Comprehensive Dermatologic Drug Therapy (4th Edition)

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Download Comprehensive Dermatologic Drug Therapy (4th Edition) written by Stephen E. Wolverton, Jashin J. Wu in PDF format. This book is under the category Medicine and bearing the isbn/isbn13 number 323612113/9780323612111. You may reffer the table below for additional details of the book.

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Designed with practical usability in mind; Comprehensive Dermatologic Drug Therapy; 4th Edition; (PDF) helps you effectively and safely treat the skin disorders you are likely going to see in your practice. Dr. Stephen E. Wolverton and new associate editor Dr. Jashin J. Wu lead a team of global experts to bring you complete and concise guidance on today’s full spectrum of intralesional; topical; and systemic drugs. You will prescribe with confidence thanks to expert coverage of which drugs to use; when to use them; and any adverse effects to monitor. The latest 4th edition includes:

  • Covers the best uses for new biologic therapeutics.
  • Features a highly detailed; disease-specific index; as well as purchase information for major drugs.
  • Helps you assess your knowledge and prepare for recertification or certification with about 800 review questions and answers throughout the ebook.
  • Contains quick-access summaries of indications/contraindications; dosage guidelines; drug interactions; adverse effects; drug monitoring guidelines; and treatment protocols.
  • Includes new drug interaction tables; drug risk profiles; and FDA guidelines; as well as two new appendices that summarize chapter questions and summarize highest-risk drug interactions.
  • Contains new chapters covering medical decision-making principles; PDE-4 and JAK inhibitors; interleukin 23 inhibitors; additional biologic therapeutics; interleukin 17 inhibitors; and hedgehog pathway inhibitors.

NOTE: This sale only includes the ebook Comprehensive Dermatologic Drug Therapy 4e in PDF. No access codes included.

Additional information

book-author

Stephen E. Wolverton, Jashin J. Wu

publisher

Elsevier; 4th edition

file-type

PDF

pages

3622 pages

language

English

asin

B0831MYMT5

isbn10

323612113

isbn13

9780323612111

Table of contents


Table of contents :
Cover
Comprehensive Dermatologic Drug Therapy
Copyright
Dedication
Contributors
Preface
Acknowledgments
PART I Introduction
1 – Basic Principles of Pharmacology
1 – Basic Principles of Pharmacology
Introduction
Pharmacokinetics—Part I (Tables 1.2 and 1.3)
Drug Absorption (The Drug has to be Absorbed and Enter Circulation)
Distribution (The Drug has to Travel to the Site of Intended Action or to a Reservoir)
Bioavailability (The Drug has to be ‘Available’ at The Site of Intended Action)
Pharmacodynamics (The Drug Produces the Desired Pharmacologic Effect)
Definitions (Table 1.4)
Drug Receptors
Enzyme Systems Inhibited by Drugs
Signal Transduction and Transcription Factors
Pharmacokinetics—Part II
Metabolism (The Drug Becomes More Hydrophilic to Favor Renal and Biliary Excretion)
Excretion (The Relatively Hydrophilic Drug Metabolites Must Leave the Body)
Percutaneous Absorption
General Principles
Vehicles
Tachyphylaxis
Transdermal Medication Formulations
Summary
Bibliography: Important Reviews and Chapters
2 –
Principles for Maximizing the Safety of Dermatologic Drug Therapy
Introduction
Anticipation
Patient Selection
Patient Education
Baseline Laboratory and Related Tests
Concomitant Drug Therapy—Drug Interactions
Evolving Guidelines—Risk Factors
Prevention
Patient Measures to Reduce Risks
Therapeutic Interventions to Minimize Drug Risk
Timing of Risk and Medication Errors
Diagnosis
Evolving Guidelines for Monitoring
A Teamwork Approach for Maximizing the Safety of Drug Therapy
Use of Optimal Diagnostic Tests
Higher-Risk Scenarios
Management
What to do if Problems Arise—Relatively Minor Complications
What to do if Problems Arise—Potentially Serious Complications
What to do if Problems Arise—Potentially Serious Complications
Parting Thoughts
Bibliography: Important Reviews and Chapters
3 – Polymorphisms: Why Individual Drug Responses Vary
Introduction
Evaluating the Patient
Factors That Influence Medication Effects (Including Adverse Effects)
Absorption
Phase I and Phase II Drug Metabolism
Drug Metabolism—Phase I Reactions
Cytochrome P-450 Enzyme System Overview
CYP1A2 Polymorphism
CYP2B6 Haplotype Variation
CYP3A4 Variability
CYP2C9 Polymorphism
CYP2C19 Polymorphism
CYP2D6 Polymorphism
CYP2D6 Testing
Sources for Additional Information on CYP-Based Interactions
Dihydropyrimidine Dehydrogenase
Drug Metabolism—Phase II Reactions
P-Glycoprotein
Thiopurine Methyltransferase
N-Acetyltransferase
Glucose-6-Phosphate Dehydrogenase
Glutathione S-Transferase
Thymidylate Synthase and Other Polymorphisms in the Folate Pathway
65Tests for Genetic Polymorphisms and Clinical Significance
Pharmacogenomic Databases
Conclusions and Future Directions
Bibliography: Important Reviews and Chapters
References*
4 – Adherence to Drug Therapy
Introduction
Measures of Adherence
Factors that Influence Adherence Behavior
Strategies to Improve Adherence Behavior
The Physician–Patient Relationship
Choice of Treatments
Stress Good Initial Adherence
Achieving Adherence in Special Groups
Conclusions
Bibliography: Important Reviews and Chapters
References*
5 – Medical Decision Making
Introduction
Patient Individualization and Prioritization (Box 5.1)
Principle #1. Not all patients with a given diagnosis are of equal risk for complications
Principle #5. There is power in being able to say to the patient ‘I do not know
Medical Decision Making (Box 5.2)
Causation Determination (Box 5.3)
Principle #7. Correlation in timing does not establish causation
Principle #8. Master the causation algorithm to assess risk from drug therapy versus chance occurrence alone
Principle #9. Avoid common pitfalls of causation determination
Principle #10. Boxed warnings or ‘Warnings and Precautions’ by the US Food and Drug Administration are generally not a statement…
Evaluating the Medical Literature (Box 5.4)
Principle #11. Keep up to date on the medical literature
Principle #12. Be aware of what medical literature is available on a given therapeutic issue
Principle #13. There are ways to know a drug is effective without large studies ‘required’ by evidence-based medicine
Interpretation of Medical Literature (Box 5.5)
Principle #14. Seek an optimal level of certainty in medical decision making
Principle #15. Develop interpretive skills with the ‘P-value’ to minimize type I and II errors
Principle #16. There are several limitations to the P-value
Principle #17. Gain ‘confidence’ in interpreting 95% confidence intervals for various ratios
Principle #18. Seek to understand the true level of risk by looking at attributable risk
Risk Management (Box 5.6)
Principle #19. When deciding to take on risk while making a medical decision, agreement between the prescribing physician with b…
Principle #20. The therapeutic efficacy of a treatment must be scrutinized against the safety profile of that treatment modality…
Prescriber Responsibilities (Box 5.7)
Principle #21. Be aware of the cost of your chosen treatment to both the patient and the healthcare system
Principle #22. Suboptimal efficacy and treatment failure are different and must be distinguished
Longitudinal Patient Care Decisions (Box 5.8)
Principle #23. Starting treatment before disease diagnosis is appropriate in many instances
Principle #24. Realize that many variables may be involved when a patient is not improving
Principle #25. Techniques to maximize the successful withdrawal of an intervention include (1) setting expectations, (2) accessi…
Decision-Making Realities (Box 5.9)
PART II Important Drug Regulatory Issues
6 – The FDA Drug ApprovalProcess
6 – The FDA Drug Approval Process
Introduction
Federal Legislation for Drug Safety and Efficacy
Food Drug and Cosmetic Law
Kefauver–Harris Drug Amendment
General Testing Required Prior to Marketing
Phase I to IV Testing
Phase I Testing
Phase II Testing
Phase III Testing
Pharmacovigilance Process
Phase IV Studies
Prescription Drug User Fee Act
US Food and Drug Administration Advisory Panels
Off-Label Drug Use
US Food and Drug Administration Modernization Act
Generic Drugs
Systemic Drugs Bioequivalence
Topical Drug Testing Required
Special Drug Approval Categories
Compassionate Use Regulations
Drug Price Competition and Patent Restoration Act
Orphan Drug Act
Related Issues
Regulation of Over-the-Counter Drugs, Biologics, and Generics
Regulation of Combination Products and Surgery
Comparisons of FDA Regulation With Other Countries
Precision Medicine
Some Final Thoughts
Bibliography: Important Reviews
7 – Pharmacovigilance: Verifying that Drugs Remain Safe
Introduction
Summary
Bibliography: Important Reviews and Chapters
References*
8 – Drugs Taken Off the Market: Important Lessons Learned
Introduction
Presentation of Risk–Benefit in Labeling
Product Label ‘Lifecycle’ Changes
Risks and Benefits: US Food and Drug Administration Safety Information
Drug Withdrawal
General Principles Concerning Drug Withdrawal Decisions
Medical Principles—Specific Examples
Medical Principles—General Issues
Acknowledgement
Bibliography: Important Reviews and Websites For Supplemental Information
References
PART III Systemic Drugs for Infectious Diseases
9 – Systemic Antibacterial Agents
9 – Systemic Antibacterial Agents
Introduction
Penicillins
Cephalosporins
β-Lactam and β-Lactamase Inhibitor Combinations
Other Systemic Antibacterials that Inhibit Cell Wall Synthesis
Macrolides
Fluoroquinolones
Tetracyclines
Rifampin and Other Rifamycins
Folate Synthesis Inhibitors
Lincosamides
Oxazolidinones
Special Topics
Bibliography: Important Reviews and Chapters
References*
10 – Systemic Antifungal Agents
Introduction
Pharmacokinetics in Skin
Pharmacokinetics in Nails
Pharmacokinetics in Hair
Mechanism of Action
Clinical Use
Contraindications
Adverse Effects
Drug Interactions
Monitoring Guidelines
Conclusion
Bibliography: Important Reviews and Chapters
References*
11 – Systemic Antiviral Agents
Introduction
Drugs for Human Herpes Virus Infections
Acyclovir
Pharmacology
Acyclovir (9-2-hydroxyethoxymethyl guanine or acycloguanosine) (ACV), a guanosine analog, is the most well-known and widely used…
Clinical Use
Indications for ACV are found in Box 11.1.1,3,5–19 Box 11.2 details various risks of ACV
US Food and Drug Administration-Approved Indications
Herpes Simplex Virus Infections. ACV can be administered topically, orally, and intravenously. The oral form is the most widely …
Chickenpox. When used to treat first-episode VZV, the recommended adult dose of oral ACV is 800 mg 5 times daily for 7 days and …
Herpes Zoster. ACV is used for recurrences of VZV known as HZ (or shingles). Acute HZ requires 800 mg of ACV to be taken 5 times…
Off-Label Dermatologic Uses
Other Herpes Simplex Infections. A variety of subsets of HSV can be treated with ACV in a fashion similar to the regimens outlin…
Adverse Effects. ACV is generally well tolerated regardless of the route of administration. Infrequent adverse effects (AE) with…
Drug Interactions. ACV is not metabolized by hepatic microsomal (cytochrome P-450 [CYP]) enzymes. ACV is eliminated by active tu…
Valacyclovir
Pharmacology
Q11.5 Valacyclovir (VACV) is an oral prodrug of acyclovir. (Note that the drug is also commonly spelled ‘valaciclovir’ in the li…
Clinical Use
Indications for VACV are found in Box 11.1.1,20–31 Box 11.2 details various risks of VACV
US Food and Drug Administration-Approved Indications
Herpes Simplex Infections. VACV is indicated for the treatment of both genital and orofacial HSV infections. For first-episode g…
Herpes Zoster. Q11.6 VACV has an FDA indication for use in HZ. Treatment requires 1000 mg TID for 7 days. VACV has been shown to…
Off-Label Dermatologic Uses
Recurrent Erythema Multiforme. Q11.4 There are few reports in the English-language literature on suppressive VACV therapy for re…
Other Herpes Simplex Infections. A variety of subsets of HSV can be treated with VACV in a fashion similar to the regimens outli…
Adverse Effects. The reported AE of VACV include nausea and headaches (as in ACV), with incidences usually not significantly dif…
Drug interactions. Given that VACV and its active form ACV are not metabolized by hepatic microsomal (CYP) enzymes, there is a r…
Famciclovir
Pharmacology
Q11.5 FCV is the oral prodrug of penciclovir (PCV), an acyclic nucleoside (see Fig. 11.1). Like ACV, PCV must be phosphorylated …
Clinical Use
Indications for FCV are found in Box 11.1.1,35–48 Box 11.2 details various risks of FCV
US Food and Drug Administration-Approved Indications
Herpes Simplex Infections. FCV is used for treatment of both orofacial and genital HSV. In the treatment of genital HSV, it is u…
Herpes Zoster. FCV has been shown to be highly effective in the treatment of HZ. The FDA-recommended FCV dose for zoster in immu…
Off-Label Dermatologic Uses
Other Herpes Virus Infections. A variety of subsets of HSV can be treated with FCV in a fashion similar to the regimens outlined…
Adverse Effects. Like ACV, FCV can rarely cause such AE as headache, nausea, or diarrhea. FCV shares with ACV and VACV an excell…
Drug Interactions. Given that FCV and its active form PCV are not metabolized by hepatic microsomal (CYP) enzymes, there is a re…
Vaccines for Human Herpes Virus Infections
Varicella-Zoster Virus Vaccines. The first available vaccine for prevention of a VZV virus infection is a live-attenuated vaccin…
Herpes Simplex Virus Vaccines. Prophylactic and therapeutic HSV vaccines have been in development for more than 90 years. Vaccin…
Overview
Integrase Strand Transfer Inhibitors
Highlights of Combination Medications
Human Immunodeficiency Virus Vaccine Development
Summary
12 – Systemic Antiparasitic Agents
Ivermectin
Pharmacology
Clinical Use
Clinical Comparisons
Albendazole
Pharmacology
Clinical Use
Thiabendazole
Pharmacology
Clinical Use
Alternative Agents—Doxycycline As Antiparasitic Agent
Bibliography: Important Reviews and Chapters
References*
PART IV Systemic Immunomodulatory Drugs
13 – Systemic Corticosteroids
13 – Systemic Corticosteroids
Systemic Corticosteroids
Pharmacology (Table 13.1)
Structure
Absorption and Distribution
Metabolism and Excretion
Mechanism of Action
Clinical Use
Food and Drug Administation-Approved Indications and Off-Label Dermatologic Uses
Intramuscular Corticosteroid Administration
Pulse Intravenous Corticosteroid Administration
Adverse Effects
Hypothalamic-Pituitary-Adrenal-Axis Suppression
Drug Interactions
Monitoring Guidelines
Therapeutic Guidelines
Bibliography: Important Reviews and Chapters
References*
14 – Methotrexate
Introduction
Pharmacology
Structure
Absorption and Distribution
Metabolism and Excretion
Mechanism of Action
Effects on Deoxyribonucleic Acid (DNA) Synthesis. Q14.1 MTX competitively and reversibly binds to DHFR within 1 hour, with an af…
T-cell Effects. Q14.1 The mechanism of action of MTX in psoriasis was originally thought to be caused by the suppression of hype…
Immunosuppressive Effects. Q14.1 MTX has activity as an immunosuppressive agent. The effect probably occurs because of inhibitio…
Anti-inflammatory Effects. Q14.1 It has been traditionally taught that both the beneficial effects and the toxicity of MTX were …
Folic Acid Effects on Methotrexate Therapy. Q14.3 The use of folic acid as a method of inhibiting MTX-induced GI AE and reducing…
Clinical use
Indications
US Food and Drug Administration-Approved Dermatologic Indications
Psoriasis. The major clinical use of MTX in dermatology is in the therapy of psoriasis.24 The selection of the patient for the i…
Off-Label Dermatologic Uses
Other Proliferative Disorders. MTX has been reported to be useful for several other conditions. Patients with other presumed epi…
Immunobullous Dermatoses. Diseases of presumed immunologic origin may also respond to MTX. Specifically, bullous diseases, such …
Autoimmune Connective Tissue Diseases. Patients with autoimmune connective tissue diseases (collagen vascular diseases), such as…
Vasculitis and Neutrophilic Dermatoses. Systemic vasculitis,61 including polyarteritis nodosa62 and cutaneous polyarteritis nodo…
Other Dermatoses. Significant personal experience, and some literature experience, with MTX therapy for recalcitrant atopic derm…
Summary of ‘Off-Label’ Dermatology Indications. The use of MTX for ‘off-label’ indications for dermatomyositis, BP, localized sc…
Adverse Effects
Hepatotoxicity. The potential for hepatotoxicity in a patient treated with long-term MTX is an important consideration.24,90 Hep…
Pulmonary Toxicity. In rare instances, pulmonary toxicity, such as acute pneumonitis, can occur.112–117 This pulmonary toxicity …
Hematologic Effects. Hematologic toxicity, such as pancytopenia, presents the greatest potential for loss of life as a result of…
Malignancy Induction. Q14.8 With the wider use of MTX in autoimmune connective tissue diseases, a number of patients with lympho…
Gastrointestinal Effects. Nausea and anorexia are common AE to MTX. Diarrhea, vomiting, and ulcerative stomatitis are less frequ…
Reproductive Effects. MTX has long been considered a potent teratogen and abortifacient, but it has far less long-term mutagenic…
Renal Effects. High-dose therapy (i.e., 50–250 mg/m2 intravenously; dosages used only in chemotherapy for malignant disease) may…
Other Adverse Effects. Other reported AE to MTX include mild alopecia, headaches, fatigue, and dizziness. If these reactions occ…
Drug Interactions
Monitoring Guidelines
General Issues and Risk-Factor Assessment. Before the first dose, a thorough evaluation of the patient should be completed. The …
Liver Biopsy. The need for routine liver biopsy before the initiation of therapy has been questioned. Q14.10 In general, the cho…
Q14.11 There are many situations in which pretreatment liver biopsy may not be necessary. These clinical scenarios include the f…
Q14.11 There are several other instances in which a pretreatment MTX liver biopsy is necessary, although subsequent point 5 is i…
Editor’s Note. (SEW) – At our institution and at many others, the Fibroscan has quickly evolved to the primary screening test fo…
Laboratory Monitoring. The patient should be monitored closely during the initial phases of therapy with frequent CBC (usually w…
Therapeutic Guidelines
15 – Azathioprine
Introduction
Pharmacology
Absorption and Distribution
Metabolism and Excretion
Mechanism of Action
Clinical Use
Off-Label Dermatologic uses
Contraindications
Adverse Effects (Box 15.3)
Drug Interactions
Summary
Bibliography: Important Reviews and Chapters
References*
16 – Mycophenolates
Introduction
Pharmacology
Mechanisms of Action
Clinical Use
Off-Label Dermatologic Uses
Psoriasis
Immunobullous Disease
Pemphigus
Other Immunobullous Dermatoses
Autoimmune Connective Tissue Disease
Lupus Erythematosus
Dermatomyositis
Vasculitis
Systemic Sclerosis
Atopic Dermatitis
Contraindications
Adverse Effects
Carcinogenicity
Gastrointestinal Toxicity
Hematologic
Infections
Pregnancy
Drug Interactions
Treatment Guidelines
Monitoring Guidelines
Bibliography: Important Reviews and Chapters
References*
17 – Cyclosporine
Introduction
Pharmacology
Clinical Use
Monitoring Guidelines
Summary
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
18 – Phosphodiesterase-4 and Janus Kinase Inhibitors
Introduction
Small Molecule Treatments
Mechanism of Action of Phosphodiesterase 4 Inhibition
Phosphodiesterase 4 Inhibitor Therapy
Apremilast
Clinical Use
Crisaborole
Clinical Use
Pharmacology and Pharmacokinetics
Janus Kinase Inhibitors
Mechanism of Action of Janus Kinase Pathway Inhibition
Janus Kinase Inhibitor Therapy
Tofacitinib
Additional Off-Label Uses
Monitoring
Ruxolitinib
Baricitinib
Other Janus Kinase Inhibitors
Conclusion
Bibliography: Important Reviews and Chapters
References*
19 – Cytotoxic Agents
Introduction
Patient Education Issues
Antimetabolites
Thioguanine
Pharmacology (Table 19.2)
Clinical Use
Hydroxyurea
Pharmacology
Clinical Use
Alkylating Agents
Cyclophosphamide
Pharmacology
Clinical Use
Adverse Effects
Chlorambucil
Pharmacology
Clinical Use
Off-Label Dermatologic Uses
Adverse Effects
Melphalan
Bibliography: Important Reviews and Chapters
References*
20 – Dapsone
Introduction
Pharmacology
Absorption and Bioavailability
Metabolism (Fig. 20.2)
Excretion
Mechanisms of Action (Table 20.3)
Clinical Use
Dermatologic Indications – Consistent Efficacy
Contraindications
Adverse Effects—Pharmacologic
Adverse Effects—Idiosyncratic
Pregnancy and Lactation
Drug Interactions
Monitoring Guidelines
Therapeutic Guidelines
Bibliography: Important Reviews and Chapters
References*
Web References
21 – Antimalarial Agents
Introduction
Pharmacology
Structure
Absorption and Bioavailability
Metabolism and Excretion
Mechanism of Action
Clinical Use
Off-Label Uses
Other Potential Benefits
Contraindications (Box 21.2)
Adverse Effects
Monitoring Guidelines84–86,125
Drug Interactions
Therapeutic Guidelines
Treatment of PCT
Bibliography: Important Reviews and Chapters
References*
22 – Systemic Retinoids
Introduction and Historical Perspective
Pharmacology
Vitamin a Physiology
Q22.1 Vitamin A cannot be synthesized in vivo by the human body, and so must be acquired through the diet. In mammals, vitamin A…
Structure
Absorption and Distribution
Metabolism and Excretion
General Aspects. The metabolism of retinoids is mainly via oxidation and chain shortening to biologically inactive, water-solubl…
Acitretin Re-esterification (Reverse Metabolism). Q22.2 Alcohol indirectly enhances the re-esterification of acitretin to etreti…
Mechanism of Retinoid Action
Transport of Retinoids. Physiologically, RA is predominantly in the all-trans form (ATRA). A small fraction is transported as 13…
Mechanism At the Nuclear Level. Retinoids exert their physiologic effects by binding to receptors present in the nucleus (Table …
Clinical Use
Practical Considerations
Psoriasis—Retinoids As Monotherapy. After etretinate was removed from the market in 1998, owing to concerns about its long half-…
Psoriasis—Retinoids in Combination Therapy. Q22.4 Combination therapy with systemic retinoids and phototherapy is more effective…
Retinoids in Combination with Biologic Agents. Because retinoids are generally not considered to be immunosuppressive, they may …
Acne Vulgaris. The only systemic retinoid that is FDA approved for the treatment of acne is isotretinoin. Current FDA guidelines…
Cutaneous T-Cell Lymphoma—Mycosis Fungoides and Sézary Syndrome. In 1999 the FDA approved bexarotene for the treatment of the cu…
Off-Label Dermatologic Uses
Rosacea. Compared with acne, rosacea tends to be a more chronic disease that frequently flares when systemic therapy is disconti…
Hidradenitis Suppurativa and Dissecting Cellulitis of the Scalp. Only a few reports describe the use of retinoids in hidradeniti…
Darier Disease. In early studies involving patients with inherited ichthyosiform diseases, patients with Darier disease were als…
Pityriasis Rubra Pilaris. Retinoid use in pityriasis rubra pilaris (PRP) has been reported.76–79 Goldsmith and colleagues evalua…
Ichthyosiform Dermatoses. Although both vitamin A and retinoic acid showed some therapeutic benefit in treating keratinizing dis…
Chemoprevention of Malignancy. Q22.6 Given the ability of retinoids to influence epidermal development and differentiation,87 va…
Lupus Erythematosus. Both isotretinoin and etretinate have been used successfully by patients with various forms of cutaneous lu…
Lichen Planus. Both isotretinoin and etretinate 1 mg/kg daily give mediocre results. Although many patients respond within 4 wee…
Chronic Hand Eczema. Although not currently approved for this indication in the United States, at the time this chapter was writ…
Adverse Effects
Teratogenicity—Women Exposed To Retinoids. Teratogenicity is the most important AE of the retinoids. Q22.7 Common retinoid-induc…
Teratogenicity—Males Exposed To Retinoids. The outcomes of 13 pregnancies in which the father was taking acitretin, at or around…
The ‘iPledge’ Registry Requirements. Because of concerns about the number of pregnancies that continued to occur, while patients…
Mucocutaneous Adverse Effects. Dry mucous membranes and skin is a common complaint in patients taking isotretinoin and acitretin…
Lipid Effects. Q22.8 The most common laboratory abnormality observed in patients taking systemic retinoids is elevation in serum…
Depression. Psychiatric AE are primarily reported with isotretinoin use; however, the exact nature and cause of these AE are not…
Inflammatory Bowel Disease. Q22.10 Isotretinoin has also been implicated as a cause of inflammatory bowel disease (IBD), in the …
Bone Effects. The potential for retinoid use to cause similar bone effects to what is seen in chronic vitamin A toxicity (diffus…
Ocular Effects. Blepharoconjunctivitis is defined as a low-grade inflammation of the conjunctiva and lid margins, and has been r…
Liver Effects. Elevated transaminases have been reported with both acitretin and isotretinoin use. It has been assumed that thes…
Thyroid Effects. Q22.11 Abnormalities in thyroid function have only been reported for bexarotene and occurred in 80% of patients…
Central Nervous System Effects. Changes of pseudotumor cerebri, although infrequent, are the most important central nervous syst…
Muscle Effects. Myalgias are noted in roughly 15% of isotretinoin-treated patients. An increased frequency and severity of these…
Hair and Nail Effects. The risk of telogen effluvium caused by the systemic retinoids has been reported to vary over a range of …
Hematologic Effects. In CTCL studies, up to 43% of patients receiving bexarotene (300 mg/m2 daily) had reversible leukopenia (10…
Drug Interactions
Monitoring Guidelines
Therapeutic Guidelines
PART V Drugs Used in Conjunction with UV or Visible Light
23 – Psoralen Plus Ultraviolet A Photochemotherapyand Other Phototherapy Modalities
23 – Psoralen Plus Ultraviolet A Photochemotherapy and Other Phototherapy Modalities
Introduction
Pharmacology
Structure
Absorption
Bioavailability
Metabolism
Excretion
Photochemistry
Mechanism of Action
Clinical Use
Treatment Procedure
Narrow-Band Ultraviolet B Phototherapy
Introduction
Clinical Use
Contraindications
Treatment Protocol
Protection
Adverse Effects
Targeted Phototherapy
Introduction
Clinical Use
Contraindications
Treatment Protocol
Protection
Adverse Effects
Uva-1 Phototherapy
Clinical Use
Contraindications
Treatment Protocol
Adverse Effects
Acknowledgments
Bibliography: Important Reviews and Chapters
References*
24 – Extracorporeal Photochemotherapy (Photopheresis)
Introduction
Treatment Delivery and Considerations
Pharmacology
Cutaneous T-Cell Lymphoma
Autoimmune Dermatoses
Clinical Use
US Food and Drug Administration-Approved Indications
Other Dermatologic Uses—Treatment of T-Cell-Mediated Autoimmune Dermatoses
Adverse Effects
Therapeutic Guidelines
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
25 – Photodynamic Therapy
Introduction
Pharmacology
Structure
Absorption and Bioavailability
Metabolism and Elimination
Mechanisms of Action
Formulations Available
Clinical Use
US Food and Drug Administration-Approved Indications
Off-Label Uses
Contraindications
Precautions
Adverse Effects
Drug Interactions
Monitoring Guidelines
General Therapeutic Guidelines for Photodynamic Therapy Treatment of Actinic Keratoses
Bibliography: Important Reviews and Chapters
References*
PART VI Biologic Therapeutics
26 – Tumor Necrosis FactorInhibitors
26 – Tumor Necrosis Factor Inhibitors
Introduction—Psoriasis Pathogenesis
Etanercept
Pharmacology
Clinical Use
Infliximab
Pharmacology
Clinical Use
Off-Label Dermatologic Uses
Adalimumab
Pharmacology
Clinical Use
Certolizumab Pegol
Pharmacology
Clinical Use
Tumor Necrosis Factor–Inhibitor Use for Psoriatic Arthritis
Adverse Effects of the TNFi In General
Bibliography: Important Reviews and Chapters
References*
27 – Interleukin 12/23 Inhibitors
Introduction
Monoclonal Antibody Treatments
Interleukin-12/23 Therapy – Ustekinumab
US Food and Drug Administration Approval
Ustekinumab
Clinical Use—Ustekinumab
Adverse Effects
Overview of Adverse Effects—Interleukin Inhibitors
Conclusions
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
28 – Interleukin 17 Inhibitors
Introduction
Secukinumab
Dermatologic Indications and Dosages
Pharmacology
Clinical Use: Plaque Psoriasis
Clinical Use: Psoriatic Arthritis
Off-Label/Other Dermatologic Uses
Safety and Monitoring
Ixekizumab
Dermatologic Indications and Dosages
Pharmacology
Clinical Use: Plaque Psoriasis
Clinical Use: Psoriatic Arthritis
Off-Label/Other Dermatologic Uses
Brodalumab
Dermatologic Indications and Dosages
Pharmacology
Clinical Use: Plaque Psoriasis
Off-Label/Other Dermatologic Uses
Safety and Monitoring Guidelines
Common Adverse Events Among All IL-17 Inhibitors
Infections
Candidiasis
Neutropenia
Inflammatory Bowel Disease
Latent Tuberculosis Infection
Live Vaccinations
Summary
Bibliography: Important Reviews and Chapters
References*
29 – Interleukin 23 Inhibitors
Introduction
US Food and Drug Administration Approval
Guselkumab
Pharmacology
Clinical Use
Adverse Effects
Tildrakizumab
Pharmacology
Clinical Use
Adverse Effects
Risankizumab
Pharmacology
Clinical Use
Adverse Effects
Future IL-23 Inhibitors for Psoriasis
Conclusion
Bibliography: Important Reviews and Chapters
References*
30 – Rituximab
Introduction
Rituximab
Pharmacology
Clinical Use
Bibliography: Important Reviews and Chapters
References*
31 – Additional Biologic Therapeutics: Dupilumab, Omalizumab, Others
Dupilumab
Pharmacology
Structure. Dupilumab is a recombinant, fully human IgG4κ mAb targeted against the α-subunit of IL-4 receptors (type 1 and type 2…
Pharmacokinetics. Dupilumab demonstrates nonlinear pharmacokinetic behavior. Systemic exposure to dupilumab increases more than …
Mechanism of Action. Q31.4 Dupilumab directly antagonizes the α-subunit of both type 1 and type 2 IL-4 receptors. Type 1 recepto…
Clinical Use
US Food And Drug Administration-Approved Dermatology Indication (Box 31.1). Dupilumab has been FDA-approved for the treatment of…
Off-Label Dermatologic Indications. Q31.5 Dupilumab was developed and investigated as a targeted therapy for AD. Clinicians are …
Alopecia Areata. Clinical reports of dupilumab use and alopecia areata are both conflicting and limited. One case report of conc…
Idiopathic Chronic Eczematous Eruption of Aging. Dupilumab has been used in one case of idiopathic chronic eczematous eruption o…
Pemphigus Vulgaris and Pemphigus Foliaceus. Similar to the Th2 dominance seen in AD, pemphigus vulgaris (PV) and pemphigus folia…
Contraindications. Dupilumab is contraindicated in patients with a known hypersensitivity to the drug or any of its components.1…
Warnings and Precautions
General Considerations. Administration of live vaccinations should be avoided in patients on dupilumab. Administration of limite…
Hypersensitivity. Hypersensitivity reactions to dupilumab are rare, reported in less than 1% of drug-receiving subjects in clini…
Special Populations. Dupilumab has not been studied in human pregnancy. Endogenous IgG transfers from mother to fetus across the…
Adverse Effects. The most common AE with dupilumab are injection site reactions, conjunctivitis, oral herpes, blepharitis, dry e…
Injection Site Reaction. Q31.6 Injection site reaction is the most common AE with dupilumab. Incidence in trials was 13.2% with …
Conjunctivitis and Keratitis. Meta-analysis of AE from four clinical trials (CHRONOS, SOLO1, SOLO2, and a phase IIb trial) revea…
Drug Interactions. During states of chronic inflammation, increased cytokine levels (including IL-4 and IL-13) can affect cytoch…
Monitoring Guidelines. There are no recommended monitoring guidelines for dupilumab
Omalizumab
Pharmacology
Structure. Omalizumab is a recombinant humanized IgG1κ mAb directed against free human IgE with a molecular weight of 149kDa (Ta…
Pharmacokinetics. The pharmacokinetics of omalizumab follow a first-order absorption model and become linear with dosages greate…
Mechanism of Action. Q31.8 Omalizumab selectively binds free IgE with high affinity at the Cε3 domain on the heavy chain, at the…
Q31.9 The most well understood and agreed upon mechanisms for omalizumab in CIU are summarized here
Clinical Use
US Food and Drug Administration-Approved Indications (Box 31.3). Omalizumab is FDA-approved for patients 6 years and older with …
Off-Label Dermatologic Indications
Atopic Dermatitis. The efficacy of omalizumab in AD has been a topic of debate, with numerous conflicting case reports and serie…
Bullous Pemphigoid. Bullous pemphigoid (BP) is characterized by IgG autoantibodies directed against hemidesmisomal proteins bull…
Latex Allergy. Latex allergy is a type I hypersensitivity reaction mediated by IgE that is commonly seen in occupational setting…
Food Allergy. As previously mentioned, studies with omalizumab have shown that IgE FcεRI receptor suppression is separated tempo…
Other Possible Uses. There have been numerous reports of omalizumab used to treat several other dermatologic conditions off-labe…
Contraindications. Omalizumab is contraindicated in patients who have a known severe hypersensitivity to the drug or any of its …
Warnings and Precautions
Anaphylaxis. Q31.10 Omalizumab carries a Boxed Warning for the risk of anaphylaxis. Symptoms of anaphylaxis with omalizumab incl…
Malignancy. Initial phase I to III clinical trials with omalizumab demonstrated a slightly increased incidence of malignancy (0….
Special Populations. Omalizumab is traditional pregnancy category B. As an IgG antibody, omalizumab is able to cross the placent…
Helminth (Parasite) Infection. A 1-year trial of patients at increased risk for helminth infections in Brazil found that 50% (34…
Adverse Effects. Initial phase III CIU trials reported similar incidences of AE between omalizumab and control groups.80,81,83 H…
Monitoring Guidelines. Clinicians should monitor patients for an appropriate period of time after omalizumab administration for …
Other Biologic Therapies in Development
PART VII Miscellaneous Systemic Drugs
32 – Antihistamines
32 – Antihistamines
Historical Overview
First-Generation H1 Antihistamines
Second-Generation H1 Antihistamines
The Mast Cell, its Mediators and Stimuli
Histamine Receptors and Resultant Effects
Antihistamine Mechanism of Action
First-Generation Antihistamines
Second-Generation H1 Antihistamines
Fexofenadine
Loratadine
Cetirizine
Desloratadine
Levocetirizine
H1 Antihistamine in Pregnancy and Lactation
H2 Antihistamines
Tolerance (Tachyphylaxis and Subsensitivity)
Oral and Topical Doxepin
Antihistamines for Atopic Dermatitis
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
33 – Vasoactive and Antiplatelet Agents
Pathophysiology Involving Cutaneous Vasculature
Calcium Channel Blockers
Pharmacology
Clinical Use
β-Blockers
Pharmacology
Clinical Use
Aspirin
Pharmacology
Clinical Use
Dipyridamole (Box 33.4)
Pharmacology
Clinical Use
Pentoxifylline (Box 33.5)
Pharmacology
Clinical Use
Nitric Oxide Donors
Phosphodiesterase-5 Inhibitors
Iloprost
Antiangiogenesis Agents
Psoriasis
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
34 – Antiandrogens and Androgen Inhibitors
Introduction
Physiologic Role of Androgens
Males
Females
Mechanism of Action
Antiandrogens
Spironolactone
Pharmacology
Clinical Use
Progestins
Cimetidine
Flutamide
Experimental Therapies
Androgen Inhibitors
Finasteride
Pharmacology
Clinical Use
Topical Finasteride
Adverse Effects
Drug Interactions
Monitoring Guidelines
Dutasteride
Pharmacology
Clinical Use
Off-Label Use
Adverse Effects
Ketoconazole
Pharmacology
Hormone Preparations
Oral Contraceptives, Transdermals/Gels, Injectables, Intrauterine Devices
Pharmacology
Clinical Use
Adverse Effects
Gonadotropin-Releasing Hormone Analogs
Herbal and Experimental Therapies
Saw Palmetto, Green Tea, Pygeum, Stinging Nettle, and Others
Bibliography: Important Reviews and Chapters
References*
Web References
35 – Psychotropic Agents
Introduction
Classification of Psychodermatologic Disorders
Categories of Psychodermatologic Disorders
General Principles in Management of the Above Categories
Four Major Underlying Psychopathologic Conditions
The Management of Anxiety in Dermatology
General Principles
Specific Medications
Acute Anxiety
Chronic Anxiety
The Management of Depression in Dermatology
General Principles
Specific Medications
Alternatives to Selective Serotonin Reuptake Inhibitor Antidepressants
The Management of Delusional Disorders in Dermatology
General Principles
Specific Medications—Pimozide
The Management of Obsessive–Compulsive Disorder in Dermatology
General Principles
Specific Antidepressants for Obsessive–Compulsive Disorder
Selective Serotonin Reuptake Inhibitor Antidepressant Choice—Principles Involved
Psychotropic Medications for Purely Dermatologic Conditions
Doxepin
Amitriptyline
Other Tricyclic Antidepressants
Summary
Bibliography: Important Reviews and Chapters
References*
36 – Intravenous Immunoglobulin Therapy
Introduction
Pharmacology
Mechanism of Action
Clinical Use
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
37 – Systemic Anticancer Agents: Dermatologic Indications and Adverse Events
Introduction
Epidermal Growth Factor Receptor Inhibitors
Multitargeted Kinase Inhibitors
Sorafenib
Imatinib Mesylate
Nilotinib
Alkylating Agents
Carboplatin
Cisplatin
Dacarbazine
Topoisomerase Inhibitors
Etoposide
Antimicrotubule Agents (Taxanes)
Paclitaxel
Docetaxel
Anthracyclines
Doxorubicin Hydrochloride Liposome (Pegylated Liposomal Doxorubicin)
Histone Deacetylase Inhibitors
Romidepsin
Vorinostat
Miscellaneous
Denileukin Diftitox
Monoclonal Antibodies
Alemtuzumab
Antimetabolites
Gemcitabine
Pralatrexate
Capecitabine
Biotherapy (Immunokines)
Ipilimumab
PD-1 Inhibitors
Pembrolizumab
Nivolumab
Cemiplimab
Braf Inhibitors
Vemurafenib
Summary
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
38 – Hedgehog Pathway Inhibitors
Introduction
Pharmacology
Structure
Absorption and Distribution
Metabolism and Excretion
Clinical Use
Us Food and Drug Aministration-Approved Indications
Off-Label Dermatologic Uses
Nevoid Basal Cell Carcinoma Syndrome
Neoadjuvant Use Before Surgery
Lymphoma
Graft-Versus-Host Disease
Systemic Sclerosis
Melanoma
Neurofibromatosis
Other Possible Dermatologic Uses
Adverse Effects
Teratogenicity
Effects on Breastfeeding and Menses
Overview of Other Adverse Effects
Effects on Hair Growth
Taste Disturbances
Cutaneous Malignancy Risk
Treatment Resistance
Pediatric and Geriatric Risk
Drug Interactions
Monitoring Guidelines
Other Hedgehog Inhibitors
Bibliography: Important Reviews and Chapters
References*
39 – Drugs for the Skinternist
Introduction
Bisphosphonates
Pharmacology
Clinical Use
Adverse Effects
Bexarotene for Cutaneous T-Cell Lymphoma—Central Hypothyroidism
Thyroid Replacement Therapy
Pharmacology
Clinical Use
Adverse Effects
Therapy for Retinoid- or Cyclosporine-Induced Hyperlipidemia
Lipoprotein Physiology and Pathophysiology
Statins (HMG-COA Reductase Inhibitors)
Pharmacology
Clinical Use
Fibric Acid Derivatives
Fenofibrate and Gemfibrozil
Pharmacology
Clinical Use
Adverse Effects
Ezetimibe
Vitamin D Therapy
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
40 – Miscellaneous Systemic Drugs
Introduction
Anticholinergic Agents—Glycopyrrolate and Oxybutynin
Attenuated Androgens—Danazol
Pharmacology
Clinical use
Off-Label Dermatologic Uses
Biotin
Clofazimine
Pharmacology
Mechanism of Action
Clinical use
Off-Label Dermatologic Uses
Adverse Effects
Colchicine
Pharmacology
Clinical Use
Off-Label Dermatologic Uses
Fumaric Acid Esters
Niacinamide
Pharmacology
Clinical Use
Nonsteroidal Anti-inflammatory Drugs
Pharmacology
Clinical Use
Penicillamine
Pharmacology
Clinical Use
Adverse Effects
Potassium Iodide
Pharmacology
Clinical Use
Off-Label Dermatologic Uses
Thalidomide
Pharmacology
Clinical Use
Us Food and Drug Administration-Approved Indication
Off-Label Dermatologic Uses—Well-Documented Benefits
Adverse Effects
Monitoring Guidelines
Vitamin E
Zinc Sulfate
Gabapentin and Pregabalin
Off-Label Uses
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
PART VIII Topical Drugs for Infectious Diseases
41 – Topical Antibacterial Agents
Introduction
Drugs Used for Wound Care and Minor Topical Bacterial Infections
Bacitracin
Pharmacology
Clinical Use
Polymyxin B
Pharmacology
Clinical Use
Neomycin
Pharmacology
Clinical Use
Mupirocin
Pharmacology
Clinical Use
Retapamulin
Pharmacology
Clinical Use
Ozenoxacin
Pharmacology
Clinical Use
Gentamicin
Silver Sulfadiazine
Iodoquinol
Drugs Used for Acne and Rosacea
Topical Antibacterial Resistance
Benzoyl Peroxide
Clinical Use
Clindamycin
Pharmacology
Clinical Use
Erythromycin
Pharmacology
Clinical Use
Metronidazole
Pharmacology
Clinical Use
Azelaic Acid
Pharmacology
Clinical Use
Dapsone
Pharmacology
Clinical Use
Sodium Sulfacetamide
Antiseptics
Triclosan
Chlorhexidine
Povidone-Iodine
References*
42 – Topical Antifungal Agents
Introduction
Polyenes
Nystatin
Pharmacology
Clinical Use
Azoles
Miconazole
Pharmacology
Clinical Use
Clotrimazole
Pharmacology
Clinical Use
Ketoconazole
Pharmacology
Clinical Use
Oxiconazole
Pharmacology
Clinical Use
Econazole
Pharmacology
Clinical Use
Sulconazole
Pharmacology
Clinical Use
Sertaconazole
Pharmacology
Clinical Use
Luliconazole
Pharmacology
Clinical Use
Efinaconazole
Pharmacology
Clinical Use
Allylamines and Benzylamines
Naftifine
Pharmacology
Clinical Use
Terbinafine
Pharmacology
Clinical Use
Butenafine
Pharmacology
Clinical Use
Other Topical Antifungals
Ciclopirox Olamine
Pharmacology
Clinical Use
Selenium Sulfide
Tavaborole
Pharmacology
Clinical Use
Comparative Studies
Dermatophytes
Candidiasis
Special Properties
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
43 – Topical and Intralesional Antiviral Agents
Introduction
Viricidal Drugs
Acyclovir
Pharmacology
Clinical Use
Penciclovir
Pharmacology
Clinical Use
Cidofovir
Pharmacology
Clinical Use
Foscarnet
Idoxuridine
Immune-Enhancing Drugs
Imiquimod
Pharmacology
Clinical Use
Off-Label Dermatologic Uses
Quadrivalent Human Papillomavirus Vaccine
Verruca Vulgaris (Off Label)
Mechanism of Action
Clinical Use
Interferon-α
Intralesional Immunotherapy
Mechanism of Action
Adverse Effects
Clinical Use
Cytodestructive Drugs
Bleomycin
Pharmacology
Clinical Use
Potassium Hydroxide
Mechanism of Action
Clinical Use
Hydrogen Peroxide
Mechanism of Action
Clinical Use
Podophyllin and Podofilox
Pharmacology
Clinical Use
Trichloroacetic Acid
Clinical Use
Cantharidin
Clinical Use
Salicylic Acid
5-Fluorouracil
Mechanism of Action
Contraindications and Adverse Effects
Clinical Use
Off-Label Dermatologic Use
Sinecathechin
Mechanism of Action
Contraindications and Adverse Events
Clinical Use
Off-Label Dermatologic Use
Bibliography: Important Reviews and Chapters
References*
44 – Topical Antiparasitic Agents
Introduction
Permethrin and Pyrethrins
Pharmacology
Mechanism of Action. Q44.1 Pyrethrin and pyrethroids inhibit closure of voltage-gated sodium channels, thereby inhibiting nerve …
Resistance. Permethrins preferentially bind to voltage-gated sodium channels at a site away from the pore when it is in an open …
Clinical Use
Indications
Scabies. Q44.2 Multiple compiled trials comparing permethrin 5% cream or lotion, topical ivermectin 1% lotion, and oral ivermect…
Pediculosis. Pyrethrins with piperonyl butoxide (Rid, A-200, Proto, R & C shampoo, End Lice) and permethrin 1% cream rinse (Nix)…
Permethrin 5% cream (Elimite) can also be used in the treatment of head and pubic lice, particularly when resistance to the 1% c…
Adverse Effects. There have been no reported adverse effects (AE) other than local irritation, which is common to all topical ap…
Pregnancy and Lactation Prescribing Status. These medications are thought to be safe to use in pregnancy and in breastfeeding wo…
It is not known whether permethrin is secreted in human milk; however, the manufacturers suggest that nursing should be disconti…
Ivermectin—Topical (Table 44.3)
Pharmacology
Clinical Use
Indications
Scabies. Topical ivermectin is not FDA-approved for the treatment of scabies. However, a 2018 Cochrane review comparing the effe…
Pediculosis. In 2012 the FDA approved ivermectin 0.5% lotion (Sklice) to treat pediculosis in individuals older than 6 months. I…
Adverse Effects. No serious systemic or toxic AE have been reported with topical ivermectin. The most common reactions are skin …
Pregnancy and Lactation Prescribing Status. Because there is minimal systemic absorption, topical ivermectin lotion is thought t…
Malathion (Table 44.4)
Pharmacology
Clinical Use
Indications
Pediculosis. Malathion 0.5% lotion (Ovide) is one of the most effective agents for treating pediculosis capitis in the United St…
Adverse Effects. No serious systemic AE have been reported with the topical application of malathion.17 Additionally, no signifi…
Pregnancy and Lactation Prescribing Status. Based on limited human data, malathion is not teratogenic and may be used in pregnan…
Clinical Comparisons. Q44.6 Numerous studies have proven that malathion has superior pediculicidal and ovicidal activity compare…
Spinosad (Table 44.5)
Pharmacology
Indications
Pregnancy and Lactation Prescribing Status
Crotamiton
Benzyl Benzoate
Precipitated Sulfur
Lindane
Melaleuca Alternifolia (Tea Tree) Oil
Nonpharmacologic Therapy for Head Lice
Miscellaneous Antiparasitic Agents
Albendazole
Pharmacology
Mechanism of Action. Q44.10 The medication works through binding the colchicine-sensitive cells of tubulin in the intestinal cel…
Clinical Use
Indications—Cutaneous Larva Migrans. Cryotherapy was once used as a primary treatment modality; however, this proved to be ineff…
Adverse Effects. When albendazole is used topically, AE are limited to local irritation and skin ulceration.41
Drug Interactions. There are no known drug interactions when albendazole is used topically
Pregnancy and Lactation Prescribing Status. The pregnancy prescribing safety information states that oral albendazole should be …
Bibliography: Important Reviews and Chapters
References*
IX Topical Immunomodulatory Drugs
45 –

Topical Corticosteroids
45 – Topical Corticosteroids
Introduction
Pharmacology
Estimating Topical Corticosteroid Potency
Pharmacokinetics
Mechanism of Action
Clinical Use
Indications
Adverse Effects—Systemic
Adverse Effects—Local
Therapeutic Guidelines
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
46 – Topical Retinoids
Introduction
Pharmacology
Structure
Mechanism of Action
Teratogenicity
All-Trans Retinol and All-Trans Retinoic Acid
Adapalene
Tazarotene
Bexarotene
Alitretinoin (9-Cis Retinoic Acid)
Clinical Use
Indications
Cosmeceuticals
Adverse Effects
Acknowledgment
Bibliography: Important Chapters and Reviews
References*
47 – Topical and Intralesional Chemotherapeutic Agents
Introduction
Topical Chemotherapeutic Agents
5-Fluorouracil
Pharmacology
Clinical Use
Mechlorethamine/Nitrogen Mustard
Pharmacology
Clinical Use
Adverse Effects
Therapeutic Guidelines
Carmustine/Bischlorethylnitrosourea
Pharmacology
Clinical Use
Therapeutic Guidelines
Intralesional Chemotherapeutic Agents
Vinblastine
Pharmacology
Clinical Use
Vincristine
Pharmacology
Clinical Use
Bleomycin
Pharmacology
Clinical Use
Bibliography: Important Reviews and Chapters
References*
48 – Topical Calcineurin Inhibitors
Introduction
Tacrolimus
Pharmacology
Clinical Use
Pimecrolimus
Pharmacology
Clinical Use
Acknowledgment
References*
49 – Topical Vitamin D3
Introduction
Pharmacology
Structure and Biosynthesis
Metabolism
Mechanism of Action
Vitamin D Analogs
Calcipotriene
Calcitriol
Tacalcitol
Other Vitamin D Analogs
Calcipotriene—Clinical Use
US Food and Drug Administration-Approved Indication—Psoriasis
Plaque Psoriasis. Calcipotriene is approved for the treatment of plaque-type psoriasis in adults. Early studies were all short t…
Intertriginous Psoriasis. In an open and uncontrolled study, patients with psoriasis in the axillary, inguinal, and anal regions…
Scalp Psoriasis. In a multicenter prospective observational cohort study, patients with scalp psoriasis were treated with calcip…
Nail Psoriasis. A controlled double-blind comparison of calcipotriene ointment with a combination of betamethasone dipropionate …
Pustular Psoriasis. Calcipotriene may be an effective treatment option for pustular psoriasis. One study showed improvement of g…
Psoriasis in Children. A prospective, double-blind, randomized controlled trial examining calcipotriene in children found no imp…
High-Dose Calcipotriene. Inpatients with severe psoriasis were treated with 200 g of calcipotriene ointment for 1 week, followed…
Calcipotriene Plus Betamethasone Dipropionate
Scalp Psoriasis. A scalp formulation of calcipotriene–betamethasone dipropionate developed for once-daily treatment of scalp pso…
Nail Psoriasis. In an open-label, uncontrolled study, patients with nail psoriasis treated with the two-compound product of calc…
Calcitriol
US Food and Drug Administration-Approved Indication—Psoriasis. Calcitriol is approved for the treatment of mild to moderate plaq…
Intertriginous Psoriasis. A double-blind, randomized controlled trial showed that calcitriol 3 μg/g was as well tolerated as tac…
Scalp and Nail Psoriasis. There have been no studies on the efficacy of calcitriol in scalp and nail psoriasis. However, there i…
Combination Use with Other Antipsoriasis Therapies
Ultraviolet B and Psoralen Plus Ultraviolet A. Multiple studies have demonstrated that a combination of a vitamin D analog and U…
Topical Corticosteroids. The combination of vitamin D3 analogs with TCS was discussed previously.51
Compatibility Study. Q49.8 When combining calcipotriene with another topical agent, the stability of each agent can be altered. …
Systemic Treatments. Q49.9 Because of potential toxicities with systemic therapies, calcipotriene has been combined with multipl…
Off-Label Uses
Disorders of Keratinization. Q49.10 Calcipotriene was applied to the skin of patients with congenital ichthyosis (including X-li…
Prurigo Nodularis. A randomized, prospective, double-blind, right-left comparative trial found that calcipotriol ointment was su…
Morphea. In a 3-month open-label study, patients with morphea or linear scleroderma were treated with calcipotriene under occlus…
Vitiligo. A placebo-controlled, double-blind study assessing whether the addition of topical calcipotriene to psoralen plus UVA …
Other Off-Label Uses. Case reports have documented improvement in multiple disorders with topical calcipotriene use. These inclu…
Adverse Effects
Hypercalcemia. Q49.11 The greatest concern with the use of topical vitamin D preparations is their potential to cause hypercalce…
Irritation. The application of calcipotriene can cause lesional and perilesional irritation. Irritation is self-limiting and res…
Photosensitivity. Q49.12 Mild photosensitivity has been reported in psoriatic patients treated with a combination of calcipotrie…
Allergic Contact Dermatitis. Q49.12 Evidence suggests that calcipotriene is both a weak contact allergen and a contact irritant….
Bibliography: Important Reviews and Chapters
References*
PART X Miscellaneous Topical Drugs
50 –

Sunscreens
50 – Sunscreens
Introduction
Sunscreen Options
Active Sunscreen Ingredients
Ultraviolet B Sunscreens
Ultraviolet A Sunscreens
Physical Blockers
Sunscreens Pending Approval
Clinical Use
Indications
Sun Protection Factor Level
Ultraviolet A Protection
Sunscreen Vehicles
Adverse Effects
Special Patient Group Instructions
Theoretical Inhibition of Vitamin D Synthesis
Sunless Tanners—Dihydroxyacetone
Summary
Bibliography: Important Reviews and Chapters
References*
51 – Therapeutic Shampoos
Introduction
Dermatoses Involving the Scalp
Historical Perspective
Pharmacology
Mechanism of Action
Systemic Absorption
Clinical Use
Contraindications
Adverse Effects
Safety in Pregnancy and Lactation
Safety in Children
Therapeutic Guidelines
General Considerations
Management Strategy
Role in Systemic Therapy
Drug Interactions
Therapeutic Monitoring
Summary
Bibliography: Important Reviews and Chapters
References*
Web References
52 – α-Hydroxy Acids
Introduction
Pharmacology
Structure
Mechanism of Action
Polyhydroxy Acids Effects
Clinical Use
Xerosis and Ichthyosis
Hyperpigmentation and Pigmented Lesions
Acne Vulgaris and Related Conditions
Psoriasis
Nail Disorders
Actinic Keratoses
α-Hydroxy Acid in Chemical Peels
Formulations and Bioavailability
Safety and Adverse Effects
Irritation and Pigmentary Changes
Photosensitivity
Herpes Simplex Infections
Summary
Bibliography: Important Reviews and Chapters
References*
53 – Chemical Peels
Introduction
Superficial Chemical Peels
α-Hydroxy Acids
β-Hydroxy Acids
Jessner’s Solution
Medium-Depth Chemical Peels
Combination Peels
Deep Chemical Peels
Clinical Use
Bibliography: Important Reviews and Chapters
References*
54 – Products for the Care of Chronic Wounds
Introduction
Wound Healing Physiology and Ideal Wound Healing Environment
General Approach to a Patient with Chronic Wounds
Wound History
Past Medical History
Past Surgical History
Medication History
Social History
Review of Systems
Physical Examination
Laboratory Evaluation
Venous Ulcer Disease
Compression Therapy for Venous Leg Ulcers
Wound Bed Preparation
Systemic and Surgical Treatments
Pentoxifylline
Surgical Therapy
Growth Factor Therapy
Bibliography: Important Reviews and Chapters
References*
55 – Agents Used for Treatment of Hyperkeratosis
Introduction
Salicylic Acid
Pharmacology
Mechanism of Action
Clinical Use
Adverse Effects
Sulfur
Pharmacology
Mechanism of Action
Clinical Use
Tar
Pharmacology
Clinical Use
Adverse Effects
Urea
Pharmacology
Mechanism of Action
Clinical Use
Dermatologic Uses
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
56 – Irritants and Allergens: When to Suspect Topical Therapeutic Agents
Introduction
Contact Dermatitis: the Concept
Allergic Contact Dermatitis
Irritant Contact Dermatitis
When to Suspect Contact Dermatitis
Regional Approach
Final Thoughts
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
57 – Miscellaneous Topical Agents
Introduction
Topical Antioxidants
Ascorbic Acid (Vitamin C)
Pharmacology
Clinical Use
Vitamin E
Pharmacology
Clinical Use
Selenium
Zinc
Aluminum Chloride
Pharmacology
Clinical Use
Ferric Subsulfate
Other Topical Agents
Phytonadione (Vitamin K1)
Pharmacology
Clinical Use
Minoxidil
Pharmacology
Clinical Use
Bimatoprost
Capsaicin
Anthralin
Pharmacology
Clinical Use
Off-Label Dermatologic Uses
Aloe Vera
Brimonidine
Pharmacology
Clinical Use
Off-Label Dermatologic Uses
Oxymetazoline
Pharmacology
Clinical Use
Hydrogen Peroxide
Bibliography: Important Reviews and Chapters
References*
PART XI Injectable and Mucosal Routes of Drug Administration
58 – Local Anesthetics
Introduction
Injectable Local Anesthetics
Lidocaine and Related Amide Anesthetics
Pharmacology
Mechanism of Action
Clinical Use
Off-Label Dermatologic Uses
Therapeutic Guidelines
Topical Anesthetics
Eutectic Lidocaine and Prilocaine
Pharmacology
Clinical Use
Off-label Dermatologic Uses
Topical Lidocaine
Benzocaine
Dyclonine
Coinjectable Vasoconstrictors
Epinephrine
Pharmacology
Clinical Use
Adverse Effects
Drug Interactions
Other Agents with Local Anesthetic Effects
Capsaicin
Clinical Use
Diphenhydramine
Bibliography: Important Reviews and Chapters
References*
59 – Injectable Dermal and Subcutaneous Fillers
Introduction
Categories of Dermal Fillers
Collagen
Hyaluronic Acid
Calcium Hydroxyapatite
Poly-L-Lactic Acid
Polymethylmethacrylate
Silicone
Autologous Human Fibroblasts
Fillers on the Horizon
Adverse Effects
Immediate Adverse Effects (0–2 Days)
Early Adverse Effects (3–14 Days)
Late Adverse Effects (15 Days–1 Year)
Delayed (>1 Year)
Acknowledgment
Bibliography: Important Reviews and Chapters
References*
60 – Botulinum Toxin Injections
Introduction and History
Pharmacology
Mechanism of Action
Clinical Use
Indications
Adverse Effects
Therapeutic Guidelines
Conclusions
Bibliography: Important Reviews and Chapters
References*
61 – Oral Mucosal Therapeutics
Introduction
Review of Common Terminology
Erosive Gingivostomatitis
Mouth Rinses
Topical Therapy
Corticosteroids
Steroid-Sparing Immunosuppressants
Topical Anesthetics
Intralesional Corticosteroids
Systemic Therapy
Herpetic Gingivostomatitis
Topical Therapy
Oral Candidiasis
Tips and Clinical Pearls—Oral Candidiasis
Topical Therapy
Systemic Therapy
Hairy Tongue
Topical Therapy
Recurrent Aphthous Stomatitis
Topical Therapy
Intralesional Corticosteroids
Systemic Therapy
Anti-inflammatory Agents
Immunobiologic Agents
Tips and Clinical Pearls—Anug
Topical Therapy
Systemic Therapy
Mucositis (Stomatitis)
Tips and Clinical Pearls—Mucositis
Topical Therapy
Systemic Therapy
Xerostomia
Tips and Clinical Pearls—Xerostomia
Topical Therapy
Anesthetics and coating agents
Antimicrobials
Anti-inflammatory agents
Systemic Therapy. Q61.10
Burning Mouth Syndrome
Topical Therapy
Systemic Therapy. Q61.11
PART XII Major Adverse Effects From Systemic Drugs
62 – Hepatotoxicity of Dermatologic Drug Therapy
Introduction
The Liver and Drug Metabolism
Hepatic Drug Metabolism
Polymorphisms
Mechanisms of Drug Hepatotoxicity
General Mechanisms Involved
Toxic Versus Idiosyncratic Reactions
Risk Factors for Drug Hepatotoxicity
General Risk Factors
Drug-Specific Risk Factors
Predictive Testing for Polymorphisms
Drug Information Dissemination Issues
Risk with Real World Drug Use
Potential Predictors of Hepatotoxicity
Classification Systems
Drug Etiologies
Common Dermatologic Drug Etiologies
Less Common Drug Etiologies
Diagnosis
Diagnostic Algorithm
Differential Diagnosis
Referral Criteria
Liver ‘Function’ Tests
Management
Background Issues
Management Options
Looking to the Future—Lessons from the Past
Bibliography: Important Reviews and Chapters
References*
63 – Hematologic Toxicity of Drug Therapy
Introduction
General Principles
Mechanisms of Hematologic Toxicities
Timing of Hematologic Toxicity
Prediction of Risk for Hematologic Toxicities
Agranulocytosis
Aplastic Anemia (Pancytopenia)
Thrombocytopenia
Neoplasia
Methotrexate
Azathioprine
Cyclophosphamide
Chlorambucil
Hydroxyurea
Interferons
Dapsone
Sulfonamides
Sulfasalazine
Trimethoprim-Sulfamethoxazole
Antimalarials
Colchicine
Gold and Penicillamine
Mycophenolate Mofetil
Rituximab
Miscellaneous Drugs
Treatment of Hematologic Toxicities
Guidelines for Drug Cessation and Rechallenge
Transfusion Criteria
Management of Agranulocytosis
Bibliography: Important Reviews and Chapters
References*
64 – Drug-Induced Malignancy
Introduction
Assessment of Drug Causation for Malignancy Induction
General Principles and a Drug Causation Determination Algorithm
Entire Population Versus Disease-Specific Databases
Comparisons with Drug-Specific Databases
General Principles of Carcinogenesis
Multistep Model of Carcinogenesis
Oncogenes and Tumor Suppressor Genes
Review of Malignancy Risk with Organ Transplantation
Malignancies Having Increased Risk with Organ Transplantation
Viral Cofactors
Rheumatoid Arthritis
Inflammatory Bowel Disease
Multiple Sclerosis
Psoriasis
Specific Drugs Used in Dermatology and their Potential Risk for Malignancy
Alkylating Agents—Cyclophosphamide and Chlorambucil
Antimetabolites—Azathioprine and Methotrexate
Calcineurin Inhibitors—Cyclosporine
Biologic Therapies for Psoriasis—Tumor Necrosis Factor Inhibitors
Psoralen and Ultraviolet a Photochemotherapy Versus Organ Transplantation Squamous Cell Carcinoma and Melanoma Risk
Prevention and Detection of Possible Malignancies
Cyclophosphamide
Psoralen and Ultraviolet A and Organ Transplantation Patients
Biologic Therapies and Cyclosporine
The Bottom Line
Bibliography: Important Reviews and Chapters
References*
65 – Dermatologic Drugs During Pregnancy and Lactation
Introduction
General Principles
Sources for Information—Drug Use in Pregnancy and Lactation
Risk Related to Time of Drug Consumption
Timing—Before Conception
Timing—First Trimester
Timing—Second Trimester
Timing—Third Trimester and Preterm
Timing—During Lactation
Guide for Specific Drug Use
Summary
References*
Web References
66 – Drug Interactions
Introduction
General Principles of Drug Interactions
Potential Consequences of Drug–Drug Interactions
Absorption
Distribution
P-Glycoprotein (Fig. 66.2)
Metabolism
Excretion
Cytochrome P-450–Based Drug Interactions
Cytochrome P-450 Enzymes Background Information
Induction of Cytochrome P-450 3A4
Inhibition of CYP3A4
Drug Interaction Risks by Drug Category
Azole Antifungals
Allylamine Antifungals
Azathioprine
Colchicine
Cyclosporine
Grapefruit Juice
Herbal Remedies
HMG CoA Reductase Inhibitors
Macrolide Antibiotics
Methotrexate
Hormonal Contraceptives
Pimozide
Warfarin
Genetic Polymorphisms
Antagonistic Effect
Synergistic Effects
Do All Drugs in a Given Class Behave in a Similar Manner?
Summary
Bibliography: Important Reviews and Chapters
References*
67 – Cutaneous Drug Reactions With Systemic Features
Introduction
Pseudolymphoma
Anticonvulsants
Q67.2 DRESS has been commonly associated with the aromatic anticonvulsants, namely phenytoin, phenobarbital, oxcarbazepine, and …
Sulfonamide Antibiotics
Dapsone
Minocycline
Other Drugs
Differential Diagnosis
Treatment
Treatment
Drug-Induced Lupus
Minocycline
Antitumor Necrosis Factor Agents
General Discussion
PART XIII Special Pharmacology and Therapeutics Topics
68 –

Informed Consent and Risk
Management
68 – Informed Consent and Risk Management
Introduction
Historical Perspective
Ethical Perspective
Basic Legal Principles
Components of Informed Consent
Systemic Drugs and Informed Consent
Optimizing Patient Understanding
Medicolegal Risk Management
Dermatology Malpractice
Summary
References*
Web References
69 – Compounding in Dermatology
Introduction
The Compounding Triad
The Patient
The Pharmacist
The Physician
Developing a Stable Compounding Formula
Clinical Evidence
Feasibility
Properly Write the Prescription
Compounding Formula Instructions
Patient Instructions for use of the Compound
Monitor the Patient
Evaluation of the Treatment
Documentation
New Mixing Technology Used to Prepare Topical Compounded Preparations12
Common Topical Compounded Preparations
Summary
References*
70 – Dermatologic Drug Therapy in Children
Introduction
Pediatric Pearls
Topical Corticosteroids
Systemic Corticosteroids
Beta Blockers
Systemic Retinoids
Isotretinoin
Acitretin
Systemic Immunosuppressive Therapies
Methotrexate
Azathioprine
Cyclosporine
Biologic Therapies
Tumor Necrosis Factor Inhibitors in Children
Etanercept
Adalimumab
Infliximab
Acknowledgement
Bibliography: Important Reviews and Chapters
References*
Appendix
I – Core Questions for Understanding Systemic Dermatologic Drugs
Section 1—Pharmacology Basic Science
Section 2—Clinical Use
Section 3—Severe Adverse Effects
Section 4. Less Serious Adverse Effects
Section 5 – Drug Safety Monitoring
Section 6—Drug Interactions (see also Appendix 2)
Section 7—Miscellaneous Issues
Appendix
II – The Most Potentially Serious Drug Interactions
General Principles for Creating This Appendix
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Z

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