.

yCorticosteroids .. 2495
y Hydrocortisone

(eczematous dermatoses)

Corticosteroid
y

y 4
(hexane 3
pentane 1 )
3

Corticosteroid
y

(Ring structure)

(Side chain)

Corticosteroid
y
y

y
y

Structure of Corticosteroids
Triamcinolone acetonide

Betamethasone dipropionate

Mechanism of action

Pharmacology
y (Anti-inflammatory effects)
y (Immunosuppressive effects)
y (Antiproliferative

effects) : fibroblasts
(collagen and
ground substances)
9

Pharmacology
y (Vasoconstriction)

histamine,
bradykinins & prostaglandins

10

Pharmacology
y (Vasoconstriction)


Corticosteroids
vasoconstrictor assay
vasoconstriction test

11
Corticosteroids

vasoconstrictor assay

y 5 mg

9 12
y infrared reflection photometers /
thermal conductivity / laser doppler
velocimetry
y
metabolism

12


y 7

( 1 7
)
y 4 mild,
moderate, very potent, super potent

13

Class 1 superpotent Betamethasone

dipropionate 0.05%
Clobetasol
propionate 0.05%
Class 2 potent,
Desoximetasone
upper mild strength 0.25%
Mometasone
furoate 0.1%
Class 3
Betamethasone
potent,upper mild
valerate 0.1
strength

Diprotop
ointment/gel/lotion
Dermovate cream
Topicort cream
Elomet ointment

14

Class 4 mild strength Fluocinolone

acetonide 0.025%
Mometasone
furoate 0.1%
Prednicabate 0.1%
Class 5 lower mild Triamcinolone
strength
acetonide 0.1%

Synalar ointment
Elomet
cream/lotion
Dermatop ointment

15

Class 6 mild strength Triamcinolone

acetonide 0.02%
Class 7 least
Hydrocortisone
strength
0.5,1,2.5%
Prednisolone 0.5%

16

 Corticosteroids
(chemical characteristics)
9Fluticasone propionate : local
adverse effect
9Mometasone furoate :

17

Corticosteroids
(vehicles)
9corticosteroid

9
(ointment) (cream) (lotion)

18

 Corticosteroids
(vehicles) : (ointment)
9 (preservative) :

9 (lichenification)

9

19

Corticosteroids
(vehicles) : (cream)
9

(intertriginous area)

20

 Corticosteroids
(vehicles) : (lotion) (gel)
(solution)
9
9 alcohol propylene
glycol /
:
21

Corticosteroids
(potency)
9class 6-7 or low potency

9class 2-5

22

 Corticosteroids

9 corticosteroids
99
1

23

Corticosteroids

9 atopic dermatitis

9 2 10

24

 Corticosteroids

9 dyshidrosis
lichen
simplex chronicus
9 :

25

Corticosteroids

9 / 300
potency
9 potency
salicylic
acid

(occlusion)
26


1. / 2. 3.

4.
5. /
6. /
7. / 8. / 9.
10.
27

0.1 % Triamcinolone acetonide cream

0.1 % Triamcinolone acetonide lotion
28

0.1 % Triamcinolone acetonide cream

0.1 % Triamcinolone acetonide lotion
29

2
0.1 % Betamethasone valerate cream
0.05 % Betamethasone dipropionate
ointment
30

0.1 % Betamethasone valerate cream

0.05 % Betamethasone dipropionate
ointment
31

Potency

yConcentration
y0.1 % Triamcinolone acetonideX
y0.02 % Triamcinolone acetonide Y

32

 Potency

yDosage Form :
yOintment is absorbed better than

cream or lotion
y0.1 % Mometasone furoate ointment X
y0.1 % Mometasone furoate cream Y
33

Potency

ySalt of Drug

y0.05 % Betamethasone dipropionate X

y0.1 % Betamethasone valerate Y

34

yLow potency
yShort term
y
yRotational therapy

35

36

Side Effect
y

(local adverse effects)

y
(systemic reactions)

37

Side Effect local adverse effects

(atrophic changes)
y . . 2506 Triamcinolone
acetonide
y

(epidermal atrophy)
(alteration in
38
skin elasticity)

Side Effect local adverse effects

(atrophic changes)
y
/
potency
:

39

Side Effect local adverse effects

(atrophic changes) :
dermal atrophy
y fibroblasts
y collagen : 3
2

40

Side Effect local adverse effects

(atrophic changes) :
dermal atrophy
y 0.1% Betamethasone valerate 3

9 15
9
(telangiectasia) (easy bruising)
(purpura)
41

telangiectasia

42

purpura

easy bruising

43

Side Effect local adverse effects

(hypopigmentation)
y melanocyte : melanin

44

Side Effect local adverse effects

y 16 43
y (tinea versicolor)
(tinea incognito) (onychomycosis)
(herpes simplex infection) (molluscum
contagiosum) (scabiasis)
45

Side Effect local adverse effects

(acneiform reactions)
y 3
9 steroid acne
9 (perioral dermatitis)
9 steroid rosacea

46

Steroidacne

47

steroid rosacea

48

perioral dermatitis

49

Side Effect local adverse effects

(acneiform reactions)
y perioral dermatitis & steroid rosacea
9
9
(rebound phenomenon)
9
(tachyphylaxis)
50

Side Effect local adverse effects

(acneiform reactions)
y steroid acne
9 (acne vulgaris)
9

9
51

Side Effect local adverse effects

y corticosteroid
(glaucoma)
y (vision loss)
y corticosteroid
300
52

Tachyphylaxis
y corticosteroids

53

Steroid addition
y corticosteroids
y high potenty
y rosacea telangiectasis

54

 corticosteroids
y

y
0.2 6
y corticosteroid

55

corticosteroids

Parabens
Propylene glycol
Benzyl alcohol
Chlorocresol
Ethylenediamine HCl

Isopropyl palmitate
Polysorbate 60
Stearyl alcohol
Corticosteroid
Antibiotics
56

Side Effect Systemic effects

y corticosteroid :
9High potency clobetasol propionate 0.05%
2 g/day 2 3
9Medium potency 7 g/day 2 weeks

57

Side Effect Systemic effects

y
9 /
9 :
9
9 potency of corticosteroids
58

Side Effect Systemic effects

y
9
9

59

9 1 (fingertip
units)
9 1 fingertip units : male = 0.49 g female = 0.43 g

60

1 fingertip units

61

9 Rule of hand
9 1 1 g
9 1
2

62

9 corticosteroids class 1 3 1 2
: 1
tachyphylaxis
9 corticosteroids class 4 7
2
63

9 corticosteroids High potency :

2 weeks
9 corticosteroids Medium/Low potency :
3 months

64

9 corticosteroids Low potency :

2 weeks
9 1 side effects

2.5 3 & drug
metabolism
65

9 Systemic side effects

9
9 Adrenal crisis
9

66

9 FDA USA .. 2530 2540

9 Betamethasone 79.4 (
25.7 Betamethasone dipropionate +
Clotrimazole)

67

9 Conchrane database

9
//
9 class 1

68

9 C
9 pregnancy category C
9 :

69

y Tar: 3-10 % LCD

(Liguor Carbonis Detergents)
y 3-5%CCT (Crude Coal Tar)

70

 (Topical therapy)
1. Corticosteroids
2. Tar
3. Dithranol (Anthralin)
4. Calcipotriol
5. Salicylic acid
71

CoalTar

72

 (Tars)

y DNA
y
y

73

Tar Shampoo
y20 %Coal Tar Shampoo
y Olive oil
y

74

Scalp Lotion
y0.02 % TA Lotion
yDesoximetasone
yMometasone lotion

75

Combination with Coal Tar

y Treatment Psoriasis
y Coal Tar + corticosteroid
y 5 % LCD in 0.02 % TA
y 5 % LCD in 0.1 % Bet.

Valerate
y 5 % LCD in 0.05 % Bet.
valerate
76

Tar + Corticosteroid
y5 % LCD cream
y5 % LCD in 0.02 % TA
y 5 % LCD in 0.05 % Bet. Valerate
y 5 % LCD in 0.1 % Bet. Valerate
y / /

(genital area)
77

Emollient
yCream base
yLiquid paraffin

(Mineral oil)
yPetroleum jelly
(Vaseline)

78

Keratolytic agent
y 3 - 10 % salicylic acid
y 3 - 10 % urea cream
y combind with

corticosteroid

79

Combination with Urea

y Treatment for Dry skin
y 10 % Urea in 0.02 % TA
y 10 % Urea in 0.1 % Bet.

Valerate
y 20 % Urea ointment
y 40 % Urea ointment
80

Keratolytic agent
Salicylic acid

Urea

y 3 % SA in 0.02 % TA

y 10 , 20 % Urea

y 5 % SA in 0.02 % TA

y 10 % Urea in 0.02 % TA

y 10 % SA in 0.02 % TA

y 10 % Urea in 0.05 %

y 10 % SA ointment

Bet.valerate
y 10 % Urea in 0.1 %
Bet.valerate

y 20 % SA ointment

81

Combination with Antibiotic agent

yClioquinol

(Iodochlorhydroxyquin)
yantibiotic that works by
preventing the growth of
fungus/bacteria
y3 % Vioform in 0.02 %
TA
82

Calcipotriol

y
y differentiation
y

83

Calcipotriol

y 3 ,
y 50 /

84

VitamineD3Analogues

85

Fucidicacid

86


First line drug

Second line drug

y Methotrexate 5-25 ./ y Cyclosporin 3 5 ././

3
12 . (triple dose
therapy)
y Retinoid:- acitretin 0.25-1 ./
./

1 - 2 /
(2 divided dose)

87

Methotrexate

2.5 .
88

89

Methotrexate
y Dihydrofolate reductase

DNA
y
y
y

90

 Methotrexate
yPsoriatic erythroderma
yPustular psoriasis
yPsoriasis

ySevere plaque type psoriasis

yPsoriatic arthritis
91

Methotrexate
y 2.5-25 .

y 3 12

y 2.5-5 . 1 2

92

Methotrexate 2.5 mg take 1 : 1 : 1

Begin on Monday morning
Monday 08.00 AM

1 Tab

Monday 08.00 PM

1 Tab

Tuesday 08.00 AM

1 Tab
93

Methotrexate 2.5 mg take 2 : 2 : 1

Begin on Wednesday evening
Wednesday

08.00 PM

2 Tab

Thursday

08.00 AM

2 Tab

Thursday

08.00 PM

1 Tab
94

 Methotrexate
1.
2.2
3.
4.
5.
6.
7. MTX
MTX 12
8.
95

complete blood count

2. BUN
3. creatinine
4. liver function test
1.

y
y

y 1-3

96


y HIV Immunosuppression

y
y 1.52 g liver biopsy
liver biopsy liver biopsy
1 .
y 3

97

SideEffectofMTX
y
y

y
y
y
98

SideEffectofMTX
y

(nephropathy)
y
y
y (reactivation of sunburn response)
99

DrugInteractionofMTX
y methotrexate
alcohol, salicylates, cotrimoxazole,
trimethoprim, probenecid, phenytoin, retinoids,
pyrimethamine furosemide

100

Acitretin25mg

101

y
y differentiation
y CMI HMI
y

102


1. Pustular psoriasis
2. Extensive plaque type psoriasis

3. Erythrodermic psoriasis

103

yAcitretin 0.5 - 1 ././

0.25 - 0.5 ././
3

104


y ()
y complete blood count,

liver function test, cholesterol, Triglyceride, HDL

yPregnancy test

105

y liver function test

1 - 3
y triglyceride

106

SideEffect
yCheilitis (100%), , ,

(20-50%), (100%), ,
(bruising), , (20%),
,

107

SideEffect
y
y

y
y (teratogenicity)

3
108


y
y (

3 )
y

109

y liver function test

y
y tetracycline (
intracranial hypertension) phenytoin (competition of
plasma-protein binding)
110

H1receptorantagonists
ShortActing

LongActing

yChlorpheniramine

yCetirizine

yHydroxyzine

yLoratadine
y Desloratadine
yLevocetirizine
111

H1-receptor antagonists
CPM

Details

yShort Acting

ySedative side effect

yMost common use 1

tab hs
112

H1-receptor antagonists
Hydroxyzine 10 mg

Details

yShort Acting

ySedative side effect

yMost common use 1

tab hs
113

H1-receptor antagonists
yCetirizine
yLoratadine
yLong Acting
y1 tab OD
114

115

Topical Retinoids

Retinol, Retinoic acid, Isotretinoin,
Adapalene
116

Topical Retinoids
*
*
* Glycosaminoglycan
*
117

Topical Retinoids

*


118

Topical Retinoids
*
*
*
*

119

Topical Retinoids
* Oral Retinoids

* Topical Retinoids

*
,

120

121

122

*
Carboxylic acid hydroxy
alpha
* AHA
123

*
*
*
*
*
*
124

* AHA 4-30%
(
AHA 3-10%)
* AHA 50%

125

126

 Salicylic acid
AHA BHA

127

* AHA

* Salicylic acid

128

* alpha-helical
peptide chains 3
*

129

130


1. (melanocytes)
2.

3. tyrosinase

131

4. melanosome malpighian
cell phacocytosis melanocytic dendrite
5. melanosome
oxidized form () reduced form (
)
132


1. (opacifying or covering agent)

2. (depigmentating
agent) tyrosinase

133

3. (sunscreen agent)
UV

4. (oxidizing agent)

134


- alpha hydroxy acid (AHA)


-

135

Hydroquinone
- 3 - 5 % Hydroquinone
-
-


136

Azelaic acid
-

- tyrosinase



137

Azelaicacid

138

Arbutin
- hydroquinone glycoside
Bergenia crassifolia Arctostaphylos uvaursi
- tyrosinase

hydroquinone
139

- magnesium ascorbyl
phosphate , sodium ascorbyl phosphate sodium
ascorbyl sulfate
- ascorbyl dipalmitate
, ascorbyl glucosamine
- gamma-ascorbic acid
phosphatase
140

Lactic acid
- Lactic acid tyrosinase

- 5 20 %
-

141

(UV)
y UV- A

y UV - B sunburn

142

10.00 - 15.00 .
y

143

y
y

UV
UV


UVA
144

ySPF Sun Protection Factor

UVB

SPF15,30
145

SPF15
y 30

y SPF 15
15 30
7

146

???
147

1
y 2

148

SunProtectionProduct

149

150