1. TOPICAL ANTIFUNGALS
1.1. IMIDAZOLES
1.1.1. alters cell membrane permeability
1.1.2. Clotrimazole (Lotrimin)
1.1.2.1. tx: candidiasis
1.1.2.1.1. 1% - topical/vaginal/troche x 1week
1.1.2.2. OTC
1.1.2.3. C/I lomitapide, PREGNANCY B
1.1.2.4. AE: abnormal LFT's
1.1.3. Econazole (SPectazole)
1.1.3.1. tinea & candidasis
1.1.3.2. RX 1% cream qDay x 2wks
1.1.3.2.1. 4 weeks for tinea pedis
1.1.3.3. AE: erythema
1.1.3.4. PREGNANCY C
1.1.4. Ketoconazole (Nizoral)
1.1.4.1. 1% & 2% foam/cream/shampoo
1.1.4.2. seborrheic dermatitis: q12hrs x 2 weeks
1.1.4.3. tinea versicolor: shampoo 2x weekly x 4 weeks
1.1.4.4. tinea: qDay x 2 weeks (6 for pedis)
1.1.4.5. AE: irritation, itching, stinging, alopecia,
1.1.4.6. OTC/RX(2%)
1.1.5. Sertaconazole (Ertaczo)
1.1.5.1. tinea pedis: 2% cream BID x 4 weeks
1.1.5.2. AE: contact dermatitis, dry skin, burning, erythema
1.1.5.3. most lipophilic aole - s.corneum
1.2. ALLYLAMINES
1.2.1. interferes with sterol biosynthesis
1.2.2. Naftifine (Naftin
1.2.2.1. deratophytoses
1.2.2.1.1. 1% cream or gel BID
1.2.2.1.2. 2% cream or gel qDay
1.2.2.2. AE: burning, tenderness, dryness, erythema, itching
1.2.3. Terbinafine (Lamisil)
1.2.3.1. NOT for renal/hepatic
1.2.3.2. AE: HA
1.2.3.3. PO for oncymycosis
1.2.3.4. TOPICAL: 1% cream, solution, spray
1.2.3.5. 10-100x more potent than nafifine
1.3. BENZYLAMINES
1.3.1. Butenafind (Mentax)
1.3.1.1. tinea pedis: 1% cream/gel/solution BID x 1 week (RX)
1.3.1.2. tinea corporis/cruris: cream/gel/solution: qDay x 1 week
1.3.1.3. AE: burning, stinging
1.3.1.4. MOA: inhibits intermediary in synthesis of ergosterol
1.4. POLYENES
1.4.1. Nystatin
1.4.1.1. AE: N/V/D, contact dermatitis, SJS,
1.4.1.2. MOA: binds to sterols altering permeability
1.4.1.3. covers candida
1.4.1.4. 100000 USP units/g cream, ointment, powder, oral, lozenges, vaginal tablets (RX)
1.5. HYDROXYPYRIDINE
1.5.1. Ciclopirox Olamine (Loprox, Penlac)
1.5.1.1. onychomycosis - qDay lacquer
1.5.1.2. tinea pedis/corpors - cream/gel BID x 4weeks
1.5.1.3. tinea cruris/versicolor, candidasis - cream BID x 4 weeks
1.5.1.4. seborrheic dermatitis of scalp - gel/shampoo BID
1.5.1.5. AE: erythema, itching, burning, dry skin
1.5.1.6. MOA: inhibits intermediary in synthesis of ergosterol
1.5.1.7. .77% & 1% cream, gel, shampoo, lotion, 8% nail lacquer (RX)
1.6. BID X 1-4 weeks
1.7. AE: burning, stinging, pruritis, edema, erythema, blistering, peeling, hives
2. ANTI-ACNE
2.1. RETINOIC ACID DERIVATIVES
2.1.1. MOA: desquamation, anti-inflammatory, prevents clogging
2.1.2. AE: dryness, burning, erythema, photosensitivity, temporary worsening
2.1.3. C/I UV exposure, waxing, nursing mothers, PREGNANCY X
2.1.4. Isotretinoin (Accutaine)
2.1.4.1. .5-1mg/kg/day PO divided BID for 15-20 wks
2.1.4.2. increase up to 2mg/kg/day
2.1.4.3. for severe cystic acne that is unresponsive
2.1.4.3.1. rosacea, hidradenitis supprativa
2.1.4.4. PREGNANCY X
2.1.4.4.1. iPLEDGE - 2 types of BC
2.1.4.5. C/I tetracyclines, St. John's wort, Vit A, progestin-only birth control, avoid blood donation
2.1.4.6. AE: birth defects, depression, dryness, elevated LFT/Chol/TRIG, low WBC, HA, blurred vision, joint/muscle aches, colitis, diarrhea
2.1.5. Tretinoin (Retin A)
2.1.5.1. pea-sized qHS
2.1.5.2. .025%, .05%, .1% lotion/gel/cream
2.1.6. Tazarotene (Tazorac)
2.1.6.1. cream/gel/foam .05%/.1%
2.1.6.2. also for psoriasis
2.1.7. Adapalene (Differin)
2.1.7.1. thin film to face qPM after washing
2.1.7.2. sensitive skin patients cream/lotion/gel .1%/.03%
2.2. KERATOLYTICS
2.2.1. MOA: releases active O2 (anareobic in pores) + desquamative effect
2.2.2. mild to moderate inflammatory acne
2.2.3. Pregnancy C
2.2.4. Benzoyl Peroxide (Benzac)
2.2.4.1. apply qDay, inc to BID/TID
2.2.4.2. AE: contact dermatitis, erythema, peeling, dryness. bleaches hair and clothes
2.2.4.3. Available OTC
2.2.5. Salicylic Acid (Aveeno)
2.2.5.1. BID cleanser/scrub/foam/gel/wipes
2.2.5.2. stinging, burning, desquamation
2.2.5.3. C/I moles, birthmarks, eyes, warts
2.3. AZELAIC ACID
2.3.1. BID
2.3.2. 15% - finacea
2.3.3. 20% - Azelex
2.3.4. AE: burning, itching, scaling, erythema
2.3.5. MOA: antibacterial, normalizes keratinization
2.3.6. for inflammatory acne, rosacea, melasma, keratosis pilaris
2.3.7. PREGNANCY B
3. TOPICAL ANTI-VIRAL
3.1. Acyclovir (Zovirax)
3.1.1. HSV
3.1.1.1. 5% cream (RX)
3.1.1.2. q3hrs 6cx a day x 1 week
3.1.2. AE: burning, stinging, discomfort, pain at application site
3.1.3. XERESE: acyclovir + hydrocortisone 5%/1%
3.1.4. PREGNANCY C
3.1.5. MOA: interferes with DNA polymerase - chain termination
3.2. Penciclovir (Denavir)
3.2.1. HSV1/HSV2/VZV/EBV
3.2.1.1. 1% cream RX
3.2.1.2. q2hrs 6x a day x 4 days
3.2.2. AE: burning, stinging, discomfort, mild pain
3.2.3. MOA: triphosphate metabolite inhibits HSV
3.3. Docosanol (Abreva)
3.3.1. 10% cream 5x a day OTC
3.3.2. AE: burning, pruritis, xerosis, acne, erythema, edema
3.3.3. for oral-facial HSV
3.3.4. MOA: Inhibits fusion of virus envelope
4. ANTI-ITCH
4.1. MOA: H1 blocker
4.2. Diphenhydramine (Benadryl)
4.2.1. 1-2% topically, do not exceed 3-4x daily
4.2.2. AE: rash, hives, photosensitivity
4.2.3. C/I: infants, breastfeeding
4.2.4. 1st gen
4.3. Lortadine (Claritin)
4.3.1. 10mg PO qDay, do not exceed 10mg qDay
4.3.2. AE: HA
4.3.3. 2nd Generation
4.3.4. for allergic rhinitis, urticaria, itching of the skin
4.3.5. C/I severe hepatic dysfunction
4.4. Fexofenadine (Allergra)
4.4.1. 180mg PO qDay or 60mg PO BID
4.4.2. C/I grapefruit, renal dysfunction, erythromycin, ketoconazole PREGNANCY C
4.4.3. AE: vomiting
4.4.4. 2nd generation
4.4.5. for allergic rhinitis, urticaria, itching
4.5. Cetirizine (Zyrtec)
4.5.1. 5-10mg PO qDay, do not exceed 10mg
4.5.2. AE: drowsiness, HA
4.5.3. 2nd generation
4.5.4. for allergic rhinitis, urticaria, skin picking
4.5.5. PREGNANCY B
4.6. Cyprohepatidine (Periactin)
4.6.1. 4mg PO q8hr
4.6.1.1. maintenance: 4-20mg/day
4.6.1.2. up to 32mg/day
4.6.2. C/I metyraone, selegiline, infants, nursing,
4.6.3. AE: CNS depression, weakness, tachy, hypotension, N/V/D, eczema, itching blurred vision
4.7. Hydroxyzine (Vistaril)
4.7.1. 10-25mg PO TID-QID
4.7.2. for allergic rhinitis, urticaria, anxiolytic
4.7.3. AE: drowsiness, respiratory depression
4.7.4. C/I 1st trimester
4.7.4.1. Caution in HTN, glaucoma, BPH, ETOH
4.7.5. 1st Generation
5. IMMUNOMODULATORS
5.1. TACROLIMUS (PROTOPIC) & PIMECROIMUS (EIDEL)
5.1.1. MOA: inhibits phosphatase calcineurin
5.1.2. Tacrolimus - .03% 2-15y/o, .1% 16+
5.1.3. Pimecrolimus 1% BID x 6 weeks
5.1.4. for eczema, seborrheic dermatitis, lichen planus, vitiligo, psoriasis
5.1.5. C/I avoid HSV, dermatitis, herpetiformis, HSV, immunosuppression photosensitivity
5.1.6. AE: burning, irritiation, itching, erythema
5.2. IMIQUIMOD (ALDARA, ZYCLARA)
5.2.1. MOA: immumodulator binding to toll receptor 7
5.2.2. 5% or 3.75% cream
5.2.3. for HPV (anogenital), actinic keratosis, BCC, bowens, warts, keloids, lentigo maligna
5.2.4. AE: erythema, ulceration, edema, scaling, flu-like
5.2.5. PREGNANCY B
6. TOPICAL ANTI-MITOTIC
6.1. FLUOROURACIL (EFFUDEX)
6.1.1. MOA: inhibits RNA processing
6.1.2. for AK, periungal psoriasis, condyloma, Bowen's, DSAP
6.1.3. .5-5% QD 2-4weeks
6.1.4. C/I PREGNANCY X
6.1.5. AE: painful erythema, erosions, necrosis of lesions
6.2. PICATO (INGENOL MEBUTATE)
6.2.1. .015%-.05% gel
6.2.2. MOA: induces cell death
6.2.3. .015% gel for scalp/face x 3 days
6.2.4. .05% gel for body, arms, legs x 2 days
6.2.5. keep in refrigeratior
6.2.6. PREGNANCY C
6.2.7. AE: localized irritation and erythema
7. PHOTOTHERAPY
7.1. narrowband UVB (311-313nm)
7.1.1. for chronic eczema, psoriasis, vitiligo, CTCL, pruritis,
7.1.2. initial exposure: 100mJ
7.1.2.1. increase by 20-30J per tx
7.1.2.2. prior to tx: moisturizing cream will increase the effect of treatment
7.2. slows multiplication of skin cells, alters function of immune cells, darkening and thickening of skin
7.3. AE: erythema, xerosis, pruritis, blistering, HSV, photoaging, eye damage, cataracts, skin cancers
7.4. broadband UVB for psoriasis
7.4.1. psoriasis, eczema
7.4.2. poor penetration (not for palms and soles)
7.4.3. used in past with tar
7.5. PUVA
7.5.1. Psoralens - photo chemotherapy with psoriasis
7.5.2. inflammatory response that manifests as a delayed phototoxic erythema
7.5.3. AE: N/V, redness, swelling, blisters, liver damage, photoaging, AK, skin cancer, eye damage, cataracts
8. WOUND DRESSINGS
8.1. Substitutes the lost native epithelium, provides optimal environment for healing, absorb fluids, provide pressure, decrease pain
8.2. LAYERED
8.2.1. pressure vs non pressure
8.2.2. contact layer, absorbent layer, wrap layer
8.2.3. ex) telfa, cotton gauze, cover-roll
8.3. POLYMER FILMS
8.3.1. Thin, elastic self-adhesive transparent sheets
8.3.2. ex) tegaderm
8.3.3. for uncontaminated superficial wound, iv sites, skin tears, ulcers, laser wounds, mohs
8.3.4. DISADVANTAGES: difficult to handle, can adhere to wound bed, non-absorbent, bacteria accumulation
8.4. POLYMER FOAMS
8.4.1. Semi-occlusive/semi-permeable hydrophilic foam with hydrophobic backing
8.4.2. most are non-adherent and require secondary dressing
8.4.3. for chronic wounds, dermabrasion, mohs, burns
8.4.4. very absorbent, prevents leakage, contours to wound
8.4.5. frequent changing required, cannot use on dry wounds, can have a drying effect.
8.4.6. ex) reston, cutinova, lyofoam, flexzan, biopatch, crafoam, biatain
8.5. HDRYOGELS
8.5.1. 96% water
8.5.2. cooling, soothing effect, semi-permeable, semitransparent, highly absorptive
8.5.3. for dermabrasion, ulcers, burns, chemical peels,
8.5.4. in sheets, gels, impregnanted dressings
8.6. ALGINATES
8.6.1. natural complex polysaccharide from algae or kelp
8.6.2. helps with exchange of ions in wound bed
8.6.3. soluble sodium gel provides moist environement
8.6.4. hemostatic dressings, gels,
8.6.5. for highly exudative wounds, burns, mohs, decubiti and chronic ulcers
8.7. HYROCOLLOIDS
8.7.1. for burns, dermabrasion, lacerations, ulcers, bullous disorders,
8.7.2. sheets (duoderm) cuts to shape of wound, self adherent, waterproof
8.7.3. beads - gel formed prevents dressing adherence
8.7.4. can cause maceration of surrounding skin, leakage of excessive tissue exudate, yellow-brown smelly gel around wound
8.8. LEG ULCER DRESSINGS
8.8.1. need moisture retention, must be occlusive and compressing (30-40mmHg)
8.8.2. ex) polymer films & foams, hydrogels, alginates, hydrocolloids
8.8.3. Compression: Unna boot - cotton bandage impregnanted with zinc oxide, gelatin and glycerine paste
8.8.3.1. step 1) base coat - white petrolatum
8.8.3.2. step 2) paste dressing - zinc oxide, gelocast, tenderwrap, primer
8.8.3.3. step 3) elastic compression bandage - coban, ace wrap,
8.9. HYALURONIC ACID ESTER DRESSING
8.9.1. HYAFF - cell carrier of cultured keratinocytes - functions like human epidermis
8.9.2. used on exudative wounds and forms a thick gel that lasts 3 days, degrades and release HA into wound
8.9.3. in sheets and ribbons
8.10. LIVING SKIN DRESSINGS
8.10.1. for burn patients or surgical wounds
8.10.2. immediate epithelialization reduces pain
8.10.3. very expensive - applied under sterile conditions
8.11. WET DRESSINGS
8.11.1. for imflamed skin that are oozing, blistering, crusting, infection
8.11.2. apply cortisone cream or moisturizer and cover in wet disposable towels and wrap with crepe bandages
8.11.3. Burows/Domeboros solution
8.11.3.1. vinegar and water solution
8.11.4. Wet to dry dressings restricted to heavily necrotic wounds.
8.11.4.1. removes healthy tissue - non selective
9. TOPICAL STEROIDS
9.1. AE: Skin atrophy, striae, burning, hypopigmentation, hypertrichosis, folliculitis,
9.2. C/I viral, fungal tubercular lesions & eyes, hypersensitivity (Pregnancy C)
9.3. MOA: anti-inflammatory, vasoconstriction, anti-pruritic
9.4. FTU - 1/hand, 3/arm, 6/leg, 7/back, 2/foot
9.5. BID X 2 WEEKS, 1 week off + occlusion
9.6. Clobetasol propionate (Clobex)
9.6.1. For dermatoses
9.6.2. cream/foam/shampoo/emollient/lotion
9.6.3. GROUP 1 .05%
9.7. Halobetasol propionate (Ultravate)
9.7.1. inflammed and itchy deramtoses
9.7.2. GROUP 1 .05%
9.8. Fluocinonide (Lidex)
9.8.1. thin layer qDay or BID
9.8.2. for psoriasis, atopic dermatitis,
9.8.3. GROUP 2 .05%
9.9. Triamcinolone (Kenalog)
9.9.1. topical for infalmmatory
9.9.2. cream/ointment/spray
9.9.3. apply BID-QID pRN
9.9.3.1. dental paste for oral
9.9.4. GROUP 4/5 .1%
9.10. Betamethasone
9.10.1. intrabursa/intra-articular/intradermal
9.10.1.1. .25-2mL injection
9.10.2. GROUP 2 .05%
9.11. Hydrocortisone
9.11.1. apply sparingly qDay or BID +/- occlusive dressing
9.11.2. GROUP 5/7
10. PSORIASIS
10.1. Cyclosporine A
10.1.1. severe plaque psoriasis last resort
10.1.1.1. NEVER USED
10.1.2. C/I amphotericin B, -statins, mifepristone, neomycin PO,uncontrolled HTN, kidney dysfunction, malignancy
10.1.3. AE: tremor, nephrotox, HTN, infx, HA, hirsutism
10.1.3.1. BB: immunosuppression,
10.1.4. MOA: calcineurin inhibitor - immune suppression
10.2. Methotrexate
10.2.1. severe psoriasis last resort
10.2.1.1. PO/IV/IM 20mg 1 X WEEK
10.2.1.2. + 1g folic acid
10.2.1.3. max 30g/week
10.2.2. C/I LIVE VACCINES, Pregnancy X
10.2.3. AE: reddening of skin, hyperuricemia, glossitis, gingivitis, N/V/D, anorexia, mucositis
10.2.3.1. BB: immunosuppresion
10.2.4. MOA: inhibits dihydrofolic acid reductase - blocks DNA synthesis
10.3. Fumaric Acid (Fumaderm)
10.4. Hydroxyurea (Droxia, Hydrea)
10.4.1. off-label for psoriasis
10.4.1.1. 1000-1500 mg/day PO qDay-BID
10.4.2. C/I Live vaccines
10.4.3. AE: N/V/D/C, myelosuppression, hyperuricemia, renal failure, rash, hyperpigmentation
10.4.3.1. BB: myelosuppression
10.4.4. MOA: DNA synthesis inhibition
10.5. Thioguanine (Tabloid)
10.6. Sulfasalazine
10.6.1. MOA: disease modifying antirheumatic drug
10.6.2. for inflammatory bowel disease, rheumatoid arthritis, psoriatic arthritis
10.6.3. C/I intestinal or urinary obstruction, porphyria, hypersensitive to sulfasalazine
10.6.4. NEVER USED FOR PSORIASIS
10.7. Acitretin (Soriatane)
10.7.1. 2nd generation retinoid
10.7.2. MOA: reduce epidermal hyperplasia, slowing of cell reproduction
10.7.3. similar to isotretinoin
10.7.4. used for menopausal women with psoriasis
10.7.5. need to wait 3 years before conceiving or donating blood
10.8. Apremilast (Otezla)
10.8.1. MOA: inhibits PDE4
10.8.2. for psoriasis and psoriatic arthritis
10.8.3. 30mg BID (titrate dose)
10.8.4. AE: weight loss, HA, depression, GI distress
10.8.5. Good option for people who don't want biologics
10.9. Calcipotriol (Dovonex)
10.9.1. MOA: increases differentiation and inhibits proliferation of keratinocytes
10.9.2. .005% cream BID
10.9.3. AE: skin irritation,
10.10. Calcitriol (Vectical)
10.10.1. MOA: increases differentiation & inhibits proliferation of keratinocytes
10.10.2. 3mcg/g ointment BID
10.10.2.1. MAX 200g/wk
10.10.3. AE: pruritis, hypercalcemia
10.11. Calcipotriene & betamethasone diproprionate (Taclonex)
10.11.1. .005% & .064% QD x 1 month ointment
10.11.2. MOA: synthetic VD3 analogue
10.11.3. AE: pruritus and scaly rash
11. ANTIBIOTICS
11.1. TOPICAL SKIN INFECTIONS
11.1.1. Gentamycin (Garamycin)
11.1.1.1. .1% ointment or cream TID-QID
11.1.1.2. MOA: 30S binding
11.1.1.3. for superficial skin infections
11.1.1.4. AE: erythema, pruritis, edema, photosensitivity, resistant Pseudomonas, PREGNANCY C
11.1.2. Neomycin (Myciguent)
11.1.2.1. .5% ointment or cream QD-TID
11.1.2.1.1. DO NOT USE
11.1.2.2. MOA: binds to 30S
11.1.2.3. for superfical infections, minor scrapes burns and cuts
11.1.2.4. C/I P. Aeruginosa
11.1.2.5. AE: 15% contact dermatitis, pruritis, erythema, edema, PREGNANCY C
11.1.3. Bacitracin (Baciquent)
11.1.3.1. 400-500u/g ointment TID
11.1.3.2. MOA: cell wall synthesis inhibitor
11.1.3.3. for superficial skin infections
11.1.3.4. C/I hypersensitivity
11.1.3.5. AE: irritant and allergic contact dermatitis, PREGNANCY C
11.1.4. Mupirocin (Bactroban)
11.1.4.1. TID 2% ointment or cream or nasal
11.1.4.2. S. Aureus
11.1.4.3. for superficial skin infections (MRSA)
11.1.4.3.1. furuncle, impetego, open wounds
11.1.4.4. AE: burning, stinging, tenderness, pain pruritis, PREGNANCY B
11.1.5. Retapamulin (Altabax)
11.1.5.1. MOA: inhibits bacterial protein synthesis (50S bind)
11.1.5.2. 1% ointment BID x 5 days
11.1.5.3. 9 months and older
11.1.5.4. covers S. Aureus + S. Pyogenes
11.1.5.5. for impetigo, superficial infx
11.1.5.6. AE: dermatiis, burning, itching, redness, swelling, blistering, oozing, PREGNANCY B
11.2. COMBINATIONS
11.2.1. Polymyxin B Combos
11.2.1.1. polysporin = bacitracin + polymyxin B
11.2.1.2. Neosporin = neomycin + Polymyxin B/ Bacitracin
11.2.1.3. MOA: interacts with the phospholipids of bacterial cell membranes
11.2.1.4. QD-TID, 5000-10000u/g ointment
11.2.1.5. for superficial skin infections
11.2.1.6. PREGNANCY C
11.3. TOPICALS
11.3.1. Clindamycin
11.3.1.1. for mild-mod inflammatory acne & superficial infections
11.3.1.2. QID-BID 1% gel, lotion, solution, pledgets, foam
11.3.1.2.1. +/- BPO benzaclin
11.3.1.3. MOA: inhibits protein synthesis (50S bind)
11.3.1.4. C/I hypersensitivity, eteritis, UC, abx
11.3.1.5. PREGNANCY B
11.3.1.6. AE: erythema, burning, stinging, pruritis, peeling, folliculits (-), pseudomembranous colitis
11.3.2. Sodium Sulfacetamide
11.3.2.1. 10% lotion QD-BID
11.3.2.2. MOA: inhibits nucleic acid and protein synthesis
11.3.2.3. mild-mod inflammatory acne or rosacea
11.3.2.4. C/I hypersensitivity
11.3.2.5. NOT first line
11.3.2.6. AE: xeroisis, pruritis, cross reaction, PREGNANCY C
11.3.3. Erythromycin (Akne-Mycin)
11.3.3.1. 1.5-2% solution,gel, pledgets, ointment BID
11.3.3.1.1. +/- BPO benzamycin
11.3.3.2. mild to moderate inflammatory acne
11.3.3.3. C/I hypersensitivity
11.3.3.4. PREGNANCY B
11.3.3.5. AE: erythema, burning, pruritus, peeling
11.3.3.6. MOA: inhibits protein synthesis (50S bind)
11.4. ORAL
11.4.1. Minocycline (Solodyn)
11.4.1.1. most lipid-soluable tetracycline
11.4.1.2. AE: HA, vertigo, SLE, photosensitivity, teeth staining
11.4.1.3. C/I children under 8, PREGNANCY D,
11.4.1.4. for acne, rosacea, lyme,
11.4.2. Tetracycline (Sumycin, Minocin)
11.4.2.1. for acne, rosacea, lyme
11.4.2.2. AE: photosensitivity, staining of teeth
11.4.2.3. C/I kids under 8, PREGNANCY D
12. SEBORRHEA
12.1. Pyrithione
12.1.1. shampoo
12.1.2. AE: stinging, burning, desquamation
12.1.3. MOA: fungistatic & bacteriostatic
12.1.4. head and shoulders
12.2. Selenium Sulfide (Selsun Blue)
12.2.1. tinea versicolor - 2.5% lotion/shampoo qDay x 1 week
12.2.2. seborrhea - 5-10mL shampoo BID x 2weeks
12.2.3. AE: stinging, burning, lethargy, alopecia, termor
12.2.4. MOA: cytostatic on epidermis
12.3. Ketoconazole (Nizoral)
12.3.1. 200-400mg/day PO
12.3.2. C/I -zosin, -ides, simvastatin, quinidine, procainamide, methadone, isoniazid, indapamide
12.3.3. AE: N/V, itching, abdominal pain
12.3.4. BB: hepatotoxicity, QT prolongation
12.3.5. MOA: inhibits cell membrane formation
12.4. Sulfanilamide
12.4.1. candida vulvovaginitis
12.4.1.1. 1 applicator (6g) intravaginal qD-BID x 30 days
12.4.2. C/I 3rd trimester
13. ROSACEA
13.1. Azelaic Acid (Azelex)
13.1.1. massage thin layer on face q12hrs
13.1.2. AE: burning, stinging, tingling
13.1.3. C/I avoid rosacea tirggers,
13.1.4. MOA: inhibits growth of bacteria by inhibiting protein synthesis
13.2. Metroniadazole (flagyl)
13.2.1. .75%-1% gel, cream lotion QD-BID
13.2.2. MOA: DNA breaking + anti-oxidant/inflammation
13.2.3. mild-moderate inflammatory acne/roscea
13.2.4. C/I hypersensitivity
13.2.5. AE: watery eyes, metallic taste, numbness, PREGNANCY B