.
1
yCorticosteroids .. 2495y Hydrocortisone (eczematous dermatoses)
2
Corticosteroidy y 4
(hexane 3 pentane 1 )
3
Corticosteroidy (Ring structure) (Side chain)
4
Corticosteroidy y yy
5
Structure of CorticosteroidsTriamcinolone acetonide Betamethasone dipropionate
6
7Mechanism of action
8
Pharmacologyy (Anti-inflammatory effects)y (Immunosuppressive effects)y (Antiproliferative
effects) : fibroblasts (collagen and ground substances)
9
Pharmacologyy (Vasoconstriction)
histamine, bradykinins & prostaglandins
10
Pharmacologyy (Vasoconstriction)
Corticosteroids
vasoconstrictor assay vasoconstriction test
Corticosteroids 11
vasoconstrictor assayy 5 mg
9 12 y infrared reflection photometers /
thermal conductivity / laser doppler velocimetry
y metabolism 12
y 7
( 1 7 )y 4 mild,
moderate, very potent, super potent
13
Class 1 superpotent Betamethasone
dipropionate 0.05% Clobetasolpropionate 0.05%
Diprotopointment/gel/lotion Dermovate cream
Class 2 potent, upper mild strength
Desoximetasone0.25% Mometasonefuroate 0.1%
Topicort cream
Elomet ointment
Class 3 potent,upper mild strength
Betamethasonevalerate 0.1
14
Class 4 mild strength Fluocinolone
acetonide 0.025% Mometasonefuroate 0.1% Prednicabate 0.1%
Synalar ointment
Elometcream/lotion Dermatop ointment
Class 5 lower mild strength
Triamcinoloneacetonide 0.1%
15
Class 6 mild strength Triamcinolone
acetonide 0.02%Class 7 least strength
Hydrocortisone 0.5,1,2.5% Prednisolone 0.5%
16
Corticosteroids (chemical characteristics)9Fluticasone propionate : local
adverse effect 9Mometasone furoate :
17
Corticosteroids (vehicles)9corticosteroid 9
(ointment) (cream) (lotion)
18
Corticosteroids (vehicles) : (ointment)9 (preservative) : 9 ( lichenification) 9
19
Corticosteroids (vehicles) : (cream)9 (intertriginous area)
20
Corticosteroids (vehicles) : (lotion) (gel) (solution)9 9 alcohol propylene
glycol / :
21
Corticosteroids (potency)9class 6-7 or low potency 9 class 2-5
22
Corticosteroids9 corticosteroids 99 1
23
Corticosteroids9 atopic dermatitis 9 2 10
24
Corticosteroids9 dyshidrosis lichen simplex chronicus 9 :
25
Corticosteroids9 / 300 potency 9 potency
salicylic acid (occlusion)
26
1. / 2.
3.
4. 5. / 6. /7. / 8. / 9. 10.
27
0.1 % Triamcinolone acetonide cream
0.1 % Triamcinolone acetonide lotion
2
28
0.1 % Triamcinolone acetonide cream
0.1 % Triamcinolone acetonide lotion
29
0.1 % Betamethasone valerate cream
0.05 % Betamethasone dipropionate ointment
2
30
0.1 % Betamethasone valerate cream
0.05 % Betamethasone dipropionate ointment
31
PotencyyConcentrationy0.1 % Triamcinolone acetonideXy0.02 % Triamcinolone acetonide Y
32
PotencyyDosage Form : yOintment is absorbed better than
cream or lotiony0.1 % Mometasone furoate ointment Xy0.1 % Mometasone furoate cream Y
33
PotencyySalt of Drugy0.05 % Betamethasone dipropionate Xy0.1 % Betamethasone valerate Y
34
yLow potencyyShort termy yRotational therapy
35
36
Side Effecty
(local adverse effects)y (systemic reactions)
37
Side Effect local adverse effects (atrophic changes)y . . 2506 Triamcinolone
acetonide y (epidermal atrophy) (alteration in
skin elasticity) 38
Side Effect local adverse effects (atrophic changes)y / potency :
39
Side Effect local adverse effects (atrophic changes) :
dermal atrophyy fibroblasts y collagen : 3 2
40
Side Effect local adverse effects (atrophic changes) :
dermal atrophyy 0.1% Betamethasone valerate 3 9 159
(telangiectasia) (easy bruising) (purpura)
41
telangiectasia
42
purpura easy bruising
43
Side Effect local adverse effects (hypopigmentation)y melanocyte : melanin
44
Side Effect local adverse effectsy 16 43y (tinea versicolor) (tinea incognito) (onychomycosis) (herpes simplex infection) (molluscum contagiosum) (scabiasis)
45
Side Effect local adverse effects (acneiform reactions)y 3 9steroid acne9 (perioral dermatitis)9steroid rosacea
46
Steroidacne
47
steroid rosacea
48
perioral dermatitis
49
Side Effect local adverse effects (acneiform reactions)y perioral dermatitis & steroid rosacea99
(rebound phenomenon) 9
(tachyphylaxis) 50
Side Effect local adverse effects (acneiform reactions)ysteroid acne9 (acne vulgaris) 9 9
51
Side Effect local adverse effectsy corticosteroid (glaucoma)y (vision loss)y corticosteroid 300
52
Tachyphylaxisy corticosteroids
53
Steroid additiony corticosteroidsy high potenty y rosacea telangiectasis
54
corticosteroidsy y 0.2 6y corticosteroid
55
corticosteroids Parabens Isopropyl palmitatePropylene glycol Polysorbate 60Benzyl alcohol Stearyl alcoholChlorocresol CorticosteroidEthylenediamine HCl Antibiotics
56
Side Effect Systemic effectsy corticosteroid :9High potency clobetasol propionate 0.05% 2 g/day 2 3 9Medium potency 7 g/day 2 weeks
57
Side Effect Systemic effectsy 9 /9 : 9 9 potency of corticosteroids
58
Side Effect Systemic effects y 9 9
59
9 1 (fingertip
units) 9 1 fingertip units : male = 0.49 g female = 0.43 g
60
1 fingertip units
61
9 Rule of hand9 1 1 g9 1 2
62
9 corticosteroids class 1 3 1 2 : 1 tachyphylaxis9corticosteroids class 4 7 2
63
9 corticosteroids High potency : 2 weeks9corticosteroids Medium/Low potency : 3 months
64
9 corticosteroids Low potency : 2 weeks9 1 side effects 2.5 3 & drug metabolism
65
9Systemic side effects 9 9 Adrenal crisis9
66
9 FDA USA .. 2530 25409 Betamethasone 79.4 ( 25.7 Betamethasone dipropionate + Clotrimazole)
67
9 Conchrane database 9 //9 class 1
68
9 C 9 pregnancy category C9 :
69
y Tar: 3-10 % LCD
(Liguor Carbonis Detergents)y 3-5%CCT (Crude Coal Tar)
70
(Topical therapy)1. Corticosteroids 2. Tar 3. Dithranol (Anthralin) 4. Calcipotriol 5. Salicylic acid
71
CoalTar
72
(Tars) y DNA y y
73
Tar Shampooy20 %Coal Tar Shampooy Olive oily
74
Scalp Lotiony0.02 % TA LotionyDesoximetasone yMometasone lotion
75
Combination with Coal TaryTreatment PsoriasisyCoal Tar + corticosteroidy5 % LCD in 0.02 % TAy5 % LCD in 0.1 % Bet.
Valeratey5 % LCD in 0.05 % Bet.
valerate
76
Tar + Corticosteroidy5 % LCD creamy5 % LCD in 0.02 % TAy 5 % LCD in 0.05 % Bet. Valeratey 5 % LCD in 0.1 % Bet. Valeratey //
(genital area) 77
EmollientyCream baseyLiquid paraffin
(Mineral oil)yPetroleum jelly
(Vaseline)
78
Keratolytic agenty 3 - 10 % salicylic acidy 3 - 10 % urea creamy combind with
corticosteroid
79
Combination with UreayTreatment for Dry skiny10 % Urea in 0.02 % TAy10 % Urea in 0.1 % Bet.
Valeratey20 % Urea ointmenty40 % Urea ointment
80
Keratolytic agentSalicylic acid Urea
y 3 % SA in 0.02 % TAy 5 % SA in 0.02 % TAy 10 % SA in 0.02 % TAy 10 % SA ointmenty 20 % SA ointment
y10 , 20 % Urea y 10 % Urea in 0.02 % TAy 10 % Urea in 0.05 %
Bet.valeratey 10 % Urea in 0.1 %
Bet.valerate81
Combination with Antibiotic agentyClioquinol
(Iodochlorhydroxyquin)yantibiotic that works by
preventing the growth of fungus/bacteriay3 % Vioform in 0.02 %
TA82
Calcipotriol y y differentiation y
83
Calcipotriol y 3 , y 50 /
84
VitamineD3Analogues
85
Fucidicacid
86
First line drug Second line drug
yMethotrexate 5-25 ./ 3 12 . (triple dose therapy) y Retinoid:- acitretin 0.25-1 ././
y Cyclosporin 3 5 ././ 1 - 2 / (2 divided dose)
87
Methotrexate
2.5 . 88
89
Methotrexatey Dihydrofolate reductase DNA y y y
90
MethotrexateyPsoriatic erythroderma yPustular psoriasis yPsoriasis ySevere plaque type psoriasis yPsoriatic arthritis
91
Methotrexatey 2.5-25 . y 3 12 y 2.5-5 . 1 2
92
Methotrexate 2.5 mg take 1 : 1 : 1
Monday 08.00 AM 1 Tab
Monday 08.00 PM 1 Tab
Tuesday 08.00 AM 1 Tab
Begin on Monday morning
93
Methotrexate 2.5 mg take 2 : 2 : 1
Wednesday 08.00 PM 2 Tab
Thursday 08.00 AM 2 Tab
Thursday 08.00 PM 1 Tab
Begin on Wednesday evening
94
Methotrexate1.2.23.4.5.6.7. MTX
MTX 12 8.
95
1. complete blood count2. BUN3. creatinine4. liver function test
yy y 1-3
96
y HIV Immunosuppression y y 1.52 g liver biopsy liver biopsy liver biopsy 1 . y 3
97
SideEffectofMTXy y y y y
98
SideEffectofMTXy (nephropathy) y y y (reactivation of sunburn response)
99
DrugInteractionofMTXy methotrexate alcohol, salicylates, cotrimoxazole, trimethoprim, probenecid, phenytoin, retinoids, pyrimethamine furosemide
100
Acitretin25mg
101
y y differentiation y CMI HMI y
102
1. Pustular psoriasis 2. Extensive plaque type psoriasis
3. Erythrodermic psoriasis
103
yAcitretin 0.5 - 1 ././ 0.25 - 0.5 ././ 3
104
y () y complete blood count,
liver function test, cholesterol, Triglyceride, HDL yPregnancy test
105
y liver function test 1 - 3 y triglyceride
106
SideEffectyCheilitis (100%), , ,
(20-50%), (100%), , (bruising), , (20%), ,
107
SideEffecty y y y (teratogenicity) 3
108
y y ( 3 ) y
109
y liver function test y y tetracycline ( intracranial hypertension) phenytoin (competition of plasma-protein binding)
110
H1receptorantagonistsShortActing LongActing
yChlorpheniramineyHydroxyzine
yCetirizineyLoratadiney DesloratadineyLevocetirizine
111
H1-receptor antagonistsCPM Details
yShort ActingySedative side effectyMost common use 1
tab hs
112
H1-receptor antagonistsHydroxyzine 10 mg Details
yShort ActingySedative side effectyMost common use 1
tab hs
113
H1-receptor antagonistsyCetirizineyLoratadineyLong Actingy1 tab OD
114
115
Topical Retinoids Retinol, Retinoic acid, Isotretinoin, Adapalene
116
Topical Retinoids* * * Glycosaminoglycan *
117
Topical Retinoids *
118
Topical Retinoids* * * *
119
Topical Retinoids* Oral Retinoids * Topical Retinoids * , 120
121
122
* Carboxylic acid hydroxy alpha * AHA
123
* * * * * *
124
* AHA 4-30% ( AHA 3-10%) * AHA 50%
125
126
Salicylic acid
AHA BHA
127
* AHA * Salicylic acid 128
* alpha-helical peptide chains 3 *
129
* *
130
1. (melanocytes)2. 3. tyrosinase
131
4. melanosome malpighian cell phacocytosis melanocytic dendrite
5. melanosome oxidized form () reduced form ()
132
1. (opacifying or covering agent) 2. (depigmentating agent) tyrosinase
133
3. (sunscreen agent) UV
4. (oxidizing agent)
134
- alpha hydroxy acid (AHA) -
135
Hydroquinone
- 3 - 5 % Hydroquinone- -
136
Azelaic acid- - tyrosinase 137
Azelaicacid
138
Arbutin- hydroquinone glycoside Bergenia crassifolia Arctostaphylos uvaursi - tyrosinase hydroquinone
139
- magnesium ascorbyl phosphate , sodium ascorbyl phosphate sodium ascorbyl sulfate - ascorbyl dipalmitate , ascorbyl glucosamine - gamma-ascorbic acid phosphatase 140
Lactic acid - Lactic acid tyrosinase - 5 20 % -
141
(UV)y UV- A
y UV - B sunburn
142
y 10.00 - 15.00 . y
143
y y UV UV UVA
144
y ySPF SunProtectionFactor UVB SPF15,30
145
SPF15 y 30 y SPF 15 15 30 7
146
???
147
y 1y 2 y
148
SunProtectionProduct
149
150
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