Part 3Drugs 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 | ||||
Cr: Cream; F: Foam; G: Gel; L: Lotion; O: Ointment; S: Solution; Sp: Spray; Sh: Shampoo.
* Available in generic.
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
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
Antibiotics – topical
Mupirocin/Bactroban/Centany bid/tid 2% Cr, O – 15, 30 g
Polysporin – (bacitracin + polymyxin) – OTC
Silvadene 1% Cr – 20, 50, 400, 1000 g
Antibiotics – systemic
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
Antibiotic preoperative prophylaxis
One hour prior to surgery
Cephalexin: 2 g × 1; 500 mg tab
Dicloxacillin: 2 g × 1; 500 mg tab
If allergic to penicillin
Azithromycin: 500 mg × 1; 500 mg tab
Clarithromycin: 500 mg × 1; 500 mg tab
Clindamycin: 600 mg × 1; 300 mg tab
If oral site
Amoxicillin 2 g × 1; 500 mg tab
If lower extremity/groin
Cephalexin 2 g × 1; 500 mg tab
Bactrim DS × 1; 1 tab
Levofloxacin 500 mg × 1; 500 mg tab
Antifungal
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%
Antiparasitics
Elimite/Permethrin – Cr 5% – 60 g
Ivermectin 0.2 mg/kg × 1; 6 mg tab
Antivirals
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
Antipruritic
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
Anxiolytics/Sedation
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
Antihistamines
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
Bleaching agents
Azelex 20% Cr – 30, 50 g
Hydroquinone (EpiQuin Micro, Lustra, Triluma, others) bid. 4% Cr – 30, 60 g
Chemotherapy
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
CTCL
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
Hair
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
Hyperhidrosis
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
Psoriasis
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
Rosacea
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;
Miscellaneous
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
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: IntercalateIn 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 |
* Available in generic.
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 moHalf‐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 wkHalf‐life: 7 h pregnancyAvoidance = 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 SQ2× per wk × 3 mo then 50 mg qw | Baseline: PPD and/or CXR, Tb testing f/u annuallyConsider CBC, CMP, HepB, HepC, and HIV | Recombinant fusion protein FcIgG1 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 weekRA: 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 |
Nomenclature of biologics: mab (monoclonal antibody); ximab (chimeric); zumab (humanized); umab (human); cept (receptor–antibody fusion protein).
: Pregnancy category.
General Reference
Metric measurements
15 ml = 15 cc = 1 tablespoon
5 ml = 5 cc = 1 teaspoon
250 ml = 8 oz
454 g = 16 oz
30 g = 1 oz
Dose calculations
1% = 1 g/100 ml = 10 mg/cc
0.1% = 0.1 g/100 ml = 1 mg/cc
Topical medication dispensing and absorption
1 g Cream (or ~0.95 g Ointment) → covers 100 cm2
1 Fingertip Unit (FTU) = 2 cm of cream on fingertip = 0.5 g
| 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 |
Percutaneous absorption by anatomic site: scrotum > cheeks > abdomen and chest > scalp and axillae > back > forearms > palms > ankles > soles.
| 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 | ||
* Available in generic.
Others
| Spironolactone* (Aldactone) | 25, 50, and 100 mg | X |
| 25–200 mg qd, start 25–50 mgWeakly antiandrogenic effects for PCOS patientsSE: hyperkalemia, gynecomastia, and hypotension. Careful with ACE inhibitors, digoxin. | ||
Analgesics
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.
| 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 |
** ibuprofen is pregnancy category D in third trimester.
Opioids Dose: 1–2 tabs po q4–6 h PRN pain (in increasing strength)
| Tylenol #3* | Codeine + AcetaminophenCan 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 mg7.5/500 mg | C |
| Percocet* | Oxycodone + AcetaminophenStrong, rarely prescribed in Dermatology. Use 5/325 mg for major abd surgeries, etc. | 2.5/325 mg5/325 mg7.5/3 25 mg | C |
* Available in generic.
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 cream30 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
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%
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 dropsFor pseudomonas nails, drop to nails daily | 10 g | C |
For pseudomonas nails (green nails)
|
* Available in generic.
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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