increased sebum production

propionibacterium acnes

hormonal, cosmetics, sweating, animal fats

non inflammatory- closed and open comedones

inflammatory-papules, pustules, cysts, nodules

Antibacterial and comedolytic

Rx and OTC

2.5-10% gels, creams, lotions cleanser...

Cleansing agents

ph closer to skin at 5.5

minimizes irritation

(cetaphil)

Topical antibiotic

1% solution gel, lotion

topical antibiotic

1.5-2% gel, powder, solution

topical antibiotic

2.2% solution

Benzamycin

&

Benzaclin

Combinations

Erythromycin +benzoyl peroxide

Clindamycin + benzoyl peroxide

corrects abnormalities of the follicular keratinocyte

Retin- A antiwrinkle

Rein- A micro

Avita

phototoxic 

avoid high dose vit A

(differin)

Retinoid like compound

Better tolerated and more efficacious than tretinoin gel

Pregnancy cat C

Apply 2-3 times a day

Adverse- irritaion, acne flares initially

Tetracycline- 1g daily for 2-3 weeks/daily for severe

Minocycline- long term 100mg bid vestibular toxicity 

Doxycycline- 50-100mg bid

Androgen levels-sebum production

inhibits p. acnes growth

inhibits inflammation

alters keratinization

for severe acne that's unresponsive

16 weeks 70% success- 20 month remission

Dose .5-1 mg/kg/day 

Adverse effects

skin-drying peeling, pruritis, photosensitivity

mucous membranes- chelitis, dry nose, mouth, eyes, blepharoconjuctivits

Hepatoxicity, athralgias, hyperlipidemia, decrease night vision

Emollients- hydrate statum corneum, minimize itching

Keratolytics- remove scales, salicylic acid prep

N/V, tinnitus, hyperventilation

Corticosteriods- reduce inflammation, anti-itch, inhibit cell prolif

burning, local irritation, acne, thin skin, hypopigmentation, bruising

hydrocortisone (hytone, penecort, synacort) Flucinolone (synalar)

Hydrocortisone valerate (wesetcort)

Hydrocortisone (locoid)

Desonide (tridesilon)

Fluticasone propionate (Cutivate)

Clocortolone pivalate (Cloderm)

Betamethasone (Diprolene)

Mometasone fuorate (Elocon)

Halobetasol proprionate (Ultravate)

Diflorasone diacetate (Maxiflor, florone, psorcon)

Clobetasol (Temovate)

scalp- potent steroids (fluocinolone)

Face- low potency

Extensor surfaces- High potency

Inhibits enzymes assoc with cell prolif of psoriasis

Messy strong odor, irritant

shampoos, creams, lotions, gels

can cause phototoxicity

Vitamin D3 analog

Regulates cell prolif & suppresses lymphocytic activity

BID for 8-10 dys

Expensive- safe and effective long and short term

Topical retinoid

Vitamin A derivatives

mild-mod psoriasis

1 week improvement 70%

expensive

Pregnancy risk X

Topical

Tacrolimus .1% and Pimecrolimus 1%

Facial and axillary psoriasis

primary use in eczema

link b/w lymphoma nad skin cancer- second line agent

Methotrexate- Rheumatrex

systemic psoriasis tx

Antimetabolite- folic acid analog and blocks purine and thymidine synthesis

effects cell prolif

Adverse- N/V, hepatotoxicity, bone marrow

Acitretin (Soriatane) metabolite

more severe disease

anti inflammatory

Adverse- alcohol controls to etretinate

category X

Psoralen + UV radiation

"PUVA"

severe unresonsive psoriasis

DNA becomes irradiated -> covalent bonding of psoralens to DNA pyrimidines

Ustekinumab (Stelara)- targest interleukins

Alafacept (amevive)- inhibit t cell

Etanercept (Enbrel) 

Infliximab (Remicade)

Adalimumab (Humira)

Ustekinumab (stelara)

Biological for Psoriasis

human monoclonal antibody targes IL-2 and IL-23

Slows hyperkeritinazation

12 weeks of treatment- improvement 75%

Alefacept (Amevive)

Biological tx for psoriasis

28-33% pts had 75% improvement

relapse 211 days

Infusion related reactions

constitutional symptoms

serious infections

lymphomas

myelosuppression

Wet dressings- drying acute inflamed lesions, cooling, decrease vasoconstriction, erythema

Baths- oatmeal, alpha-keri bath oils

Lotions- powder in water provides lubrication to dry inflamed skin- calamine lotion

Aerosols- anesthetics, antifungals

Powders- promote drying, especially in skinfold creases and or heavy sweat areas

Creams- designed to vanish

ointments- water soluble, best for thick dry fissured lesions