Drugs used in Skin Disorders PSORIASIS It is an autoimmune disease which is characterized by marked increase in undifferentiated epidermal cell proliferation and can increase the number of superficial cells having abnormal keratinization ACITRETIN It is a metabolite of the aromatic retinoid, etretinate used in the treatment of psoriasis Adverse effects include elevation of cholesterol and triglycerides levels; hepatotoxicity and raised liver enzyme levels has also been reported TAZAROTENE It is an acetylenic retinoid prodrug which is hydrolysed to active metabolite tazarotenic acid, binds to retinoic acid receptors resulting in modified gene expression CALCIPOTRIENE It is a synthetic vitamin D3 derivative effective in the treatment of plaque type psoriasis vulgaris Adverse effects include itching and mild irritation KERATOLYTIC AGENTS These are the agents used in the treatment of disorders of keratin which cause mild peeling of superficial layers of the skin Salicylic acid is used to treat various hyperkeratotic lesions like corns, warts, ring- worm, athlete’s foot, chronic dermatitis etc 453 Propylene glycol is an effective keratolytic agent for the removal of hyperkeratotic debris It is also used in combination with salicylic acid in the treatment of ichthyosis, psoriasis, keratosis pilaris and hypertrophic lichen planus Podophyllum resin, an alcoholic extract of Podophyllum palatum is used in the treatment of condyloma acuminatum and other verrucae Urea is used in cream or ointment to make it less greasy, it increases the water content of stratum corneum which may be because of its hygroscopic property It also possesses keratolytic property Cantharidin is the active irritant isolated from cantharides It is mainly used in the treatment of molluscum contagiosum and verruca vulgaris, particularly periungual warts Fluorouracil, a fluorinated pyrimidine antimetabolite is used topically for the treatment of multiple actinic keratoses and intralesionally for keratoacanthomas Benzoic acid is a antifungal with mild keratolytic action ANTIPRURITIC AGENTS Pruritus is a common symptom in skin along with itching Antihistaminics and hydrocortisone are very effective in pruritus due to inflammation DOXEPIN Topical doxepin in the form of cream is used in the treatment of pruritus associated with atopic dermatitis or lichen chronicus Adverse effects include marked burning and stinging at the treatment site Section 13/ Miscellaneous 454 PRAMOXINE It is a topical anaesthetic which can provide temporary relief from pruritus with mild eczematous dermatoses shampoo are used in dandruff which is most common problem Selenium sulfide also has antikeratolytic and fungicidal properties MISCELLANEOUS COMPOUNDS TRICHOGENIC AGENTS MINOXIDIL Topical minoxidil is effective in reversing the progressive miniaturization of scalp hairs associated with androgenic alopecia (male pattern baldness) It is a hereditary disorder due to excessive conversion of testosterone to dehydrocorticosterone in the scalp skin in genetically susceptible men FINASTERIDE It is a inhibitor of 5-alpha reductase and blocks the conversion of testosterone to dehydrotesto-sterone It prevents further hair loss in the significant proportion of men in the androgenic alopecia Adverse effects include decreased libido, ejaculation disorders and erectile dysfunction It is used in the treatment of benign prostatic hypertrophy in the dose of mg daily In mg dose it is used in the treatment of androgenic alopecia Dutasteride is newer compound similar to finasteride ANTISEBORRHEIC AGENTS These agents are effective in seborrheic dermatitis which is characterized by erythematous scaling lesions The various agents, e.g selenium sulfide and imidazole antifungals lotion or These are the agents which can be used in various skin disorders e.g., atopic dermatitis, seborrheic dermatitis and certain types of psoriasis and other related disorders TACROLIMUS It is an immunosuppressant macrolide antibiotic produced by Streptomyces tsukubaensis Like cyclosporine, tacrolimus binds to a cytoplasmic immunophylin and the complex inhibits the activity of the calcium dependent phosphatase known as calcineurin This in turn, inhibits the translocation of the transcription factor NF-AT into the cell nucleus, blocking the initiation of NF-AT dependent T-cell responses It is indicated in atopic dermatitis It is recently approved for immunosuppression in liver and kidney transplant patients SIROLIMUS It is a newer agent derived from Streptomyces hygroscopicus that binds immunophylin (same as in tacrolimus and cyclosporine) It is indicated in the management of psoriasis and uveoretinitis PREDNICARBATE It is a halogen free steroid and highly active corticosteroid for topical application Drugs used in Skin Disorders It has pronounced antiinflammatory, antiallergic, anti-exudative and antipruritic properties It is indicated in atopic dermatitis, seborrheic dermatitis and certain types of psoriasis Certain other agents are also used in other 455 skin disorders like antimalarials in lupus erythematosus, antimetabolites in psoriasis, dapsone in dermatitis herpetiformis and erythema elevatum diutinum, interferon in viral warts and thalidomide in erythema nodosum leprosum This page intentionally left blank Appendices ... of NF-AT dependent T-cell responses It is indicated in atopic dermatitis It is recently approved for immunosuppression in liver and kidney transplant patients SIROLIMUS It is a newer agent derived... psoriasis and uveoretinitis PREDNICARBATE It is a halogen free steroid and highly active corticosteroid for topical application Drugs used in Skin Disorders It has pronounced antiinflammatory, antiallergic,... antimalarials in lupus erythematosus, antimetabolites in psoriasis, dapsone in dermatitis herpetiformis and erythema elevatum diutinum, interferon in viral warts and thalidomide in erythema nodosum