Systemic retinoids include both natural and synthetic compounds that have structural or biological activities similar to vitamin A. There are over 1500 systemic retinoids that have been developed and classified into generations based on their chemical structure. Common retinoids used to treat skin conditions such as acne, psoriasis, and skin cancer include isotretinoin, acitretin, and bexarotene. While effective, retinoids can cause side effects involving mucocutaneous tissues and lipids that require monitoring during treatment.
This document discusses retinoids, which are compounds that have biological activity similar to vitamin A. It covers the history, structures, mechanisms of action, classifications, effects, and clinical uses of various retinoids. Key points include: retinoids are used topically and orally to treat acne, psoriasis, and other skin conditions; isotretinoin is very effective for nodular cystic acne; acitretin is used for psoriasis; and retinoids work by regulating cell growth and differentiation through retinoid receptors. Side effects and appropriate dosing are also addressed.
This document provides an overview of retinoids, including:
- Retinoids are derivatives of vitamin A or compounds with similar structure or function to vitamin A.
- They have a long history of medical use dating back to ancient Egypt.
- Retinoids act through nuclear retinoid receptors and influence gene expression and cell differentiation.
- They have various applications in dermatology for conditions like acne and psoriasis, ophthalmology for preventing blindness, and oncology for treating cancers like cutaneous T-cell lymphoma.
- Both topical and oral retinoids are used depending on the condition, and they can have beneficial effects as well as potential adverse side effects that require monitoring.
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.
Cyclosporine is an immunosuppressive drug that was originally isolated from fungi in 1970 and approved by the FDA for transplant rejection in 1983. It is a cyclic polypeptide consisting of 11 amino acids that acts by inhibiting T cell activation through the calcineurin/NFAT pathway. It has since been approved for treating various dermatological conditions like psoriasis, atopic dermatitis, and pyoderma gangrenosum. While effective, cyclosporine use can cause nephrotoxicity, hypertension, and increased risk of infection and skin cancer with long term use. It can also interact with various other drugs that are metabolized through the CYP3A4 pathway.
This document discusses systemic retinoids, including their sources, generations, pharmacokinetics, mechanisms of action, uses, and side effects. It focuses on isotretinoin and its use for severe acne. Isotretinoin is well absorbed from the gut and transported to target cells via intracellular proteins. It has a half-life of about 20 hours and is metabolized and eliminated by the liver. Isotretinoin reduces sebum production and inflammation for acne clearance. Strict monitoring and contraceptive measures are required due to its teratogenicity. Common side effects include dryness, cheilitis and hypertriglyceridemia.
Retinoids are compounds that have structural or functional similarities to vitamin A. They are classified based on their structure and mechanism of action. Common forms include isotretinoin, acitretin, and bexarotene. Retinoids are FDA approved for severe acne and cancer but are also used for other conditions like rosacea, psoriasis, and keratinization disorders. Side effects include mucocutaneous dryness and hyperlipidemia. Strict monitoring guidelines must be followed due to teratogenicity risks, including effective contraception for women of childbearing age.
The drugs included in the presentation are Methotrexate, Cyclosporine, Azathioprine, Cyclophosphamide, Mycophenolate mofetil and Intravenous Immunoglobulin.
It is useful mainly for dermatologists.
Acne is most common in adolescents aged 12-18 years and more severe in males. The major factors involved in acne pathogenesis are increased sebum production stimulated by androgens, proliferation of the bacteria Propionibacterium acnes in hair follicles, altered keratinization of follicles, and inflammation. Treatment involves topical and oral antibiotics, retinoids, and isotretinoin for severe acne. Dietary factors like high glycemic load and sugar intake may influence acne, but evidence is limited. Acne is graded based on the number and type of lesions present.
This document discusses retinoids, which are compounds that have biological activity similar to vitamin A. It covers the history, structures, mechanisms of action, classifications, effects, and clinical uses of various retinoids. Key points include: retinoids are used topically and orally to treat acne, psoriasis, and other skin conditions; isotretinoin is very effective for nodular cystic acne; acitretin is used for psoriasis; and retinoids work by regulating cell growth and differentiation through retinoid receptors. Side effects and appropriate dosing are also addressed.
This document provides an overview of retinoids, including:
- Retinoids are derivatives of vitamin A or compounds with similar structure or function to vitamin A.
- They have a long history of medical use dating back to ancient Egypt.
- Retinoids act through nuclear retinoid receptors and influence gene expression and cell differentiation.
- They have various applications in dermatology for conditions like acne and psoriasis, ophthalmology for preventing blindness, and oncology for treating cancers like cutaneous T-cell lymphoma.
- Both topical and oral retinoids are used depending on the condition, and they can have beneficial effects as well as potential adverse side effects that require monitoring.
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.
Cyclosporine is an immunosuppressive drug that was originally isolated from fungi in 1970 and approved by the FDA for transplant rejection in 1983. It is a cyclic polypeptide consisting of 11 amino acids that acts by inhibiting T cell activation through the calcineurin/NFAT pathway. It has since been approved for treating various dermatological conditions like psoriasis, atopic dermatitis, and pyoderma gangrenosum. While effective, cyclosporine use can cause nephrotoxicity, hypertension, and increased risk of infection and skin cancer with long term use. It can also interact with various other drugs that are metabolized through the CYP3A4 pathway.
This document discusses systemic retinoids, including their sources, generations, pharmacokinetics, mechanisms of action, uses, and side effects. It focuses on isotretinoin and its use for severe acne. Isotretinoin is well absorbed from the gut and transported to target cells via intracellular proteins. It has a half-life of about 20 hours and is metabolized and eliminated by the liver. Isotretinoin reduces sebum production and inflammation for acne clearance. Strict monitoring and contraceptive measures are required due to its teratogenicity. Common side effects include dryness, cheilitis and hypertriglyceridemia.
Retinoids are compounds that have structural or functional similarities to vitamin A. They are classified based on their structure and mechanism of action. Common forms include isotretinoin, acitretin, and bexarotene. Retinoids are FDA approved for severe acne and cancer but are also used for other conditions like rosacea, psoriasis, and keratinization disorders. Side effects include mucocutaneous dryness and hyperlipidemia. Strict monitoring guidelines must be followed due to teratogenicity risks, including effective contraception for women of childbearing age.
The drugs included in the presentation are Methotrexate, Cyclosporine, Azathioprine, Cyclophosphamide, Mycophenolate mofetil and Intravenous Immunoglobulin.
It is useful mainly for dermatologists.
Acne is most common in adolescents aged 12-18 years and more severe in males. The major factors involved in acne pathogenesis are increased sebum production stimulated by androgens, proliferation of the bacteria Propionibacterium acnes in hair follicles, altered keratinization of follicles, and inflammation. Treatment involves topical and oral antibiotics, retinoids, and isotretinoin for severe acne. Dietary factors like high glycemic load and sugar intake may influence acne, but evidence is limited. Acne is graded based on the number and type of lesions present.
1. Cutaneous photosensitivity reactions require absorption of light energy by molecules, leading to damage and clinical disease.
2. Common photosensitivity disorders include polymorphic light eruption (PLE), chronic actinic dermatitis (CAD), and solar urticaria.
3. Clinical features, histopathology, and phototesting help differentiate types of photosensitivity dermatoses.
The document provides safety guidelines for the drug isotretinoin (Accutane). It discusses the drug's indications, pharmacokinetics, risks, and regulations. Key information includes:
1) Isotretinoin is used to treat severe cystic acne but can cause birth defects, so female patients must not get pregnant while taking it or for 1 month after.
2) The iPLEDGE program requires registration of patients, prescribers, and pharmacies and monthly pregnancy tests for female patients to help prevent fetal exposure.
3) Risks include depression, psychosis, birth defects, pancreatitis, and increased triglycerides. Strict contraception and testing protocols aim to eliminate risk of
This document discusses keratinization disorders and epidermal differentiation. It begins by defining keratinocytes and describing their role in synthesizing keratin. It then explains the process of epidermal differentiation as keratinocytes progress from the basal layer to the stratum corneum. Key events include the formation of the cornified envelope and changes in keratin and lipid expression. Disorders can arise from defects in proliferation, differentiation, keratin expression or desquamation. Examples described in detail include ichthyosis vulgaris and X-linked ichthyosis.
Isotretinoin is a highly effective treatment for acne that works by reducing sebum production and modifying the follicular epithelium. It has immunomodulatory effects that help resolve inflammation. The document summarizes guidelines for isotretinoin use and dosing from international experts. It is recommended for severe nodular cystic acne or less severe acne that causes scarring or psychological distress. Low-dose and intermittent dosing regimens can be effective with fewer side effects. Precautions are needed in women of childbearing age due to teratogenicity. Isotretinoin provides long-term remission and is beneficial as early treatment to prevent scarring.
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 summarizes Blaschko lines, which describe the developmental growth patterns of the skin seen in certain dermatological conditions. It notes that in 1901, Alfred Blaschko described lines that did not correspond to vascular, nervous, or lymphatic patterns. The lines follow patterns of ectodermal migration and proliferation from the neural crest during embryogenesis. Common line patterns include V-shapes on the back and neck, S-shapes on the lateral trunk, and inverted U-shapes in the breast area. The causes of Blaschko lines are thought to involve inborn errors of morphogenesis or stretching of the skin during embryogenesis.
This is a powerpoint presentation on the epidermal keratinization and its associated disorders, presented by Dr. Jerriton, Dermatology resident of SVMCH, Pondicherry.
This document discusses hair science and the classification of alopecia. It begins by covering hair anatomy and the hair cycle process. It then classifies different types of alopecia as either noncicatricial (non-scarring) or cicatricial (scarring). One type covered in detail is alopecia areata, which is described as a chronic inflammatory disorder characterized by patchy hair loss without scalp atrophy. The etiology, clinical features, investigations, histopathology and prognosis of alopecia areata are summarized.
Acne scarring can be classified as icepick, boxcar, or rolling scars based on their width, depth, and architecture. Treatment options include topical agents, superficial and medium-depth peels, dermabrasion, fillers, fat transfer, needling, fractional photothermolysis, and surgical techniques like excision, grafting, and subcision. Superficial peels improve boxcar scars but may require multiple sessions. Dermabrasion is effective for acne scars but requires proper patient selection and technique. Fillers and fat transfer work best for atrophic depressed scars. Needling induces collagen without damage to induce healing. Surgical techniques are best for deep
Dyschromatosis and Reticulate pigmentary disorderssanjay singh
This document summarizes several rare pigmentary disorders including reticulate pigmentary disorders, dyschromatosis, and related conditions. Key points include:
- Reticulate pigmentary disorders involve freckle-like macules joined at margins in a net-like pattern, while dyschromatosis involves interspersed hyperpigmented and hypopigmented macules.
- Several conditions are classified including acral, flexural, generalized types like reticulate acropigmentation of Kitamura and dyschromatosis symmetrica hereditaria.
- Genetic mutations in genes like ADAM10, DSRAD, KRT5 are associated with these conditions. Histopathology often
This document provides an overview of acne, its grading system, stages of development, and treatment options. It discusses the pathophysiology and four main factors involved in acne. Treatment involves patient education, topical therapies like retinoids, antibiotics, and oral medications. Other forms of acne like rosacea and folliculitis are also summarized. The document concludes with an overview of cosmetic treatments for skin rejuvenation such as microdermabrasion, laser resurfacing, and chemical peels.
Acne occurs when pores become clogged with dead skin cells, sebum, and bacteria. It starts in sebaceous glands that secrete an oily substance called sebum, which can become trapped in pores along with skin cells and bacteria, causing blackheads or whiteheads. Pimples develop as small red bumps when sebaceous glands become overactive and clog pores. The most common areas for acne are the face, chest, back and shoulders.
Hyperpigmentation on the face slide sharevanita rattan
Hyperpigmentation on the face. How to recognise the distribution of hyperpigmentation on the face and how to treat it. The classic causes of Hyperpigmentation.
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
Definition, development, function & Site-specific of Melanocyte Definition, formation & function of Melanosomes, Definition & function of Melanin
Melanogenesis
This document discusses various treatment options for acne scars. It begins by explaining the impact of acne scars on quality of life. It then describes the different types of acne scars and the biological processes involved in scar formation. Various surgical and non-surgical treatment approaches are outlined, including dermarolling, subcision, punch excision, fillers, and lasers. Risks and techniques for each approach are provided. The goal of treatments is to induce new collagen formation and improve scar appearance.
This document discusses ablative and nonablative lasers for face rejuvenation. It provides details on how different laser wavelengths interact with tissue and the appropriate depth of penetration. It also discusses patient evaluation and pre/postoperative care for procedures like CO2 laser resurfacing. Complications can include prolonged erythema, milia, acne, and contact dermatitis. Selecting the right patient and laser settings is important to achieve results safely based on a person's skin type and goals.
This document discusses post inflammatory scarring, specifically acne scarring. It defines different types of scarring such as hypertrophic, keloid, and atrophic scarring. It further classifies atrophic scarring into icepick, boxcar, and rolling scars. The document then discusses various treatment options for acne scarring including chemical peels, microdermabrasion, subcision, and skin needling. It provides details on how these procedures work and reviews studies showing their effectiveness in improving acne scarring.
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 several types of palisaded granulomatous dermatoses including granuloma annulare (GA), annular elastolytic giant cell granuloma, and actinic granuloma. It provides information on the presentation, associations, and treatments for localized and generalized GA. It also includes photographs and descriptions of GA lesions on the hands. Treatment options discussed include topical steroids for localized GA and tetracycline combined with nicotinamide or PUVA for generalized GA.
Retinoids are a class of chemical compounds that are related chemically to vitamin A.
-Retinoids (found in animal foods)
-Carotenoids (found in plant foods)
Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth.
1. Cutaneous photosensitivity reactions require absorption of light energy by molecules, leading to damage and clinical disease.
2. Common photosensitivity disorders include polymorphic light eruption (PLE), chronic actinic dermatitis (CAD), and solar urticaria.
3. Clinical features, histopathology, and phototesting help differentiate types of photosensitivity dermatoses.
The document provides safety guidelines for the drug isotretinoin (Accutane). It discusses the drug's indications, pharmacokinetics, risks, and regulations. Key information includes:
1) Isotretinoin is used to treat severe cystic acne but can cause birth defects, so female patients must not get pregnant while taking it or for 1 month after.
2) The iPLEDGE program requires registration of patients, prescribers, and pharmacies and monthly pregnancy tests for female patients to help prevent fetal exposure.
3) Risks include depression, psychosis, birth defects, pancreatitis, and increased triglycerides. Strict contraception and testing protocols aim to eliminate risk of
This document discusses keratinization disorders and epidermal differentiation. It begins by defining keratinocytes and describing their role in synthesizing keratin. It then explains the process of epidermal differentiation as keratinocytes progress from the basal layer to the stratum corneum. Key events include the formation of the cornified envelope and changes in keratin and lipid expression. Disorders can arise from defects in proliferation, differentiation, keratin expression or desquamation. Examples described in detail include ichthyosis vulgaris and X-linked ichthyosis.
Isotretinoin is a highly effective treatment for acne that works by reducing sebum production and modifying the follicular epithelium. It has immunomodulatory effects that help resolve inflammation. The document summarizes guidelines for isotretinoin use and dosing from international experts. It is recommended for severe nodular cystic acne or less severe acne that causes scarring or psychological distress. Low-dose and intermittent dosing regimens can be effective with fewer side effects. Precautions are needed in women of childbearing age due to teratogenicity. Isotretinoin provides long-term remission and is beneficial as early treatment to prevent scarring.
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 summarizes Blaschko lines, which describe the developmental growth patterns of the skin seen in certain dermatological conditions. It notes that in 1901, Alfred Blaschko described lines that did not correspond to vascular, nervous, or lymphatic patterns. The lines follow patterns of ectodermal migration and proliferation from the neural crest during embryogenesis. Common line patterns include V-shapes on the back and neck, S-shapes on the lateral trunk, and inverted U-shapes in the breast area. The causes of Blaschko lines are thought to involve inborn errors of morphogenesis or stretching of the skin during embryogenesis.
This is a powerpoint presentation on the epidermal keratinization and its associated disorders, presented by Dr. Jerriton, Dermatology resident of SVMCH, Pondicherry.
This document discusses hair science and the classification of alopecia. It begins by covering hair anatomy and the hair cycle process. It then classifies different types of alopecia as either noncicatricial (non-scarring) or cicatricial (scarring). One type covered in detail is alopecia areata, which is described as a chronic inflammatory disorder characterized by patchy hair loss without scalp atrophy. The etiology, clinical features, investigations, histopathology and prognosis of alopecia areata are summarized.
Acne scarring can be classified as icepick, boxcar, or rolling scars based on their width, depth, and architecture. Treatment options include topical agents, superficial and medium-depth peels, dermabrasion, fillers, fat transfer, needling, fractional photothermolysis, and surgical techniques like excision, grafting, and subcision. Superficial peels improve boxcar scars but may require multiple sessions. Dermabrasion is effective for acne scars but requires proper patient selection and technique. Fillers and fat transfer work best for atrophic depressed scars. Needling induces collagen without damage to induce healing. Surgical techniques are best for deep
Dyschromatosis and Reticulate pigmentary disorderssanjay singh
This document summarizes several rare pigmentary disorders including reticulate pigmentary disorders, dyschromatosis, and related conditions. Key points include:
- Reticulate pigmentary disorders involve freckle-like macules joined at margins in a net-like pattern, while dyschromatosis involves interspersed hyperpigmented and hypopigmented macules.
- Several conditions are classified including acral, flexural, generalized types like reticulate acropigmentation of Kitamura and dyschromatosis symmetrica hereditaria.
- Genetic mutations in genes like ADAM10, DSRAD, KRT5 are associated with these conditions. Histopathology often
This document provides an overview of acne, its grading system, stages of development, and treatment options. It discusses the pathophysiology and four main factors involved in acne. Treatment involves patient education, topical therapies like retinoids, antibiotics, and oral medications. Other forms of acne like rosacea and folliculitis are also summarized. The document concludes with an overview of cosmetic treatments for skin rejuvenation such as microdermabrasion, laser resurfacing, and chemical peels.
Acne occurs when pores become clogged with dead skin cells, sebum, and bacteria. It starts in sebaceous glands that secrete an oily substance called sebum, which can become trapped in pores along with skin cells and bacteria, causing blackheads or whiteheads. Pimples develop as small red bumps when sebaceous glands become overactive and clog pores. The most common areas for acne are the face, chest, back and shoulders.
Hyperpigmentation on the face slide sharevanita rattan
Hyperpigmentation on the face. How to recognise the distribution of hyperpigmentation on the face and how to treat it. The classic causes of Hyperpigmentation.
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
Definition, development, function & Site-specific of Melanocyte Definition, formation & function of Melanosomes, Definition & function of Melanin
Melanogenesis
This document discusses various treatment options for acne scars. It begins by explaining the impact of acne scars on quality of life. It then describes the different types of acne scars and the biological processes involved in scar formation. Various surgical and non-surgical treatment approaches are outlined, including dermarolling, subcision, punch excision, fillers, and lasers. Risks and techniques for each approach are provided. The goal of treatments is to induce new collagen formation and improve scar appearance.
This document discusses ablative and nonablative lasers for face rejuvenation. It provides details on how different laser wavelengths interact with tissue and the appropriate depth of penetration. It also discusses patient evaluation and pre/postoperative care for procedures like CO2 laser resurfacing. Complications can include prolonged erythema, milia, acne, and contact dermatitis. Selecting the right patient and laser settings is important to achieve results safely based on a person's skin type and goals.
This document discusses post inflammatory scarring, specifically acne scarring. It defines different types of scarring such as hypertrophic, keloid, and atrophic scarring. It further classifies atrophic scarring into icepick, boxcar, and rolling scars. The document then discusses various treatment options for acne scarring including chemical peels, microdermabrasion, subcision, and skin needling. It provides details on how these procedures work and reviews studies showing their effectiveness in improving acne scarring.
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 several types of palisaded granulomatous dermatoses including granuloma annulare (GA), annular elastolytic giant cell granuloma, and actinic granuloma. It provides information on the presentation, associations, and treatments for localized and generalized GA. It also includes photographs and descriptions of GA lesions on the hands. Treatment options discussed include topical steroids for localized GA and tetracycline combined with nicotinamide or PUVA for generalized GA.
Retinoids are a class of chemical compounds that are related chemically to vitamin A.
-Retinoids (found in animal foods)
-Carotenoids (found in plant foods)
Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth.
The document discusses adrenocortical steroids, which are synthesized in the adrenal cortex and have glucocorticoid and mineralocorticoid activities. Glucocorticoids penetrate cells, bind to receptors, and regulate protein synthesis. Examples include hydrocortisone, prednisolone, and dexamethasone. Corticosteroids are powerful drugs that can cause both improvements in disease and adverse effects, so proper use and monitoring is important. They have a variety of ophthalmic and non-ophthalmic uses and indications.
This document provides an overview of necrobiotic disorders including granuloma annulare, necrobiosis lipoidica, and granuloma multiforme. It discusses the etiology, clinical features, histopathology, differential diagnosis, and treatment of each condition. Granuloma annulare commonly presents as annular or arciform plaques on the extremities of young people. Necrobiosis lipoidica typically causes yellow-brown, atrophic plaques on the pretibial area that may ulcerate. Granuloma multiforme forms firm papules aggregated into plaques or forming the edges of annular lesions, predominantly affecting sun-exposed areas.
Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units
Acne can present as noninflammatory lesions, inflammatory lesions, or a mixture of both,
affecting mostly the FACE but also the back and chest.
Non infectious&necrobiotic granulomatous diseases of the skin by M.Y.Abdel-MawlaYousry Abdel-mawla
Here are the key histopathologic features of necrobiotic xanthogranuloma:
- Palisaded foamy histiocytes surrounding areas of hyaline necrobiosis in the dermis
- Large numbers of necrotic inflammatory cells throughout the reticular dermis
- Presence of foam cells, multinucleated giant cells, cholesterol clefts, and extracellular lipid deposits
- Extensive fat necrosis can be seen in subcutaneous tissue
- Associated findings include superficial and deep perivascular lymphocytic infiltrates, and sometimes lymphoid follicles
The histopathology demonstrates necrobiosis surrounded by a palisade of foamy histiocytes, characteristic of this rare
Glucocorticoids act on glucose, fat, protein, and water metabolism. The major glucocorticoids are cortisol, corticosterone, and cortisone, which are secreted by the adrenal cortex. Glucocorticoids increase blood glucose, promote fat mobilization, and enhance protein breakdown. They also regulate water balance and have anti-inflammatory effects. Glucocorticoid secretion is regulated by ACTH from the pituitary gland and CRF from the hypothalamus through a negative feedback loop.
DARIER’S DISEASE, Keratosis folliculiris, rare genetic disorder that is manifested predominantly by skin changes, due to ATP2A2 mutation, The histology is characteristic, known as focal acantholytic dyskeratosis associated with varying degrees of papillomatosis
This document discusses several viral infections significant to clinical dentistry. It describes Herpes Simplex Virus infection, including pathogenesis, clinical features of primary and secondary infection, histopathology, differential diagnosis, and treatment. It also summarizes Varicella-Zoster virus infection, Hand Foot and Mouth disease, Herpangina, and Measles, outlining the etiology, pathogenesis, clinical features, histopathology, diagnosis, differential diagnosis and treatment for each viral infection.
Glucocorticoids have metabolic effects such as increasing hepatic gluconeogenesis and reducing glucose utilization in cells. They play an important role in the body's adaptation to stress and have anti-inflammatory and anti-allergic effects. Long term use of glucocorticoids can have undesirable side effects including gastric ulcers, high blood pressure, and bone thinning. Aldosterone has a greater mineralocorticoid activity than cortisol and its effects include regulating sodium and potassium levels and blood pressure. Conditions like Cushing's syndrome and Addison's disease involve imbalances in cortisol and aldosterone levels in the body.
The presentation include basics like adrenal gland and functions. Synthesis of glucocorticoids, details of glucocorticoid receptor, Human Glucocorticoid Receptor ultra structure, and domains. The presentation give special preference to its receptor signaling and and biological effects,
This document discusses several vesiculobullous diseases including pemphigus vulgaris, pemphigoid, erythema multiforme, and epidermolysis bullosa. Pemphigus vulgaris is an autoimmune disease causing fluid-filled blisters and ulcers in the mouth and skin. Pemphigoid includes bullous pemphigoid and cicatricial pemphigoid, which are autoimmune diseases affecting the elderly that cause subepithelial blistering. Erythema multiforme is often triggered by infection and causes red macules and mouth sores. Epidermolysis bullosa is a group of genetic disorders that results in easy blist
For more free medical powerpoints, visit www. medicaldump.com, Free updates everyday on all specialties including cardiology, nephrology, neurology, pulmonology, etc.
This document provides information on Mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB). It discusses the physiology and structure of M. tuberculosis, how it is transmitted, diagnosed, and its typical appearance under microscopy. The document also categorizes and describes the mechanisms and uses of both first- and second-line anti-tuberculosis drugs, including isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin from the first line and ethionamide, cycloserine, and thiacetazone from the second line. It addresses drug-resistant TB and the different groupings of alternative drugs used to treat multi- and extensively drug-resistant strains.
Corticosteroids are a class of steroid hormones produced in the adrenal cortex that are involved in stress response, immune response, inflammation, metabolism, and other physiological systems. They include glucocorticoids like cortisol which control carbohydrate, fat and protein metabolism and are anti-inflammatory, and mineralocorticoids like aldosterone which control electrolyte and water levels. Corticosteroids have various medical uses but also carry risks of side effects if not taken correctly.
Beta blockers are a class of drugs that are used to treat high blood pressure and heart conditions by blocking beta-adrenergic receptors. There are several types of beta blockers that are categorized based on their selectivity and other properties. Some are cardioselective, meaning they mainly affect the heart, while others are non-selective. Beta blockers have various therapeutic uses for conditions like hypertension, angina, arrhythmias, and migraine prevention. Their effects are primarily cardiovascular in nature by slowing the heart rate and reducing blood pressure. Common adverse effects include worsening heart failure and bronchospasm.
This document discusses various anti-tubercular drugs used to treat tuberculosis. It describes the classification of first-line drugs which include isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin. It also discusses second-line drugs including para-amino salicylic acid, ethionamide, cycloserine, thiacetazone, fluoroquinolones and macrolides. For each drug, it provides information on mechanisms of action, pharmacokinetics, dosing, adverse effects and drug interactions. The document is intended as an educational reference on anti-tubercular medications.
This document provides information on various dermatological conditions including:
- Pityriasis versicolor, describing presentation, diagnosis via KOH mount, and treatment with selenium sulfide or ketoconazole.
- Acne vulgaris, outlining exacerbating factors to avoid and medical management approaches for moderate and severe cases including topical and oral medications. Details are given on isotretinoin use and monitoring.
- Rosacea, defining diagnostic criteria and stages, differential diagnosis, and treatment approaches including lifestyle modifications and topical or oral antibiotics.
- Vitiligo, alopecia areata, scabies, lichen planus, and psoriasis, briefly covering presentation, diagnosis
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 summarizes information on the treatment of various medical conditions including:
- Treatment for active tuberculosis involving a multi-drug regimen over several months.
- Potential allergic reactions to penicillin and cephalosporins.
- Common adverse drug reactions for medications like acyclovir, nystatin, methotrexate, isotretinoin, timolol.
- Superinfections that can develop after long-term antibiotic use and conditions they may cause.
- Uses and side effects of medications for conditions like gout, hemorrhoids, scabies, nicotine withdrawal, acne.
learning objectives : Pathophysiology of Psoriasis
Common sites with pictures
Pharmacotherapy of Psoriasis
Local Drug therapy
Systemic Drug therapy
Biological therapy
Phototherapy
This document discusses drugs used on the skin, mucous membranes, eyes, ears, and nose. It covers corticosteroids like glucocorticoids and mineralocorticoids which suppress inflammation. It also discusses antipruritics for itching including anti-inflammatories, antibacterials, antifungals, and others. Specific drugs are provided for various conditions affecting the skin, eyes, ears, nose, and treatment of scabies and lice. Nursing responsibilities are outlined like monitoring for side effects and ensuring proper application of topical medications.
This document provides guidance on managing acne in a community setting. It outlines a treatment algorithm beginning with mild acne treatments like topical retinoids and progressing to oral antibiotics and referrals for moderate or severe acne. The algorithm and guidance notes cover appropriate treatment stages and options based on acne severity, emphasizing the importance of reviewing treatment response and considering alternative options if there is a poor response. Referral for isotretinoin therapy is suggested for severe nodular cystic acne or acne that has not responded to oral antibiotic treatment.
The document discusses the sebaceous gland and its role in acne pathogenesis. It describes how sebum composition changes in acne, with increased levels of triglycerides, free fatty acids and other lipids that promote P. acnes bacteria growth and inflammation within pilosebaceous follicles. The four main pathologic features of acne are increased sebum production due to androgens, P. acnes infection, follicular hyperkeratinization, and inflammation.
This document defines and discusses adverse drug reactions (ADRs). It notes that ADRs affect 6-30% of patients and are a leading cause of death. ADRs are classified as non-immunological or immunological. Risk factors include age, number of drugs used, and immune status. Evaluation of ADRs involves a drug history, ruling out other causes, and assessing the temporal relationship to drug intake. Management involves discontinuing the offending drug if possible. Common ADRs to anti-TB drugs are discussed as well as their management.
The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold
This document discusses various topics related to ophthalmic drugs including antibiotics, steroids, and drugs used to treat glaucoma. It provides details on the mechanisms of action, indications, and side effects of different drug classes. It describes commonly used antibiotics like aminoglycosides, macrolides, and quinolones. It also outlines steroid drugs and their anti-inflammatory mechanisms and ocular uses. The document discusses various agents used to lower intraocular pressure in glaucoma including parasympathomimetics, sympathomimetics, alpha-agonists, and beta-blockers.
Acne and rosacea are extremely common skin conditions that can have a significant psychological and social impact. Acne is caused by factors like blocked hair follicles, increased sebum production, inflammation, bacteria, and hormones. Rosacea has different clinical forms including papules/pustules and redness/telangiectasias. Both are managed with topical treatments like retinoids, antibiotics, and oral antibiotics/isotretinoin for more severe cases. Patients require long-term treatment to control symptoms.
Methylprednisolone 4 mg tablets smpc taj pharmaceuticalsTaj Pharma
This document is the summary of product characteristics (SMPC) for methylprednisolone 4 mg tablets produced by Taj Pharmaceuticals. It provides information on the pharmaceutical form, clinical uses, posology, contraindications, and warnings for methylprednisolone. The drug is indicated for conditions requiring glucocorticoid activity, including autoimmune, rheumatic, dermatological, ophthalmic, respiratory, and hematological disorders. It lists recommended initial daily dosages for various conditions. Contraindications include infections and hypersensitivity. Warnings cover immunosuppressive effects and increased infection risk, endocrine effects like adrenal suppression, and metabolic effects such as worsening diabetes.
Methotrexate is an anti-metabolite drug used to treat psoriasis and rheumatoid arthritis. It works by inhibiting dihydrofolate reductase and interfering with DNA synthesis. It was first approved by the FDA in 1971 for psoriasis. Methotrexate is absorbed quickly after oral administration and distributed throughout the body, with potential side effects including hepatotoxicity, bone marrow suppression, and pulmonary toxicity. Careful monitoring of liver and blood tests is required when using this drug.
The document discusses photodynamic therapy (PDT), a treatment that uses photosensitizing drugs activated by light to treat cancer and other diseases. It describes several FDA-approved photosensitizing drugs including porfimer sodium, aminolevulinic acid, methyl ester of ALA, and verteporfin. The document also discusses the mechanism of PDT, advantages, potential side effects of the drugs, and future directions for improving PDT treatments.
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.
Background, physiology, immunology and recommended managements for patients in chemotherapy-induced hypersensitivity reactions. Details both cytotoxic and monoclonal antibody therapies. Delivered at HSE South East Regional Ongology Meeting March 2016.
Acne is the result of overactive sebaceous glands and excessive keratin production, leading to excessively oily skin that is prone to blackheads and pimples. You cannot change your skin type you cannot stop this process permanently. However, you can control this process and minimise your acne breakout reoccurrence by....
Psoriasis is a chronic autoimmune disease characterized by abnormal skin cell proliferation and differentiation. It has several subtypes including plaque, guttate, pustular, and nail psoriasis. Treatment involves topical therapies like corticosteroids, vitamin D analogues, and tar-based treatments. Phototherapy using UVB or PUVA is also used. For more severe cases, systemic therapies like methotrexate, ciclosporin, and biologics that target TNF-α may be used. Psoriasis has links to psoriatic arthritis and inflammatory bowel disease and is triggered by factors like infection, stress, and trauma.
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.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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.
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).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. The term retinoids includes all natural and synthetic
compounds that have structural or biological activities like
vitamin A
There are more than 1500 retinoids have been developed
First generation(nonaromatic): Tretinone: all-trans retinoic
acid , Isotretinoin : 13-cis retinoic acid, Alitretinoin: 9-cis
retinoic acid
Second generation(monoaromatic): Etretinate, acitretin
Third generation(polyaromatic): Adapalene, Tazarotene,
Bexarotene
The original second generation retinoid used for psoriasis, etretinate,
was superseded by its natural metabolite, acitretin, which was shown to
have similar efficacy with a better pharmacokinetic profile
3.
4. Approved Systemic Retinoids
Chemical
name
Trade name
Date approval Indication
(removal)
Isotretinoin
Accutane
5/7/1982
Amnesteem
11/2002
Sotret
12/2002
Claravis
4/2003
Etretinate
Tegison
9/30/1986
(12/20/2002)
Severe recalcitrant
psoriasis
Acitretin
Soriatane
10/26/1996
Severe psoriasis
Bexarotene
Targretin
12/29/1999
Refractory CTCL
Severe recalcitrant
nodular acne
4
6. Mechanism of action
These synthetic hormones bind to nuclear retinoid
receptors , thereby altering gene transcription and
returning keratinocyte proliferation and differentiation to
normal.
As well as modification of inflammatory responses and
neutrophil function
8. Psoriasis
Retinoids , since they are not immunosuppressive,
retinoids have a role in the treatment of psoriasis in
children, patients with HIV infection and those who are
prone to cancer. It is generally safe for long-term use and
has no time limit restrictions.
Retinoids are considered excellent for use in combination
with other treatments and when used with UVB or PUVA,
their dose and the number of phototherapy treatments
can be reduced, with the added benefit of a potential
reduction in skin carcinogenesis
9. Acitretin is as effective as etretinate .
Plaque psoriasis : variable response:
30% complete clearance, 50% significant
improvement (60-70% reduction of PASI score)
Erythrodermic and Pustular psoriasis: retinoids
are the first-line therapy
Complete clearance usually requires
a combination of therapy such as:
1. Retinoids + topical steroids
2. Retinoids + topical vit D derivatives
3. Retinoids + anthralin
4. Retinoids + PUVA (Re-PUVA): retinoids are
started for 14 days before starting PUVA
5. Retinoids + UVB
10. Psoriasis
Within few days of
initiating therapy at
dose 30-70mg/day
An initial worsening of
the disease with
increase of erythema
and/or extent of
involvement
Initial low dose: 10
mg/day
Followed by increasing
of dose
Efficacy of low-dose
acitretin is as placebo
Effective doses
25,50,75 mg /day
(0.5-1 mg/kg/day)
12. PRP
Systemic Vitamin A had been used with considerable
effectiveness. The advent of synthetic retinoids has
largely supplanted vitamin A therapy
Isotretinoin:
Acitretin
1mg/kg/day
1mg/kg/day
80% of patients
showed clearance of
lesions after an
average 25 weeks
treatment
Alone or in
combination with UVR
13.
14. Acne vulgaris
Isotretinoin is a systemic retinoid that is highly
effective in the treatment of acne vulgaris.
Isotretinoin causes normalization of epidermal
differentiation, depresses sebum excretion by 70%,
is anti-inflammatory, and even reduces the presence
of P acnes.
Treatment with isotretinoin can lead to both marked
improvement
and
long-lasting
remission.
Essentially,
isotretinoin
has
the
capacity to “cure” acne.
15. Initially with the introduction of isotretinoin, only
patients with severe nodular cystic acne or
severe inflammatory acne, who were not
responding to conventional therapy were given
the drug.
Now, with more than 20 years of treatment
experience, expanded guidelines for its use
include:
1. Moderate acne relapse (<50% improvement)
after a single adequately-dosed course of
antibiotics or hormonal therapy of 4 months
2. Significant psychosocial impairment
3. Gram negative folliculitis
4. Scarring or persistent dyschromia
16. Acne conglobata is certainly the best indication for isotretinoin
therapy; however acne fulminans, after initial "calming" of the
exacerbation with oral tapering dose steroids over 4-6 weeks,
responds well to the retinoid.
Gram-negative folliculitis can be effectively treated not only with
ampicillin, co-trimoxozole or trimethoprim, but with isotretinoin
as well.
Hidradenitis suppurativa and rosacea patients have benefited
from isotretinoin therapy as well
Isotretinoin is used in pyoderma faciale after initial oral steroids
for the first 4 weeks.
Acne excoriee is often quelled with a course of isotretinoin
Good results have been reported in its use for granulomatous
perioral dermatitis.
17. Acne vulgaris
Isotretinoin therapy should be initiated at a dose of 0.5
mg/kg/d for 4 weeks and increased as tolerated until a
cumulative dose of 120-150 mg/kg is achieved.
Recommended course of therapy is 4-5 months , but
some dermatologists continue therapy 2 months after
clearance with average 7 months.
Coadministration with steroids at the onset of therapy
may be useful in severe cases to prevent initial
worsening.
Initial response can be seen by 8 weeks, But if
comedones is more present than inflammatory lesions
improvement may be delayed until 3 months
18. Some patients may respond to doses lower
than the standard recommendation dosages.
A lower dose (0.25-0.4 mg/kg/d) may be as
effective as the higher dose given for the
same time period and with greater patient
satisfaction.
But may result in higher recurrence rate
Lower intermittent dosing schedules (1 week
out of each month) are not as effective.
19.
20. Isotretinoin absorption is increased by
coadministration with lipids. Thus, patients
are instructed to take their doses with a
small, fatty meal.
Given the half-life of 10 to 20 hours, it is best
to take isotretinoin twice aday.
21. Non-responding patients to "normal" courses of
isotretinoin may have been responders had the following
potential pit-falls been adequately addressed during the
initial course in assessing response:
1. Compliance: check the lips for signs of cheilitis.
2.
Isotretinoin must be taken with a fat containing food.
3.
Insufficient dosage: clinical experience has shown that the
dosing guidelines given in the product monograph are
inadequate to achieve optimal response in most patients.
4.
Truncal acne, family history, early onset before age 12,
long established acne that has been inadequately treated
for years: all require more aggressive treatment.
5.
Ovarian cause (PCOS) may require hormonal therapy.
22. Hidradenitis suppuritiva (HS)
Acitretin for HS is barely
mentioned in the
literature; however, its
positive effect is
pharmacologically
reasonable, as the primary
event in HS is follicular
occlusion, and acitretin
induces normalization of
epithelial cell proliferation
and differentiation.
Not surprisingly,
isotretinoin is ineffective
for HS, as this agent
primarily works on
sebaceous glands, which
are not involved in the
pathogenesis of HS.
The observation that 35%
of treated patients still
responded to isotretinoin is
more likely to be due to the
immunomodulatory
effects of this retinoid.
23. NMSC pre-malignant lesions
Chemoprevention of nonmelanoma skin
cancer in patients with a history of numerous
tumors or high-risk skin cancer patients
(Xeroderma pigmentosum, nevoid BCC
syndrome, organs transplant patients )
Treatment of premalignant skin lesions as HPVinduced tumors (condyloma accuminatum) and
actinic keratoses.
Etretinate or aciretine 30 mg/day for 6 months
25. Ichthyosis
Acitretin
Ichthyosis vulgaris
X-linked recessive
Good
Lammelar ichthyosis
Non-bullous congenital
Best
ichthyosiform
erythroderma
Bullous congenital
ichthyosiform
erythroderma
May result in intial increase
of bulla formation
26. A case of KID syndrome treated with systemic
retinoids 3o mg/day and urea-based emollient
for 5 months
27. CTCL
Bexarotene is a retinoid specifically selective
for retinoid X receptors (RXR), as opposed to
the retinoic acid receptors (RAR).
Bexarotene is indicated for the treatment of
cutaneous manifestations of cutaneous T-cell
lymphoma in people who are refractory to at
least one prior systemic therapy.
28.
29. Systemic retinoid toxicity is similar to hypervitaminosis A;
hence, mucocutaneous side-effects (e.g., skin dryness,
conjunctivitis, and hair loss) are common. Other sideeffects include hyperlipidaemia, osteoporosis and
ligamentous calcifications
30. Skin fragility:
a frequent side effect of
oral synthetic retinoids,
Light and electron
microscopy showed
fraying or loss of the
stratum corneum and
outer layers of the viable
epidermis, loss of
desmosomes and
tonofilaments, and
intracellular and
intercellular deposits of
amorphous material that
did not stain with stains
for mucin.
32. The most common side effects are
mucocutanous effects such as cheilitis and
hair loss, which are dose-dependent.
33. Teratogenicity
Systemic retinoids should be considered with extreme
caution in females in childbearing peroid and pregnancy
must be avoided.
Contraception counseling is mandatory, and 2 negative
pregnancy test done at least 21 days after the last
menstrual peroid (serum pregnancy test is more accurate)
results are required prior to the initiation of therapy.
The length of time the drug is present in the body is of
great importance because of its possible teratogenic
effects
34. Etretinate is approximately 50 times more
lipophilic than acitretin
Etretinate is stored in adipose tissues from which
it is released slowly
Re-esterification of acitretin to etretinate may
occur when acitretin is taken with alcohol
Isotretinoin and its major metabolites are
present after discontinuation of the drug and
reaches its normal levels within 2 weeks
The time of compulsory contraception:
1. 1 month in isotretinoin
2. 2-3 years in etretinate and acitretin
35. Checklist for prescribing
isotretinoin
Adequate sexual history
Frank explanation of the treatment and potential
pregnancy effects
Assessment of patient comprehension
Oral contraceptive pills
Serum pregnancy test last week of cycle
Stat OCP and retinoids on 2-3 day of next cycle
Consent form signed
Each visit-discuss contraception and avoidance of
pregnancy
OCP continued after therapy
Immediate notification of physician if suspect pregnancy
36. Investigations
laboratory examination should also include
fasting cholesterol and triglyceride assessment,
hepatic transaminase levels, and a CBC count.
Pregnancy tests and laboratory examinations
should be repeated monthly during treatment.
Patients with prior history of hyperlipidemias,
blood sugar or liver abnormalities may require
increased testing frequencies
37.
38. A recent pharmacogenetic study concluded
that "people who develop hypertriglyceridemia during isotretinoin therapy, as
well as their parents, are at increased risk for
future hyperlipidemia and the metabolic
syndrome.“
Therefore the physician may take advantage
of this side-effect to predict the risk of the
patient and their first degree relatives of
developing diabetes, high blood pressure and
obesity later in life.
39. While using isotretinoin, the patient is
considered at high risk for abnormal healing and
the development of excessive granulation tissue
following procedures.
Many dermatologists delay elective procedures,
such as dermabrasion or laser resurfacing (eg,
with carbon dioxide laser or erbium:YAG laser),
for up to 1 year after completion of therapy.
Other procedures to be avoided during therapy
include tattoos, piercings, leg waxing, and other
epilation procedures