DermatopharmacologyDermatopharmacology
Prof Werner SinclairProf Werner Sinclair
Department of DermatologyDepartment of Dermatology
University of the Free StateUniversity of the Free State
Outcomes for this LectureOutcomes for this Lecture
After this lecture the student should be able to:After this lecture the student should be able to:
Name the most important characteristics and uses of the following antifungals:Name the most important characteristics and uses of the following antifungals:
Griseofulvin Griseofulvin
Terbinafine Terbinafine
Ketoconazole Ketoconazole
Fluconazole Fluconazole
Itraconazole Itraconazole
Topical imidazole creams Topical imidazole creams
Discuss the characteristics and uses of the different strengths and formulations oftopical steroidsDiscuss the characteristics and uses of the different strengths and formulations oftopical steroids
Name the indications for and most important side-effects of chloroquineName the indications for and most important side-effects of chloroquine
Discuss the indications and use of topical retinoidsDiscuss the indications and use of topical retinoids
Discuss the origin, characteristics of and indications for mupirocinDiscuss the origin, characteristics of and indications for mupirocin
Discuss the use of tetracyclines in dermatologyDiscuss the use of tetracyclines in dermatology
Name the uses of the different types of antihistamines (sedating vs non-sedating) indermatologyName the uses of the different types of antihistamines (sedating vs non-sedating) indermatology
Name the indications for and side-effects of anti-androgens and imiquimodName the indications for and side-effects of anti-androgens and imiquimod
Drugs To Be Discussed1Drugs To Be Discussed1
Antifungals: GriseofulvinAntifungals: Griseofulvin
Terbinafin Terbinafin
Fluconazole Fluconazole
Itraconazole Itraconazole
Ketoconazole Ketoconazole
Corticosteroids: TopicalCorticosteroids: Topical
Systemic Systemic
ChloroquineChloroquine
Drugs To Be Discussed2Drugs To Be Discussed2
Retinoids: TopicalRetinoids: Topical
Systemic Systemic
Benzoyl peroxideBenzoyl peroxide
ShampoosShampoos
BarriersBarriers
Antibiotics: TopicalAntibiotics: Topical
Systemic Systemic
Antivirals: AcyclovirAntivirals: Acyclovir
Podophyllin Podophyllin
Antiscabies: Benzoyl benzoateAntiscabies: Benzoyl benzoate
Drugs To Be Discussed3Drugs To Be Discussed3
AntihistaminesAntihistamines
Anti-androgensAnti-androgens
ImiquimodImiquimod
AntifungalsAntifungals
GriseofulvinGriseofulvin
TerbinafinTerbinafin
FluconazoleFluconazole
ItraconazoleItraconazole
KetoconazoleKetoconazole
GriseofulvinGriseofulvin
Only active against dermatophytes(keratolytic fungi)Only active against dermatophytes(keratolytic fungi)
FungistaticFungistatic
Absorbed with fatty food (milk)Absorbed with fatty food (milk)
Very safe in childrenVery safe in children
10 – 20 mg per kg per day10 – 20 mg per kg per day
TerbinafinTerbinafin
Only active against dermatophytesOnly active against dermatophytes
FungicidalFungicidal
Tablets and creamTablets and cream
Some severe immunological side-effectsSome severe immunological side-effects
FluconazoleFluconazole
Broad spectrumBroad spectrum
FungistaticFungistatic
Convenient once per week dosageConvenient once per week dosage
Can be used in neonatesCan be used in neonates
Used for: CandidaUsed for: Candida
Cryptococcus Cryptococcus
ItraconazoleItraconazole
Very broad spectrumVery broad spectrum
FungistaticFungistatic
To be taken with mealsTo be taken with meals
Capsules and suspension availableCapsules and suspension available
Used for: Any fungal infectionUsed for: Any fungal infection
Not better than terbinafin for Not better than terbinafin for
dermatophytes dermatophytes
KetoconazoleKetoconazole
Broad spectrumBroad spectrum
FungistaticFungistatic
To be taken with mealsTo be taken with meals
Tablets, cream and shampoo availableTablets, cream and shampoo available
Used for: Seborrheic dermatitisUsed for: Seborrheic dermatitis
Pityriasis versicolor Pityriasis versicolor
Candidiasis Candidiasis
Side-effects: Liver toxicitySide-effects: Liver toxicity
P450 inducer P450 inducer
Imidazole CreamsImidazole Creams
Variety available
Similar spectra
Little to choose
Price deciding factor
E.g.. Ketoconazole, econazole,clotrimazole
CorticosteroidsCorticosteroids
TopicalTopical
SystemicSystemic
Topical CorticosteroidsTopical Corticosteroids
3 Strengths3 Strengths
Fluorinated vs Non-fluorinatedFluorinated vs Non-fluorinated
Ointments, Creams, Lotions, ShampoosOintments, Creams, Lotions, Shampoos
Topical CorticosteroidsTopical Corticosteroids
Ointments: More potentOintments: More potent
Penetrates deeper Penetrates deeper
More atrophy More atrophy
Used for: Dry lesionsUsed for: Dry lesions
Thick lesions Thick lesions
Thick skin Thick skin
Topical CorticosteroidsTopical Corticosteroids
Creams: Less potentCreams: Less potent
Penetrates less Penetrates less
Less atrophy Less atrophy
Used for: Acute, thin lesionsUsed for: Acute, thin lesions
Moist lesions Moist lesions
Thin skin (Face, skin folds) Thin skin (Face, skin folds)
Topical CorticosteroidsTopical Corticosteroids
Lotions: Least potent, least atrophyLotions: Least potent, least atrophy
Used for: Hairy areas (scalp)Used for: Hairy areas (scalp)
Wet lesions (Watery solutions) Wet lesions (Watery solutions)
Topical CorticosteroidsTopical Corticosteroids
ShampoosShampoos
Clobetasol: Used for psoriasis of the scalpClobetasol: Used for psoriasis of the scalp
Systemic CorticosteroidsSystemic Corticosteroids
Prednisone / PrednisolonePrednisone / Prednisolone
Potent, fast acting anti-inflammatoryPotent, fast acting anti-inflammatory
CheapCheap
Side-effects: Short term: Almost noneSide-effects: Short term: Almost none
Long term: Severe Long term: Severe
Used once daily, in the morningUsed once daily, in the morning
ChloroquineChloroquine
Indications: Cutaneous lupus erythematosusIndications: Cutaneous lupus erythematosus
Porphyria cutanea tarda Porphyria cutanea tarda
Side-effects: Corneal deposits (Temporary)Side-effects: Corneal deposits (Temporary)
Maculopathy (Permanent) Maculopathy (Permanent)
Other Other
RetinoidsRetinoids
Topical: TretinoinTopical: Tretinoin
Adapalene Adapalene
Tazarotene Tazarotene
Comedolytic, anti-inflammatoryComedolytic, anti-inflammatory
Indications: Acne (All forms)Indications: Acne (All forms)
Anti-aging Anti-aging
Other Other
RetinoidsRetinoids
Systemic: IsotretinoinSystemic: Isotretinoin
Acitretin Acitretin
Indications: AcneIndications: Acne
Psoriasis Psoriasis
Lymphomas Lymphomas
Many others Many others
Side-effects, etc: See acne lectureSide-effects, etc: See acne lecture
Benzoyl peroxideBenzoyl peroxide
Comedolytic, antisepticComedolytic, antiseptic
Gel / CreamGel / Cream
Superficial, inflammatory acne vulgarisSuperficial, inflammatory acne vulgaris
ShampoosShampoos
Ketoconazole: Seborrheic dermatitisKetoconazole: Seborrheic dermatitis
Pityriasis versicolor Pityriasis versicolor
(Not for tinea capitis) (Not for tinea capitis)
Coal tar (LPC): PsoriasisCoal tar (LPC): Psoriasis
Povidone iodine (Betadine)Povidone iodine (Betadine)
Selenium sulfide (Selsun)Selenium sulfide (Selsun)
Zinc pyrithioneZinc pyrithione
BarriersBarriers
Zinc/Castor oil BP: Nappy rashZinc/Castor oil BP: Nappy rash
AntibioticsAntibiotics
Topical: MupirocinTopical: Mupirocin
Fucidic acid Fucidic acid
Gentamycin Gentamycin
Erythromycin Erythromycin
Clindamycin Clindamycin
Systemic: Tetracyclines (oxytetracycline,doxycycline, minocycline, lymecycline)Systemic: Tetracyclines (oxytetracycline,doxycycline, minocycline, lymecycline)
Penicillins (amoxycillin, cloxacillin,amoxycillin-clavulanic acid Penicillins (amoxycillin, cloxacillin,amoxycillin-clavulanic acid
Erythromycin Erythromycin
MupirocinMupirocin
Manufactured by Pseudomonas bacteriaManufactured by Pseudomonas bacteria
Broad spectrumBroad spectrum
Esp effective against StaphylococciEsp effective against Staphylococci
Ointment and creamOintment and cream
No systemic useNo systemic use
Reserved for short term useReserved for short term use
TetracyclinesTetracyclines
Bacteriostatic antibiotics, potent anti-Bacteriostatic antibiotics, potent anti-
inflammatory effects inflammatory effects
Used widely in acne, rosacea, bullous diseasesUsed widely in acne, rosacea, bullous diseases
Oxytetracycline: RosaceaOxytetracycline: Rosacea
Lymecycline: Drug of choice for acneLymecycline: Drug of choice for acne
Minocycline: Acne in white patients (pigmentation)Minocycline: Acne in white patients (pigmentation)
Doxycycline: Acne in black patients (phototoxicity)Doxycycline: Acne in black patients (phototoxicity)
PenicillinsPenicillins
Cloxacillin, Flucloxacillin, Amoxycillin-Clavulanic acid: Staph infectionsCloxacillin, Flucloxacillin, Amoxycillin-Clavulanic acid: Staph infections
Amoxycillin, erythromycin: Strep infectionsAmoxycillin, erythromycin: Strep infections
AntiviralsAntivirals
Acyclovir: Cream, tablets and IVAcyclovir: Cream, tablets and IV
Used for: Herpes simplex 1 and 2Used for: Herpes simplex 1 and 2
Herpes zoster Herpes zoster
(Cream useless on skin) (Cream useless on skin)
Side-effects: Practically noneSide-effects: Practically none
Podophyllin: 25% in TBCo: Used forcondylomata acuminata and verrucaePodophyllin: 25% in TBCo: Used forcondylomata acuminata and verrucae
AntiscabiesAntiscabies
Benzoyl benzoateBenzoyl benzoate
Only effective treatment for scabiesOnly effective treatment for scabies
Method of use: See lecture on skininfectionsMethod of use: See lecture on skininfections
AntihistaminesAntihistamines
Sedating: PromethazineSedating: Promethazine
Chlorpheniramine Chlorpheniramine
Hydroxyzine (Aterax®) Hydroxyzine (Aterax®)
AntihistaminesAntihistamines
Sedating: PromethasineSedating: Promethasine
Chlorpheniramine Chlorpheniramine
Hydroxyzine (Aterax®) Hydroxyzine (Aterax®)
Used for: Atopic dermatitisUsed for: Atopic dermatitis
Acute urticaria Acute urticaria
Other forms of night-time pruritus Other forms of night-time pruritus
AntihistaminesAntihistamines
Sedating: PromethasineSedating: Promethasine
Chlorpheniramine Chlorpheniramine
Hydroxyzine (Aterax®) Hydroxyzine (Aterax®)
Used for: Atopic dermatitisUsed for: Atopic dermatitis
Acute urticaria Acute urticaria
Other forms of night-time pruritus Other forms of night-time pruritus
Side-effects: Sedation (NB: Driving)Side-effects: Sedation (NB: Driving)
Photo-allergy (not hydroxyzine) Photo-allergy (not hydroxyzine)
Dry mouth Dry mouth
AntihistaminesAntihistamines
Non-sedating: LoratidineNon-sedating: Loratidine
Cetirizine Cetirizine
Desloratidine Desloratidine
Levocetirizine Levocetirizine
Used for: Acute and chronic urticariaUsed for: Acute and chronic urticaria
Allergic rhinitis Allergic rhinitis
Side-effects: Almost noneSide-effects: Almost none
Anti-androgensAnti-androgens
Cyproterone acetateCyproterone acetate
Progestogen, blocks 5α-reductase Progestogen, blocks 5α-reductase
2mg in Diane-35® 2mg in Diane-35®
10mg in Androcur 10mg in Androcur
Used mostly for acne Used mostly for acne
Side-effects: Depression, weight gain Side-effects: Depression, weight gain
DrosperinoneDrosperinone
Ingredient of Yasmin® Ingredient of Yasmin®
Imiquimod (Aldara®)Imiquimod (Aldara®)
Topical immunostimulantTopical immunostimulant
Used for condylomata acuminataUsed for condylomata acuminata
Superficial spreading basal cell CA Superficial spreading basal cell CA
Side-effects: Severe local inflammationSide-effects: Severe local inflammation