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PH 38 (CLINPHARM 2)


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Pharmacologic Therapy For severe acne
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1.Antiandrogens 2.Isotretinoin 3.Topical and oral antibiotics

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Pharmacologic Therapy For severe acne
1.Antiandrogens 2.Isotretinoin 3.Topical and oral antibiotics
Pharmacologic Therapy For severe acne
1.Antiandrogens 2.Isotretinoin 3.Topical and oral antibiotics
Pharmacologic Therapy For severe acne
1.Antiandrogens 2.Isotretinoin 3.Topical and oral antibiotics
ACNE VULGARIS FOUR MAJOR ETIOLOGICAL FACTORS
1 Increased sebum production 2 Hormonal influences 3 Bacterial colonization of the duct with Propionibacterium acnes 4 Production of inflammation in acne sites
Increased glucocorticoid secretion =>
Potentiation of the effects of androgens
Foods that are perceived to exacerbate acne
1 Chocolate 2 Cola drinks 3 Milk 4 Milk products
THE PATHOGENESIS OF ACNE 4 stages
1.Increased follicular keratinization 2.Increased sebum production 3.Bacterial lipolysis of sebum triglycerides to free fatty acids 4.Inflammation
Acne Vulgaris Pathophysiology (step by step)
1 Acne results from obstructed sebaceous follicle (microcomedone) 2 Cells adhere to each other; forms dense keratinous plug 3 Sebum becomes trapped behind keratin plug 4 sebum solidifies; forms OPEN or CLOSED comedone 5 Pooling of sebum increases Anaerobic Bacterium Propionibacterium acnes; generate T cell response; results to inflammation
TYPES OF ACNE
1 Blackheads 2 Whiteheads 3 Papules 4 Pustules 5 Nodules 6 Cysts
ACNE VULGARIS Nonpharmacologic Therapy
1.Cleansing 2.Proper shaving 3.Comedone extraction 4.Ultraviolet light 5.Prevention of Cosmetic Acne
Pharmacologic Therapy For mild to moderate acne
1.Topical retinoids 2.Salicylic acid 3.Benzoyl peroxide 4.Sulfur 5.Resorcinol
Pharmacologic Therapy For moderate to severe acne
1.Benzoyl peroxide 2 Topical antibiotics (Clindamycin/Clindamycin + Benzoyl peroxide) 3 Oral antibiotics (erythromycin, tetracycline, or minocycline) 4 Retinoids (tretinoin, adapalene, and tazarotene, and azeleic acid).
Pharmacologic Therapy For severe acne
1.Antiandrogens 2.Isotretinoin 3.Topical and oral antibiotics
Pharmacologic Therapy Anti-sebum agents
1 Oral Contraceptives (norgestimate + ethinyl estradiol or norethindrone acetate + ethinyl estradiol) 2.Spironolactone 3.Cyproterone Acetate 4.Oral Corticosteroids 5.Oral Isotretinoin
Psoriasis two peak ages of onset
20 to 30 years of age. 50 to 60 years of age.
PSORIASIS TWO MAJOR ETIOLOGICAL FACTORS:
1 Genetics 2 Predisposing and precipitating factors
PSORIASIS Predisposing FACTORS
1 horse-fly bite (Koebner phenomenon) 2 viral or streptococcal infection 3 use of β-adrenergic blockers
PSORIASIS Precipitating FACTORS
1 NSAIDS 2 antimalarials 3 β -adrenergic blockers 4 withdrawal of corticosteroids
Are responsible for the EPIDERMAL HYPERPLASIA and DERMAL INFLAMMATION that is seen in psoriasis.
Interaction of dermal dendritic cells activated T cells of TH-1, TH-17 lineage with cytokines and growth factors
TYPES OF PSORIASIS
1 Plaque 2 Flexural or Intertriginous 3 Seborrheic 4 Scalp 5 Acrodermatitis of Hallopeau 6 Palm or soles 7 Erythodermic 8 Guttate 9 Generalized Pustular Psoriasis
Diagnostic Tests of PSORIASIS
1.Body surface area (BSA) 2.Psoriasis Area and Severity Index (PASI) 3.Physician’s Global Assessment (static PGA) 4 Quality-of-life measures such as the Dermatology Life Quality Index (DLQI) or the Short Form (SF-36) Health Survey.
Nonpharmacologic Therapy
1.Stress-reduction strategies 2.Moisturizers 3.Oatmeal baths 4.Skin protection using sunscreens.
PSORIASIS Pharmacologic Therapy
Topical Therapies 1 Corticosteroids (mainstay for the majority) 2 Vitamin D3 Analogues (calcipotriol (calcipotriene), calcitriol (the active metabolite of vitamin D), and tacalcitol) 3 Retinoids (Tazarotene) 4 Anthralin (direct antiproliferative effect) 5 Coal Tar (one of the earliest agents) 6 Salicylic Acid (for patients with scalp psoriasis) 7 Calcineurin Inhibitors (for atopic dermatitis)
PSORIASIS Pharmacologic Therapy 1 Phototherapies and Photochemotherapy:
1.UVB 2.NB-UVB (Narrowband UVB) 3.UVA 4.PUVA (UVA + Psoralens)
PSORIASIS Pharmacologic Therapy 1 Systemic Therapies:
1.Acitretin 2.Cyclosporine 3.Methotrexate
Skin consists of
1 Outer Epidermis 2 Inner Epidermis
Epidermis parts
1 stratum basale (basal layer), 2 stratum spinosum (prickle cell layer) 3 stratum granulosum (granular layer) 4 stratum corneum (horny layer)
PATHOPHYSIOLOGY: 1 Localized DRUG-INDUCED REACTIONS 2 Allergic DRUG-INDUCED REACTIONS Depend on inducing an immune response from the host Classified as:
1 Chemical vaginitis (vaginal douches, spermicides, and imidazoles) 2 Blistering Exanthematous Pustular eruptions Urticarial
COMMON SKIN DISORDER
1 CONTACT DERMATITIS 2 DIAPER DERMATITIS 3 SKIN CANCER
DRUG-INDUCED REACTIONS MANAGEMENT Management & Treatment 1 IF severe case: 2 IF w/ fever: 3 IF SJS/TEN:
Termination of suspected drug 1 IF severe case: -- Corticosteroids 2 IF w/ fever: -- Acetaminophen 3 Broad spectrum antibiotics & vancomycin, IVIG
CONTACT DERMATITIS MANAGEMENT 1) 1st goal: 2) 2nd goal:
. 1 identify, withdraw, avoid offending agent using Patch Test -> gold standard 2 provide symptomatic relief while decreasing skin lesions. -> cold compresses -> topical corticosteroids
DIAPER DERMATITIS MANAGEMENT 1 Non pharmacologic 2 Drugs 3 DOC for candidal rash:
1) Frequent diaper changes Air drying Gentle cleansing 2) Zinc oxide (astringent) Petrolatum (moisture) 3 imidazole
SKIN CANCER MANAGEMENT 1 Squamous Cell Carcinoma (SCC) treatment 2 Basal Cell Carcinoma (BCC) 3 Malignant melanoma - give also drug for metastatic melanoma
. 1 surgical excision 2 may involve surgical excision; topical agents (imiquimod or antineoplastic agents, such as 5-fluorouracil) 3 antineoplastic therapy, (temozolomide) or (dacarbazine for metastatic melanoma)