.

1

yCorticosteroids .. 2495y Hydrocortisone (eczematous dermatoses)

2

Corticosteroidy y 4

(hexane 3 pentane 1 )

3

Corticosteroidy (Ring structure) (Side chain)

4

Corticosteroidy y yy

5

Structure of CorticosteroidsTriamcinolone acetonide Betamethasone dipropionate

6

7Mechanism of action

8

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

effects) : fibroblasts (collagen and ground substances)

9

Pharmacologyy (Vasoconstriction)

histamine, bradykinins & prostaglandins

10

Pharmacologyy (Vasoconstriction)

Corticosteroids

vasoconstrictor assay vasoconstriction test

Corticosteroids 11

vasoconstrictor assayy 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% Clobetasolpropionate 0.05%

Diprotopointment/gel/lotion Dermovate cream

Class 2 potent, upper mild strength

Desoximetasone0.25% Mometasonefuroate 0.1%

Topicort cream

Elomet ointment

Class 3 potent,upper mild strength

Betamethasonevalerate 0.1

14

Class 4 mild strength Fluocinolone

acetonide 0.025% Mometasonefuroate 0.1% Prednicabate 0.1%

Synalar ointment

Elometcream/lotion Dermatop ointment

Class 5 lower mild strength

Triamcinoloneacetonide 0.1%

15

Class 6 mild strength Triamcinolone

acetonide 0.02%Class 7 least strength

Hydrocortisone 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 9 class 2-5

22

Corticosteroids9 corticosteroids 99 1

23

Corticosteroids9 atopic dermatitis 9 2 10

24

Corticosteroids9 dyshidrosis lichen simplex chronicus 9 :

25

Corticosteroids9 / 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

2

28

0.1 % Triamcinolone acetonide cream

0.1 % Triamcinolone acetonide lotion

29

0.1 % Betamethasone valerate cream

0.05 % Betamethasone dipropionate ointment

2

30

0.1 % Betamethasone valerate cream

0.05 % Betamethasone dipropionate ointment

31

PotencyyConcentrationy0.1 % Triamcinolone acetonideXy0.02 % Triamcinolone acetonide Y

32

PotencyyDosage Form : yOintment is absorbed better than

cream or lotiony0.1 % Mometasone furoate ointment Xy0.1 % Mometasone furoate cream Y

33

PotencyySalt of Drugy0.05 % Betamethasone dipropionate Xy0.1 % Betamethasone valerate Y

34

yLow potencyyShort termy yRotational therapy

35

36

Side Effecty

(local adverse effects)y (systemic reactions)

37

Side Effect local adverse effects (atrophic changes)y . . 2506 Triamcinolone

acetonide y (epidermal atrophy) (alteration in

skin elasticity) 38

Side Effect local adverse effects (atrophic changes)y / potency :

39

Side Effect local adverse effects (atrophic changes) :

dermal atrophyy fibroblasts y collagen : 3 2

40

Side Effect local adverse effects (atrophic changes) :

dermal atrophyy 0.1% Betamethasone valerate 3 9 159

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

45

Side Effect local adverse effects (acneiform reactions)y 3 9steroid acne9 (perioral dermatitis)9steroid rosacea

46

Steroidacne

47

steroid rosacea

48

perioral dermatitis

49

Side Effect local adverse effects (acneiform reactions)y perioral dermatitis & steroid rosacea99

(rebound phenomenon) 9

(tachyphylaxis) 50

Side Effect local adverse effects (acneiform reactions)ysteroid acne9 (acne vulgaris) 9 9

51

Side Effect local adverse effectsy corticosteroid (glaucoma)y (vision loss)y corticosteroid 300

52

Tachyphylaxisy corticosteroids

53

Steroid additiony corticosteroidsy high potenty y rosacea telangiectasis

54

corticosteroidsy y 0.2 6y corticosteroid

55

corticosteroids Parabens Isopropyl palmitatePropylene glycol Polysorbate 60Benzyl alcohol Stearyl alcoholChlorocresol CorticosteroidEthylenediamine HCl Antibiotics

56

Side Effect Systemic effectsy corticosteroid :9High potency clobetasol propionate 0.05% 2 g/day 2 3 9Medium potency 7 g/day 2 weeks

57

Side Effect Systemic effectsy 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 hand9 1 1 g9 1 2

62

9 corticosteroids class 1 3 1 2 : 1 tachyphylaxis9corticosteroids class 4 7 2

63

9 corticosteroids High potency : 2 weeks9corticosteroids Medium/Low potency : 3 months

64

9 corticosteroids Low potency : 2 weeks9 1 side effects 2.5 3 & drug metabolism

65

9Systemic side effects 9 9 Adrenal crisis9

66

9 FDA USA .. 2530 25409 Betamethasone 79.4 ( 25.7 Betamethasone dipropionate + Clotrimazole)

67

9 Conchrane database 9 //9 class 1

68

9 C 9 pregnancy category C9 :

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 Shampooy20 %Coal Tar Shampooy Olive oily

74

Scalp Lotiony0.02 % TA LotionyDesoximetasone yMometasone lotion

75

Combination with Coal TaryTreatment PsoriasisyCoal Tar + corticosteroidy5 % LCD in 0.02 % TAy5 % LCD in 0.1 % Bet.

Valeratey5 % LCD in 0.05 % Bet.

valerate

76

Tar + Corticosteroidy5 % LCD creamy5 % LCD in 0.02 % TAy 5 % LCD in 0.05 % Bet. Valeratey 5 % LCD in 0.1 % Bet. Valeratey //

(genital area) 77

EmollientyCream baseyLiquid paraffin

(Mineral oil)yPetroleum jelly

(Vaseline)

78

Keratolytic agenty 3 - 10 % salicylic acidy 3 - 10 % urea creamy combind with

corticosteroid

79

Combination with UreayTreatment for Dry skiny10 % Urea in 0.02 % TAy10 % Urea in 0.1 % Bet.

Valeratey20 % Urea ointmenty40 % Urea ointment

80

Keratolytic agentSalicylic acid Urea

y 3 % SA in 0.02 % TAy 5 % SA in 0.02 % TAy 10 % SA in 0.02 % TAy 10 % SA ointmenty 20 % SA ointment

y10 , 20 % Urea y 10 % Urea in 0.02 % TAy 10 % Urea in 0.05 %

Bet.valeratey 10 % Urea in 0.1 %

Bet.valerate81

Combination with Antibiotic agentyClioquinol

(Iodochlorhydroxyquin)yantibiotic that works by

preventing the growth of fungus/bacteriay3 % Vioform in 0.02 %

TA82

Calcipotriol y y differentiation y

83

Calcipotriol y 3 , y 50 /

84

VitamineD3Analogues

85

Fucidicacid

86

First line drug Second line drug

yMethotrexate 5-25 ./ 3 12 . (triple dose therapy) y Retinoid:- acitretin 0.25-1 ././

y Cyclosporin 3 5 ././ 1 - 2 / (2 divided dose)

87

Methotrexate

2.5 . 88

89

Methotrexatey Dihydrofolate reductase DNA y y y

90

MethotrexateyPsoriatic erythroderma yPustular psoriasis yPsoriasis ySevere plaque type psoriasis yPsoriatic arthritis

91

Methotrexatey 2.5-25 . y 3 12 y 2.5-5 . 1 2

92

Methotrexate 2.5 mg take 1 : 1 : 1

Monday 08.00 AM 1 Tab

Monday 08.00 PM 1 Tab

Tuesday 08.00 AM 1 Tab

Begin on Monday morning

93

Methotrexate 2.5 mg take 2 : 2 : 1

Wednesday 08.00 PM 2 Tab

Thursday 08.00 AM 2 Tab

Thursday 08.00 PM 1 Tab

Begin on Wednesday evening

94

Methotrexate1.2.23.4.5.6.7. MTX

MTX 12 8.

95

1. complete blood count2. BUN3. creatinine4. liver function test

yy y 1-3

96

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

97

SideEffectofMTXy y y y y

98

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

99

DrugInteractionofMTXy 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

SideEffectyCheilitis (100%), , ,

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

107

SideEffecty 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

H1receptorantagonistsShortActing LongActing

yChlorpheniramineyHydroxyzine

yCetirizineyLoratadiney DesloratadineyLevocetirizine

111

H1-receptor antagonistsCPM Details

yShort ActingySedative side effectyMost common use 1

tab hs

112

H1-receptor antagonistsHydroxyzine 10 mg Details

yShort ActingySedative side effectyMost common use 1

tab hs

113

H1-receptor antagonistsyCetirizineyLoratadineyLong Actingy1 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

y 10.00 - 15.00 . y

143

y y UV UV UVA

144

y ySPF SunProtectionFactor UVB SPF15,30

145

SPF15 y 30 y SPF 15 15 30 7

146

???

147

y 1y 2 y

148

SunProtectionProduct

149

150