This document provides an overview of commonly used systemic dermatological agents. It discusses drug classes like sulfones (dapsone), antihistamines, systemic steroids, antibacterial agents (penicillins, cephalosporins, aminoglycosides), antifungals, antivirals, and antiparasitics. For each drug class, it covers mechanisms of action, indications, dosages, side effects and precautions. It provides detailed information on individual drugs like dapsone, doxycycline, erythromycin and others. The document is intended as an educational reference for dermatologists.
Hematoxylin and eosin staining is the standard stain used in dermatopathology. It yields a predictable pattern where hematoxylin stains basophilic structures blue-purple and eosin stains eosinophilic structures pink-red. Special stains are used in addition to H&E to selectively stain cells and components and provide additional information. Common special stains include PAS for mucins, Fontana-Masson for melanin, von Kossa for calcium, Perl's Prussian blue for iron, trichrome stains for collagen, Congo red for amyloid, Oil Red O for fat, Giemsa and toluidine blue for mast cells, Gram stain for bacteria, GMS
This presentation includes -classification, biological in psoriasis,TNF alpha inbitors, T cell inhibitos, IL-12/23 inhibitors (indications,containdications,guidelines, adverse effects)
This document provides information on various types of palmoplantar keratoderma (PPK). It describes the clinical patterns, genetic causes, histopathological findings, and management options for different syndromic and non-syndromic forms of PPK, including epidermolytic, punctate, striate, and transgradient PPK as well as disorders associated with PPK like pachyonychia congenita and Naxos syndrome. The document discusses the characteristic features, genetic defects, and treatment approaches for these PPK subtypes.
- Mycobacterium leprae is the bacterium that causes leprosy. It was discovered in 1873 by Norwegian physician Gerhard Hansen.
- M. leprae is an intracellular parasite that infects macrophages and peripheral nerves. It is a straight or slightly curved, capsulated, non-motile, non-sporulating, acid-fast bacillus.
- It is cultured from the footpads of nine-banded armadillos and has a cell wall with an outer and inner layer, a capsule, cell membrane, and cytoplasm. M. leprae is not cultivable in laboratory conditions.
This document discusses the dermo-epidermal junction (DEJ) and dermis. It describes the four layers of the basement membrane zone (BMZ) of the DEJ - the basal keratinocyte layer containing hemidesmosomes, the lamina lucida, lamina densa containing type IV collagen and laminins, and the lamina fibroreticularis containing anchoring fibrils made of type VII collagen. It also discusses the cells and extracellular matrix components of the dermis, including collagen, elastic fibers, proteoglycans, fibroblasts, macrophages, dendrocytes and mast cells. Disorders of the DEJ like epidermolysis bullosa are also mentioned.
This document provides an overview of dermatopharmacology and summarizes key topics including skin structure, principles of topical drug application, antimicrobial agents, antifungal agents, antiviral agents, immunosuppressants, and recent advances. It discusses the structure of the epidermis and dermis, formulations for topical drug delivery, potency classifications of topical corticosteroids, mechanisms and indications for various antimicrobial, antifungal and antiviral agents.
Hereditary disorder of keratinization characterized by expanding atrophic anular patch(es) surrounded by prominent keratotic ridge called the cornoid lamella
- The epidermis maintains homeostasis through balanced cell production and loss in the basal layer. Three cell populations exist: stem cells, transient amplifying cells, and post-mitotic cells.
- Stem cells give rise to the epidermis and reside in the basal layer and hair follicle bulge. Transient amplifying cells can undergo limited proliferation.
- Keratinocytes take 12-19 days to transit from basal layer to stratum corneum, and 14 more days to transit through the stratum corneum. A variety of growth factors regulate epidermopoiesis.
Hematoxylin and eosin staining is the standard stain used in dermatopathology. It yields a predictable pattern where hematoxylin stains basophilic structures blue-purple and eosin stains eosinophilic structures pink-red. Special stains are used in addition to H&E to selectively stain cells and components and provide additional information. Common special stains include PAS for mucins, Fontana-Masson for melanin, von Kossa for calcium, Perl's Prussian blue for iron, trichrome stains for collagen, Congo red for amyloid, Oil Red O for fat, Giemsa and toluidine blue for mast cells, Gram stain for bacteria, GMS
This presentation includes -classification, biological in psoriasis,TNF alpha inbitors, T cell inhibitos, IL-12/23 inhibitors (indications,containdications,guidelines, adverse effects)
This document provides information on various types of palmoplantar keratoderma (PPK). It describes the clinical patterns, genetic causes, histopathological findings, and management options for different syndromic and non-syndromic forms of PPK, including epidermolytic, punctate, striate, and transgradient PPK as well as disorders associated with PPK like pachyonychia congenita and Naxos syndrome. The document discusses the characteristic features, genetic defects, and treatment approaches for these PPK subtypes.
- Mycobacterium leprae is the bacterium that causes leprosy. It was discovered in 1873 by Norwegian physician Gerhard Hansen.
- M. leprae is an intracellular parasite that infects macrophages and peripheral nerves. It is a straight or slightly curved, capsulated, non-motile, non-sporulating, acid-fast bacillus.
- It is cultured from the footpads of nine-banded armadillos and has a cell wall with an outer and inner layer, a capsule, cell membrane, and cytoplasm. M. leprae is not cultivable in laboratory conditions.
This document discusses the dermo-epidermal junction (DEJ) and dermis. It describes the four layers of the basement membrane zone (BMZ) of the DEJ - the basal keratinocyte layer containing hemidesmosomes, the lamina lucida, lamina densa containing type IV collagen and laminins, and the lamina fibroreticularis containing anchoring fibrils made of type VII collagen. It also discusses the cells and extracellular matrix components of the dermis, including collagen, elastic fibers, proteoglycans, fibroblasts, macrophages, dendrocytes and mast cells. Disorders of the DEJ like epidermolysis bullosa are also mentioned.
This document provides an overview of dermatopharmacology and summarizes key topics including skin structure, principles of topical drug application, antimicrobial agents, antifungal agents, antiviral agents, immunosuppressants, and recent advances. It discusses the structure of the epidermis and dermis, formulations for topical drug delivery, potency classifications of topical corticosteroids, mechanisms and indications for various antimicrobial, antifungal and antiviral agents.
Hereditary disorder of keratinization characterized by expanding atrophic anular patch(es) surrounded by prominent keratotic ridge called the cornoid lamella
- The epidermis maintains homeostasis through balanced cell production and loss in the basal layer. Three cell populations exist: stem cells, transient amplifying cells, and post-mitotic cells.
- Stem cells give rise to the epidermis and reside in the basal layer and hair follicle bulge. Transient amplifying cells can undergo limited proliferation.
- Keratinocytes take 12-19 days to transit from basal layer to stratum corneum, and 14 more days to transit through the stratum corneum. A variety of growth factors regulate epidermopoiesis.
This document provides information about immunofluorescence techniques used in dermatopathology. It begins with the history and components of immunofluorescence microscopy. It then discusses the various applications of immunofluorescence including in skin, muscle, and renal biopsies. Specific techniques for skin biopsies like direct immunofluorescence, indirect immunofluorescence, antigen mapping, and salt split skin technique are explained. Common staining patterns seen in dermatological conditions like pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceus, and paraneoplastic pemphigus are summarized. The document emphasizes the utility of immunofluorescence in diagnosing and classifying autoimmune bullous diseases and connective tissue disorders.
This document summarizes epidermal kinetics and dynamics. It discusses the structure of the epidermis, epidermal proliferation units, cell cycle kinetics like turnover time and labeling index. Disturbances in epidermal kinetics like acanthosis, parakeratosis and dyskeratosis are described. Kinetics in normal skin versus psoriasis are compared. Epidermal differentiation and terminal differentiation involving keratinization are outlined. Drugs acting on epidermal cells like retinoids, vitamin D analogues, and salicylic acid are mentioned. Cancers of the epidermis are briefly described.
This document summarizes information about retinoids in dermatology. It discusses the history, structure, and classification of natural and synthetic retinoids. It describes the mechanism of action of retinoids involving retinoid receptors and their effects on keratinization, sebaceous glands, and inflammation. Specific retinoids discussed include tretinoin, isotretinoin, acitretin, and bexarotene. Indications for topical and oral retinoid therapy are provided.
This document provides a historical overview and detailed information on botulinum toxin (BTX), including:
- Its discovery in the early 19th century by Justinus Kerner who identified botulism from sausage poisoning.
- Isolation of the Clostridium botulinum bacterium in 1895 and use of botulinum toxin to treat human disease beginning in 1980.
- FDA approval of Botox Cosmetic in 2002 for frown lines and additional approvals through 2004.
- Mechanism of action whereby BTX blocks acetylcholine release at neuromuscular junctions.
- Commercial preparations of botulinum toxin serotype A and approved therapeutic uses in medical conditions and for cosmetic purposes.
crisaborole the new topical treatment of atopic dermatitis.
it is used in patient with atopic dermatitis 2 years and more.
safe treatment for atopic dermatitis.
The skin is the largest organ of the body. It covers the entire external surface and has important protective, sensory, and metabolic functions. The skin is composed of two main layers, the epidermis and dermis. The epidermis contains keratinocytes, melanocytes, Merkel cells, and Langerhans cells. The dermis lies underneath and contains collagen, elastic fibers, nerves, blood vessels, and skin appendages. The skin regulates body temperature, provides immune protection and sensation, and plays a role in vitamin D synthesis and hormone reception.
1. Topical therapy involves applying medicaments directly to the skin or mucosa. Drug penetration is inversely related to the thickness of the stratum corneum and maximal over mucous membranes.
2. Percutaneous absorption of drugs occurs via transcellular, intercellular, or transappendageal pathways across or between skin cells or through hair follicles and glands.
3. Proper topical treatment requires selecting an appropriate agent, considering the affected area and disease state, and defining dosage and duration to maximize efficacy and minimize side effects.
Psoralens are compounds found naturally in certain plants that cause photosensitivity when combined with sunlight. They are used therapeutically in combination with UVA light (PUVA therapy) to treat various skin conditions like psoriasis and vitiligo. The most commonly used psoralen is methoxsalen, which is administered orally or topically before UVA exposure. Psoralens work by intercalating into DNA upon UVA activation and forming crosslinks that inhibit DNA replication in hyperproliferating skin cells. While PUVA is effective, it can cause side effects ranging from nausea to increased cancer risks with frequent or high dose use.
The Biology of the Basement Membrane Zone Ibrahim Farag
It is a critical interface between the epidermis and dermis and is a highly specialized structure that allows for communication between different cell types.
Examination of BMZ/Structure of BMZ/Origin of BMZ/Function of BMZ/Examples of Some diseases affecting BMZ
This document discusses newer drugs for the treatment of leprosy. It begins by providing context on the evolution of leprosy treatment from Dapsone monotherapy to multidrug therapy (MDT). It then discusses several classes of newer drugs that are being studied and tested, including fluoroquinolones like ofloxacin and moxifloxacin, tetracyclines like minocycline, and macrolides like clarithromycin. It outlines criteria for ideal newer anti-leprosy drugs and provides details on clinical trials and effectiveness of various candidate drugs. Throughout, it emphasizes the need for newer drugs to further simplify treatment regimens and reduce duration, side effects, and incidence of reactions and rel
This document provides an overview of various bedside investigations in dermatology including KOH mount, Gram stain, Tzank smear, AFB stain, slit skin smear, dark ground microscopy, diascopy, Wood's lamp examination, patch testing, intradermal testing and more. Procedures, indications, interpretations and clinical significance are described for each test to aid in the diagnosis of various skin conditions.
This document discusses various surgical techniques for treating vitiligo, including grafting techniques like minipunch grafting, suction blister grafting, and thin split thickness skin grafting. It also covers non-grafting techniques like dermabrasion and micropigmentation. For cellular grafts, it describes autologous non-cultured epidermal cell suspension and cultured melanocyte transplantation. Key factors in selecting a surgical approach include the type and extent of vitiligo lesions as well as equipment and surgeon expertise. Complications, advantages, and disadvantages of each technique are also reviewed.
The dermal-epidermal junction (DEJ):
- Is the largest epithelial-mesenchymal junction, attaching the epidermis and papillary dermis.
- Consists of collagenous and non-collagenous molecules that provide a selective permeability barrier and structural foundation securing the epidermis.
- Its main components are the basal plasma membrane, basement membrane with lamina lucida, densa and fibroreticularis layers, and hemidesmosomes which thickened the keratinocyte plasma membrane.
This document provides a classification and overview of the differential diagnosis of papular lesions that can occur on the face. It categorizes potential causes into infections, inflammatory disorders, tumors, and others. Key points include descriptions of common infections like molluscum contagiosum and lupus vulgaris. Inflammatory conditions discussed are acne, rosacea, perioral dermatitis, and sarcoidosis. Benign and malignant tumors of the skin and adnexal structures are also reviewed. Differential diagnoses and treatment approaches are mentioned for many of the conditions.
The document provides information on the pilosebaceous unit, which is composed of hair follicles, hair shafts, arrector pili muscles, and sebaceous glands. It discusses the anatomy and histology of hair and sebaceous glands. Sebaceous glands develop from the hair follicle and are holocrine glands composed of lobules that produce an oily secretion called sebum. The document outlines the locations of sebaceous glands on the body, their functions, and how their activity is regulated by hormones such as androgens and estrogens. Common diseases associated with abnormalities in sebaceous glands are also mentioned.
Cutaneous tuberculosis can present in several forms based on the route of infection and immune status of the host. Lupus vulgaris is the most common form in adults, presenting as slowly expanding reddish plaques on the head and neck. Scrofuloderma results from contiguous spread from underlying bone or lymph node infection, causing ulcerating nodules. Tuberculosis verrucosa cutis, or warty tuberculosis, occurs through inoculation and presents as painless verrucous plaques. Diagnosis involves biopsy showing granulomatous inflammation with caseation necrosis and occasionally visualizing acid-fast bacilli. Treatment involves anti-tubercular therapy targeting Mycobacterium tuberculosis.
- A 7 year old female presented with a skin biopsy from her left gluteal region for a clinical diagnosis of granuloma annulare.
- Microscopic examination showed features consistent with granuloma annulare including hyperkeratosis, acanthosis, lymphocytic infiltration, and histiocytes surrounding degenerated collagen extending into the dermis.
- Granuloma annulare is a benign inflammatory dermatosis more common in females that involves skin and subcutaneous tissue, though the etiology is unknown.
This document discusses various immunosuppressive agents used in dermatology, including their mechanisms of action, indications, contraindications, side effects, and monitoring guidelines. It covers systemic corticosteroids, methotrexate, and azathioprine. Corticosteroids suppress inflammation through regulating gene transcription. Methotrexate and azathioprine suppress immune responses by inhibiting DNA synthesis. They are used for various inflammatory and autoimmune dermatological conditions. Monitoring includes checking for side effects like infections, myelosuppression, and hepatotoxicity.
This document discusses various immunosuppressive agents used in dermatology, including their mechanisms of action, indications, contraindications, side effects, and monitoring guidelines. It covers systemic corticosteroids, methotrexate, and azathioprine. Corticosteroids suppress inflammation through regulating gene transcription. Methotrexate and azathioprine suppress immune responses by inhibiting DNA synthesis. These agents are used to treat various inflammatory and autoimmune skin conditions. Monitoring is needed due to potential serious side effects like infections, malignancies, and myelosuppression.
This document provides information about immunofluorescence techniques used in dermatopathology. It begins with the history and components of immunofluorescence microscopy. It then discusses the various applications of immunofluorescence including in skin, muscle, and renal biopsies. Specific techniques for skin biopsies like direct immunofluorescence, indirect immunofluorescence, antigen mapping, and salt split skin technique are explained. Common staining patterns seen in dermatological conditions like pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceus, and paraneoplastic pemphigus are summarized. The document emphasizes the utility of immunofluorescence in diagnosing and classifying autoimmune bullous diseases and connective tissue disorders.
This document summarizes epidermal kinetics and dynamics. It discusses the structure of the epidermis, epidermal proliferation units, cell cycle kinetics like turnover time and labeling index. Disturbances in epidermal kinetics like acanthosis, parakeratosis and dyskeratosis are described. Kinetics in normal skin versus psoriasis are compared. Epidermal differentiation and terminal differentiation involving keratinization are outlined. Drugs acting on epidermal cells like retinoids, vitamin D analogues, and salicylic acid are mentioned. Cancers of the epidermis are briefly described.
This document summarizes information about retinoids in dermatology. It discusses the history, structure, and classification of natural and synthetic retinoids. It describes the mechanism of action of retinoids involving retinoid receptors and their effects on keratinization, sebaceous glands, and inflammation. Specific retinoids discussed include tretinoin, isotretinoin, acitretin, and bexarotene. Indications for topical and oral retinoid therapy are provided.
This document provides a historical overview and detailed information on botulinum toxin (BTX), including:
- Its discovery in the early 19th century by Justinus Kerner who identified botulism from sausage poisoning.
- Isolation of the Clostridium botulinum bacterium in 1895 and use of botulinum toxin to treat human disease beginning in 1980.
- FDA approval of Botox Cosmetic in 2002 for frown lines and additional approvals through 2004.
- Mechanism of action whereby BTX blocks acetylcholine release at neuromuscular junctions.
- Commercial preparations of botulinum toxin serotype A and approved therapeutic uses in medical conditions and for cosmetic purposes.
crisaborole the new topical treatment of atopic dermatitis.
it is used in patient with atopic dermatitis 2 years and more.
safe treatment for atopic dermatitis.
The skin is the largest organ of the body. It covers the entire external surface and has important protective, sensory, and metabolic functions. The skin is composed of two main layers, the epidermis and dermis. The epidermis contains keratinocytes, melanocytes, Merkel cells, and Langerhans cells. The dermis lies underneath and contains collagen, elastic fibers, nerves, blood vessels, and skin appendages. The skin regulates body temperature, provides immune protection and sensation, and plays a role in vitamin D synthesis and hormone reception.
1. Topical therapy involves applying medicaments directly to the skin or mucosa. Drug penetration is inversely related to the thickness of the stratum corneum and maximal over mucous membranes.
2. Percutaneous absorption of drugs occurs via transcellular, intercellular, or transappendageal pathways across or between skin cells or through hair follicles and glands.
3. Proper topical treatment requires selecting an appropriate agent, considering the affected area and disease state, and defining dosage and duration to maximize efficacy and minimize side effects.
Psoralens are compounds found naturally in certain plants that cause photosensitivity when combined with sunlight. They are used therapeutically in combination with UVA light (PUVA therapy) to treat various skin conditions like psoriasis and vitiligo. The most commonly used psoralen is methoxsalen, which is administered orally or topically before UVA exposure. Psoralens work by intercalating into DNA upon UVA activation and forming crosslinks that inhibit DNA replication in hyperproliferating skin cells. While PUVA is effective, it can cause side effects ranging from nausea to increased cancer risks with frequent or high dose use.
The Biology of the Basement Membrane Zone Ibrahim Farag
It is a critical interface between the epidermis and dermis and is a highly specialized structure that allows for communication between different cell types.
Examination of BMZ/Structure of BMZ/Origin of BMZ/Function of BMZ/Examples of Some diseases affecting BMZ
This document discusses newer drugs for the treatment of leprosy. It begins by providing context on the evolution of leprosy treatment from Dapsone monotherapy to multidrug therapy (MDT). It then discusses several classes of newer drugs that are being studied and tested, including fluoroquinolones like ofloxacin and moxifloxacin, tetracyclines like minocycline, and macrolides like clarithromycin. It outlines criteria for ideal newer anti-leprosy drugs and provides details on clinical trials and effectiveness of various candidate drugs. Throughout, it emphasizes the need for newer drugs to further simplify treatment regimens and reduce duration, side effects, and incidence of reactions and rel
This document provides an overview of various bedside investigations in dermatology including KOH mount, Gram stain, Tzank smear, AFB stain, slit skin smear, dark ground microscopy, diascopy, Wood's lamp examination, patch testing, intradermal testing and more. Procedures, indications, interpretations and clinical significance are described for each test to aid in the diagnosis of various skin conditions.
This document discusses various surgical techniques for treating vitiligo, including grafting techniques like minipunch grafting, suction blister grafting, and thin split thickness skin grafting. It also covers non-grafting techniques like dermabrasion and micropigmentation. For cellular grafts, it describes autologous non-cultured epidermal cell suspension and cultured melanocyte transplantation. Key factors in selecting a surgical approach include the type and extent of vitiligo lesions as well as equipment and surgeon expertise. Complications, advantages, and disadvantages of each technique are also reviewed.
The dermal-epidermal junction (DEJ):
- Is the largest epithelial-mesenchymal junction, attaching the epidermis and papillary dermis.
- Consists of collagenous and non-collagenous molecules that provide a selective permeability barrier and structural foundation securing the epidermis.
- Its main components are the basal plasma membrane, basement membrane with lamina lucida, densa and fibroreticularis layers, and hemidesmosomes which thickened the keratinocyte plasma membrane.
This document provides a classification and overview of the differential diagnosis of papular lesions that can occur on the face. It categorizes potential causes into infections, inflammatory disorders, tumors, and others. Key points include descriptions of common infections like molluscum contagiosum and lupus vulgaris. Inflammatory conditions discussed are acne, rosacea, perioral dermatitis, and sarcoidosis. Benign and malignant tumors of the skin and adnexal structures are also reviewed. Differential diagnoses and treatment approaches are mentioned for many of the conditions.
The document provides information on the pilosebaceous unit, which is composed of hair follicles, hair shafts, arrector pili muscles, and sebaceous glands. It discusses the anatomy and histology of hair and sebaceous glands. Sebaceous glands develop from the hair follicle and are holocrine glands composed of lobules that produce an oily secretion called sebum. The document outlines the locations of sebaceous glands on the body, their functions, and how their activity is regulated by hormones such as androgens and estrogens. Common diseases associated with abnormalities in sebaceous glands are also mentioned.
Cutaneous tuberculosis can present in several forms based on the route of infection and immune status of the host. Lupus vulgaris is the most common form in adults, presenting as slowly expanding reddish plaques on the head and neck. Scrofuloderma results from contiguous spread from underlying bone or lymph node infection, causing ulcerating nodules. Tuberculosis verrucosa cutis, or warty tuberculosis, occurs through inoculation and presents as painless verrucous plaques. Diagnosis involves biopsy showing granulomatous inflammation with caseation necrosis and occasionally visualizing acid-fast bacilli. Treatment involves anti-tubercular therapy targeting Mycobacterium tuberculosis.
- A 7 year old female presented with a skin biopsy from her left gluteal region for a clinical diagnosis of granuloma annulare.
- Microscopic examination showed features consistent with granuloma annulare including hyperkeratosis, acanthosis, lymphocytic infiltration, and histiocytes surrounding degenerated collagen extending into the dermis.
- Granuloma annulare is a benign inflammatory dermatosis more common in females that involves skin and subcutaneous tissue, though the etiology is unknown.
This document discusses various immunosuppressive agents used in dermatology, including their mechanisms of action, indications, contraindications, side effects, and monitoring guidelines. It covers systemic corticosteroids, methotrexate, and azathioprine. Corticosteroids suppress inflammation through regulating gene transcription. Methotrexate and azathioprine suppress immune responses by inhibiting DNA synthesis. They are used for various inflammatory and autoimmune dermatological conditions. Monitoring includes checking for side effects like infections, myelosuppression, and hepatotoxicity.
This document discusses various immunosuppressive agents used in dermatology, including their mechanisms of action, indications, contraindications, side effects, and monitoring guidelines. It covers systemic corticosteroids, methotrexate, and azathioprine. Corticosteroids suppress inflammation through regulating gene transcription. Methotrexate and azathioprine suppress immune responses by inhibiting DNA synthesis. These agents are used to treat various inflammatory and autoimmune skin conditions. Monitoring is needed due to potential serious side effects like infections, malignancies, and myelosuppression.
Rheumatoid arthritis is an autoimmune disorder that causes chronic inflammation of the joints. It can affect many tissues and organs but principally attacks the joints, causing swelling and pain and potentially resulting in damage to cartilage and bones. Disease-modifying antirheumatic drugs are commonly used treatments and include immunosuppressants like methotrexate as well as biologic agents that target inflammatory cytokines like TNF-alpha. Corticosteroids may also be used as adjuvant therapy to reduce inflammation.
This document provides an overview of antifungal drugs, including their mechanisms of action, therapeutic uses, and adverse effects. It discusses several major classes of antifungals - azoles (imidazoles, triazoles), polyenes (amphotericin B), echinocandins, allylamines (terbinafine), and antimetabolites (flucytosine, griseofulvin). The most common fungal infections treated are candidiasis, aspergillosis, cryptococcosis, and dermatophytosis. Choice of antifungal depends on infecting organism, site of infection, resistance patterns, drug interactions, tolerability, and
This document summarizes antiprotozoal and antihelminthic drugs. It discusses various protozoal diseases including malaria, amebiasis, toxoplasmosis, and trypanosomiasis. It provides details on common antimalarial agents like chloroquine, mefloquine, primaquine, and artemisinin derivatives. It also discusses antifolate drugs, adverse reactions, and treatment approaches. The document then summarizes drugs used for amebiasis, including metronidazole, diloxanide, and emetine. It also briefly discusses drugs for other protozoal infections. Finally, it introduces antihelminthic drugs and classifications
The document summarizes various toxicities caused by anticancer drugs and their management. It discusses acute and delayed toxicities affecting organs like bone marrow, gastrointestinal tract, liver, kidney, lung and heart. It provides examples of drugs causing specific toxicities like neutropenia, anemia, thrombocytopenia and strategies to ameliorate them, including hematopoietic growth factors, cytoprotective agents, dose adjustments and supportive care. The summary highlights management of common toxicities like nausea, diarrhea, stomatitis and alopecia through symptomatic measures and agents.
This document discusses various anti-malarial drugs. It begins by describing the life cycles of malarial parasites and the different species that cause malaria. It then covers the classes of anti-malarial drugs, including 4-aminoquinolines like chloroquine, quinoline-methanols like mefloquine, and artemisinin derivatives. The mechanisms of action, pharmacokinetics, uses, and adverse effects of several important anti-malarial drugs like chloroquine, quinine, mefloquine, primaquine, and artemisinins are discussed in detail. Resistance to chloroquine and the combinations of sulfonamides and py
This document discusses different types of antifungals and their mechanisms of action. It covers several classes of antifungals that target the fungal cell membrane or cell wall, such as polyenes like amphotericin B and azoles like fluconazole. It provides details on the spectrum, pharmacokinetics, dosing and side effects of various azoles including fluconazole, ketoconazole and voriconazole. Lipid formulations of amphotericin B are mentioned which are less toxic than conventional amphotericin B. Mechanisms of antifungal resistance and the importance of drug interactions are also summarized.
This document summarizes various alkylating agents and antimetabolites used in cancer chemotherapy. It discusses the history and mechanisms of alkylating agents such as nitrogen mustards, nitrosoureas, triazines, and platinum compounds. It provides details on specific alkylating agents including their mechanisms of action, uses, dosages, and adverse effects. The summary highlights the development of nitrogen mustard as the first alkylating agent to treat cancer and the discovery of platinum-based drugs like cisplatin through serendipity.
This seminar presentation discusses the uses of dapsone, colchicine, and thalidomide in dermatology. For dapsone, it provides a detailed history, mechanisms of action, indications, dosing, administration, and adverse effects. It is commonly used to treat dermatitis herpetiformis, leprosy, and other chronic inflammatory dermatoses. For colchicine, it discusses the mechanisms of action, pharmacokinetics, and various dermatological uses including papulosquamous dermatoses, recurrent aphthous stomatitis, Behcet's syndrome, bullous diseases, vasculitis, and others. Adverse effects include gastrointestinal issues and bone marrow
This document discusses antimalarial drugs and their classification, mechanisms of action, and therapeutic uses. It begins by identifying the four main Plasmodium species that infect humans. It then covers individual drugs like chloroquine, primaquine, mefloquine, and artemisinin derivatives. It classifies drugs based on their therapeutic effects and chemical structures. Key points include how each drug works against the malaria parasite, their pharmacokinetics, adverse effects, and indications. Artemisinin-based combination therapy is highlighted as the recommended treatment for acute uncomplicated malaria.
Management of adverse effects of cancer chemotherapy 1Dr. Pooja
This document discusses the management of adverse effects from cancer chemotherapy. It covers nausea and vomiting, myelosuppression, alopecia, mucositis, and teratogenicity. For nausea and vomiting, it describes the physiology and classifications, as well as antiemetic agents used for low, moderate, and high emetogenic chemotherapy. It also discusses the use of growth factors to manage chemotherapy-induced myelosuppression and thrombocytopenia. Methods for preventing and treating alopecia and mucositis are summarized.
This document discusses drugs used to treat uveitis. It describes three main groups of drugs: steroids, immunosuppressants, and mydriatics. Steroids are the mainstay of initial therapy and can be administered topically or via injection. Immunosuppressants like methotrexate, azathioprine, and cyclosporine work to modulate the immune system and are used when steroids are not effective or cause intolerable side effects. Mydriatics are used to dilate the pupil and relieve pain. The document provides details on specific drugs, their mechanisms of action, indications for use, and potential adverse effects.
This document summarizes various antifungals, including their mechanisms of action, classifications, and indications. It discusses polyene antibiotics like amphotericin B and nystatin, azoles like fluconazole and itraconazole that inhibit ergosterol synthesis, squalene epoxidase inhibitors like terbinafine, echinocandins that disrupt the fungal cell wall, and other antifungals. It provides a timeline of antifungal development and covers the pharmacology, spectrum of activity, dosing, and adverse effects of major antifungal classes.
1. Chemotherapeutic agents can be classified according to their chemical structure, mechanism of action, or cell cycle specificity. Common classes include alkylating agents, antimetabolites, antitumor antibiotics, and mitotic spindle agents.
2. The mechanisms of action of these drug classes vary but include alkylating DNA, inhibiting nucleic acid synthesis, interfering with transcription and RNA synthesis, and influencing protein synthesis and function. Many agents act during specific phases of the cell cycle.
3. Examples of specific chemotherapeutic drugs discussed include cyclophosphamide, cisplatin, methotrexate, 5-fluorouracil, vincristine, paclitaxel, doxorubicin,
1. Antimalarial drugs can be classified based on their mechanism of action and targets in the parasite lifecycle. Chloroquine is a widely used antimalarial that is effective against sensitive strains of Plasmodium.
2. Artemisinin derivatives like artesunate are the most rapidly acting antimalarials currently available. They are recommended in combination therapies to reduce the risk of resistance developing.
3. Severe and complicated malaria requires parenteral administration of artesunate, artemether, or quinine along with supportive care. Oral antimalarials are used once the patient can tolerate them.
The document discusses several severe cutaneous adverse drug reactions including acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), drug-induced exfoliative dermatitis, and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). It provides details on the clinical features, pathogenesis, diagnostic criteria, investigations and treatment for each condition. Common culprit drugs, complications, differential diagnoses and scoring systems for SJS/TEN are also outlined.
This document discusses corticosteroids and their use in ophthalmology. It begins by describing the basic structure and functions of steroids produced naturally in the body. It then outlines the history of corticosteroid discovery and use in medicine, including their introduction to ocular therapy in the 1950s. The document goes on to explain the mechanisms of action of corticosteroids and their effects on inflammation. It provides details on the administration, pharmacokinetics, efficacy and side effects of systemic corticosteroid use as well as topical ocular administration through eye drops, ointments and injections. Guidelines are given for dosing and monitoring patients on long-term corticosteroid therapy.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation and circulating autoantibodies directed against self-antigens. SLE predominantly affects females and can involve many organs systems, leading to a variety of clinical manifestations. Diagnosis is based on meeting 4 out of 11 criteria developed by the Systemic Lupus International Collaborating Clinics, including at least 1 clinical and 1 immunologic criteria. Treatment involves controlling symptoms, preventing organ damage, and immunosuppressive drugs such as corticosteroids and hydroxychloroquine. The course of SLE can be variable with periods of disease exacerbation and remission.
This document summarizes information about anti-tuberculosis drugs. It discusses the classification of first-line and second-line drugs, their mechanisms of action, resistance, administration and metabolism. First-line drugs like isoniazid and rifampin are front-line treatments while second-line drugs have higher toxicity and are used in special cases. Multi-drug therapy is recommended to prevent resistance. Newer drugs include fluoroquinolones and macrolides. Treatment regimens vary depending on patient category under WHO guidelines. Multi-drug resistant TB requires longer, directly observed treatment with second-line drugs. Treatment is similar for HIV patients but substitutes rifabutin for rifampin. Common first-line
Similar to Dermatotherapeutics - Systemic.pptx (20)
Dr. Sherman Lai, MD — Guelph's Dedicated Medical ProfessionalSherman Lai Guelph
Guelph native Dr. Sherman Lai, MD, is a committed medical practitioner renowned for his thorough medical knowledge and caring patient care. Dr. Lai guarantees that every patient receives the best possible medical care and assistance that is customized to meet their specific needs. She has years of experience and is dedicated to providing individualized health solutions.
Benefits:
Linga mudra generates excessive heat within the body and is very useful for dealing with colds.
It also helps in boosting the immune system and makes the body more resistant to colds and similar infections.
The benefits of penis posture also extend to the respiratory system and it can help loosen the phlegm accumulated from the throat.
This posture also helps in weight loss.
Discomfort experienced in an air conditioned room is relieved by this mudra.
Difficulty in breathing can be relieved by this mudra.
Congested nose can be relieved by this mudra immediately and one can get good sleep.
It controls the flow of the menstrual cycle. Performing the Linga mudra with the Sun Mudra gives better results – both 15 minutes each, one after the other.
When navel center is shifted from its original place, comes back to its place by this mudra.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
At Malayali Kerala Spa Ajman we providing the top quality massage services for our customers.
Our massage center prioritizes efficiency to ensure a quality massage experience for our clients at Malayali Kerala Spa Ajman. We offer a convenient appointment system and precise massage services.
Reach us at Villa No 7, Near Ammar Bin Yasir Street Al Rashidiya 2 - Ajman - United Arab Emirates.
Phone : +971 529818279
Exosome Therapy’s Regenerative Effects on Skin and Hair RejuvenationAdvancexo
Explore the transformative effects of exosome therapy on skin and hair rejuvenation. Learn how these tiny vesicles deliver essential growth factors and stimulate cellular repair, offering natural solutions for aging skin and hair loss. Discover the science behind exosomes and their benefits in aesthetic dermatology.
Solution manual for managerial accounting 18th edition by ray garrison eric n...rightmanforbloodline
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
1. Prof. Satyendra Kumar Singh
Department of Dermatology and Venereology
Institute of Medical Sciences,
B.H.U., Varanasi
Dermatotherapeutics -
Systemic
Digital LectureSeries
3. Introduction
• A better understanding of diseases has resulted in the evolution of
drugs that act more specifically with minimal risk to the patient
• Today dermatologists are well equipped with an array of new
therapeutic tools in his/her armamentarium for the successful
management of various dermatoses
• Drug interactions, resistance and side effects, however, pose
challenge to the treating physician
• Commonly used systemic agents in dermatological disorders will be
discussed
4. Sulfone : Dapsone
• Dapsone is 4,4-diaminodiphenylsulfone derivative of sulfones
• Metabolized in liver and excreted by the kidneys
• It can cross blood brain brain barrier and placenta & is detectable in breast milk
• Doses : 50 to 300 mg/day
• Mechanism of action
• Antimicrobial agent interfere with folate biosynthetic pathway by inhibiting
dihydrofolic acid via inhibiting dihydropteroate synthatase
• Antinflammatory action by inhibiting migration of neutrophil & inhibiting
neutrophil chemotaxis
• Also Inhibits release of inflammatory mediators
• Drug interaction : with rifampicin, probenecid and trimethoprim
5. Sulfone : Dapsone
• Dapsone resistance : In leprosy (changes in DNA sequences in fol P gene)
• Indications
− Antiinfective drug- Hansen disease, malaria, leshmaniasis, pneumocystis
− Antiinflammatory drug-
• Consistently responsive : Dermatitis herpetiformis, erythema elevatum diutinum,
linear IgA dermatosis etc
• Adjunctive combination treatment :
− Autoimmune blistering diseases: pemphigus, bullous pemphigoid, mucous
membrane pemphigoid
− Neutrophilic dermatosis: subcorneal pustular dermatosis, pyoderma
gangrenosum, Sweet syndrome
− Autoimmune diseases & others like Behcet’s disease, hidradenitis suppurativa
7. Laboratory Monitoring with Dapsone
• Before initiation of therapy
− CBC
− Reticulocyte count
− Hepatic function test
− Renal function test
− glucose -6- phosphate
dehydrogenase( if needed)
• During therapy
− CBC weekly for first month
and twice a month for next 2
months, periodically
thereafter
− Reticulocyte count weekly for
first month and twice a month
for next 2 months;
periodically thereafter
8. Antihistamines
• Histamine receptors are heptahelical transmembrane molecules.
• They are wildly expressed on body and are of four types:-
− H1 receptors & H2 receptors : found on neuron, smooth muscle, epithelium,
endothelium and multiple immune cells.
− H2 receptors : also found on gastric mucosal parietal cells
− H3 receptors : located on histaminergic neuron, & responsible for histamine
production & release.
− H4 receptors : expressed in bone marrow and on pheripheral hematopoietic
cells
• Antihistamine classification:-
− First generation H1 Antihistamines
− Second generation H1 Antihistamines
− Tricyclic antihistamine
− Mast cell degranulation inhibitor
9. • H1 antihistamine are lipophilic and cross blood brain barrier reaches
CNS causes sedation
• Metabolized in liver and excreted in urine caution to be taken with
liver disease and likelihood of interaction with drugs
Firstgeneration antihistamines Doses
Chlorpheniramine maleate 25-50mg, 6-8 hourly
Diphenylhydramine HCl 25-50mg, 6-8 hourly
Promethazine 12.5-25mg, 6-8 hourly
Hydroxyzine HCl 12.5-25mg, 6-8 hourly
Cyproheptadine HCl 4-8mg, 8-12 hourly
First Generation Antihistamines
10. Second Generation Antihistamines
• Second generation antihistamines act as inverse agonist on histamine
receptors
• They have minimal sedative, anticholinergic effects and once a day
dosing
Drug dose
cetrizine 5-10mg
desloratidine 2.5-5mg
ebastine 10-20mg
fexofenadine 120-180 mg
levocetrizine 5-10 mg
loratidine 5-10 mg
11. Mechanism of Action
• Act by competitive inhibition of the actions of histamine by receptor
blockade thereby reducing histamine mediated pruritus.
• These drugs also prevent vasodilation, transduction and formation of
typical wheals on the vascular endothelial surface.
• Key points
− Desloratadine and mizolastine are safe in renal disease patients
− Cetrizine, fexofenadine and desloratadine are safe in hepatic patients
− Loratidine is currently approved as a safe drug to use in pregnancy &
lactation
− Chlorpheniramine and diphenhydramine are also considered safe in
pregnancy
12. H1 Antihistamines (H1 AH)
• Indication
− Acute urticaria
− Chronic idiopathic urticaria and
dermatographism
− Pruritus associated with histamine
release
− Mastocytosis
• Adverse effect
− CNS disturbance-sedation, blurred
vision, tremor etc.
− GI complaints- nausea, vomiting
anorexia etc
− Anticholinergic effects-dry mouth,
postural hypotention
− Cardiac arrhythmias
• Contraindication
− Narrow angle glaucoma
− Concomitant use of mono amine
oxidase inhibitor
• Risk benefit assessment
− History of cardiac arrhythmias
− First trimester of pregnancy
− Prostatic hypertrophy
13. Systemic Steroids
• Systemic steroids are used for their anti-inflammatory &
immunosuppressive effects in various dermatoses
• Mostly low doses are used over the shortest possible time period
• High doses of steroids are used in emergencies & in periods of stress
and trauma
14. Mechanism of Action
• At the Cellular Level
− Steroids passively diffuse through the cell membrane
− Bind to intra-cytoplasmic soluble protein receptors to form a
complex
− This complex enters the nucleus
− Regulates the transcription of a limited number of genes
− Decreased synthesis of pro-inflammatory molecules (ILs, cytokines,
& proteases)
15. Mechanism of Action
• Synthesis of lipocortin increases
• Reduces phospholipase A2 activity
• Reduces the concentration of PGs, & LTs
• Steroids reduce the no. of monocytes, lymphocytes & eosinophils and
increase the no. of neutrophils
• Modify cellular activation, proliferation & differentiation
16. Indications
• Long Term Systemic Steroids – Pemphigus, bullous pemphigoid, SLE,
dermatomyositis, eosinophilic fasciitis, vasculitis, neutrophilic
dermatoses & lepra reaction
• Short Term Schedule – Atopic dermatitis, acute/disseminated eczema
of varying etiology
• Also used in toxic epidermal necrolysis, erythema nodosum, erythema
multiforme, exfoliative dermatitis, lichen planus and discoid lupus
erythematosus
17. FDA- Approved Indications of Systemic Steroids
• Pemphigus vulgaris, pemphigus foliaceus
• Bullous pemphigoid
• Stevens Johnson Syndrome and TEN
• Systemic lupus erythematosus
• Dermatomyositis
• Erythema multiforme minor
• Severe urticaria
20. Side Effects
• Adverse effects vary & depend on the type of steroid used, the dosage
& duration and patient factors
• Low dose administration over a longer duration is more likely to
precipitate side effects than a high dose over a short period
• Immunosuppression, precipitation of infection & suppression of the
HPAaxis
• Calcium and Vitamin D supplementation is essential in
postmenopausal women & elderly patient
21. Side Effects
• Following lists the side effects in head-to-toe order :-
raised ICT
, psychosis, glaucoma, premature cataract, Cushingoid
features, activation of pulmonary TB, hypertension, gastritis,
perforation, pancreatitis, worsening of diabetes, osteoporosis,
premature closure of epiphysis, avascular necrosis of the femur
22. Antibacterial Agents
• Penicillins
− Still the drug of choice for infections caused by gram-positive cocci
− Antistaphylococcal penicillins include oxacillin, dicloxacillin,
flucloxacillin and naficillin orally for mild infections or systematically
− Acute side effects:- Life-threatening angioedema and hypersensitivity
reactions such as urticaria, morbifilliform rashes, exfoliatve
dermatitis, drug fever, serum sickness or Stevens Johnson syndrome
− Injectable form are always preferred over oral forms for their proven
efficacy
23. Other Penicillins
• Aminopenicillins (ampicillin, amoxicillin)
• Carboxypenicillins (Carbenicillin, Ticarcillin)
• Ureidopenicillin (Mezlocillin, Azlocillin, Piperacillin)
• ß-lactam group of Monobactams (Aztreonam) & Carbapenems
(Imipenem, Meropenem)
• ß-lactamase inhibitors – Clavulanic acid, Sulbactam, Tazobactam
• NOTE : In combination formulations these restore the antibiotic
activity of Amoxicillin (Clavulanic acid), ampicillin (Sulbactam) &
Piperacillin (Tazobactam) against a spectrum of both gram positive &
negative organisms
24. Other Penicillins
• Benzathine penicillin G in syphilis-
− Primary, secondary or early latent syphilis- 2.4 million units IM
single dose
− Late latent, latent with unknown duration, or tertiary syphilis
(with normal cerebrospinal fluid examination)- 2.4 million units
IM weekly for 3 weeks
• Aqueous penicillin G in syphilis-
− Neurosyphilis (including ocular)- 3-4 million unit IV every4
hours for 10-14 days
26. Aminoglycoside
• Action spectrum of aminoglycosides is mainly against gram-negative
bacteria, and they act synergistically with penicillins against
staphylococci
• Should not be used alone in skin infections to avoid drug resistance
among gram-negative bacteria and Ps. aeruginosa
• Systemic : Tobramycin, Netilmicin and Amikacin
• Topical : Neomycin
• Both Topical & Systemic : Gentamicin
• Side effects include Ototoxicity & Nephrotoxicity
27. Tetracyclines
• Based on their half-lives these are classified as follows:-
• Short acting- Oxytetracycline and tetracycline
• Intermediate acting- Demeclocycline and methacycline
• Long acting- Doxycycline, Minocycline, Tigecycline
• Dosage Schedule
− Tetracycline – 250-500mg QID daily
− Doxycycline - 200mg loading dose, f/b 100mg /day
− Minocycline -200mg loading dose, f/b 100mg BD
− Side effects - photosensitivity & gastrointestinal disturbances
− Minocycline - Vertigo ( in females around day 2-4 of starting the drug)
29. Precautions
• Avoid in pregnancy, lactation and <8 yr of age, as it causes teeth
anomalies and skeletal growth depression in foetus
• Tetracyclines should not be administered with food, antacids, milk or
iron containing compound
30. Macrolides & Lincosamides
• Macrolides - Erythromycin, Roxithromycin, Azithromycin,
Clarithromycin
• Lincosamides - Lincomycin, Clindamycin
• Cross-resistance amongst macrolides and lincosamides is the rule
• Their main Spectrum of action is against Gram-positive cocci
• Clarithromycin is effective against MRSA, Mycobacterium leprae
• Telithromycin is a newer semisynthetic macrolide that acts against
Gram-positive bacteria
31. Dosage Schedule
• Erythromycin - 250-500mg, orally, 6 hourly
• Clarithromycin - 250-500mg, orally, 12 hourly
• Azithromycin - 500 mg, orally before food, 24 hourly
• Lincomycin - 500 mg, IV/orally, 8 hourly
• Clindamycin - 300-600mg, IV/orally, 8-12 hourly
• Side effects
− Erythromycin may cause gastritis
− Lincosamides may cause diarrhoea
− 10% of patients may suffer from pseudomembranous colitis
32. Quinolones
• Quinolones (norfloxacin, ciprofloxacin, ofloxacin, moxifloxacin,
pefloxacin, enoxacin) have a wide range of action & good tolerability
• Their use in dermatology is limited to P
.aeruginosa infections, UTI
and Leprosy
• Side effects:-
− GI disturbances are more frequent than CNS &phototoxic
adversities
33. Vancomycin and Lipoglycopeptides
• Vancomycin
−A glycopeptide, effective against gram positive bacteria
− Dose: 1 gm, 12 hourly,i.v.
−Side effects: Nephrotoxicity, Ototoxicity, Red man syndrome,
Phlebitis
• Lipoglycopeptides
− Dalbavancin, Oritavancin andTelavancin
−Semisynthetic derivative of vancomycin
34. Oxazolidinones and Daptomycin
• Oxazolidinones
− Linezolid: 600mg twice daily, Tedizolid: 200mg once daily
− Inhibit protein synthesis by binding to the 23S and 50S ribosomal subunit
− Active against gram positive organism (including anaerobes) and
nontuberculous mycobacteria such as M. chelonae and M. fortuitum
− Side effects: thrombocytopenia and leukopenia
• Daptomycin
− A lipopeptide antibiotic
− Approved for the complicated skin and soft tissue infection caused by S.
aureus (including MRSA), penicillin resistant S. pneumoniae and vancomycin
resistant enterococcus
− Dose: 4mg/kg i.v. every 24 hours for 7-14 days
− Side effect: myopathy
35. JAK Inhibitors
• The Janus Kinase and signal transducer and activator of transcription
(JAK-STAT) is an intracellular signaling pathway upon which many
different pro-inflammatory signaling pathways converge
• First generation JAK inhibitors
Drug Inhibits FDAapproved
indications
Dose
Tofacitinib JAK1/3>2 Rheumatoidarthritis 5mg twicedaily
Ruxolitinib JAK1/2 Myelofibrosis
Polycythemiavera
5-25mg twicedaily
Baricitinib JAK1/2 none none
Oclacitinib JAK1 Canine atopicdermatitis n/a
40. • Sildenafil, vardenafil and tadalafil have been associated with hearing
loss
• Often the hearing loss is unilateral and may occur during the initial 24
hours
• It is temporary in one third of cases
• Blue tinted visual disturbances- temporary and reversible
• Periapism- erection lasting more than 4 hours
41. Antifungal Drugs
• Systemic antifungal drugs play an important role in the management
of superficial, deep and systemic fungal infections
• Fungal cell wall is made up of chitin and their cell membrane is made
up of ergosterol
42. Classification of Antifungals Based on
Mechanism of Action
1. Nucleic acid synthesis inhibitor- Flucytosine
2. Disruption of microtubules- Griseofulvin
3. Cell wall synthesis inhibitor- Echinocandins
4. Cell membrane
−Azoles-
• Triazoles- Itraconazole, voriconazole, fluconazole,
posaconazole
• Imidazoles- Ketoconazole
− Allylamines-Terbinafine
−Polyenes- Amphotericin-B
43. Indications for Systemic Antifungals
• Failure of topical therapy
• Poor compliance regarding topical application
• Extensive superficial fungal infections
• Deep mycoses/systemic fungal infection
• Recurrent attacks presence
• Involvement of hair & nails
• Presence of associated immunocompromised states
44. Systemic Antifungal : AZOLES
• Triazoles- Itraconazole, Fluconazole, Voriconazole, Posaconazole
• Imidazoles - Ketoconazole
• Mechanism of action: by inhibiting 14-α demethylase affecting
ergosterol synthesis in the cell membrane
• Drug interactions are more with these groups because of the
involvement of cytochrome P-450 system
45. Azoles Common Indications Comments
Itraconazole Candidiasis (100-200mg/day)
Pityriasis versicolor (200mg/day)
Dermatophytosis (200mg/day)
Pulse therapy in onychomycosis(400
mg/day for 1 week every month for 2 or 3 months
for finger & toenails,respectively)
Deep fungal: Eumycetoma,chromomycosis,
histoplasmosis, blastomycosis,aspergillosis
Increased riskof
hepatotoxicity,
congestive heart
failure, prolong
QT-interval and
druginteractions
Fluconazole Candidiasis (100-200mg/day)
Pityriasis versicolor (300 mg/week for 2 weeks)
Dermatophytosis (300 mg/week for 6weeks)
Cryptococcal meningitis
Coadministration
with statins
(increased
myopathy),safe
in infants
46. Azoles Common Indications Comments
Ketoconazole Candidiasis (200-400mg/day)
Pityriasis versicolor (400 mg single dose
or 200 mg/day for 5 days)
Dermatophytosis (200-400 mg/dayfor
4- 8 weeks)
Eumycetoma, sporotrichosisand
chromomycosis.
Hepatotoxicity,
gynecomastia,adrenal
insufficiency, strong
inhibitor ofCYP-3A4
Voriconazole Candidemia, invasiveaspergillosis,
Fluconazole resistant oralcandidiasis
For >40 kg weight- 400mg BD for first 24
hour then 200mg BDthereafter
Photophobia,
abnormalvision,
hallucination
48. Systemic Antifungal : ALLYLAMINES
• Terbinafine
− Mechanism of action- inhibiting squalene epoxidase, results in the
accumulation of squalene and subsequent deficiency of ergosterol
− Drug resistance in dermatophytes is attributed to single nucleotide
polymorphisms (SNPs) in squalene epoxidase (SE) gene
− Indications:-
• Tinea cruris/corporis- 7.5mg/kg once a day for 4- 6 weeks
• Onychomycosis- 6 weeks for fingernails, 12 weeks for toenails
− Side effects:-
• Headache, GI symptoms, altered taste, loss of smell
• Acute generalized exanthematous pustulosis (AGEP)
49. Polyenes
• Derived from Streptomyces species
• Include Amphotericin B, Nystatin and Natamycin
• Binds on to the cell membrane and cause cell leakage
• Amphotericin-B
− Oral absorption is very poor
− Indications:- Mucormycoses (Black fungus), aspergillosis,
candidiasis, cryptococcal meningitis in HIV, visceral leishmaniasis,
febrile neutropenia and deep mycosis
50. Amphotericin-B
• Available in four parenteral forms:
• Amphotericin B deoxycholate/Conventional (0.5-1 mg/kg/day)
• Liposomal amphotericin B (AmBisome) (3 mg/kg/day)
• Amphotericin B lipid complex (ABLC)
• Amphotericin B colloid dispersion (ABCD)
• Side effects : infusion related (fever, chills, thrombophlebitis),
Nephrotoxicity- which is countered to a certain extent by tagging
liposomes to the drug, anemia
51. Griseofulvin
• Derived from Penicillium griseofulvum
• Sweat potentiates the entry of the drug in the stratum corneum
• Mechanism of Action
− Inhibition of intracellular microtubules and so inhibits the
formation of mitotic spindles
− Defective fungal filaments dehydrate and curl; hence griseofulvin
was also called – curling factor
− Also known to inhibit leucocyte movement and has an anti-
inflammatory action
52. Griseofulvin
• Indications
− Effective only against dermatophytes and used in Tinea capitis, T
.
cruris, corporis, pedis and unguim
− Oral dose is 6-8 mg/kg/day in two divided doses for 4 – 8 weeks
• Side effects
− Nausea, gastritis, intolerable headache
− Disulfiram like reaction
− Photosensitivity, pancytopenia
53. Systemic Antifungals in Special Situations
• Elderly :- Terbinafine is the antifungal of choice for dermatophytosis &
onychomycosis because of clinically insignificant drug interaction and
Less hepatotoxic than azoles
• Hepatic failure :- Fluconazole may be used with caution, Voriconazole
can be used (halve the dose) in mild to moderate hepatic cirrhosis
• Renal failure :- Oral itraconazole and voriconazole – No dose adjustment,
• Terbinafine and Fluconazole are excreted primarily through kidney
54. Systemic Antifungals in Special Situations
• Cardiac disease :- Terbinafine
• Pregnancy :-
− Category B- Terbinafine,Amphotericin-B
− Category C- Itraconazole, Fluconazole, Ketoconazole
− Category D- Voriconazole
• Lactation :- Fluconazole is compatible with breastfeeding
55. Antiviral Drugs
• Early use of antivirals is advisable to reduce viraemia and fulminant
infection and to minimize nerve damage
• In herpes simplex, varicella and herpes zoster, antiviral drugs should
be used within 24, 48 and 72 hours of skin eruption respectively
HerpesZoster
56. Acyclovir
• Synthetic purine analogue used orally, intravenously, and topically
• It is converted by viral thymidine kinase to acyclovir triphosphate
which subsequently inhibits viral DNA polymerase
• Resistance due to alteration or deficiency of viral thymidine kinase
• Half life is 2 to 3.5 hours and excretion is almost entirely renal
• Commonly used orally to treat herpes simplex and varicella zoster
virus infection
57. Acyclovir
• Intravenous acyclovir is used in fulminant infections, the occurrence
of CNS complications and in immunocompromised patients
• Neonatal HSV infection:- 20 mg/kg every 8 hour, IV for 14 – 21 days
• Side effects:-
− Renal tubular crystallization with rapid IV administration
− Interstitial nephritis
− Thrombophlebitis
58. Dosage Schedule of Antivirals
Acyclovir Valacyclovir Famciclovir
Herpes simplex
Primary
200mg, 5 timesa
day for 7-10days
1g, twice a dayfor
7-10 days
250mg, 3 timesa
day for 7-10days
Recurrence
400mg, 3 timesa
day for 5days
500mg, twice aday
for 3 days
125mg, twice aday
for 5 days
Suppressive 400mg, twice aday 1g, once aday 250mg, twice aday
Herpes zoster
800mg, 5timesa
day for 7days
1g, 3 times a day
for 7 days
500mg, 3 timesa
day for 7days
59. Foscarnet
• Pyrophosphate-containing antiviral drug
• Noncompetitively inhibits viral DNA polymerases
• Does not require phosphorylation therefore active against many strains of
virus that are resistant to acyclovir, famciclovir, or ganciclovir
• Indications:-
− CMV retinitis
− Acyclovir-resistant HSV infections (40mg/kg every 8 hour for 14-21
days)
• Side effects:-
− Nephrotoxicity (typically occurs during 2nd week)
− Diarrhoea
60. Interferons
• Interferon α, β and γ belong to the cytokine network and are
implicated in host defense
• They have antiviral, anti-proliferative and immunomodulatory
properties
• α-interferon is frequently used in dermatology in mycosis fungoides,
viral warts, Behçet disease, Kaposi sarcoma, nonmelanoma skin
cancer
• Dosing : 1 to 3 million units I.M. 1 to 3 times/week (CTCL)
• Side effect: flu-like symptoms, fatigue and neutropenia
• Caution: cardiac disease and psychiatric illness
61. Antiparasitic Drugs
• Ivermectin:
• Semisynthetic anthelminthic derived from fermented products of
Streptomyces avermitilis
• Indications: strongyloidisasis and onchocerciasis, scabies and pediculosis
capitis
• Dose of 200 µg/kg is advocated on an empty stomach, half life 18 hours
• Mechanism of action
− It blocks glutamate-gated chloride ion channels, causing
neuromuscular paralysis in the parasite
• Adverse effects:
− Less common: pruritus, fever, lymphadenopathy
− Rare SJS/TEN, tachycardia, encephalopathy
62. Thiabendazole
• Acts by inhibition of the enzyme fumarate reductase
• Metabolized in liver excretion by urine
• Indication: cutaneous larva migrans and currens
• Dosage: 1.5g/day for 2 days
• Adverse effects : anorexia, abdominal discomfort, hepatotoxicity
63. Retinoids
• It include all synthetic and natural compounds that have activity
similar to vitamin-A
• Classification :-
− First generation (non-aromatic) - isotretinoin and tretinoin (all-
trans retinoic acid)
− Second generation (mono-aromatic) - etretinate and acitretin
− Third generation (poly-aromatic) – bexarotene
64. Retinoids : Mechanism of Action
• At the cellular level, the cytosolic retinoid binding protein ⟹
transfers it to the nucleus
• Retinoids activate the nuclear receptors and regulate gene
transcription
• They induce cellular differentiation, have anti-inflammatory and
antiproliferative action
• In skin they have an anti-keratinising effect, and in sebaceous glands,
they reduce sebum production and decrease maturation of sebocytes
65. Retinoids : Indications
• FDA-Approved :
− Severe acne (isotretinoin)
− Severe plaque psoriasis (acitretin)
− Cutaneous T-cell lymphoma (bexarotene)
• Off label uses: rosacea (papulopustular, granulomatous), hidradenitis
suppurativa, pityriasis rubra pilaris, Darier’s disease, ichthyosis and
keratodermas
67. Retinoids :Dosage Schedule
• Acitretin (25-75mg/day) is the chosen retinoid for psoriasis, although
uses is limited to pustular and palmoplantar psoriasis
• Acitretin with PUVA is termed Re-PUVA
• Side effects:-
− Cheilitis (earliest and most common)
− Paronychia, pyogenic granuloma
− Hypertriglyceridemia, deranged LFT
− Diffuse idiopathic hyperostosis (DISH)
69. Methotrexate
• Dosage Schedule
− Can be taken orally, I.V., S.C. or I.M.
− Oral dose commonly used is 2.5-15 mg/week in single dose
− ‘Winstein-Frost’ schedule recommends usage in 3 divided doses, given
at an interval of 12 hours, on a weekly basis
• Side effects
− Side effects infrequent when used as per standard therapeutic
guidelines
− Hepatotoxicity, pneumonitis, diffuse interstitial fibrosis,
pancytopenia, gastritis
− MTx is a potential teratogen and abortifacient(category X)
71. Methotrexate
• Monitoring guidelines
− Includes complete haemogram, LFT and USG scan of the liver
− Tests are best done at 0,1,2,4,8, & 12 weeks, and later regularly
every third month in long term therapy
− Baseline liver biopsy is indicated at a cumulative dose of 1.5 g of
total methotrexate usage in high-risk patients while in others at 4g
− Patients with grade I and II disease- can continue therapy
− Grade IIIA- can continue with repeat biopsy after 6 months
− Grade IIIB and IV- Discontinuation of therapy
72. Methotrexate
• Indications in psoriasis
− Erythrodermic psoriasis, psoriatic arthritis, pustular, extensive severe
plaque not responding to conventional treatment, lack of response to
PUVA/UVB or systemic retinoids
• Contraindications
− Pregnancy, severe renal and liver compromise, chronic alcoholism,
active infection, immunosuppresion
• Risk factors for mtx induced hepatotoxicity
− Extensive alcohol consumption, persistent abnormal LFT
, coexisting
hep B & hep C infection, diabetes, obesity, hyperlipidaemia,
hepatotoxic drugs, lack of folate supplementation
73. Azathioprine
• Derived from 6-mercaptopurine, and considered a safer
immunosuppressant because of infrequent toxicity
• Indications
− Used for its both immunosuppressive
and anti-inflammatory effects
− Commonest indication is pemphigus
vulgaris
− Other indications:- vasculitis, neutrophilic
dermatoses, CTD and recalcitrant
photodermatoses
Pemphigusvulgaris
74. Azathioprine
• Bioavailability 88%, protein binding 30%
• Elimination half-life is 5 hours
• Enzymes for the 3 metabolic pathway includes Thiopurine
methyltransferase (TPMT), Xanthine oxidase (XO) and Hypoxanthine
guanine phospho-ribosyltransferase (HGPRT)
• Drug interaction
− ACE inhibitors such as captopril may increase the risk of
leukopenia
− Sulphasalazine inhibits TPMT enzyme activity, thus causes toxicity
75. Azathioprine
• Absolute contraindications include pregnancy, TPMT (thiopurine
methyltransferase) levels of <5 U and the presence of fulminant
infections
• Pregnancy category D
• Dosage Schedule
− 0.5-2.5mg/kg/day, while the commonly used dosage 50-100
mg/day
• Side effects
− Pancytopenia, precipitation of infections and drug hypersensitivity
syndromes, teratogenicity, hepatic transaminase elevations
− TPMT assay prior to starting treatment is always advisable
76. Cyclophosphamide
• Derivative of nitrogen mustard acts by damaging the DNA molecule
through its active metabolites
• It is cell cycle nonspecific and depresses B cell functions more than T
cells
• Acrolein, an inactive metabolite, is the responsible for bladder toxicity.
Hence proper hydration and good urinary output is needed
• Indications
− Used in severe pemphigus alone or as a constituent of
Dexamethasone-Cyclophosphamide pulse therapy
− Advanced mycosis fungoides, lupus erythematosus and Wegener’s
granulomatosis
77. Cyclophosphamide
• Dosage Schedule
− Orally in a dose of 1-5 mg/kg/day in equal divided doses or as a
single dose of 50-200 mg/day
− Parental dose of 5-9 mg/kg/day in lupus nephropathy and serious
lupus vasculitis
− Pregnancy category D drug
• Side effects
− Haemorrhagic cystitis, bladder carcinoma, leucopenia, anagen
effluvium are common toxicities. Risk of bladder cancer is 8-10-
fold higher in these patients
78. Hydroxyurea
• Affects DNA synthesis & repair and gene regulation through inhibition
of ribonucleotide reductase
• Withdrawal of drug results in a rapid reversal of its effect
• Oral tab are used in a dose of 1-1.5 g/day in divided doses
• Used infrequently in recalcitrant psoriasis, erythromelalgia and Sweet
syndrome
• Side effects
− Marrow suppression, elevated transaminases, altered renal
function and poikiloderma
− Pregnancy category D drug
79. Cyclosporine-A
• Acts by decreasing T-cell & keratinocyte proliferation
• Also reduces levels of ILs & TNF
• Used in widespread erythrodermic or pustular psoriasis
• It’s a rapid ‘cooldown’ of the inflammatory component of a florid
psoriasis
• Also used in atopic dermatitis, recalcitrant urticaria & pyoderma
gangrenosum
• Dose : 2.5-5 mg/kg/day
• Side effects
− Renal dysfunction, hypertension, tremors & gingival hyperplasia
− Pregnancy category C drug
80. Mycophenolate Mofetil
• MPA was used widely in psoriasis in previous years and mycophenolate
mofetil, an esterified form with greater bioavailability is now used in
atopic dermatitis, lupus erythematosus, psoriasis, refractory P
.G. and
bullous diseases
• MMF gets cleaved to MPA after absorption. It acts by inhibiting de novo
purine synthesis
• It affects T & B- cells predominantly
• Side effects
− Include nausea, diarrohea, strangury and an increased incidence of
viral & bacterial infections
− Pregnancy category D drug
81. Antimalarials : Hydroxy Chloroquine (HCQ)
• Immunologic and anti-inflammatory effects: decrease in T cell release
of IL-1, IL-6, TNF and interferon gama
• Usual dose : 400 mg/day
• Photoprotective effects: high concentration in epidermis because of
their affinity for pigment
• Metabolized in liver but only 15 to 25 % of total clearance is through
kidney
• Half life is 40-50 days, excretion 20% unchanged in urine, also biliary
excretion
82. Antimalarials : Hydroxy Chloroquine (HCQ)
• Dermatologic indications
• Lupus erythematosus, porphria cutanea tarda, solar urticaria,
dermatomyositis, generalized granuloma annulare, polymorphous
light eruption (PMLE)
• Contraindication
• Severe blood dyscresis, hepatic dysfuntion and retinal or visual
field changes
• Pregnancy category C drug
83. • FDA pregnancy safety category of common topical/systemic
medications used in dermatology
Drugs Used During Pregnancy and Lactation
89. Drugs Used During Pregnancy and Lactation
• Antihistamines
• Safe- diphenhydramine, chlorpheniramine, cyproheptadine and
loratidine
• Avoid- hydroxyzine, fexofenadine
• Antihistamines may suppress lactation and create infantile irritability
• Chlorpheniramine, is regarded as first-line antihistamine treatment
for pregnant patients
• Loratadine is recommended as a treatment for dermatoses of
pregnancy, such as mild pemphigoid gestationis, after the first
trimester or for polymorphic eruption of pregnancy
90. Drugs Used During Pregnancy and Lactation
• Systemic corticosteroids
• Avoid in the first trimester because of a risk of multiple-organ anomalies
• Short-term therapy is best advocated in the second and third trimesters
• High-dose oral corticosteroid therapy during pregnancy is associated with
intrauterine growth retardation, low birth weight infants, and inhibition
of endogenous corticosteroid production, and orofacial clefts
• Although listed in category C, the literature indicates that topical
steroids are first-line therapy in inflammatory diseases during pregnancy
91. Drugs Used During Pregnancy and Lactation
• Antibacterial Agents
• Safe : macrolides, penicillins and cephalosporins
• Avoid : quinolones, tetracycline. Silver sulphadiazine is not advised in
the third trimester because of risk of foetal haemorrhage
• Antiviral Drugs
• Systemic antivirals are safe in all trimesters
• Acyclovir is indicated as a topical treatment for herpes simplex or as
a systemic treatment for herpes zoster, genital herpes, or varicella
92. Drugs Used During Pregnancy and Lactation
• Antiparasitic Drugs
• Treatment of choice indicated for pregnant patients suffering from
scabies is topical permethrin, which is category B and safe during
pregnancy
• Sodium stibogluconate is indicated as a treatment for leishmaniasis.
Studies have included pregnant patients treated with the drug, but
data are insufficient to determine its safety
93. Drugs Used During Pregnancy and Lactation
• Retinoids
• Systemic retinoids are totally contraindicated during pregnancy and
lactation
• Topical retinoids, tretinoin and adapalene, both are category C and
should not be used during pregnancy
94. Drugs Used During Pregnancy and Lactation
• Acitretin :
• Category X
• Risk of fetal anomalies is 25 times higher than for the general population
• May cause microtia/anotia, micrognathia, cleft palate, congenital heart defects
and aortic-arch abnormalities, thymic defects, retinal or optic-nerve
abnormalities, and central nervous system malformations
• Total elimination of acitretin and its metabolites from the body takes up to 2
months
• With alcohol consumption during treatment, acitretin is metabolized to
etretinate, which has a half life of up to 168 days, and the teratogenic effect may
hold up to 3 years
• Female patients should be advised not to drink alcohol during and at least 2
months after discontinuation of acitretin therapy and to use at least two kinds of
contraception for 3 years after discontinuation of the drug
95. Drugs Used During Pregnancy and Lactation
• Isotretinoin :
• Category X
• During the first trimester, it may cause fetal loss, and later use
may cause malformations, such as microtia, stenosis of the
external ear canal, cleft palate, hydrocephalus, and cardiac
outflow tract defects
• Female patients of child-bearing age who are sexually active
should use two methods of birth control during and for 1 month
after treatment
96. Effect of Drug With Respect to the Trimesters
of Pregnancy & Lactation
• Before Conception (contraception Failure)
• Use of Azathioprine, Methotrexate, NSAIDs, Griseofulvin,
Itraconazole, Tetracycline and Rifampicin may result in contraceptive
failure either directly or through hepatic enzyme induction
• First Trimester
• Differentiating cells, when affected, result in defective organogenesis
and congenital anomalies
• Hence, FDA pregnancy Category X and D drugs are totally avoided;
they include Retinoids, Finasteride, Methotrexate, Thalidomide,
Colchicine, Spironolactone, Griseofulvin and Cyclophosphamide
97. Effect of Drug With Respect to the Trimesters
of Pregnancy & Lactation
• Second Trimester
• Metabolism of drugs may be at a slower pace in the foetus compared to the
mother
• Drug excretion into the amniotic fluid results in a prolonged contact of the foetal
skin with the drug
• Third Trimester
• Non-teratogenic conditions occur; for example, sulphonamide-induced
kernicterus, rifampicin-related foetal haemorrhage and immunosuppression ,
NSAIDs causing oligo hydroamnios
• Lactation
• Teratogenic drugs are best avoided. This include anti-neoplastics which may
induce immunosuppression or a possible carcinogenesis
98. MCQs
1) Methotrexate falls under the categoryof?
A. Folate antagonist metabolite
B. Folate reductase agonist
C. Folate antagonist antimetabolite
D. Folate synthetaseagonist
Q.2) Which of the following is incorrect about retinoids?
A. First generation-isotretinoin
B. Second generation-acitretin
C. Third generation-trifarotene
D. Fourth generation-etretinate
99. 3) Fexofenadine pregnancy category is?
A. A
B. B
C. C
D. X
Q.4) The dosage of intravevous methylene blue in the treatment of dapsone-
induced methaemoglobinemia?
A. 50-60mg/kg
B. 0.1-0.2mg/kg
C. 5mg/kg
D. 1-2mg/kg
MCQs
100. MCQs
Q.5) Central hypothyroidism is an adverse effect of:
A. Acitretin
B. Isotretinoin
C. Oral Tretinoin
D. Bexarotene
Q.6) Which of the following doesn’t affect microtubules:
A. Gresiofulvin
B. Vemurafenib
C. Colchicine
D. Paclitaxel
101. MCQs
Q.7) Which of the following is not an adverse effect of
Hydroxychloroquine?
A. Cardiomyopathy
B. Hematologic toxicity
C. Retinal toxicity
D. Phototoxicity
Q.8) Which of the following is Not an Antistaphylococcal penicillin:
A. Oxacillin
B. Dicloxacillin
C. Flucloxacillin
D. Benzathine penicillin
102. MCQs
Q.9. Which of the following is the more commonly associated with
photosensitivity?
A. AKT
B. Sulfonamides
C. Doxycycline
D. Minocycline
Q.10. Oxsoralen plus UVA results in the following except:
A. Forms monofunctional adducts
B. Binds to purine bases
C. Can form DNA crosslink
D. Suppresses DNA synthesis
103. MCQs
Q.11. Which of the following is the most appropriate treatment for
intrahepatic cholestasis-
A. Methotrexate
B. Mycophenolate mofetil
C. Ursodeoxycholic acid
D. Topical steroid
104. A 60 yr old male,farmer by occupation, presented with facialand hand lesions
since 10 months. Identify the lesions and best treatment :
A. Psoriasis vulgaris, topicalsteroid
B. Atopic dermatitis, topicalsteroid
C. ChronicActinic Dermatitis,Azathioprine
D. Lichen planus pigmentosus, topicalsteroid
Photo Quiz
105. A 23 yr old male presented with eruption of grouped vesicles on an
erythematous base 20 days before. The patient now complains of pain inthe
same area.The most appropriate treatment for the pain is:
A. Oral Steroids
B. OralAcyclovir
C. Methylcobalamine withpregabalin
D. Calaminelotion
Photo Quiz
106. A 12-month-old male brought by mother with history of fever and ruptured
bullae and erosions with honey crust around mouth for 3 days. Identify the
condition and its treatment:
A. Herpes labialis, oralacyclovir
B. Bullous impetigo,
oralantistaphylococcal
C. Scabies, topicalpermethrin
D. Psoriasis, topicalsteroid
Photo Quiz
107. Q. Identify the condition and best treatment for patient:
A. Tinea corporis, oralantifungal
B. Lupus vulgaris, oralsteroid
C. Psoriatic arthritis, Oralmethotrexate
D. Psoriasis vulgaris, oralsteroids
Photo Quiz
108. Photo Quiz
Q.28 weeks amenorrheic lady with skin lesions on abdomen since 10
days.
Diagnosis and treatment?
A. Pemphigoid gestationis, oral steroids
B. PUPPP
, oral steroids
C. Tinea corporis, oral fluconazole
D. Psoriasis vulgaris of pregnancy, emollient