1. Dermatopharmacology Prof Werner Sinclair Department of Dermatology
University of the Free State

2. Outcomes for this Lecture
After this lecture the student should be able to:
Name the most important characteristics and uses of the following antifungals:
Griseofulvin
Terbinafine
Ketoconazole
Fluconazole
Itraconazole
Topical imidazole creams
Discuss the characteristics and uses of the different strengths and formulations of topical steroids
Name the indications for and most important side-effects of chloroquine
Discuss the indications and use of topical retinoids
Discuss the origin, characteristics of and indications for mupirocin
Discuss the use of tetracyclines in dermatology
Name the uses of the different types of antihistamines (sedating vs non-sedating) in dermatology
Name the indications for and side-effects of anti-androgens and imiquimod

3. Drugs To Be Discussed1 Antifungals: Griseofulvin Terbinafin
Fluconazole
Itraconazole
Ketoconazole
Corticosteroids: Topical
Systemic
Chloroquine

4. Drugs To Be Discussed2 Retinoids: Topical Systemic Benzoyl peroxide
Shampoos
Barriers
Antibiotics: Topical
Antivirals: Acyclovir
Podophyllin
Antiscabies: Benzoyl benzoate

5. Drugs To Be Discussed3
Antihistamines
Anti-androgens
Imiquimod

6. Antifungals Griseofulvin Terbinafin Fluconazole Itraconazole
Ketoconazole

7. Griseofulvin Only active against dermatophytes (keratolytic fungi)
Fungistatic
Absorbed with fatty food (milk)
Very safe in children
10 – 20 mg per kg per day

8. Terbinafin Only active against dermatophytes Fungicidal
Tablets and cream
Some severe immunological side-effects

9. Fluconazole Broad spectrum Fungistatic Convenient once per week dosage
Can be used in neonates
Used for: Candida
Cryptococcus

10. Itraconazole Very broad spectrum Fungistatic To be taken with meals
Capsules and suspension available
Used for: Any fungal infection
Not better than terbinafin for
dermatophytes

11. Ketoconazole Broad spectrum Fungistatic To be taken with meals
Tablets, cream and shampoo available
Used for: Seborrheic dermatitis
Pityriasis versicolor
Candidiasis
Side-effects: Liver toxicity
P450 inducer

12. Imidazole Creams Variety available Similar spectra Little to choose
Price deciding factor
E.g.. Ketoconazole, econazole, clotrimazole

13. Corticosteroids
Topical
Systemic

14. Topical Corticosteroids
3 Strengths
Fluorinated vs Non-fluorinated
Ointments, Creams, Lotions, Shampoos

15. Topical Corticosteroids
Ointments: More potent
Penetrates deeper
More atrophy
Used for: Dry lesions
Thick lesions
Thick skin

16. Topical Corticosteroids
Creams: Less potent
Penetrates less
Less atrophy
Used for: Acute, thin lesions
Moist lesions
Thin skin (Face, skin folds)

17. Topical Corticosteroids
Lotions: Least potent, least atrophy
Used for: Hairy areas (scalp)
Wet lesions (Watery solutions)

18. Topical Corticosteroids
Shampoos
Clobetasol: Used for psoriasis of the scalp

19. Systemic Corticosteroids
Prednisone / Prednisolone
Potent, fast acting anti-inflammatory
Cheap
Side-effects: Short term: Almost none
Long term: Severe
Used once daily, in the morning

20. Chloroquine Indications: Cutaneous lupus erythematosus
Porphyria cutanea tarda
Side-effects: Corneal deposits (Temporary)
Maculopathy (Permanent)
Other

21. Retinoids Topical: Tretinoin Adapalene Tazarotene
Comedolytic, anti-inflammatory
Indications: Acne (All forms)
Anti-aging
Other

22. Retinoids Systemic: Isotretinoin Acitretin Indications: Acne Psoriasis
Lymphomas
Many others
Side-effects, etc: See acne lecture

23. Benzoyl peroxide Comedolytic, antiseptic Gel / Cream
Superficial, inflammatory acne vulgaris

24. Shampoos Ketoconazole: Seborrheic dermatitis Pityriasis versicolor
(Not for tinea capitis)
Coal tar (LPC): Psoriasis
Povidone iodine (Betadine)
Selenium sulfide (Selsun)
Zinc pyrithione

25. Barriers
Zinc/Castor oil BP: Nappy rash

26. Antibiotics Topical: Mupirocin Fucidic acid Gentamycin Erythromycin
Clindamycin
Systemic: Tetracyclines (oxytetracycline, doxycycline, minocycline, lymecycline)
Penicillins (amoxycillin, cloxacillin, amoxycillin-clavulanic acid

27. Mupirocin Manufactured by Pseudomonas bacteria Broad spectrum
Esp effective against Staphylococci
Ointment and cream
No systemic use
Reserved for short term use

28. Tetracyclines Bacteriostatic antibiotics, potent anti-
inflammatory effects
Used widely in acne, rosacea, bullous diseases
Oxytetracycline: Rosacea
Lymecycline: Drug of choice for acne
Minocycline: Acne in white patients (pigmentation)
Doxycycline: Acne in black patients (phototoxicity)

29. Penicillins
Cloxacillin, Flucloxacillin, Amoxycillin-Clavulanic acid: Staph infections
Amoxycillin, erythromycin: Strep infections

30. Antivirals Acyclovir: Cream, tablets and IV
Used for: Herpes simplex 1 and 2
Herpes zoster
(Cream useless on skin)
Side-effects: Practically none
Podophyllin: 25% in TBCo: Used for condylomata acuminata and verrucae

31. Antiscabies Benzoyl benzoate Only effective treatment for scabies
Method of use: See lecture on skin infections

32. Antihistamines Sedating: Promethazine Chlorpheniramine
Hydroxyzine (Aterax®)

33. Antihistamines Sedating: Promethasine Chlorpheniramine
Hydroxyzine (Aterax®)
Used for: Atopic dermatitis
Acute urticaria
Other forms of night-time pruritus

34. Antihistamines Sedating: Promethasine Chlorpheniramine
Hydroxyzine (Aterax®)
Used for: Atopic dermatitis
Acute urticaria
Other forms of night-time pruritus
Side-effects: Sedation (NB: Driving)
Photo-allergy (not hydroxyzine)
Dry mouth

35. Antihistamines Non-sedating: Loratidine Cetirizine Desloratidine
Levocetirizine
Used for: Acute and chronic urticaria
Allergic rhinitis
Side-effects: Almost none

36. Anti-androgens Cyproterone acetate Progestogen, blocks 5α-reductase
2mg in Diane-35®
10mg in Androcur
Used mostly for acne
Side-effects: Depression, weight gain
Drosperinone
Ingredient of Yasmin®

37. Imiquimod (Aldara®) Topical immunostimulant
Used for condylomata acuminata
Superficial spreading basal cell CA
Side-effects: Severe local inflammation