperkeratinization and sebum production, as well as combat the propionobacterium that is associated with acne inflammation. vitamin A derivatives such as isoretinoin are particularly effective, although potentially teratogenic. finally, PUVA is a treatment used for psoriasis and stands for psoralen plus UV-A light-- psoralen is a compound that reacts with ultraviolet light. phototherapy is one step in the progression of the treatment of psoriasis, which also involves corticosteroids, vitamin D3, and TNF inhibitors.

questions
neosporin...
1. effective against MRSA or cellulitis?
2. what is neosporin?
3. indications for neosporin?
4. mechanism of action?
5. neosporin is also sometimes used with...
6. avoid use of...

muciprocin / bactroban...
7. used for...
8. effective against which microorganisms?
9. mechanism?
10. special instructions when treating MRSA?

ketoconazol / nizarol...
11. class?
12. indication?
13. mechanism of action?
14. side effect?

topical glucocorticoids...
15. should be avoided on what type of skin and why?
16. indications?
17. local side effects?
18. when applied to the face, has potential for which side effects?
19. indications for intralesional injection?

retinoids and acne...
20. structure?
21. effect on skin?
22. indications?
23. drug treatment strategy for acne?

tretinoin / retin A...
24. indication?
25. mechanism of action?
26. side effects?

isoretinoin / accutane...
27. indications?
28. mechanism of action?
29. recurrence of acne when drug is stopped?
30. contraindicated in...
31. measures taken to prevent negative effects from [30]?
32. potential GI side effect?

psoriasis...
33. immune system involvement in production of psoriatic skin lesions?
34. treatment of psoriasis involves stepwise progression of...
35. describe the phototherapy protocol.
36. what is PUVA?
37. other indications for PUVA?
38. side effects?

answers
1. no.
2. polymyxin B plus neomycin.
3. superficial bacterial skin infections. eyes and ear infection.
4. polymyxin disrupts bacterial cell membrane, bacitracin interferes with PDG's of cell wall.
5. corticosteroids.
6. otic solution, because of potential ototoxicity of neomycin.

7. impetigo, other bacterial skin infections.
8. bacteria, not viruses or fungi.
9. inhibits bacterial protein synthesis.
10. apply to the nasal nares as well as the infection site to eradicate potential nasal infection.

11. anti-fungal.
12. superficial fungal infection.
13. inhibits sterol synthesis.
14. skin irritation.

15. abraded unless with antimicrobials because of greater systemic absorption.
16. dermatitis, eczema, psoriasis,
17. skin atrophy
striae
telangiectasias
purpura
acneiform lesions
perioral dermatitis
18. rosacea and perioral dermatitis when stopped abruptly.
19. cystic acne
psoriasis
discoid lupus

20. vitamin A derivatives.
21. cellular proliferation and differentiation
immune function
inflammation
sebum production
22. SCC
actinic keratosis
cystic acne
23. salicylic acid, benzoyl peroxide, antibiotics, retinoids.

24. acne or photo damaged skin.
25. reduction of hyperkeratinization, thickening of epidermis, dermal collagen synthesis.
26. erythema
peeling
burning / stinging
photosensitivity

27. acne / acne rosacea, hidradenitis suppurativa
28. reduction of hyperkeratization, reduction of sebum production, reduction of propionobacterium acne.
29. 40% of patients within 6 months.
30. pregnancy.
31. two forms of birth control required for females of child bearing age on this medication.
32. ulcerative colitis.

33. immune cells move from the dermis to the epidermis, where they stimulate keratinization.
34. corticosteroids
vitamin D3
phototherapy
systemic therapy
TNF inhibitors
35. use ultraviolet A or B light source along with a psoralen drug such as methoxsalen
36. psoralen plus ultraviolet A.
37. vitiligo
T cell lymphomas
alopecia areata
urticaria pigmentosa
38. nausea, erythema, blistering
skin cancer, actinic keratosis.