Transcript - Abdel Hamid Derm Atlas

Retinoids used in dermatology
Tretinoin
First generation
Topically in acvne & anti-aging
products
Isotretinoin
First generation
Systemically for acne & hidroadenitis
suppurativa
Alitretinoin
First generation
Systemically for hand eczem
Etretinate
Second generation
Systemically for psoriasis, now rarely
used
Acitretin
Second generation
Systemically for psoriasis, a
metabolite for etretinate
Tarazotene
Third generation
Topically for psoriasis & acne
Bexarotene
Third generation
Systemically for cutaneous
lymphoma
Adapalene
Third generation
Topically for acne
Biological agents used in psoriasis
Etanercept
(Enbrel)
Fully human , Anti-TNF
monoclonal antibody
25 mg or 5O mg twice
weekly or 5O mg once
weekly
Infliximab
(Remicade)
Chimeric (25% mouse, 75%
human), anti-TNF monoclonal
antibody.
5 mg/kg at baseline,2
weeks, 5 weeks then 8 12 weekly.
Adalimumab
(Humira)
Fully human, anti-TNF
monoclonal antibody
Ist dose 8O mg then 4O
mg every 2 weeks
Alefacept
(Amevive)
Fully human, inhibitor of CD2&
LFA-3
15 mg weekly
Efalizumab
(Raptiva)
Fully human, inhibitor of CDIIa
1 mg/kg weekly.
Ustekinumab
(Stelara)
Fully human, inhibitor of IL-12 ^
IL-23
45 mg at baseline, week
4 & week 12 then 12
weekly.
Side effects of biological therapies
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@ Injection site reactions occur with all biologic agents are most commonly
seen with etanercept. They are rarely serious.
@ All biological agents carry a small increased risk of malignancy,
especially lymphoma
@ There is an increased risk of infection & serious infections with all
biological agents, reactivation of latent tuberculosis is well recognized.
@ Anti-TNF biological agents are associated with a new onset
demyelinating disorders & exacerbation of pre-existing multiple sclerosis.
@ Some patients develop ANA antibodies while on biological therapies, only
rarely does this lead to a drug induced lupus which tends to resolve on
stopping the medication.
@ Patients may develop antibodies to the biological agents but this is only
clinically relevant for infliximab where antibodies are associated with an
increased risk of an infusion reactions & reduced efficacy
Side effects of biological therapies
(continue)
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2O% of patients on infliximab develop non serious infusion reactions such
as headache, flushing & nauseas; 1%develop serious reactions such as
anaphylaxis, hypotension & chest pain
@ Adalimumab can be associated with leucopenia & thrombocytopenia,
aleacept with lymphopenia & efalzumab with thrombocytopenia.
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Absolute contraindications include sensitivity to the drug, pregnancy &
active or chronic infection
Relative contraindications include a family or personal history of
demyelinating diseases, history of malignancy & concomitant
immunosuppressive treatment.. Congestive cardiac failure is a
contraindication for infliximab & etanercept.. Thrombocytopenia is a
contraindication for treatment with efalizumab & lymphopenia is a
contraindication for using alefacept
Commercially available topical steroid preperations
Hydrocortisone O.5% to 1%
Mild
Fluocinolone acetonide O.OO25%
Synalar 1:1O
Mild
Clobetasone butyrate O.O5%
Eumovate, Trimovate Moderate
Betasmethasone valerate O.O25%
Betnovate
Moderate
Flucocinolone acetonide O.OO625%
Synalar I:4
Moderate
Betnovate valerate O.I%
Betnovate
Potent
Hydrocortisone butyrate O.I%
Locoid
Potent
Diflucortolone valerate O.I%
Nerisone
Potent
Commercially available topical steroid preperations
Mometasone furoate
O.1%
Elecone
Moderate
Triamcinolone
acetonide O.1%
Kenacort , cinolone
Potent
Clobetasol propionate
O.O5%
Dermovate
Super potent
Clobetasol propionate
O.O5%
Clovocort
Super potent
Betamethasone
dipropionate O.O5%
Diprosone ,Kerella
Moderate
Diflucortolone valerate
O.3%
Nerisone forte
Super potent
If you are obliged to change from oral corticosteroid (e.g. due to
vomiting) to systemic corticosteroid; the equivalent doses of commonly
used systemic steroids are:
PREDNISOLONE
1O mg
Hydrocortisone
4O mg
Triamcinolone
8 mg
Dexamethasone
1.5 mg
• If a patient is taking
8Omg/ day of
predinosolone orally , this
is equal to 12 mg
dexamethasone
systemically