Methotrexate is a folic acid analogue that inhibits dihydrofolate reductase and is used to treat various inflammatory and proliferative skin conditions. It can be administered orally, intravenously, intramuscularly or subcutaneously. It is well distributed throughout the body except in the brain. Around 50% is bound to plasma proteins and it has a terminal half-life of 10-27 hours. It works by inhibiting DNA synthesis and blocking T cell migration. Common side effects include gastrointestinal upset and hepatotoxicity. It is contraindicated in pregnancy due to risk of teratogenicity. Monitoring for toxicity and supplementing with folic acid can help reduce adverse effects.
tofacitinib (Tofacent) is an oral drug used for treating rheumatoid arthritis. It belongs to a class of drugs called Janus kinase (JAK) inhibitors. buy tofacitinib only at $6. Visit our website to know more https://emergencydrug.com/drug/tofacitinib-5mg/
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 discusses psoriasis, including its epidemiology, pathogenesis, clinical features, diagnosis, and treatment. Psoriasis is a chronic inflammatory skin condition that causes red, scaly plaques and affects the skin and joints. It occurs equally in both sexes and most commonly appears for the first time between ages 15-25. The pathogenesis involves hyperproliferation of skin cells and an immune response characterized by inflammatory cells in the skin. Diagnosis is usually based on appearance, and biopsy may be used to confirm. Treatment includes topical therapies like steroids, vitamin D analogues, and UVB, as well as systemic therapies like PUVA, methotrexate, ciclosporin,
This presentation includes -classification, biological in psoriasis,TNF alpha inbitors, T cell inhibitos, IL-12/23 inhibitors (indications,containdications,guidelines, adverse effects)
This document discusses neutrophilic dermatoses, a spectrum of disorders characterized by neutrophilic infiltration of the skin without true vasculitis. Key points include:
- Common features include a neutrophilic vascular reaction, some cases having a reactive or systemic cause, disorders may coexist or occur sequentially in individuals.
- Classification includes disorders grouped by location of neutrophilic infiltrate (epidermal vs dermal).
- Pyoderma gangrenosum is discussed in depth, including its pathogenesis, associated diseases, diagnostic criteria, variants (classic, pustular, bullous etc.), investigations and histopathology. Treatment involves immunosuppressive therapy.
This document discusses the definition, measurement, pathophysiology, receptors, mediators, and causes of pruritus (itch). It defines pruritus as a subjective unpleasant sensation that elicits an immediate desire to scratch. Measurement methods in animals and humans are described. The pathophysiology involves polymodal nociceptors and transient receptor potential ion channels. Mediators like histamine, proteinases, substance P, opioids, neurotrophins, prostanoids, cytokines and acetylcholine are discussed. Causes include systemic disease, dermatological conditions like atopic dermatitis, infections, neoplasms, genetic disorders and others.
This is a powerpoint presentation on the epidermal keratinization and its associated disorders, presented by Dr. Jerriton, Dermatology resident of SVMCH, Pondicherry.
Methotrexate is a folic acid analogue that inhibits dihydrofolate reductase and is used to treat various inflammatory and proliferative skin conditions. It can be administered orally, intravenously, intramuscularly or subcutaneously. It is well distributed throughout the body except in the brain. Around 50% is bound to plasma proteins and it has a terminal half-life of 10-27 hours. It works by inhibiting DNA synthesis and blocking T cell migration. Common side effects include gastrointestinal upset and hepatotoxicity. It is contraindicated in pregnancy due to risk of teratogenicity. Monitoring for toxicity and supplementing with folic acid can help reduce adverse effects.
tofacitinib (Tofacent) is an oral drug used for treating rheumatoid arthritis. It belongs to a class of drugs called Janus kinase (JAK) inhibitors. buy tofacitinib only at $6. Visit our website to know more https://emergencydrug.com/drug/tofacitinib-5mg/
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 discusses psoriasis, including its epidemiology, pathogenesis, clinical features, diagnosis, and treatment. Psoriasis is a chronic inflammatory skin condition that causes red, scaly plaques and affects the skin and joints. It occurs equally in both sexes and most commonly appears for the first time between ages 15-25. The pathogenesis involves hyperproliferation of skin cells and an immune response characterized by inflammatory cells in the skin. Diagnosis is usually based on appearance, and biopsy may be used to confirm. Treatment includes topical therapies like steroids, vitamin D analogues, and UVB, as well as systemic therapies like PUVA, methotrexate, ciclosporin,
This presentation includes -classification, biological in psoriasis,TNF alpha inbitors, T cell inhibitos, IL-12/23 inhibitors (indications,containdications,guidelines, adverse effects)
This document discusses neutrophilic dermatoses, a spectrum of disorders characterized by neutrophilic infiltration of the skin without true vasculitis. Key points include:
- Common features include a neutrophilic vascular reaction, some cases having a reactive or systemic cause, disorders may coexist or occur sequentially in individuals.
- Classification includes disorders grouped by location of neutrophilic infiltrate (epidermal vs dermal).
- Pyoderma gangrenosum is discussed in depth, including its pathogenesis, associated diseases, diagnostic criteria, variants (classic, pustular, bullous etc.), investigations and histopathology. Treatment involves immunosuppressive therapy.
This document discusses the definition, measurement, pathophysiology, receptors, mediators, and causes of pruritus (itch). It defines pruritus as a subjective unpleasant sensation that elicits an immediate desire to scratch. Measurement methods in animals and humans are described. The pathophysiology involves polymodal nociceptors and transient receptor potential ion channels. Mediators like histamine, proteinases, substance P, opioids, neurotrophins, prostanoids, cytokines and acetylcholine are discussed. Causes include systemic disease, dermatological conditions like atopic dermatitis, infections, neoplasms, genetic disorders and others.
This is a powerpoint presentation on the epidermal keratinization and its associated disorders, presented by Dr. Jerriton, Dermatology resident of SVMCH, Pondicherry.
This document provides an overview of facial melanosis and approaches to patients presenting with it. It begins with the anatomy and physiology of melanocytes and Fitzpatrick skin types. It then classifies the three main types of facial hypermelanosis as brown, blue, or mixed. Common causes of facial melanosis include melasma, freckles, lentigines, periorbital melanosis, seborrheic melanosis, and exogenous ochronosis. Melasma is described as the most common cause, with classifications based on location and patterns of pigmentation. Freckles and lentigines are also briefly discussed.
Wood's lamp uses long-wave UV radiation to cause tissues to fluoresce, allowing diseases and conditions to be diagnosed. It emits radiation between 320-400nm, causing fluorophores in the skin like collagen to glow blue. Various conditions have distinctive fluorescence - vitiligo appears bright blue due to lack of melanin, while pityriasis versicolor glows yellow-gold due to a skin yeast. Wood's lamp is useful for diagnosing infections caused by fungi, bacteria, and viruses based on the fluorescent compounds they produce. It can also detect pre-cancerous and cancerous lesions treated with fluorescent precursors.
This document discusses various treatment options for psoriasis, including topical therapies. It provides details on topical vitamin D analogues like calcipotriene, which are first-line treatments and have efficacy without reduced effects from long-term use. Topical corticosteroids are also discussed as first-line options for mild cases, though they carry risks of tachyphylaxis and rebound with prolonged use. Other topical treatments covered include anthralin, retinoids, salicylic acid, coal tar, and calcineurin inhibitors.
This document provides an overview of erythroderma, also known as generalized exfoliative dermatitis. It defines erythroderma as an inflammatory dermatosis involving 90% or more of the skin surface. The clinical presentation includes patchy erythema becoming universal over 24-48 hours accompanied by malaise, shivering and pyrexia, followed by scaling after 2-6 days. Erythroderma can be caused by conditions like eczema, psoriasis, malignancy, and drug reactions. Complications can include edema, lymphadenopathy, cardiac failure, metabolic disturbance, hypothermia, and cutaneous or respiratory infection. Management involves close inpatient monitoring and initially topical st
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 discusses skin failure, which is defined as the loss of normal temperature regulation and ability to maintain core body temperature and fluid/electrolyte balance. It causes various physiological changes including altered hemodynamics, impaired thermoregulation, metabolic complications, fluid/electrolyte imbalances, infections, and more. The management of skin failure requires intensive monitoring and care of fluid/electrolyte balance, nutrition, infection prevention, and topical therapies to address the systemic effects.
The document discusses several acne related syndromes:
1) SAPHO syndrome presents with sudden onset haemorrhagic acne on the face and chest along with palmoplantar pustulosis and pain over the chest wall. Its etiology is unknown but may involve an autoimmune reaction.
2) PAPA syndrome involves pyogenic artheritis, pyoderma gangrenosum, and acne conglobata. It is an autoinflammatory disorder caused by a gene mutation leading to increased interleukin-1beta.
3) Endocrine acne is associated with conditions like PCOS, Cushing's disease, and congenital adrenal hyperplasia which alter hormone levels.
INTRODUCTION OF PSORIASIS, EPIDEMIOLOGY OF PSORIASIS, CLINICAL FEATURES OF PSORIASIS, PROGNOSIS OF PSORIASIS, HISTOPATHOLOGY OF PSORIASIS, TRIGGERING FACTORS OF PSORIASIS, PATHOGENESIS OF PSORIASIS
The drugs included in the presentation are Methotrexate, Cyclosporine, Azathioprine, Cyclophosphamide, Mycophenolate mofetil and Intravenous Immunoglobulin.
It is useful mainly for dermatologists.
This document provides information on the bacteriology, immunology, and pathogenesis of Mycobacterium leprae, which causes leprosy. It describes the taxonomy and characteristics of M. leprae, how it is transmitted and the animal models used to study it. The mechanisms of nerve damage, immune responses in leprosy including cytokine profiles in tuberculoid and lepromatous states, and the genetic factors involved in susceptibility are summarized. Immunological events leading to reactions are also outlined.
This document discusses irritant contact dermatitis (ICD) and its causes, pathogenesis, epidemiology, clinical manifestations, and differences from allergic contact dermatitis. ICD is caused by contact with irritating chemicals, physical agents, or microbes in the environment. It results in skin lesions, mucosa lesions, or semi-mucosa lesions through irritant pathogenic mechanisms. ICD presents with erythema, edema, weeping lesions, vesicles or bullae and the reaction peaks quickly then starts to heal. In contrast, allergic contact dermatitis involves a sensitization phase and elicitation phase and presents with pruritus, vesicles and oozing lesions that spread beyond the contact area.
Dermatitis herpetiformis (DH) is a chronic, recurrent skin rash characterized by tiny blisters and itchy bumps that are symmetrically located on the elbows, knees, buttocks, and back. It is associated with celiac disease and gluten sensitivity. A skin biopsy shows IgA antibody deposits that help diagnose DH. Treatment involves medication like dapsone or sulfasalazine to relieve symptoms, along with maintaining a lifelong gluten-free diet to prevent flare-ups.
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.
- 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 discusses surgical techniques for treating vitiligo, including tissue grafting and cellular grafting methods. The most common tissue grafting techniques are mini punch grafting, suction blister grafting, and thin split thickness skin grafting. Mini punch grafting involves using small punches to harvest grafts from pigmented donor skin and placing them in recipient areas. Suction blister grafting uses suction to raise blisters from donor skin and transfer just the epidermis. Split thickness skin grafting transfers thin sheets of donor skin as grafts. Cellular grafting techniques discussed include non-cultured melanocyte suspensions created by centrifuging donor skin cells. Surgical techniques aim to transfer viable melanocytes from
This document summarizes guidelines for the topical treatment of psoriasis. It discusses several topical treatment options including corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, salicylic acid, anthralin, coal tar, and combination therapies. It provides details on the efficacy, dosing, safety and guidelines for each treatment. It also discusses when systemic therapies like methotrexate may be appropriate and provides dosing guidelines for methotrexate treatment of psoriasis.
This document provides an overview of vitiligo, including its definition, epidemiology, etiology, classification, clinical manifestations, pathogenesis, diagnosis, and treatment. Some key points are:
- Vitiligo is a skin condition characterized by loss of pigment-producing cells that results in white patches on the skin. It affects around 0.5-1% of the population worldwide.
- The precise causes are unknown but are believed to involve genetic and environmental factors that may trigger an autoimmune response targeting melanocytes.
- Vitiligo can be classified based on the distribution of lesions as segmental, non-segmental, generalized, or other subtypes.
- Treatment options include phototherapy, topical
This document discusses treatment options for genital warts. It provides details on patient-applied and provider-applied treatment modalities including podofilox, imiquimod, sinecatechins, podophyllin resin, TCA, cryotherapy, and surgical removal. It recommends treatment be guided by patient preference, resources, and provider experience. The most effective treatments aim to relieve symptoms while removing warts, with the goal of inducing wart-free periods.
This document provides an overview of facial melanosis and approaches to patients presenting with it. It begins with the anatomy and physiology of melanocytes and Fitzpatrick skin types. It then classifies the three main types of facial hypermelanosis as brown, blue, or mixed. Common causes of facial melanosis include melasma, freckles, lentigines, periorbital melanosis, seborrheic melanosis, and exogenous ochronosis. Melasma is described as the most common cause, with classifications based on location and patterns of pigmentation. Freckles and lentigines are also briefly discussed.
Wood's lamp uses long-wave UV radiation to cause tissues to fluoresce, allowing diseases and conditions to be diagnosed. It emits radiation between 320-400nm, causing fluorophores in the skin like collagen to glow blue. Various conditions have distinctive fluorescence - vitiligo appears bright blue due to lack of melanin, while pityriasis versicolor glows yellow-gold due to a skin yeast. Wood's lamp is useful for diagnosing infections caused by fungi, bacteria, and viruses based on the fluorescent compounds they produce. It can also detect pre-cancerous and cancerous lesions treated with fluorescent precursors.
This document discusses various treatment options for psoriasis, including topical therapies. It provides details on topical vitamin D analogues like calcipotriene, which are first-line treatments and have efficacy without reduced effects from long-term use. Topical corticosteroids are also discussed as first-line options for mild cases, though they carry risks of tachyphylaxis and rebound with prolonged use. Other topical treatments covered include anthralin, retinoids, salicylic acid, coal tar, and calcineurin inhibitors.
This document provides an overview of erythroderma, also known as generalized exfoliative dermatitis. It defines erythroderma as an inflammatory dermatosis involving 90% or more of the skin surface. The clinical presentation includes patchy erythema becoming universal over 24-48 hours accompanied by malaise, shivering and pyrexia, followed by scaling after 2-6 days. Erythroderma can be caused by conditions like eczema, psoriasis, malignancy, and drug reactions. Complications can include edema, lymphadenopathy, cardiac failure, metabolic disturbance, hypothermia, and cutaneous or respiratory infection. Management involves close inpatient monitoring and initially topical st
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 discusses skin failure, which is defined as the loss of normal temperature regulation and ability to maintain core body temperature and fluid/electrolyte balance. It causes various physiological changes including altered hemodynamics, impaired thermoregulation, metabolic complications, fluid/electrolyte imbalances, infections, and more. The management of skin failure requires intensive monitoring and care of fluid/electrolyte balance, nutrition, infection prevention, and topical therapies to address the systemic effects.
The document discusses several acne related syndromes:
1) SAPHO syndrome presents with sudden onset haemorrhagic acne on the face and chest along with palmoplantar pustulosis and pain over the chest wall. Its etiology is unknown but may involve an autoimmune reaction.
2) PAPA syndrome involves pyogenic artheritis, pyoderma gangrenosum, and acne conglobata. It is an autoinflammatory disorder caused by a gene mutation leading to increased interleukin-1beta.
3) Endocrine acne is associated with conditions like PCOS, Cushing's disease, and congenital adrenal hyperplasia which alter hormone levels.
INTRODUCTION OF PSORIASIS, EPIDEMIOLOGY OF PSORIASIS, CLINICAL FEATURES OF PSORIASIS, PROGNOSIS OF PSORIASIS, HISTOPATHOLOGY OF PSORIASIS, TRIGGERING FACTORS OF PSORIASIS, PATHOGENESIS OF PSORIASIS
The drugs included in the presentation are Methotrexate, Cyclosporine, Azathioprine, Cyclophosphamide, Mycophenolate mofetil and Intravenous Immunoglobulin.
It is useful mainly for dermatologists.
This document provides information on the bacteriology, immunology, and pathogenesis of Mycobacterium leprae, which causes leprosy. It describes the taxonomy and characteristics of M. leprae, how it is transmitted and the animal models used to study it. The mechanisms of nerve damage, immune responses in leprosy including cytokine profiles in tuberculoid and lepromatous states, and the genetic factors involved in susceptibility are summarized. Immunological events leading to reactions are also outlined.
This document discusses irritant contact dermatitis (ICD) and its causes, pathogenesis, epidemiology, clinical manifestations, and differences from allergic contact dermatitis. ICD is caused by contact with irritating chemicals, physical agents, or microbes in the environment. It results in skin lesions, mucosa lesions, or semi-mucosa lesions through irritant pathogenic mechanisms. ICD presents with erythema, edema, weeping lesions, vesicles or bullae and the reaction peaks quickly then starts to heal. In contrast, allergic contact dermatitis involves a sensitization phase and elicitation phase and presents with pruritus, vesicles and oozing lesions that spread beyond the contact area.
Dermatitis herpetiformis (DH) is a chronic, recurrent skin rash characterized by tiny blisters and itchy bumps that are symmetrically located on the elbows, knees, buttocks, and back. It is associated with celiac disease and gluten sensitivity. A skin biopsy shows IgA antibody deposits that help diagnose DH. Treatment involves medication like dapsone or sulfasalazine to relieve symptoms, along with maintaining a lifelong gluten-free diet to prevent flare-ups.
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.
- 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 discusses surgical techniques for treating vitiligo, including tissue grafting and cellular grafting methods. The most common tissue grafting techniques are mini punch grafting, suction blister grafting, and thin split thickness skin grafting. Mini punch grafting involves using small punches to harvest grafts from pigmented donor skin and placing them in recipient areas. Suction blister grafting uses suction to raise blisters from donor skin and transfer just the epidermis. Split thickness skin grafting transfers thin sheets of donor skin as grafts. Cellular grafting techniques discussed include non-cultured melanocyte suspensions created by centrifuging donor skin cells. Surgical techniques aim to transfer viable melanocytes from
This document summarizes guidelines for the topical treatment of psoriasis. It discusses several topical treatment options including corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, salicylic acid, anthralin, coal tar, and combination therapies. It provides details on the efficacy, dosing, safety and guidelines for each treatment. It also discusses when systemic therapies like methotrexate may be appropriate and provides dosing guidelines for methotrexate treatment of psoriasis.
This document provides an overview of vitiligo, including its definition, epidemiology, etiology, classification, clinical manifestations, pathogenesis, diagnosis, and treatment. Some key points are:
- Vitiligo is a skin condition characterized by loss of pigment-producing cells that results in white patches on the skin. It affects around 0.5-1% of the population worldwide.
- The precise causes are unknown but are believed to involve genetic and environmental factors that may trigger an autoimmune response targeting melanocytes.
- Vitiligo can be classified based on the distribution of lesions as segmental, non-segmental, generalized, or other subtypes.
- Treatment options include phototherapy, topical
This document discusses treatment options for genital warts. It provides details on patient-applied and provider-applied treatment modalities including podofilox, imiquimod, sinecatechins, podophyllin resin, TCA, cryotherapy, and surgical removal. It recommends treatment be guided by patient preference, resources, and provider experience. The most effective treatments aim to relieve symptoms while removing warts, with the goal of inducing wart-free periods.
1. Antifungal agents target components of fungal cell walls and membranes that are different from mammalian cells, such as ergosterol in fungal cell membranes.
2. Major classes of antifungals include azoles which inhibit ergosterol synthesis, polyenes which bind to ergosterol, and echinocandins which inhibit cell wall synthesis.
3. Liposomal formulations of amphotericin B have advantages of lower toxicity compared to conventional amphotericin B due to targeted delivery to fungal cells and less interaction with human membranes.
Recent advances in the treatment of dermatological diseaseDRMOHITKHER
This document discusses recent advances in pharmacotherapy for various dermatological diseases. It covers treatment options for common conditions like vitiligo, acne, psoriasis, and androgenetic alopecia. For these conditions, it describes both topical and systemic drug therapy options, including corticosteroids, retinoids, antibiotics, isotretinoin, JAK inhibitors, and phototherapy. It also provides details on specific drugs, dosages, and mechanisms of action for treating various dermatological diseases.
This document discusses various causes of acneiform eruptions beyond typical acne vulgaris, including certain medications, chemicals, occupations, cosmetics, endocrine diseases, and genetic syndromes. It provides examples of specific drugs, chemicals, and conditions that can lead to acneiform outbreaks, as well as their proposed mechanisms and treatment approaches.
This document discusses vulvar warts (condylomata acuminata), caused by human papillomavirus (HPV). It covers HPV types/strains associated with warts, acquisition, presentation, treatment options including medical therapies like podophyllotoxin and surgical excision, considerations for pregnant women and children, and risks of fetal transmission. Treatment aims to remove visible warts while clearing HPV, with recurrence rates of 30-70% requiring multiple approaches.
Anti-inflammatory agents such as steroids and NSAIDs can be used to treat ocular inflammation. Steroids like dexamethasone and prednisolone are very effective but can increase intraocular pressure and have systemic side effects. Newer steroids like loteprednol have fewer side effects. NSAIDs like ketorolac and nepafenac can provide analgesic effects after surgery and reduce inflammation and complications like cystoid macular edema. Topical NSAIDs need to be used with caution due to risks of corneal melting.
This document discusses difficulties in treating acne and poor responders to treatment. It notes that while most patients respond well to standard acne treatments, 10-15% are poor responders. Poor response can be due to antibiotic-resistant Propionibacterium acnes bacteria, non-acne infections, or high sebum production diluting antibiotics. Treatment of poor responders depends on the underlying cause and may include isotretinoin, stronger antibiotics, or hormone therapies. The document provides detailed guidelines for managing treatment-resistant acne and acne variants based on underlying pathological factors.
This document provides information on the management of anogenital warts (condyloma acuminata). It discusses that human papillomavirus (HPV) causes anogenital warts, which can be transmitted sexually or through non-sexual contact. Treatment options for external genital warts include patient-applied therapies like podofilox and imiquimod cream, as well as provider-administered cryotherapy, podophyllin, and surgical removal. The choice of treatment depends on factors like wart size, number and location. Patient education emphasizes that HPV is common, warts may recur, and treatment aims to remove visible warts, not eliminate the virus.
Presented at the joint International Eczema Council and National Alopecia Areata Foundation Symposium, "Atopic Dermatitis and Alopecia Areata: Comparison and Contrast”, held during the 2019 Annual American Academy of Dermatology meeting in Washington, DC to explore the similarities and differences between these two common but complex skin diseases and the implications from bench to bedside.
Rituximab is an effective and well-tolerated treatment for aggressive ocular cicatricial pemphigoid (OCP) when used as monotherapy or in combination with other immunomodulatory treatments. OCP is a chronic autoimmune disease characterized by subepithelial fibrosis and scarring of the conjunctiva that can progress to cause vision loss. Management involves immunosuppressive medications, surgery, and supportive care of ocular surface disease. Untreated, OCP can lead to blindness through complications like corneal perforation.
This document provides information on various anti-fungal drugs including their classification, mechanisms of action, uses, and side effects. The major classes discussed are polyenes such as amphotericin B, azoles including imidazoles and triazoles like ketoconazole and fluconazole, and antimetabolites like flucytosine. Amphotericin B is described as the gold standard but has significant toxicity, while azoles have fewer side effects and both topical and oral formulations are used to treat superficial and systemic fungal infections.
Ustekinumab is a human monoclonal antibody that inhibits the p40 subunit of interleukin 12 and 23, thus inhibiting the differentiation of T cells into Th1 and Th17 cells and reducing inflammatory cytokines. It is approved for treatment of moderate to severe plaque psoriasis. Rituximab is a chimeric monoclonal antibody against CD20 that causes depletion of mature B cells. It is used off-label for various autoimmune blistering disorders. Belimumab inhibits BLyS, which plays a key role in B cell development, and is approved for treatment of systemic lupus erythematosus.
Dr. Rieva Farah Dwiyana, dr., Sp.KK., M.Kes - Newer & Upcoming Therapy in Hyp...AdiSutriwantoPasarib1
This document summarizes newer and upcoming therapies for hypopigmentation. It discusses the etiology and pathogenesis of hypopigmentation, which can involve disorders in melanocyte precursors, melanosome transfer, inflammation, and secondary effects after inflammation. Current therapies discussed include topical corticosteroids, phototherapy using UVB, narrowband UVB, and excimer lamps. Combination therapies using phototherapy with vitamin D or topical corticosteroids are shown to have better outcomes. New potential therapies mentioned that are still under investigation include gene therapy, stem cells, prostaglandin analogs, tofacitinib citrate, and topical tincture iodine with UVA light. In conclusion
This document summarizes dermatological pharmacology. It discusses the structure of skin and topical vehicles like creams, lotions, gels and ointments used to deliver drugs to the skin. It also discusses various drug classes used in dermatology like glucocorticoids, retinoids, antibiotics, antifungals and immunomodulators. Specific drugs covered include tretinoin, adapalene, isotretinoin, calcipotriene and phototherapy agents. It also provides information on treatment of conditions like acne, hyperpigmentation and photoprotection with sunscreens.
This document provides information on various antiviral agents used to treat different viral infections:
1. Acyclovir and valacyclovir are effective against HSV and VZV. They require phosphorylation inside infected cells to inhibit viral DNA synthesis. Famciclovir and penciclovir are prodrugs of active metabolites that also inhibit HSV and VZV.
2. Ganciclovir, valganciclovir and cidofovir are effective against CMV. They require phosphorylation for activation and inhibition of viral DNA polymerase.
3. Amantadine and rimantadine inhibit influenza A by preventing viral uncoating. They are effective for prevention but
Ocular allergy are a group of external ocular conditions resulting from one or more types of hypersensitivity reactions to allergens.
Anti Allergic eye drops are liquid medicine used to treat symptoms of eye allergies.
This document discusses skin pigmentation and disorders of pigmentation. It begins by explaining the basis of skin pigmentation including melanosomes, melanin synthesis and transport. It then discusses different types of chromophores and pigments that determine skin color. The document further describes melanocyte development, migration and function. It provides details on melanin types, melanosome biogenesis and transfer. Finally it discusses various disorders of hypopigmentation and hyperpigmentation.
Collagen is the most abundant protein in the human body, making up 25-30% of total protein content. It forms connective tissues like skin, bone, cartilage and is classified into different types based on structure and function. There are at least 28 types of collagen coded by 42 genes. Collagen provides structure and strength to tissues, supports skin and basement membranes. Its biosynthesis involves post-translational modifications within cells and extracellular cross-linking. Disorders can result from deficient or defective collagen synthesis, including scurvy, Menkes disease, osteogenesis imperfecta and Ehlers-Danlos syndrome. Excess collagen deposition can cause keloids and scleroderma. Cosmetic procedures use collagen fillers for wrink
Topical 5 fluorouracil in dermatologic diseaseRANJANDASH12
The document summarizes research on the use of topical 5-fluorouracil (5-FU) in treating various dermatological conditions. It reviews 34 studies on 5-FU's efficacy for actinic keratosis, squamous cell carcinoma, and keratoacanthoma. For actinic keratosis, lower-dose 0.5% 5-FU shows efficacy while causing less irritation than 5% 5-FU. Combining 5-FU with cryotherapy or imiquimod improves clearance rates over monotherapies. 5-FU shows efficacy for squamous cell carcinoma in situ, though photodynamic therapy performs better. Topical 5-FU also demonstrates potential for treating keratoacanthomas
Diagnostic approach to a case of Hirsutism RANJANDASH12
Hirsutism, or excessive body hair in women, can have significant psychosocial impacts. It is important to distinguish normal variations from true hirsutism through a diagnostic approach involving history, clinical evaluation, and biochemical testing. This helps determine if the cause is ovarian or adrenal hyperandrogenism, which may indicate conditions like PCOS, CAH, or tumors. A thorough workup is needed to identify treatable causes and rule out serious underlying pathology while alleviating psychological distress.
1. The document discusses porphyrins and porphyria, focusing on haem synthesis, types of porphyria, and specific conditions like porphyria cutanea tarda and acute intermittent porphyria.
2. Haem is synthesized through 8 steps starting from glycine and succinyl-CoA and involving the mitochondria and cytoplasm. Deficiencies in enzymes in the pathway cause different types of porphyria.
3. The main types discussed are porphyria cutanea tarda, characterized by skin lesions and mutations in the UROD enzyme, and acute intermittent porphyria, which causes abdominal and neurological symptoms due to a PBGD enzyme defect.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. Imiquimod is chemically 2-2 methylpropyl-H-imidazoquinolin-4-amine
molecular formula of C14H16N4
an odourless, white to off-white crystalline solid
I
M
I
Q
U
I
M
O
D
Immune
Quinoline derivative
Modulator
3. Pharmacokinetics
• Available as topical formulation (2.5% , 3.75% , 5%)
• Elimination t1/2 : 30 hr
• Systemic absorption is minimal
4. Mechanism of action
Activates immune cells by engaging TLR7 and (to a lesser extent) Toll-like receptor-8 (TLR8) signalling
Activation of nuclear factor-kappa B (NF-κB)
Induces pro-inflammatory cytokines, such as IFNα, tumour necrosis factor (TNFα), interleukin IL-2, IL-6,
IL-8, IL-12
Imiquimod induces an increase in markers for IFN-γ and the interferon inducible gene product 2’5’-
oligoadenylate synthetase at the treatment site
The antiviral activity is indirect through cytokine induction of IFN-alpha
5. Enhances costimulatory marker expression, increase CCR7and improve pDC viability
Interfere with adenosine receptor (AR) signalling pathways, particularly A2A
Receptor-independent reduction of adenylyl cyclase activity augmenting the pro-inflammatory
activity of imiquimod
Infiltrate of tumour-destructive cells (T lymphocytes, dendritic cells and macrophages) at the
superficial basal cell carcinoma lesions
Exert some pro-apoptotic activity against tumour cells
6.
7. Therapeutic guidelines
Occlusive dressings are not recommended
To be applied on external areas only
Usually applied at bedtime and to be washed with soap water next morning
A thin layer to be applied and massaged gently till no longer visible
Avoid external exposure to nasal mucosa ,lip and eyes
8. FDA Approved Indications
Approved for the first time in 1997 for external genital and perianal wart
Other non viral indications
1. Actinic keratosis
2. Superficial BCC(non facial)
9. Off Label Indications
INFECTIOUS NEOPLASTC INFLAMMATORY OTHERS
Non genital wart Bowen disease Granuloma annulare Keloid
Herpes labialis/genitalis Melanoma in situ Morphea Follicular mucinosis
Molluscum contagiosum keratoacanthoma Porokeratosis of mibelli
Leshmaniasis Extramammary Pagets disease
Epidermodysplsia
verruciformis
Kaposi sarcoma
Pyogenic granuloma
11. Contraindications
• Absolute
Known hypersensitivity(benzyl alcohol,paraben)
Children below 12 years
Internal urethral , intravaginal , intracervical and intra rectal
• Relative
Immunosuppression(HIV , post transplant )
Pregnancy ( Cat C) and Lactation
12. CUTANEOUS SIDE EFFECTS NON CUTANEOUS SIDE EFFECTS
Erythema , itching ,pain ,irritation , ulceration Constitutional : fever , nausea , arthalgia ,myalgia
Lupus, psoriasis ,lichen planus , lichen sclerosis FLU like symptoms
Pemphigus and vitiligo like depigmentation Insignificant transient shift of WBCS
Mycosis fungoides like histologic changes Febrile seizure
Eruptive epidermoid cysts Postural hypotension
Erosive pustular dermatosis of scalp Conjunctivitis, neuropathic pain
13. Imiquimod in external genital and peri anal wart
3.75% Imiquimod cream approved by FDA for Actinic Keratoses and Anogenital warts
Two studies comparing 2.5% vs 3.75% with once daily application for 8weeks revealed complete clearance
in 28.3 36.6 of patients
A study of in HIV+patient on HAART treated with 5 Imiquimod thrice a week showed total clearance in 32
of patients at week 16
14. Imiquimod in superficial BCC
Not a first line treatment for any BCC
FDA approved 5% cream for small<2cm non facial superficial BCC once daily 5days/wk for 6-12 wk
Clearance rate reported range from 43 to100 with various dosage frequency
Difficult to evaluate the efficacy of a cancer : 5 yr clearance rate (follow up)
Imiquimod induced scarring and hypopigmentation can mask the residual tumor
15. Improved response rate observed with twice daily application, a higher incidence of local skin
reactions occurred
Subsequently two double- blind randomized controlled trials showed 82% histologic clearance
with a five times weekly application
These studies formed the basis for approving imiquimod as a treatment for truncal/extremity
superficial BCC
Lower clearance rates have been reported with other BCC subtypes as follows: 42–100% for
nodular BCC and 56–63% for infiltrative BCC
16. Imiquimod in Actinic keratoses
Indicated for AKs on scalp and face
5% Imiquimod approved for a treatment area of approx. 25 sqcm on scalp or face (never both
simultaneously)
Duration : twice a wk for 16 wks
After an overnight stay on ,it is to be washed with soap water next morning
Complete clearance rates with thrice a wk have been reported between 45 and 84 cases for 16wk
Imiquimod can be an alternative to other first line topical treatments like 5FU
17. Recently, a new standard in managing patients with AK has been set with the target being the
detection and clearance of clinical and subclinical AK lesions across an entire sun-exposed
field
This concept has centered on using imiquimod 3.75% cream (used daily on two 2-week
treatment cycles that are separated by a 2-week treatment-free interval) and reduction in
lesions from Lmax
This treatment resulted in 92% median percentage reduction in AK lesions with sustained
lesion clearance for at least 1 year and acceptable tolerability profile
18. Conclusion
Effective immune response modifier
Contraindicated in known hypersensitivity children below 12 yr
Better to be avoided in pregnancy and lactation
FDA approved and effective in treatment external genital wart , Actinic keratoses and Superficial BCC
Significant efficacy in a few other dermatoses like keratoacanthoma , follicular mucinosis , granuloma annulare ,
porokeratosis ,Kaposi sarcoma ,etc.
But further evidence based studied needed to explore its potential in a variety of ever expanding dermatoses
Editor's Notes
Randomized vehicle-controlled clinical trials have shown that applying imiquimod 5% cream three times per weekfor up to 16 weeks completely cleared lesions in about
50% of patients. It was well tolerated, and men tended to have lower clearance rates than women, probably related
to the lower keratinization degree and increased moisture of the vulva compared to the penile shaft
Even though surgery is considered first-line treatment for
BCC, many other therapeutic modalities can be used, …. Imiquimod is currently FDA-approved for the treatment
of truncal/extremity small (<2 cm in size) superficial
BCCs.19,20 An initial randomized trial demonstrated
almost 90% histologic clearance rate of superficial BCC
when treated with 5% imiquimod cream daily for
6 weeks
Interventions available for AK include destructive therapies,
topical medications, chemical peels, and photodynamic
Therapy… Isolated lesions can be treated with
cryotherapy or surgery…. multiple lesions benefit
most from field-directed therapies such as topical 5-fluorouracil,
imiquimod, ingenol mebutate, and diclofenac……Head to head comparing imiquimod and 5FU are lacking