Cr: Cream; F: Foam; G: Gel; L: Lotion; O: Ointment; S: Solution; Sp: Spray; Sh: Shampoo. * Available in generic. Isotretinoin 0.5–1 mg/kg/d divided qd‐bid (Goal = 120–150 mg/kg) 10, 20, 30, and 40 mg. Acanya (BP 2.5%/Clindamycin 1.2%) G – 50 g Akne‐mycin (Erythromycin) 2% O – 25 g Azelex 20% Cr – 30, 50 g Benzaclin (BP 5%/Clindamycin 1%) G – 25, 50 g Benzamycin (BP 5%/Erythromycin 3%) G – 46 g BP 5%/Erythromycin 3% Generic G – 23, 46 g; Cleoclin T 1% S, L – 60 ml, 1% G – 30, 60 g, 1% pledgets – 60/box; Differin/Adapelene 0.1% Cr, G – 15, 45 g; 0.3% G – 45 g; 0.1% L – 2 oz Duac (BP 5%/Clindamyin1.2%) G – 45 g Erythromycin 2% O – 25 g; 2% G – 27, 50 g Epiduo 0, 1% G – 45 g Evoclin 1% F – 50,100 g Finacea 15% G – 30 g Klaron (Sodium sulfacetamide 10%)L – 59 ml Retin‐A Micro 0.04%, 0.1% G – 20, 45 g; Generic 0.025%, 0.05%, 0.1% Cr – 20, 45 g; Generic 0.025%, 0.1% G – 15, 45 g Sulfa 5%/Sodium sulfacetamide 10% L – 25 ml; Gel 15, 45 g; cream 30, 60 g; Tazorac 0.05%, 0.1% Cr – 15, 30, 60 g Vanoxide (BP 5%/hydrocortisone 0.05%) L – 25 g Mupirocin/Bactroban/Centany bid/tid 2% Cr, O – 15, 30 g Polysporin – (bacitracin + polymyxin) – OTC Silvadene 1% Cr – 20, 50, 400, 1000 g Bactrim DS bid Keflex 500 mg bid–qid; 250, 500 mg tab Tetracycline 500 mg bid; 250, 500 mg tab Doxycycline 100 mg bid; 50, 100 mg tab Minocycline 100 mg bid; 50, 100 mg tab One hour prior to surgery Cephalexin: 2 g × 1; 500 mg tab Dicloxacillin: 2 g × 1; 500 mg tab Azithromycin: 500 mg × 1; 500 mg tab Clarithromycin: 500 mg × 1; 500 mg tab Clindamycin: 600 mg × 1; 300 mg tab Amoxicillin 2 g × 1; 500 mg tab Cephalexin 2 g × 1; 500 mg tab Bactrim DS × 1; 1 tab Levofloxacin 500 mg × 1; 500 mg tab Ciclopirox (Penlac) 8% nail S – 6.6 ml Diflucan/Fluconazole 150–300 mg Qwk 150 mg Efinaconazole (Jublia) 10% nail qd × 48 wk – 4, 8 ml Griseofulvin 20 mg/kg/d; 250, 500 mg, 125 mg/5 ml Lamisil/Terbinafine 250 mg po qd, 250 tab; OTC 1% C, S, spray Loprox/Ciclopirox 1% Cr, L – 15, 30, 90 g Luliconazole (Luzu) 1% cr – 60 g Mentax/Butenafine1% Cr – 15, 30 g Micatin/Miconazole 2% Cr – 15, 30, 90 g Nizoral/Ketoconazole 2% Cr – 15, 30, 60 g; 2% wash – 120 ml Sertazconazole (Ertazco) 2% Cr – 30, 60 g Specatazole/Econazole 1% Cr – 15, 30, 85 g Sporanox/Itraconazole 200 mg qd or pulse dose 200 mg bid × 7 days q month Tavaborole (Kerydin) 5% nail qd × 48 wk – 4, 10 ml Thymol 4% in alcohol: 30 cc dispense with dropper. Naftin 1% G, Cr – 15, 30, 60 g Zeasorb – AF powder/miconazole 2% Elimite/Permethrin – Cr 5% – 60 g Ivermectin 0.2 mg/kg × 1; 6 mg tab Abreva/Docosanol 5×/day for 5‐10d OTC Cr 10% – 2 g Acyclovir 400 mg tid × 19 days; 400 mg tab Aldara/Imiquimod 3×/week qhs; Cr 5% – 1 box = 12 pks Denavir/Penciclovir Q2 h × 4 days; Cr 1% – 2 g Valtrex 2 g bid × 1 day; 500,1000 mg tab Veregen/Sinecatechins TID × 16 weeks; O 15% – 15, 30 g Zovirax/Acyclovir Q3 h × 5–7 days; O 5% 5×/d for 5 d – 2,10 g Capsagel, Salonpas, Zostrix/Capsaicin 0.025% Cr Elavil/Amitriptyline 10–25mg qd for anxiety, neuropathic pain; 10, 25, 50 mg tab Naltrexone 25–50mg qd; 25, 50 mg tab Neurotin/Gabapentin 300mg qd, titrate up to 1200 mg tid; 10, 25, 50 mg tab Pramosone/Pramoxine L 60, 120 ml; Cr – 30, 60g; O – 30g Phenergan/Promethazine 12.5 mg qid or 25 mg qhs; 12.5, 25 mg tab Sarna Lotion OTC Sinequan/Doxepin 10–75mg qhs; 10, 25, 50 mg tab Zofran/Ondansetron 8 mg bid; 4, 8, 24 mg tab Zonalon/Doxepin 5% Cr – 30, 45 g Valium/Diazepam 2 – 10mg po, onset 15 min, long duration; 2, 5, 10 mg tab Versed/Midazolam 0.25 – 0.5 mg/kg po, onset 10 min, short duration; 2mg/ml syrup IM 0.07 mg/kg, ~ 5 mg for adult, quick onset, short duration Xanax/Alprazolam 0.5 ‐ 4mg po, onset 30 min; 0.25, 0.5, 1 mg tab Allegra/Fexofenadine 60 mg bid or 180 mg qd; 60, 180 mg tab Atarax/Hydroxyzine 10–50 mg q4–6 h; 10, 25 mg, 10 mg/5 ml Clarinex/Desloratadine 5 mg qd; 5 mg tab Claritin/Loratadine 10 mg qd; OTC 10, 5/5 ml Doxepin 10–75 qhs; 10, 25, 50 mg tab Perlactin/Cyproheptadine 4 mg tid; 4 mg tab Phenergan/Promethazine 12.5 mg qid or 25 mg qhs; 12.5, 25 mg tab Zyrtec/Cetirizine 5–10 mg; 5, 10, 5/5 ml Azelex 20% Cr – 30, 50 g Hydroquinone (EpiQuin Micro, Lustra, Triluma, others) bid. 4% Cr – 30, 60 g Aldara/Imiquimod. For AK, BCC qhs × 8–12 weeks. Cr 5% – 1 box = 12 single‐use 250 mg packets Efudex/Fluorouracil. For AK qd–bid × 2–6 weeks. 5% Cr – 25 g; 2%, 5% S – 10 ml Picato/Ingenol mebutate. For face/scalp qd x 3 d; 0.015% G. For trunk/ext qd x 2 d; 0.05% G Solaraze/diclofenac bid × 3 months; Cr 5% – 30, 45 g Sonidegib/Odomzo. For advanced BCC. 200 mg qd; 200 mg tab Vismodegib/Erivedge. For advanced BCC. 150mg qd; 150 mg tab Bexarotene tabs 200–300 mg/m2 qd; 75 tab Nitrogen mustard bid.10 mg% in Aquaphor 2 lb Targretin/Bexarotene Gel qd–bid. 1% G – 60 g Bimatoprost/Latisse 0.03% qhs – 3ml Minoxidil/Rogaine 2%, 5% bid to scalp – 60 ml Propecia/Finesteride 1 mg qd; 1 mg tab Spironolactone 25–200 mg qd, start 25–50mg; 25, 50, 100 mg Vaniqa/Eflornithine bid. Cr 13.9% – 30 g Clonidine start 5 mg, titrate to effect; 5, 10, 15 mg Ditropan/Oxybutynin start 5mg, titrate to effect; 5, 10, 15 mg Drysol 20%/CertainDry 12.5%/Xerac‐AC 6.25% qhs until effective then spaced out; S – 35, 37.5, 60 ml Robinul/Glycopyrrolate start 1mg, titate to effect; 1 mg Dovonex/Calcipotriene bid. 0.005% O, Cr – 30, 60, 100 g; scalp S – 60 ml Dermazinc with clobetasol spray. Write Dermazinc 4 oz. compound with 50 mcg micronized clobetasol, disp. 4 oz. Liquor Carbonis Detergens (LCD): must be compounded: TMC 0.1% oint compounded with 10% LCD, disp.1 lb. Oxsoralen ultra 0.4–0.6 mg/kg 1–2 h prior to PUVA. 10 mg tab Tazorac/Tazorotene qd. Cr 0.05%, 0.1% – 15, 30, 60 g, G 0.05%, 0.1% – 30, 100 g Azelex 20% Cr – 30, 50 g Finacea 15% G – 30 g Klaron (Sodium sulfacetamide 10%)L – 59 ml Metronidazole 1% Cr – 30 g; 0.75% Cr – 30,45 g; 0.75% G – 29 g; 0.75% L – 59 ml Mirvaso/Brimonidine 0.33% G ‐ 30,45 g Rhofade/Oxymetazoline 1% Cr ‐ 30, 60 g Soolantra/Ivermectin 1% Cr ‐ 30,45, 60g Sulfa 5%/Sodium sulfacetamide 10% L – 25ml; Gel 15, 45g; cream 30, 60g; Biotin 2.5 mg qd Colchicine 0.3 mg, titrate to diarrhea; 0.6 mg tab Elidel/Pimecrolimus bid; Cr 1% – 15, 30, 100 g Folic acid 1 mg qd; 1 mg tab Lac‐hydrin (lactic acid) bid; Cr 12% – 140, 385 g; L 12% – 150, 360 ml Niacinamide 500 mg Tid; 500 mg tab Protopic/Tacrolimus bid; Cr 0.03, 0.1% – 30 g Trental 400 mg Tid; 400 mg tab * Available in generic. Nomenclature of biologics: mab (monoclonal antibody); ximab (chimeric); zumab (humanized); umab (human); cept (receptor–antibody fusion protein). ♀: Pregnancy category. 15 ml = 15 cc = 1 tablespoon 5 ml = 5 cc = 1 teaspoon 250 ml = 8 oz 454 g = 16 oz 30 g = 1 oz 1% = 1 g/100 ml = 10 mg/cc 0.1% = 0.1 g/100 ml = 1 mg/cc 1 g Cream (or ~0.95 g Ointment) → covers 100 cm2 1 Fingertip Unit (FTU) = 2 cm of cream on fingertip = 0.5 g Percutaneous absorption by anatomic site: scrotum > cheeks > abdomen and chest > scalp and axillae > back > forearms > palms > ankles > soles. * Available in generic. Acetaminophen and nonsteroidal anti‐inflammatory drugs are very effective and should be first‐line drugs for postoperative pain (may alternate every three hours). Opioids only in rare circumstances. ** ibuprofen is pregnancy category D in third trimester. Opioids Dose: 1–2 tabs po q4–6 h PRN pain (in increasing strength) * Available in generic. BLT benzocaine 20%, lidocaine 6%, tetracaine 4% TAC tetracaine 0.5%, epinephrine 1:2000, cocaine 11.8% LET lidocaine 4%, epinephrine 1:2000, tetracaine 0.5% Lasergel lidocaine 10%, tetracaine 10% 23/7 lidocaine 23%, tetracaine 7% * Available in generic.
Part 3
Drugs and Therapies
Medication Quick Reference
Topical steroids
CLASS 1 – SUPERPOTENT
Betamethasone dipropionate*
Diprolene
O/G
0.05%
15, 50 g
Clobetasol propionate*
Clobex
L/Sp/Sh
0.05%
2, 4 oz
Cormax
S
0.05%
25, 50 ml
Temovate
O/Cr
0.05%
15, 30, 45 g
Temovate
S
0.05%
25, 50 ml
Olux
F
0.05%
100 g
Olux E
F
0.05%
100 g
Desoximetasone
Topicort
Sp
0.25%
100 g
Diflorasone diacetate
Psorcon
O
0.05%
15, 30, 60 g
Psorcon E
O
0.05%
15, 30, 60 g
Fluocinonide
Vanos
Cr
0.05%
30, 60, 120 g
Flurandrenolide
Cordran
Tape
0.05%
Small, large
Halobetasol propionate*
Ultravate
O/Cr
0.05%
15, 50 g
CLASS 2 – POTENT
Amcinonide*
Cyclocort
O
0.1%
30, 60 g
Betamethasone dipropionate
Diprolene AF
Cr, L
0.05%
15, 50 g
Desoximetasone*
Topicort
O/Cr
0.25%
15, 60 g
Topicort
G
0.05%
15, 60 g
Diflorasone diacetate*
Florone
G
0.05%
15, 60 g
Psorcon
Cr
0.05%
15 g
Fluocinonide*
Lidex
O/Cr
0.05%
15, 30, 60,
G
120 g
Halcinonide
Halog
O/Cr
0.1%
15, 30, 60,
240 g
Triamcinolone acetonide*
Kenalog
O
0.5%
15 g
CLASS 3 – UPPER MID‐STRENGTH
Amcinonide*
Cyclocort
Cr, L
0.1%
30, 60 g
Betamethasone dipropionate
Diprosone
Cr
0.05%
15, 50 g
Betamethasone valerate
Luxiq
F
0.12%
100 g
Diflorasone diacetate
Florone, Maxiflor
Cr
0.05%
15 g
Fluticasone propionate
Cutivate
O
0.005%
15, 30, 60 g
Mometasone furoate
Elocon
O
0.1%
15, 45 g
Triamcinolone acetonide*
Kenalog
Cr
0.5%
15 g
CLASS 4 – MID‐STRENGTH
Desoximetasone
Topicort LP
Cr, O
0.05%
15, 60 g
Fluocinolone acetonide
Synalar‐HP
Cr
0.2%
15, 60 g
Synalar
O
0.025%
60 g
Flurandrenolide
Cordran
O
0.05%
15, 30, 60 g
Mometasone furoate
Elocon
Cr
0.1%
15, 45 g
Triamcinolone acetonide
Kenalog
O
0.1%
15, 60,
240 g, 1 lb
CLASS 5 – LOWER MID‐STRENGTH
Betamethasone dipropionate
Diprosone
L
0.05%
20, 60 g
Betamethasone valerate
Valisone
Cr/L
0.1%
15, 45 g
Clocortolone
Cloderm
Cr
0.1%
15, 45, 90 g
Fluocinolone acetonide
Capex
Sh
0.01%
120 ml
Synalar
Cr
0.03%
15, 60 g
Dermasmooth/FS
Oil
0.01%
4 oz
Flurandrenolide
Cordran
Cr, L
0.05%
15, 30, 60 g
Fluticasone propionate
Cutivate
Cr, L
0.05%
15, 30, 60 g
Hydrocortisone butyrate
Locoid
Cr
0.1%
15, 45 g
Hydrocortisone valerate
Westcort
Cr
0.2%
15, 45, 60 g
Prednicarbate
Dermatop
Cr
0.1%
15, 60 g
Triamcinolone acetonide
Kenalog
Cr/L
0.25%
15, 60, 80 g
CLASS 6 – LOW
Alclometasone dipropionate
Aclovate
O/Cr
0.05%
15, 45, 60 g
Betamethasone valerate
Valisone
L
0.1%
60 g
Desonide
DesOwen
Cr
0.05%
15, 60, 90 g
Tridesilon
Cr
0.05%
5, 15, 60 g
Desonate
G
0.05%
60 g
Verdeso
F
0.05%
50, 100 g
Fluocinolone acetonide
Synalar
Cr/S
0.01%
15, 60 g
Triamcinolone acetonide
Aristocort
Cr/L
0.1%
15, 60, 240 g
CLASS 7 – LEAST POTENT
Topicals with hydrocortisone 0.5, 1.0, and 2.5% (Cortisporin, Hytone, U‐cort, and Vytone), dexamethasone, flumethasone, methylprednisolone, and prednisolone
Nonsteroidals
Crisaborole
Eucrisa
O
2%
60, 100 g
Tacrolimus
Protopic
O
0.03, 0.1%
30, 60 g
Pimecrolimus
Elidel
Cr
0.1%
15, 30, 100 g
Commonly used drugs in dermatology
Acne Vulgaris
Antibiotics – topical
Antibiotics – systemic
Antibiotic preoperative prophylaxis
If allergic to penicillin
If oral site
If lower extremity/groin
Antifungal
Antiparasitics
Antivirals
Antipruritic
Anxiolytics/Sedation
Antihistamines
Bleaching agents
Chemotherapy
CTCL
Hair
Hyperhidrosis
Psoriasis
Rosacea
Miscellaneous
Systemic Medications
Antimalarials
Drug (Brand name) Trade size
Dose
Labs to follow
Mechanism
Adverse events
Interactions
♀
Diaminodiphenyl sulfone (Dapsone)
25, 100 mg
50 mg/d then increase to 100–200 mg/d (take with food)
Baseline: CBC, G6PD, CMP, UA, neuro exam (check reflex)
F/U: CBC qwk × 4, qmo × 6, then q6 mo; CMP, neuro exam q3–4 mo
Antimicrobial (antagonist of dihydropteroate synthetase
→ prevents formation of folic acid) and anti‐inflamm (inhibits PMN chemotaxis, Ig binding; inhibits myeloperoxidase)
Hemolysis (dose‐related), methemoglobinemia (dose‐ related; decreased incidence with cimetidine), agranulocytosis (idiosyncratic), hypersensitivity syndrome – mono‐like, neuropathy (motor), hepatitis
Rifampin, antimalarials, sulfonamides, probenecid, folate antagonists, and TMP
C
Hydroxychloroquine
(Plaquenil) 200 mg
200–400 mg/d (6.5 mg/kg/d)
Baseline: eye exam, G6PD,
CBC;F/U: eye exam: q1–5 yr; CBC qmo (→ q6mos)
ALL antimalarials: Intercalate
In to DNA preventing transcription; disrupt UV O2 radical formation; inhibit IL‐2 synthesis; inhibit chemotaxis; reduce platelet aggregation; Inhibit endosome acidification
Blue pigment, GI upset (brand name medication with decreased GI upset), corneal deposition, hemolysis, retinopathy (peripheral fields), psoriasis/ PCT flares, cardiac toxicity with overdose (2–6 g), CNS stimulant
Cimetidine, digoxin, kaolin, magnesium trisilicate; Avoid combination of chloroquine/ hydroxychloroquine
C
Chloroquine
(Aralen)
250, 500 mg
250 mg/d (4.0 mg/kg/d)
Same as Plaquenil
SAME as Plaquenil PLUS bleaches hair, increased ocular risk
Smoking decreases effectiveness and worsens underlying lupus
C
Quinacrine
(Atabrine)
100 mg
100 mg/d
Same as Plaquenil EXCEPT no eye exam, no G6PD
SIMILAR to Plaquenil BUT no ocular toxicity, yellow hyperpigment, no hemolysis
SAME as above BUT safe to use with chloroquine or hydroxychloroquine
C
Immunosuppressive agents
Drug
Dose
Labs to follow
Mechanism
Adverse events
Interactions
♀
Prednisone (1, 2.5, 5, 10, 20, 50 mg)
Variable
If long‐term therapy (>3 mo of >20 mg/d):BP, PPD, DEXA‐scan; supplement Ca++ (1000 mg)/Vit D (1000 IU) and bisphosphonate
Decreases AP‐1 cyclooxygenase, NF‐kB. Decreases proinflammatory cytokines (esp. IL‐2)
Hyperglycemia, insomnia, HTN, infection, osteoporosis, avascular necrosis, poor wound healing, peptic ulcer, water retention, adrenal insufficiency, cushingoid, glaucoma, myopathy, electrolyte imbalance (hypoK, hyperNa)
Metabolized by CYP3A4
C
Methotrexate (Rheumatrex) 2.5 mg
Begin at 5 mg up to 25 mg qwk PO/IM dose with folate 1 mg qd
Baseline CBC, CMP, Hep panel F/U: CBC/LFTs qwk x 4 → q3 mo; LIVER BX: q1–1.5 g; Grade I/II = continue; IIIA (mild fibrosis) = continue, rebx in 6 mo; IIIB (severe)/IV (cirrhosis) = stop
Inhibits dihydrofolate reductase; Cell‐cycle specific (S phase); inhibits thymidylate synthetase, methionine synthetase, and AICAR; increases local adenosine (anti‐inflammatory effects related to adenosine)
Hepatotoxic, cancer, BM depression, HA, pulm fibrosis/pneumonitis, alopecia, photosensitivity, UV burn recall, GI; increases homocysteine (↑ CV risk), anaphylactoid rxn reported (test dose at 5 mg); Leucovorin rescue
EtOH, NSAIDs, TCNs, retinoids, TMP/SMX, dapsone cyclosporin, probenecid, phenytoin, dipyridamole, chloramphenicol, phenothiazines
X
Azathioprine (Imuran) 50 mg
1–3 mg/kg/d, increase by 0.5 mg/kg/d q4 wk
Baseline: CBC, LFT, TPMT; F/U: CBC. LFT qmo × 3 → q2 mo Consider PPD
6‐Thioguanine (active metabolite via HGPRT) incorporates into DNA; inhibits de novo purine synthesis (lymphocytes)
N/V, BM suppression, oral ulcers, hepatotoxicity, cancer (lymphoma, SCC), infxn, curly hair, hypersensitivity syndrome at 14 d (fever/shock)
Allopurinol (↓ dose by 75%) warfarin, ACE‐I, TMP/SMX, sulfasalazine, IUDs
D
Mycophenolate mofetil (Cellcept 500 mg; Myfortic 180, 360 mg)
0.5–2 g bid (cellcept 1000 = myfortic 720)
Baseline: CBC, LFTs; F/U: CBC: qwk × 4 → qmo, LFTs qmo
Inhibits inosine monophosphate dehydrogenase → de novo purine biosynthesis (lymphs)
GI symptoms (Myfortic = enteric coated, less GI effects), BM depression, hepatotoxicity
Cholestyramine, iron, magnesium/aluminum hydroxide, acyclovir
D
Tofacitinib (Xeljanz) 5, 10mg tab; 11mg XR tab
Tablets 5 mg bid; extended release 11 mg qd
Baseline: CBC; lipid panel
JAK inhibitor
URI, headache, diarrhea, and nasopharyngitis
Inhibitor of CYP3A4 and CYP inducers
C
Thalidomide (Thalidomid) 50 mg
50–300 mg qh
Baseline: hCG, neuro exam, SNAP; F/U: hCG qwk× 4 then q2–4 wk; neuro q3 mo; SNAP prn
Decreases TNF‐α; inhibits angiogenesis; inhibits PMN phagocytosis; inhibits monocyte chemotaxis
Birth defects, sedation, constipation, peripheral neuropathy (sensory), and leukopenia
Sedatives, histamine, serotonin, prostaglandin
X
Cyclosporine (Neoral) 25, 100 mg
Start at 2.5 mg/kg/d max 5 mg/kg/d (without food)
Baseline, q2 wk (→ qmo): CBC, BMP, LFTs, FLP, Mg, Uric Acid, and BP; F/U: Creatinine Cl q6 mo; Trough levels if >5 mg/kg/d
Binds cyclophilin → inhibits calcineurin activation of NF‐AT; inhibits IL‐2, IFN‐γ synthesis
Nephrotoxic, HTN (use CCB, no ACE/diuretic), hyperlipidemia, infxn, cancer, HA, acne, hyperK/uricemia, hirsutism, hypoMg, paresthesias, and gingival hyperplasia
Metabolized by CYP3A4 (liver), P‐gp (intestine) – Azoles, Macrole, CCB, grapefruit juice, MTX, SSRI, ticlopidine; additive toxicity with nephrotoxic drugs
C
Cyclophosphamide (Cytoxan) 25, 50 mg
1–3 mg/kg/d or IV pulse 1 g/m2 qmo; increase fluid intake (>3 l/day)
Baseline: CBC, CMP, and UA; F/U: CBC qwk × 8 then qmo; CMP qmo; UA qwk × 12 then q2–4 wk forever; cystoscopy: yearly or if microscopic hematuria; urine cytology at >50 g
Cell cycle‐independent; Covalent DNA binding; B‐cell suppression
BM depression, hemorrhagic cystitis (acrolein metabolite), carcinogenesis (esp. TCC of bladder), hepatotoxicity, reproductive toxicity, anagen effluvium, mucositis, SIADH, pneumonitis/fibrosis, infections, nail ridging, pigmented bands on teeth, and diffuse hyperpigmentation
Allopurinol, chloramphenicol, succinylcholine, digoxin, doxorubicin, barbiturates, cimetidine, halothane, and nitrous oxide
D
Apremilast* (Otezla) 10, 20, 30 mg
Titration schedule per instructions: Day 1: 10 mg qam to Day 6 and thereafter: 30 mg BID
No monitoring
PDE4 inhibitor “selective immunosuppressant”
Depression and suicidal thoughts, weight decrease
Metabollized by strong P450 inducers
C
Systemic retinoids
Drug
Dose
Labs to follow
Mechanism
Adverse events
Interactions
♀
Isotretinoin (Accutane) 10, 20, 30, 40 mg
0.5–1 mg/kg/d with food. Total dose based on body weight = 120–150 mg/kg
Baseline: hCG, LFT, and FLP;F/U: hCG, LFT, FLP qmo.
Half Life: 10–20 h pregnancy Avoidance = 30 d
All retinoids: Affect cell growth/differentiation, morphogenesis, inhibit malignant cell growth, alter cellular cohesiveness, inhibit AP‐1, NF‐kB, ornithine decarboxylase, TLR‐2; Increase dermal collagen I, hyaluronic acid, elastic fibers, fibronectin, transglutaminase, and Th1 skewing
Dryness, myalgia/arthralgia, tendinitis, hyperostosis (long term), pseudotumor cerebri, HA, depression, transaminase elevation, alopecia (telogen effluvium), decreased night vision, PGs, photosensitivity, staph infxns, and IBD association
Tetracyclines (risk of pseudotumor cerebri), MTX (hepatotoxicity), Vitamin A, macrolides, azoles, rifampicin, alcohol, phenytoin, mini‐pill contraceptive, photosensitizers, and carbamazepine
X
Acitretin (Soriatane) 10, 25 mg
25–50 mg/d with food
Baseline: CBC, LFT, FLP, hCG, and BUN/Cr;
F/U: hCG, CBC qmo; LFT, FLP q2 wk → qmo → q3 mo
Half‐life: 50 h pregnancy Avoidance = 3 yr
Isotretinoin: no specific receptor;
Acitretin: all RAR receptor subtypes;
Bexarotene: all RXR receptor subtypes
SAME as Accutane but difference is duration of tx; longer pregnancy avoidance (3 yr), more alopecia, more hyperostosis. Alcohol can convert acitretin to etretinate (accumulates in fat)
X
Bexarotene (Targretin) 10, 75 mg
300 mg/m2/day with food (fatty foods improve bioavailability for retinoids)
Baseline: FLP, CBC, LFT, TSH/T4, and hCG;
F/U: FLP qwk until stable then q1–2 mo; CBC, LFT, hCG qmo × 3–6 mo; TSH/T4 q8 wk
Half‐life: 7 h pregnancy
Avoidance = 30 d
SAME as other retinoids PLUS more marked hypertriglyceridemia, central hypothyroidism, leukopenia, cataracts, and hypoglycemia
Same as above; gemfibrozil
X
Biologics
Drug
Dose
Labs to follow
Mechanism
Adverse events
Interactions
♀
Adalimumab (Humira) 40 mg/0.8 ml autoinjector pen or prefilled syringe
80 mg, then 40 mg SQ qow staring 1 wk later
Baseline: PPD and/or CXR, Tb testing f/u annually. Consider CBC, CMP, HepB, HepC, and HIV
IgG1 to TNF‐α; binds soluble and transmembrane TNF‐α
SAME as Enbrel
None
B
Anakinra (Kineret) 100 mg
RA dosing:
100 mg SQ daily Indicated for Periodic fever syndromes
Baseline: PPD and/or CXR, Tb testing f/u annually. Consider CBC, CMP, HepB, HepC, and HIV.
IL‐1 receptor antagonist
SAME as Enbrel
None
B
Brodalumab (Siliq) 210 mg prefilled syringe
210 mg SQ at weeks 0, 1, 2, and q2w thereafter
Baseline: PPD and/or CXR, Tb testing f/u annually. Consider CBC, CMP, HepB, HepC, and HIV. Must enroll in SILIQ REMS Program to monitor suicidal thoughts and behavior
IgG2 selectively binds to receptor blocking IL‐17A, C, E, and F
SAME as secukinumab, and counsel for suicidality
None
N/A
Dupilumab (Dupixent 300 mg prefilled syringe)
600 mg SQ followed by 300 mg qow
Consider CBC
IgG1 selectively binds to IL‐4a receptor blocking IL‐4 and IL‐13
Injection site rxn, potential increased risk for infections, increased conjunctivitis and keratitis
None
N/A
Etanercept (Enbrel) 25, 50 mg
25–50 mg SQ
2× per wk × 3 mo then 50 mg qw
Baseline: PPD and/or CXR, Tb testing f/u annually
Consider CBC, CMP, HepB, HepC, and HIV
Recombinant fusion protein Fc
IgG1 to TNF receptor; binds soluble TNF‐α
Injection site rxn, infection (TB reactivation), cancer, CHF, demyelinating disease, lupus‐like syndrome, paradoxical pustular psoriasis
None
B
Guselkumab (Tremfya) 100 mg prefilled syringe
100 mg SQ at weeks 0, 4, and q8w thereafter
Baseline: PPD and/or CXR, Tb testing f/u annually. Consider CBC, CMP, HepB, HepC, and HIV
IgG1 selectively binds to IL‐23 subunit (p19)
Injection site rxn, increased risk for infections, potential increased risk for cancer
None
N/A
Infliximab (Remicade)
3–10 mg/kg IV; Week 0, 2, 6 then q8 wk
Baseline: PPD and/or CXR, Tb testing f/u annually. Consider CBC, CMP, HepB, HepC, and HIV
Murine chimeric monoclonal IgG1 antibody to TNF‐α; binds soluble and transmembrane TNF‐α
SAME as Enbrel but slightly increased risk; infusion reactions
None
B
IVIg
2 g/kg over 2–5 d. Also see TEN protocol
Baseline: IgA levels (use Gammagard in IgA deficiency), BMP, and evaluate for heart failure
Immunomodulatory
Fluid overload, anaphylactic shock (in IgA deficiency), rare reports of hemolytic anemia, ARF, and aseptic meningitis
None
C
Ixekizumab (Taltz) 80 mg autoinjector or prefilled syringe
160 mg SQ at week 0; 80 mg at weeks 2, 4, 6, 8, 10, 12; 80 mg q4 wk
Baseline: PPD and/or CXR, Tb testing f/u annually.
IgG4 neutralizing IL‐17A
SAME as secukinumab
CYP450 drugs and live vaccinations
N/A
Omalizumab (Xolair) 75 mg/0.5 ml, 150 mg/ml prefilled syringe
150 or 300 mg SC q4w. Dosing in CIU is not dependent on serum IgE level or body weight
None for CIU
IgG1 to free IgE
Anaphylaxis, hypersensitivity reactions
None
B
Rituximab (Rituxan)
Chemo: 375 mg/m2 × 4, q week
RA: 1 g × 2, qow
Baseline: CBC Follow CD19 q6–12 mo
Murine chimeric IgG1 to CD20
Infusion rxn (worst with first infusion), JC virus infx resulting in PML, severe mucocutaneous reactions
None
C
Secukinumab (Cosentyx) 150 mg autoinjector or prefilled syringe
300 mg SQ at weeks 0, 1, 2, 3, and 4, q4w thereafter
Baseline: PPD and/or CXR, Tb testing f/u annually. Consider CBC, CMP, HepB, HepC, and HIV
IgG1 selectively binds to IL‐17A
Injection site rxn, increased risk for infections, potential increased risk for cancer, caution in UC and Crohn’s Dx
None
B
Ustekinumab (Stelara) 45, 90 mg prefilled syringe
45 mg for <=100 kg, 90 mg for >100 kg SQ at weeks 0, 4, and q12w thereafter
Baseline: PPD and/or CXR, Tb testing f/u annually. Consider CBC, CMP, HepB, HepC, and HIV
IgG1κ to p40 common subunit of IL‐12 and IL‐23
Injection site rxn, increased risk for infections, especially fungal; potential increased risk for cancer
None
B
General Reference
Metric measurements
Dose calculations
Topical medication dispensing and absorption
1 Application (G)
bid × 1 week(G)
Adult full body
10–30
170
Head and neck
2
10
Hands and feet
2
10
Single arm
3
15
Single leg
4–6
30
Trunk
7–8
60
Age
Number of FTU
3–6 mo
1
1
1.5
1
1.5
1–2 yr
1.5
1.5
2
2
3
3–5 yr
1.5
2
2
3
3.5
6–10 yr
2
2.5
4.5
3.5
5
Adult
4
8
16
14
14
Corticosteroid Dosage Equivalence
Equivalent dose (mg)
Glucocorticoid potency
Mineralo‐corticoid potency
Duration (h) (half life)
Hydrocortisone
4
1
1
8–12
Cortisone acetate
5
0.8
0.8
8–12
Prednisone
1
3.5–5
0.8
18–36
Prednisolone
1
4
0.8
18–36
Triamcinolone
0.8
5
0
18–36
Methylprednisolone
0.8
5–7.5
0.5
18–36
Dexamethasone
0.15
25–80
0
36–54
Betamethasone
0.12–0.15
25–30
0
36–54
Acne – Topical
Antibiotics/antimicrobial
Drug name (Trade Name)*
Trade size
♀
–Formulation, dosage
Benzoyl peroxide/clindamycin *
Acanya gel (2.5% BP, 1.2% C)
50 g pump
C
Benzaclin gel (5% BP, 1% C)
25, 50 g
C
Duac gel (5% BP, 1.2% C)
45 g
C
Benzoyl peroxide 5%/erythromycin 3% *
Generic gel
23, 46 g
C
Benzamycin
46 g, 60/box
C
Benzoyl peroxide 5%/hydrocortisone 0.05%
Vanoxide HC Lotion
25 g
C
Clindamycin *
Cleocin T 1% solution, lotion
60 ml
B
1% gel
30, 60 g
B
1% swabs
60/box
B
Clindagel 1% gel
7.3, 40, and 75 ml
B
ClindaReach (1% solution with applicator arm)
1 kit
B
Clindacin PAC (1% pledget and cleanser)
1 kit
B
Evoclin 1% foam
50, 100 g
B
Erythromycin *
Akne‐Mycin 2% ointment
25 g
B
Emgel 2% gel
27, 50 g
B
Sodium sulfacetamide 10%
Klaron lotion
59 ml
C
Sulfa 5%/sodium sulfacetamide * 10%
Generic lotion
25 ml
C
Avar Gel; Avar Green gel
45 g
C
Clarifoam EF
60, 100 g
C
Clenia emollient cream
1 oz
C
Novacet lotion
30, 60 ml
C
Plexion TS cream
30, 90 g
C
Rosula gel
45 ml
C
Rosanil
6 oz
/
Sulfacet R lotion
25 ml
C
Sumadan (sulfur 4.5/ SS 9%)
16 oz
/
Sumaxin pads (sulfur 4%/ SS 10%)
60 pads
/
Sumaxin wash (sulfur 4%/ SS 9%)
16 oz
/
Sumaxin TS (sulfur 4%/ SS 8%)
16 oz
/
Keratolytics
Azelaic acid
Azelex 20% cream
30, 50 g
B
Finacea 15% gel
30 g
B
Benzoyl peroxide* (BP) – Antibacterial/keratolytic for comedonal acne; may bleach clothing
Rx
Benzac AC 2.5%, 5%, 10% emollient gel
60, 90 g
C
Benzac gel 5%, 10% gel
45 g
C
Benzac W 5%, 10% wash
8 oz
C
BenzaShave 5%, 10% shaving cream
4 oz
C
BenzFoam 5.3% foam
60, 100 g
C
Brevoxyl 4%, 8% gel, lotion/cleanser
42.5, 90 g
C
Generic BP 2.5%, 5%, 10% gel, wash
C
Inova Easy Pad 4%, 8%
C
Triaz 3%, 6%, 10% gel
42.5 g
C
OTC
Clearasil 10% cream, lotion
C
Oxy balance 10% gel
C
OC8 7% gel
45 g
C
Panoxyl Bar 5%, 10% bar soap
C
Resorcinol – antimicrobial/keratolytic
OTC
Acnomel 2% Resorcinol/ 8% sulfur
28 g
Retinoids
Adapalene* (specific for RAR‐beta and gamma)
Differin 0.1%, 0.3% gel
45 g
C
Differin 0.1% cream
45 g
C
Differin 0.1% lotion
2 oz
C
Epiduo 0.1% (+benzoyl peroxide 2.5%) gel
45 g
C
Tretinoin* (binds all RAR, no RXR)
Retin‐A Micro 0.04% (gray tube), 0.1% gel (purple tube)
20, 45 g
C
Generic 0.025% (gray), 0.05% (blue), 0.1% (red) cream
20, 45 g
C
Generic 0.01% (green), 0.025% (orange) gel
15, 45 g
C
Atralin 0.05% gel
45 g
C
Avita 0.025% cream, gel
20, 45 g
C
Refissa 0.05% cream
40, 60 g
C
Renova 0.02% cream
40, 60 g
C
Tretin‐X 0.0375% cream, 0.01%, 0.025% gel
35 g
C
Veltin 0.025% (+ clindamycin 1.2%) gel
30, 60 g
C
Ziana 0.025% (+ clindamycin 1.2%) gel
30, 60 g
C
Tazarotene (specific for RAR‐beta and gamma)
Avage 0.1% cream
15, 30 g
X
Fabior 1% foam
50, 100 g
X
Tazorac 0.05%, 0.1% cream
15, 30, 60 g
X
Tazorac 0.05%, 0.1% ge
l30, 100 g
X
Others
Dapsone
Aczone 5% gel
30, 60 g
C
7.5% gel
30, 60, 90 g
Spironolactone 5% Compounding pharmacy – compound with niacinamide or benzoyl peroxide
Acne – Oral
Antibiotics
Tetracycline* (Sumycin)
250, 500 mg
D
Dose: 250–500 mg po bid‐qid
Susp 125/5 ml
Do not use in age < 8 years
Doxycycline * 50–100 mg
50, 100 mg
D
Dose: 50–100 mg po qd‐bid
Adoxa (doxycycline monohyclate)
150 mg
Doryx (doxycycline hyclate)
75, 100 mg ER
Monodox (doyxcycline monohyclate)
50, 75, and 100 mg
Vibramycin (doxycycline hyclate)
100 mg
Periostat po bid
20 mg
Oracea po qd
40 mg
SE: photosensitivity, dizziness, esophagitis: take w/8 oz water. Do not take w. calcium. Not for age <8 years
Minocycline * (Dynacin, Minocin)
50, 75, 100 mg
D
Dose: 50–100 mg po qd‐bid
50 mg/5 ml
Solodyn brand qd
55, 65, 80, 105, and 115 mg ER
Generic (Ximino) qd
45, 90, and 135 mg ER
Dosing table
45–59 kg: 45 mg qd
60–90 kg: 90 mg qd
91–136 kg: 135 mg qd
SE: gray discoloration of skin/teeth, lupus‐like syndrome, pseudotumor cerebri. Not for age <8 years
Erythromycin * (E‐mycin, Erytab)
250, 333, and 500 mg
B
Dose: 250–500 mg po qid or 333 mg po tid, or 500 mg po bid
Susp 200/5, 400/5 l
PEDs: 50 mg/kg/d divided qid
SE: nausea, diarrhea
Retinoids
Isotretinoin* (13‐cis retinoic acid)
Amnesteem, Sotret, and Claravis
10, 20, and 40 mg
X
Absorica (more bioavailable, can be taken without food)
10, 20, 30, and 40 mg
X
0.5–1 mg/kg/d divided qd–bid; may need 2 mg/kg/d for severe acne
✓ LABS: Baseline – 2 neg βhcg, lipids, LFTs, +/– CBC, glucose. Monthly – βhcg, lipids, and LFTs.
SE: dryness, teratogen, HA, arthralgias/myalgias, ↓ night vision, depression, lipid and LFT abnormalities, pseudotumor cerebri.
Elevated triglycerides‐ dosage related and reversible; if 300–500: low‐fat diet, no alcohol; lower dose; if > 500: stop medication to prevent pancreatitis if persistent
Contraindication/Interactions: pt cannot donate blood while on treatment and for 1 mo afterwards; Tetracycline with increased risk of psuedotumor cerebri
Others
Spironolactone* (Aldactone)
25, 50, and 100 mg
X
25–200 mg qd, start 25–50 mg
Weakly antiandrogenic effects for PCOS patients
SE: hyperkalemia, gynecomastia, and hypotension. Careful with ACE inhibitors, digoxin.
Analgesics
Acetaminophen
500 mg po q4–6 h
500 mg
B
Inhibits prostaglandin synthesis, COX‐3 pathway
Ibuprofen
200–800 mg po q4–6 h
200 mg
B**
Reduce inflammation through COX‐2 inhibition
Tylenol #3*
Codeine + Acetaminophen
Can cause constipation‐Rx with Colace 100 bid
15/300 mg (#2)
30/300 mg (#3)
60/300 mg (#4)
C
Vicodin*
Hydrocodone + Acetaminophen
5/500 mg
7.5/500 mg
C
Percocet*
Oxycodone + Acetaminophen
Strong, rarely prescribed in Dermatology. Use 5/325 mg for major abd surgeries, etc.
2.5/325 mg
5/325 mg
7.5/3 25 mg
C
Anesthetics – topical
EMLA Lidocaine 2.5% + prilocaine 2.5%
5, 30 g
B
May cause prilocaine‐induced methemoglobinemia in children, at large doses.
Age area
Weight (kg)
Max dose (g)
Max area (cm2)
1–3 mo
<5
1
10
4–12 mo
5–10
2
20
1–6 yr
10–20
10
100
7–12 yr
>20
20
200
LMX 4 Lidocaine 4% cream
15,30 g
B
LMX 5 Lidocaine 5% cream
15, 30 g
B
Lida‐Mantle Lidocaine 3% cream
28, 85 g
B
Lida‐Mantle HC Lidocaine 3% + 0.5% HC
28, 85 g
C
Lidoderm Lidocaine 5% patch (10 × 14 cm)
Box of 6
B
Pramosone Pramoxine + 1% or 2.5% HC
60, 120 ml solution
C
– topical for itching
30, 60 g cream
30 g ointment
Synera Lidocaine 3% + tetracaine 0.5% patch
10 patch/box
B
Topicaine Lidocaine 4%, 5% gel
10, 30, 113 g
B
Anesthetics – topical compounded
Antibiotics
Topical/antiseptic
Mupirocin *
B
2% cream (Bactroban)
15, 30 g
2% ointment (Bactroban)
1, 22 g
2% ointment (Centany)
30 g
apply bid–tid for impetigo, wound infections; for nasal MRSA eradication, use 0.5 g in each nostril bid × 5 days
Bacitracin – Polymyxin * (Polysporin)
OTC
C
Silver sulfadiazine * (Silvadene) 1% cream
20, 50, 400, and 1000 g
B
Retapamulin (Altabax) 1% ointment bid×5 days for methicillin sensitive s. aureus or s. pyogenes
5, 10, and 15 g
B
Chlorhexidine * (Hibiclens 4% cleanser) Good antimicrobial agent for bacteria, fungus, and yeast. For MRSA eradication
120, 240, 480, 960, and 3840 ml
B
Gentamicin * (Garamycin cream/ointment 0.1%)
For pseudomonas coverage (i.e. nails, wound)
15 g
D
Ciprofloxacin otic drops
For pseudomonas nails, drop to nails daily
10 g
C
For pseudomonas nails (green nails)
Systemic
Amoxicillin* (Amoxil) aminopenicillin
250, 500 mg
B
250–500 mg po tid
Susp 125 mg/5 ml
Child: 20–40 mg/kg/d po divided tid
250 mg/5 ml
Augmentin* (Amoxicillin + Clavulanic acid)
250, 500, and 875 mg
B
500–875 mg po bid/250–500 mg po tid
Susp 200 mg/5 ml
Peds: 20–40 mg/kg/d divided bid/tid
400 mg/5 ml
Azithromycin* (Zithromax) macrolide. B
500 mg po × 1; then 250 mg qd 5 d
Zpak: 250 mg
500 mg po qd for 3 d
TriPak: 500 mg
Cefaclor* (Ceclor) second gen. cephalosporin.
250, 500 mg
B
250–500 mg po tid. 250 mg/5 ml Susp 125/5,
Peds: 20–40 mg/kg/d po divided tid
250 mg/5 ml
Cefadroxil* (Duricef) first gen cephalosporin.
500 mg, 1 g
B
1 g po qd or 500 mg po bid. Susp 250/5,
Peds: 30 mg/kg/d po divided bid
500 mg/5 ml
Cephalexin* (Keflex) first gen cephalosporin
250, 500 mg
B
250–500 mg po qid
Susp
Peds: 40 mg/kg/d po divided bid
250 mg/5 ml
Ciprofloxacin* (Cipro) second gen. quinolone.
250, 500, and
C
250–750 mg po bid
750 mg
Interactions: antacids, sucralfate, Fe, Zn, theophylline, warfarin, and cyclosporine. Prolong QT interval. Risk of tendiopathy/tendon rupture esp in > 60 yo and concomitant corticosteroid use
Clarithromycin* (Biaxin) macrolide
250, 500 mg
C
250–500 mg po bid
Susp 125 mg/5 ml,
Peds: 7.5 mg/kg po bid
250 mg/5 ml
Clindamycin* (Cleocin) lincosamide
75, 150, and 300 mg
B
150–450 mg po qid
Susp
Peds: 8–25 mg/kg/d divided tid–qid
75 mg/5 ml
May cause C. difficile colitis
Doxycycline*
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