This document discusses dermatological conditions and their management. It covers the structure and function of skin, modes of treatment for skin disorders including topical, systemic, intralesional and UV radiation. It discusses factors affecting drug absorption through the skin and various skin preparations like vehicles, antibacterials, antifungals, antivirals, sunscreens, keratolytic agents and corticosteroids. It provides details on specific drugs, their preparations, doses and indications for treating bacterial, fungal and viral skin infections.

1. Dermatological conditions &
Managements
Dr. Rupendra K Bharti
MBBS MD

3. Interesting Facts about SKIN
➢ The largest organ of the body
➢ Very important protective layer of the body
➢ Also important for:
- Thermoregulation
- Immunity
- Biochemical synthesis &
- Sensory functions

4. Structure & function of skin
• Skin has two layers →
EPIDERMIS & DERMIS:
beneath dermis there is
fatty tissue
• Epidermis, the outer layer
contains:-
Keratinocytes (keratin),
melanocytes (pigment),
Langerhan’s cells (antigen),
Merkel cells (sensory)
• Keratin → present in all the
layers of epidermis
➢ Abnormal keratin production → psoriasis & icthyotic disorders

5. • Superficial keratin layer → stratum corneum
• Main function of epidermis → to form stratum
corneum
• Stratum corneum (horny layer) is important →
reducing water loss and prevention of absorption
of noxious substances
➢Stratum corneum main barrier for absorption of drugs by
topical route
Structure & function of skin contd.

6. Modes of treatment of skin disorders
• Topical
• Systemic
• Intralesional
• Controlled ultraviolet (UV) radiations
➢ UV radiations are toxic & can cause sunburn even cancer of skin

7. Factors governing rate of absorption of
Topical drugs
• Thickness of skin
• Conc. of drug in vehicle
• Degree of hydration
✓ Absorption varies in normal skin, damaged skin &
exfoliation of skin
✓ Transdermal patches → Clonidine (HT), Hyoscine
(motion sickness) & nitroglycerine (angina pectoris)

8. Drugs
• Are categorized based on:
Action
• Vehicles: (powders, greases, ointments, liquids, lotions etc.)
• Skin preparations: (adsorbants & protectives, astringents, escarotics,
demulcents, irritants & counter irritants )
• Antibacterials, Antifungals, Antivirals
• Sunscreens
• Keratolytic agents
• Corticosteroids
Disease or
symptoms
• Pruritus
• Seborrhoea
• Alopecia
• Leukoderma/Vitiligo
• Hyperpigmentation
• Scabies/ pediculosis (Ectoparasiticides)
• Acne vulgaris
• Psoriasis
• Atopic dermatitis
• Drug induced skin diseases

9. Drugs Based On
Action

10. Vehicles
• Are inert substances which carry the drugs : water
content of vehicle very imp.
• They also contain some preservatives
• Vehicle should be non-irritant & cosmetically suitable

11. ➢Powders
• Because of soothing & cooling effect → reduce
friction by absorbing moisture
• Adhere poorly to skin → reduces their usefulness
➢Greases
• Petroleum jelly & polyethylene
glycol are protective
➢Ointment
• Maintain the hydration of stratum corneum
Vehicles contd.

12. ➢Liquids
• Clean and keep the lesion/skin cool
• High water content of lotions are also called wet
dressings e.g. KMNO4, normal saline
➢Gel & jellies
• They are semisolid due to addition of polymers despite
containing liquid phase
➢Creams
• Oil in water (o/w) type eg. Vanishing/aqueous cream
• Water in oil (w/o) type eg. Cold cream
Vehicles contd.

13. ➢ Shake lotions (lotion +powder)
• Cause cooling of skin due to evaporation of
water
➢ Newer Vehicles
• Collodions
• Liposomes
• Microparticle
• Transferosomes
Vehicles contd.

14. Skin Preparations
➢Topical preparations are used for local effect
➢However, TD patches are used for systemic effects
➢ Adsorbants and protectives
• Bind to noxious and irritant substances on their
surface – adsorbant action
- Dusting powder, Zinc oxide,
Calamine, Talc, Boric acid,
polyvinyl polymer, Sucralfate

15. ➢ Astringents
• Tannic Acid
- Present in tea, catechu, nutmeg etc. → denaturation
of proteins & forms coating
- Can be used for bleeding gums (with glycerin) & bleeding piles (as suppository)
• Ethanol & methanol
- Cause precipitation of proteins and are applied locally for prevention of bed
sores and after shave lotion
➢ Escharotics (chemical cauterizers)
• Cause tissue destruction, sloughing & precipitation
of proteins
• Used to remove warts, moles, papilloma etc.
✓ Phenol, Trichloroacetic acid, silver nitrate,
podophyllum
Skin Preparations contd.

16. ➢ Demulcents: Glycerine & propylene glycol
• When applied topically they produce soothing effect on denuded
mucosa or inflammed skin
• Protect the mucous membrane and skin from air and irritant
substances
➢ Emollients: (wax – hard & soft, paraffin, olive oil etc.)
• They produce soothing effect & hydrate
the skin
• Useful for dry scaly skin
Skin Preparations contd.

17. ➢ Irritants and counterirritants (Nicotinate, salicylate, menthol,
camphor, capsaicin)
• Irritant substances produce local
inflammation, tingling, numbness, cooling
or feeling of warmth, hyperaesthesia and vasodilatation
• Counterirritants also produce local irritation and relieve pain &
inflammation arising from deeper structures.
• Used for headache, myalgia, neuralgia, joint pain etc.
Skin Preparations contd.

18. ➢ Antibacterial Agents
• Common bacterial infections affecting skin:
- Furuncle, boil, folluculitis, pyoderma, impetigo,
cellulitis etc
➢ Antifungal Agents (Benzoic acid)
• Common fungal infections- ring worm, oral
thrush, dandruff, athlete’s foot
➢ Antiviral Agents
• Herpes simplex, herpes zoster
Chemotherapeutic Agents

19. Drugs Preparation & Dose Indications Special feature
Fucidic acid 2% w/w ointment & cream
TDS for 7-10 days.
Skin infections by
staphylococcus and
streptococcus both.
Use with caution in pregnancy,
pediatric patient and patient
with hepatic disease.
Nadifloxacin 1% w/w cream BDfor 7-10
days.
Acne vulgaris, folliculitis,
suspected bacterial infections
Caution required in pregnant
and pediatric patients
Sisomicin 1% w/w cream BDfor 7-10
days
Susceptible bacterial infections Cover the area with a gauge
piece.
Neomycin 0.5% w/w cream 1-4 times/day
for 7-10 days
Minor skin infections c/I in h/o hypersensitivity to any
aminoglycosides
Gentamicin 0.5% w/w cream 3-4 times/day
for 7-10 days
Susceptible bacterial and
superficial skin infections.
Nephrotoxic potential on
excessive use.
Silver sulfadiazine 1% w/w cream BD for 7-10
days
Prevention and t/t of 2nd and
3rd degree burns
Caution required in pregnant,
pediatric patients and pts.
Allergic to sulfa drugs
Povidine iodine 1% gargles, 5% and 10% w/w
cream& oint.,5%
sol.&powder,7.5% scrub
Burns, ulcers, boils,furnculosis
surgical scrub and for dressing
the wounds etc.
Sensitivity reaction and thyroid
dysfunction on prolonged use
may occur.
Chlorhexidine 1% w/w cream,1.5% sol.,
2-4 times a day
As germicidal skin cleanser. Main use as surgical scrub and
wound cleaning.
Cetrimide 5% lotion,15-20% v/v soln.
2-4times/day
Disinfecing and cleansing
wounds, pre-operative skin
preparation.
Low conc.-bacteriostatic,
High conc.- bactericidal.
Nitrofurazone 0.2%w/w, once daily 2nd &3rd degree burns and skin
grafting
With caution use in pts. With
renal ds. And G6-PD deficiency

20. Drugs Preparation & dose Indications Special feature
Acyclovir 3% & 5% w/w cream.
Apply every 3-4 hrs for 5-7 days.
Initial and recurrent
mucosal and cutaneous
herpes simplex
Should be used in
addition to oral antiviral
t/t.
TOPICAL ANTIFUNGAL PREPARATIONS
Drugs Preparation & dose Indications Special feature
Terbinafine Cream 1% w/w
Lotion 1% w/v
Twice daily for 2-4 weeks.
Tinea pedis, T. cruris, T.
corporis, candida
albicans, pitryasis
vesicolour
Avoid direct contact with
eyes.
Alopecia pruritus and
contact dermatitis can occur.
Tolnaftate Cream 5 mg/gm
Solution 1o mg/mL
Twice daily for 2-4 weeks.
Tinea pedis, T. cruris, T.
corporis.
Cream not recommended for
nail and scalp infection.
Quiniodochlor Cream: 3%, 4% & 8%.
BD-TDS for 2-4 weeks.
Dermatophytosis,
seborrheic dermatitis,
pitryasis vesicolour
Has weak anti bacterial
activity also.
Bifonazole Cream 1% w/w OD for 21 days Tinea pedis, T. cruris, T.
corporis. pitryasis
vesicolour
Avoid direct contact with
eyes

21. Drugs Preparation & dose Indications Special feature
Clotrimazole 1% w/w cream &
powder,1%w/V lotion,2%
cream.
BD for 3-4 weeks.
Susceptible fungal infections
of skin, hair and vagina,
Powder for athlete’s foot
and ringworms
It should be used along
with oral antifungal
agents.
Miconazole 2% w/w cream, 2% lotion &
2% gel.
2% powder
BD up to 1 month.
Vulvovaginal candidiais,
tinea infection including
skin and mucous membrane.
Full course of therapy
should be done.
Avoid direct contact with
eyes.
Ketoconazole 2% w/w cream, 2% w/w
ointment & 2% w/v solution:
1-2 times/day.
2 % w/v shampoo: twice
weekly for 4 week.
Susceptible fungal infection
as above.
Cautious use while giving
terfenadine, astemazole
and cisapride may cause
cardiac arrhythmias.
Oxiconazole
nitrate
1% w/w cream and 1% w/v
lotion.
Twice daily for 2-4 weeks.
Tinea pedis, T. cruris, T.
corporis.
Hypersensitivity may
occur.
Ciclopirox olamine Cream 1% w/w
Solution 8% w/v [only for
nails]
Twice daily for 4 weeks.
Tinea pedis, T. cruris, T.
corporis.
Onychomycosis of finger
and toe nails.
Not to be used below 10
years of age.
Econazole Cream 1% w/w
Twice daily for 2-4 weeks.
Tinea pedis, T. cruris, T.
corporis.
Butenafine Cream 1% w/w
Twice daily for 2-4 weeks.
Tinea pedis: BD for 1 week.
T. cruris & T. corporis: OD
for 2 weeks
Avoid direct contact with
eyes

22. ➢ Three types of UV rays:
• UVA (Long wave): photoaging/
skin aging (collagen damage),
photosensitivity and skin cancer
• UVB (medium wave): causes
sunburn sun tan, skin cancer &
photo aging (skin aging)
• UVC (short wave): causes skin
injury, sunburn of superficial
epidermis
Ultraviolet rays & their effect on skin
➢ Protection against UV rays:
• Avoid exposure to UV rays
• Use sunscreens

23. Ultraviolet rays Wavelength Drugs effective
Ultraviolet-A [UVA] 320–400 nm  Dibenzoylmethanes
 Benzophenones
Ultraviolet-B [UVB] 280–320 nm  P -aminobenzoic acid (PABA)
 Benzophenones
Ultraviolet-C [UVC] 100–280 nm  Benzophenones

24. Sunscreens
• Required to prevent sun burn, aging and skin cancer
➢Classification of sunscreens based on:
1. Physical Action: Titanium dioxide, zinc oxide &
calamine
They are opaque to all wavelength and reflect them
2. Chemical structure:
• Para-aminobenzoic acid (PABA)
• Benzophenones [Oxybenzone, Dioxybenzone, and
Sulisobenzone]
• Dibenzoylmethanes

25. • PABA
– is most effective against erythema and sunburn
associated with sun exposure & tanning.
• Benzophenones [Oxybenzone, Dioxybenzone, and
Sulisobenzone]:
– It is used to treat erythema but is less effective than
PABA.
• Dibenzoylmethanes:
– It is used to treat polymorphous light eruption,
cutaneous lupus erythematosus and drug-induced
photosensitivity.

26. Sunscreens contd.
3. Effectiveness against radiation:
• Sunscreens for UVA:
- Benzophenones eg. Avobenzone, oxybenzone
• Sunscreens for UVB:
- PABA & its esters eg. Padimate O
- Cinnamates eg. Octyl methoxycinnamate
- Salicylates eg. Octisalate
- Octocrylene
Regular use of Sunscreens: reduce risk of actinic keratoses,
premature aging and squamous cell carcinoma of skin

27. Sun protection factor (SPF)
 The efficacy of sunscreen is quantified by its SPF.
 It measures sunscreen protection from UV-B rays, which is responsible for
sunburn and skin cancer.
 It does not measure how well a sunscreen will protect from UVA rays, which are
also damaging and dangerous.
 SPF-15 or SPF-30 is recommended as sunscreen. Higher SPFs do not give much
more protection.
 Once applied, the sunscreen protects skin for 80-90 minutes. If the sun-exposure
is going to remain for a longer duration, repeated application is required.
 The SPF (Sun Protection Factor) scale:
Sunscreen with SPF Protection against UVB
SPF 15 93%
SPF 30 97%
SPF 50 98%

28. Photosensitivity due to drugs
• Systemic use: BZDs, thiazides, hydralazine,
sulfonamides, sulfonylurea, NSAIDs, tetracycline,
chloramiphenic
• Topical use: PABA as sunscreen, musk ambrette
(used in perfumes), 6 methyl coumarin (after
shave lotion)
• Phototoxicity causes severe sun burn
• Photoallergy: reaction persists years after the
drug withdrawal

29. Keratolytic Agents
• Used to remove warts and corns, calluses &
verrucae
• Mild keratolytic
✓ Resorcinol and sulphur
• Strong keratolytic
✓Salicylic acid, silver nitrate and Trichloroacetic
acid
➢Some other keratolytic agents:
• Lactic, Glycolic & salicylic acid
• Propylene glycol
• Trichloroacetic acid
• Silver nitrate
• Urea

30. Keratolytic Agents Contd.
➢ Salicylic acid
• Corneocyte adhesion is reduced by solubilization of
intracellular cement
• Removes stratum corneum layer by layer
✓ Whitfields ointment (salicylic acid 3% & Benzoic acid 6%)
➢ Lactic and glycolic acid
• Corneocyte adhesion is reduced by disrupting ionic
bonds at lowest layer of stratum corneum
• Used for xerosis & ichthyosis

31. Corticosteroids
• Used by both systemic & topical route depending upon
disease and severity
• Have anti-infammatory and immunosuppressant action
• Reduce proliferation of keratocytes, fibroblasts and
lymphocytes – antimitotic action
• Inhibit migration of inflammatory cells and substances
released due to inflammation

32. TOPICAL GLUCOCORTICOIDS
High efficacy steroids Intermediate efficacy
steroids
Low efficacy steroids
Drug Conc. Drug Conc. Drug Conc.
Betamethasone
dipropionate
0.05% Betamethasone
valerate
0.1% Betamethasone
valerate
0.01%
Halobetasol
propionate
0.05% Mometasone 0.1% Methylprednisolone
acetate
1.0%
Clobetasol
propionate
0.05% Hydrocortisone
valerate
0.2% Hydrocortisone 0.25-
2.5%
Fluocinonide 0.05% Fluticasone 0.05 Prednisolone 0.5%
Desoximetasone 0.25% Prednicarbate 0.1%-
0.25%
Dexamethasone 0.1%
Triamcinolone
acetonide
0.5% Triamcinolone 0.05-
0.1%
Triamcinolone
acetonide
0.025%
Fluocinolone
acetonide
0.2% Fluocinolone
acetonide
0.025% Fluocinolone
acetonide
0.01%
Beclomethasine
dipropionate
0.025%

33. • Common indications of topical steroids:
– Eczema,
– psoriasis,
– otitis externa,
– lichen simplex and planus,
– contact dermatitis,
– seborrhoeic dermatitis and
– steroid responsive dermatoses.

34. • Common contraindications of topical
steroids:
• Scabies,
• acne,
• furunculosis,
• chicken pox,
• herpes,
• untreated fungal and
• bacterial infections etc.

35. • Common side effects of topical steroids:
– Skin atrophy,
– thinning of epidermis,
– easy bruising,
– delayed wound healing,
– superimposed fungal and
– bacterial infections and
– sometimes if used for prolonged periods, systemic
side effects can also appear.

36. Drugs Based On
Disease/Symptoms

37. Pruritus
• Itching – symptom of many skin diseases
• Treatment depends upon cause of pruritus
➢Drugs
• Systemic
- Antihistaminics
- Glucocorticoids
• Topical
- Corticosteroids e.g. in eczema
- Emollient cream, menthol, camphor, phenol,
calamine, tar & others

38. Seborrhoea
• Is due to over-activity of sebaceous glands and
skin is greasy → acne, baldness and dermatitis
➢ Drugs
• Selenium sulphide
- Reduces epidermal proliferation & scaling
• ketoconazole & corticosteroids
Limitation is relapse on discontinuation of the Rx

39. Drug Dose & Application Special features
Selenium sulfide 2.5% lotion or shampoo
Apply on scalp twice weekly
and then as required.
 It is an anti-keratolytic and fungicidal
to P. ovale.
 Relapse is seen in ≥50% individuals
after discontinuation of therapy.
Zinc pyrithione 1% shampoo .
Apply on scalp twice weekly
and then as required.
 Reduces epidermal turnover and
inhibits P. ovale.
 Usually combined with ketoconazole.
Ketaconazole 2%cream/shampoo/scalp
gel.
Apply on scalp twice weekly
and then as required.
 Ketoconazole (KTZ) is most effective
against P. ovale.
 It has better efficacy with negligible
side effects.
Corticosteroids 2% cream/ shampoo.
Apply on scalp twice weekly
and then as required.
 It is highly effective against seborrheic
dermatitis including dandruff.
 Relapse is high after discontinuation
of therapy.
 Prolonged use may lead to purpura and
poor healing.

40. Alopecia
• Common after age of 40 & about 50% men develop alopecia
➢ Drugs
• Menoxidil
✓ Used topically for the Rx of baldness
✓ Possibly acts by ↑ circulation around hair follicles, stimulation
of hair follicle reduces the effect of androgen
✓ Onset is delayed and takes few months
✓ Effect is transient- baldness recurs on discontinuation of drug
• ADR: Topical- local itching, burning sensation
• On significant absorption systemic S/E i.e. tachycardia,
palpitation, headache & dizziness

41. Alopecia Contd.
• Drugs
– Finasteride, Dutasteride
✓Type II 5-ᾳ reductase inhibitor
✓There are two types of 5-ᾳ reductase – type I in sebacecious
gland & type II present in hair follicles & male genital organ
✓Useful for Rx of baldness, benign hyperplasia of prostrate,
prostatic carcinoma
✓Dose: 1mg OD x 2 yrs … minimum effect to come is about 3
months
✓Therapeutic effect is lost one after discontinuation of drug
• ADR:
– Decreased libido, erectile dysfunction and reduced ejaculate
vol.

42. Pigment disorders (leukoderma/vitiligo)
• Potent photosensitive drug is used with UV rays for vitiligo &
psoriasis
➢ Drugs
– Psoralen, Methoxsalen, Trioxsalen
➢ ADR:
➢Acute: nausea, blistering & painful erythema Chronic: actinic
keratosis, photoaging, PUVA lentigins & non melenoma skin
cancer

43. Psoralen
Topical therapy
• The solution/ointment is carefully applied on the small
well defined vitiliginous lesion—which is then exposed
to sunlight for 1 minute and then occluded by bandage
or sun screen ointment.
• Weekly treatment with longer exposures is given.
• Pigmentation usually begins to appear after a few
weeks; months are needed for satisfactory results.
• This therapy should be undertaken only under direct
supervision of physician because longer exposure
causes burning and blistering.

44. Oral therapy
• The drug is given orally in the morning in a dose of
0.3–0.6 mg/kg (usually 20 mg).
• After 2 hours of a oral dose of a psoralen, skin is
exposed to sunlight (or artificial UV light), initially
for 15 minutes— gradually increasing to 30 minutes
over days.
• The therapy is given on alternate days.
• Eyes, lips and other normally pigmented areas
should be protected during exposure to sunlight.
• It is available as 5 & 10mg tablet, 0.25% solution and
ointment and 1% ointment.

45. Trioxsalen & Methoxsalen
• Trioxsalen and methoxsalen are synthetic
psoralens, which are used in combination with
photochemotherapy for repigmentation of
depigmented macules of vitiligo.
• They are combined with ultraviolet rays –A
[UVA] ranging from 320-400 nm.

46. Decapeptide
• A Basic fibroblast growth factor.
• It is applied locally and stimulates the
multiplication of melanocytes.
• It is available as lotion.
• Method of applying:
– apply 1-2 hrs before going to bed, expose to
sunlight next morning for 15 minutes.
– It has good results in vitiligo treatment.

47. Hyperpigmentation
• Demelanising agents lighten the hyper
pigmented patches on skin
➢ Drugs
• These drugs are used for the reduction
hyperpigmentation of the skin.
• These are indicated in melasma and chloasma
of pregnancy.
• Hydroquinone inhibits the tyrosinase enzyme;
hence the biosynthesis of melanin is
inhibited.
• Monobenzone has anti-melanocytic action as
it causes permanent destruction of
melanocytes.

48. • Hydroquinone:
– Available as 2%, 4% cream, solution and ointment to be
applied 2 times daily.
• Monobenzone:
– Available as 5% lotion and 20% ointment to be applied 3
times daily.
• Azelaic acid:
– Available as 10% & 20% cream to be applied 2 times
daily.
• Glycolic acid:
– Available as 10-20% lotion to be applied 2 times daily.

49. Ectoparaciticides
(Scabies & Pediculosis)
➢Scabies
• Caused by Sarcoptes scabiei
• Itching a common symptom
• Female itch mite burrows into superficial layers of
skin and lays eggs - form papule – itching (highly
contagious)
• Drugs are applied topically after a warm scrubbed
bath
➢Drugs: Premethrin, Benzyl benzoate, Benzyl
hexachloride BHC, IVERMECTIN (only oral drug)

50. Ectoparaciticides
Scabies & Pediculosis
➢Premethrin
• Delays depolarization – neurological paralysis
• Effective against scabies (5% cream) & pediculosis (1%)
• Absorption – minimal through skin, rapidly metabolized to
inactive products
• Is safest drug – provides 100% cure
➢For scabies
✓ Apply premethrin 5% cream below chin all over the body &
left there for 12 h
• For pediculosis
✓ Apply premethrin 1% cream or lotion for 10 min & then
rinse

51. Pediculosis
• Caused by pediculus captitis (head)
• Itching a common symptom
➢Drugs: Premethrin, malathion & DDT
• Premethrin is preferred drug
• Malathion used in cases not responding to premethrin
• DDT
- In powder form or solution in kerosine – widely
used as insecticide
- Not killing ova – disadvantage

52. a) TOPICAL ANTIPARASITIC/ ANTI SCABIES PREPARATIONS
Drugs Preparation & dose Indications Special feature
Gamma
benzene hexa
chloride
Lotion 1 % w/v
Cream 1% w/w
Scabies and
pediculosis
Avoid direct contact
with eyes and face
Benzyl
benzoate
Lotion 1.25% w/v Scabies and
pediculosis
Crotamiton Lotion & cream 10% w/w
& w/v
Scabies, purities and
lice infestation
Permethrin Cream 5% w/w
Lotion 1% w/v
Scabies, pediculosis

53. Acne Vulgaris
➢A common skin disorder seen in
adolescents (boys & girls)
➢ Is due infection of pilosebaceous unit
by the bacteria Propionibacium acnes
➢Changes in acne
1. Plugging of hair follicle
2. Accumulation of sebum
3. Growth of Propionibacium acnes
4. Inflammation

54. Acne Vulgaris contd.
➢ The treatment aims at:-
1. Correction of follicular abnormality
2. Reducing sebum production
3. Controlling infection and
4. Reducing Inflammation
➢ Topical Agents
o Retinoids
✓ Tretinoin, Adaplene, Tazarotene
- Normalize the maturation of follicular epithelium & reduce
inflammation

55. Acne Vulgaris contd.
➢ Topical Agents
o Antibacterials
o Reduce the population of Propionibacium acnes
✓ Erythromycin (2-3%), Clindamycin (1%), Benzoyl peroxide (5%)
- Combination with retinoids – more effective
➢ Other topical agents
o Sulfacetamide & it combination
with sulfur, Metronidazole and
Azelaic acid

56. Acne Vulgaris contd.
➢ Systemic Agents
o Retinoic acid
✓ Retinoic acid is vitamin A acid & it possesses vit. A activity in epithelial tissues
✓ No activity in other tissues such as eye & germ tissues
✓ Rapidly metabolized - eliminated in bile & urine
✓ Not stored unlike retinol
✓ Its derivatives i.e. tretinoin & isotrtinoin, are used in other conditions
o Retinoids
o Vit A analogues are called retinoids
o Have imp. Role in vision, cell proliferation & differentiation, growth of bone
etc.

57. Acne Vulgaris contd.
➢ Retinoids
➢ First generation
o Retinol, tretinoin, isotretinoin, alitretinoin
➢ Second generation
o Etretinate, acitretin
➢ Third generation
o Tazarotene, bexarotene
➢ Retinoid receptors
o Retinoic acid receptors (RARs) – subtypes ᾳ, β, ϒ
o Retinoid X receptors (RXRs) - subtypes ᾳ, β, ϒ
o Out of the above receptors mainly β and ϒ receptors of X receptors are present in
human skin
1st & 2nd Gen. retinoid lack receptor specificity – more S/E than 3rd gen.
Oral agents – teratogenicity : avoid during pregnancy

58. Acne Vulgaris contd.
➢ Antibacterials
➢ Tetracycline, erytromycin, metronidazole & co-
trimoxazole
o Reduce p. acnes colonization & also reduce
inflammation
➢ Hormone and hormone antagonists
➢ Oestrogen/ oral contraceptive pills, cypoterone
acetate & corticosteriods
o Are preferred in case of adult onset acne,
premenstrual flares of acne

59. Drugs Dose Special feature
Clindamycin 1% gel The common side effects are local
irritation, burning sensation .
Erythromycin 2% lotion and
ointment
The common side effect are local
irritation, dryness and burning
sensation of skin.
Metronidazole 1% gel The common side effect are local
irritation, dryness and burning
sensation of skin.
Sulfacetamide 4% lotion & 10
% face wash
Used in acne vulgaris and acne
Rosacea.
Contraindicated in patient with history
of hypersensitivity to sulfonamides.
Nadifloxacin 1% cream It is a newer agent for inflamed acne
and folliculitis

60. Psoriasis
• An immunological disorder
• Manifests as localized or
widespread erythematous
scaling lesions or plaques
• Increased proliferation,
inflammation of epidermis &
dermis
• Drugs can decrease the
lesions but can not cure

61. Psoriasis
➢ Aim of treatment
• To dissolve the keratin & inhibit the further
proliferation of cells
➢ Topical Agents
o Coal tar
– Mainly used with UVB – antimitotic effect
– Used as solution, gel & shampoo
– ADR: folliculitis, irritation, allergic reaction
o Calcipotriol (active vit D)
– By acting on keratinocytes – causes decrease in
proliferation of cultured keratinocytes
– By the same mechanism, it produces antipsoriatic
effect
– Vit D – effective orally & topically
➢ Other drugs ; Anthralin, Tazarotene
Local Intralesional
Photothera
py
Systemic
Method of Treatment

62. ➢Systemic Agents
– Is required in extensive and severe disease
– Cytotoxic & immunosupressants are used
➢Methotrexate
– Is a DHFR inhibitor & suppressing immune component cells
(mainly T-cells) in Skin
– Epidermal inflammation & hyperproliferation are retarded
• S/E:
– bone marrow depression, hepatotoxicity
• Other drugs:
– Hydroxurea, Cyclosporine, Efalizumab,
• Liarozole & rambazole- newer agents
Psoriasis Contd.

63. Atopic Dermatitis
• Is an inflammatory condition of skin – starts
during infancy & childhood – may persist upto
adult age
• Allergens & environmental pollutants may
cause the disease
• Itchy papules & plaques – characteristics of
this condition
• Treatment : Glucocorticoids, antihistaminics,
immunosupressive agents