DRUGS USED IN DERMATOLOGY

1. GLUCOCORTICOIDS
Potency of these agents is traditionally measured using vasoconstrictor assay (area of skin blanching).
Betamethasone, clobetasol, diflorasone, halobetasol, amcinonide, desoximetasone, fluocinonide, halcinonide,
triamcinolone, flurandrenolide, hydrocortisone, mometasone, aclometasone, dexamethasone and desonide
formulations can be used topically. Betamethasone diproprionate is most potent and hydrocortisone is least
potent topically steroid. Skin atrophy (cigarette paper skin), striae, telengictasia, purpura and acneiform
eruptions are the side effects occuring by chronic use.
2. RETINOIDS
These may be first generation (retinol, tretinoin, isotretinoin and alitretinoin), second generation
(acitretin), third generation (tazarotene and bexarotene) and retinoid-like (adaplene) compounds. These are
potent teratogens (contra-indicated in pregnancy) and may cause dry skin, nose bleeds, conjuctivitis, alopecia,
muscular pain, pseudotumor cerebri and mood alterations.
• Tretinoin is used for acne vulgaris and as an adjunctive agent for treating photoaging.
• Tazarotene is approved for psoriasis and acne vulgaris.
• Alitretinoin is approved only for treatment of skin manifestations of Kaposi’s sarcoma.
• Isotretinoin is indicated for the treatment of severe nodulocystic acne vulgaris. It may result in hyperlipidemia,
myalgia and arthralgia.
• Acitretin (major metabolite of etretinate) was used for psoriasis but was withdrawn due to very long half life
(2-3 days).
• Bexarotene is used for cutaneous T-cell lymphoma. It may cause lipid abnormalities, hypothyroidism and
gastrointestinal symptoms.
3. PHOTOCHEMOTHERAPY
Ultraviolet radiations may be classified into UV-A (320-400 nm), UV-B (290-320 nm) and UV-C (100-
290 nm) according to wavelength. UV-B is most erythrogenic and melanogenic radiation.
• PUVA: 8-Methoxypsoralen (oral) followed by UV-A is approved for treatment of vitiligo, psoriasis and
cutaneous T-cell lymphoma. Major side effects include nausea, blistering and painful erythema. It increases the
risk of melanoma and squamous cell carcinoma.
Photopheresis: After oral methoxypsoralen, leucocytes are seperated from whole blood using extracorporeal
pheresis (ECP) device and then exposed to UV-A radiation. Irradiated cells are then returned to the patient. ECP
is effective for cutaneous T-cell lymphoma.
• Photodynamic therapy: It combines photosensitizing drugs (mostly porphyrins) with visible light for the
treatment of non-melanoma skin cancers and actinic keratosis.
4. ANTIMETABOLITES
• Methotrexate is used for moderate to severe psoriasis, pemphigus vulgaris, pityriasis rubra, SLE,
dermatomyositis and cutaneous T-cell lymphoma. Pregnancy and lactation are absolute contra-indications.
• Azathioprine is steroid sparing agent for pemphigus vulgaris, bullous pemphigoid, dermatomyositis, atopic
dermatitis, SLE, psoriasis and Behcet’s disease.
• 5-FU is used for actinic keratoses and superficial basal cell carcinoma.
5. CALCINEURIN INHIBITORS
Cyclosporine is used for atopic dermatitis, psoriasis, alopecia areata, pemphigus vulgaris, bullous
pemphigoid, lichen planus and pyoderma gangrenosum. Tacrolimus and pimecrolimus are other agents in this
group.

6. BIOLOGICAL AGENTS
• Alefacept and efalizumab are aproved for moderate to severe psoriasis.
• Etanercept is approved for psoriasis, rheumatoid arthritis and ankylosing spondylitis.
• Infliximab is approved for Crohn’s disease and rheumatoid arthritis and is in phase III trials for treatment of
psoriasis.
• Denileukin diftitox is indicated for advanced cutaneous T cell lymphoma.
7. SUNSCREENS
These may protect from UV-A (avobenzone, oxybenzone, titanium oxide and zinc oxide) or UV-B
(cinnamates, salicylates etc.). Sun protection factor (SPF) defines a ratio of minimal dose of sunlight that
produces erythema on skin with sunscreens to that without sunscreen. It provides valuable information
regarding UVB protection but is useless for UVA efficacy.

8. OTHER AGENTS
• Cholestasis associated pruritis may respond to cholestyramine, ursodeoxycholic acid, ondansetron, rifampicin
and nalmefene (opioid antagonist).
• Pruritis of uremia is most effectively treated with UVB radiation. It may also respond to naltrexone and
omeprazole.
• Capsaicin is approved for the treatment of post herpetic neuralgia and painful diabetic neuropathy.
• Masoprocol is a potent 5-LOX inhibitor with antitumor activity effective for topical treatment of actinic
keratosis.
AGE -RELATE D MA CULAR DEGENERATION
• It is of two types Dry and wet. Dry form is most common but untreatable. Vitamin supplements with zinc,
lutein and zeaxanthin may delay its progression. Wet form or neovascular ARMD is amenable to therapy.
• Photodynamic therapy with verteporfin (a radiosensitizer) is the approved therapy of neovascular ARMD.
• New strategies include intravitreal administration of anti-VEGF compounds. These include pegaptanib,
ranbizumab, aflibercept and bevacizumab.
• Anecorvate is an angiogenesis inhibitor indicated for ARMD.