1. CLINICAL DERMATOLOGY
Cutaneous infections, Acne, Rosacea, Psoriasis, Melanoma, Atopic Dermatitis
A. VERRUCA (Warts)
All salicylic acid preparations are now over the counter. Most contain 17% salicylic acid. They work the best if patient will soak the wart, file off dead keratin, apply medicine and occlude qhs. EMLA cream reduces pain and is very helpful when treating children with cryotherapy. Topical Imiquimod (Aldara) is being studied.
B. ACNE VULGARIS
· Topical agents
· Agents containing resorcinol salicylic acid
· Sulfur and Sodium sulfacetacetamide, Sulfacet R
· Sodium sulfacetamide (Klaron) – old product now available in cosmetically elegant base. Antibacterial. May be of greatest benefit to patients with acne and seborrheic dermatitis.
· Benzyl peroxides – gels 2 ½ %, 5%, 10%; washes 5% and 10%
· Topical Cleocin 1% Solution, gel pledgets
o Retin A gel – 0.025% and 0.01%
o Retin A Micro – 0.1% (Slow release vehicle)
o Avita cream – 0.025%
· Adapalene gel 0.1% Differin. Retinoid activity. Appears to cause less irritation than tretinoin.
· Oral Antibiotics
o Tetracycline 500 mg bid
o Erythromycin 400-500 mg bid
o Doxycycline 100 mg bid. Very photosensitizing. Difficult to use in summer months unless that patient is darkly pigmented.
o Minocycline 50-100 mg bid. Side effects include pigmentation of teeth, gums, skin. Rare lupus like syndrome with use over 2 years.
o If not responding to antibiotics in 6-8 weeks, unlikely to respond and should try different medication.
· Accutane (Isotretinoin) – Dosage approximately 1 mg/kg; generally 40 mg bid for 20 weeks. Generally give EES 400 bid initially with Accutane, Tetracyclines contraindicted. Recently reported to cause depression.
· Recommended Lab:
o Liver function tests pretreatment, if normal do not need to repeat
o Triglyceride level pretreatment. Repeat at 1 month. If normal, not necessary to repeat. If elevated, repeat monthly. If markedly elevated, discontinue drug.
o Please ALWAYS BE AWARE OF TERATOGENICITY
o Negative pregnancy test within on week of beginning drug for females. Repeat monthly if sexually active. Sexually active females should be on 2 forms of birth control.
· Oral Contraceptives
o Generally not a primary treatment for acne, but if patients wishes to be on oral contraceptives, should choose one with weakly androgenic progestational agent such as:
§ Ortho Tri-cyclen (Contains norgestinate as progestin) – FDA approved for acne treatment.
§ Orthocept – desogetrel
§ Desogen – desogestrel