Skin Diseases

SYSTEMATIC THERAPIES

General information is provide here with disease-specific   details given later on.

Antibiotics

Antibiotics are generally used for their anti-inffective properties,   particularly for staphylococcal and strepto-coccal  skin infections. In these indications the  correct antibiotics should be selected based on bacterial sensitibe-ity  and patient factors. As examples, oral flucloxacillin may be indicated for infected eczema,  intravenous benzyL penicillin and flucloxacillin for cellulitis, and erythromycin for a patient with a staphylococcal carbun-cle who is penicillin-allergic. Optimal therapeutic doses and courses must be chosen .Several  antibiotics such as tetracyclines, erythromycin and trimethoprim,  can be used for their anti-inflammatory  effects in indications like acne vulgaris,  bullous pemphigoid and pyoderma gangrenosum.Oxytetracycline  is commonly given for acne but must be taken  on an empty stomach,  in a dose of up to 1.5 g a day . it has a good safety profile,  even with long-term use.Lymecycline is an alternative  and is taken one daily,  with or without food, thereby improve-ing  compliance. Doxycycline  is another option but commonly cases photosensitivity. Minocycline  may be given but with caution  as it can cause  hyperpigmenta-tion, autoimmune hepatitis and dru-induced lupus, and monitoring is required.

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Hormonal treatments

In women with acne, oestrogen-containing oral  contra-ceptives  can be useful adjunct,  as they are associated with a small reduction in sebum production. Combined oestrogens and anti-androgen(such as cyproterone acetate) contraceptives can also  be effective for particularly  in women with acne and hirsutism, as seen in polycystic ovary syndrome.

SYSTEMATIC THERAPIES
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Antifungals

The azoles(Ketoconazole, miconazole), triazoles (itraco-nazole, fluconazole) and triallylamines( terbinafine)  are used most widely in fungal skin disease.Topical or sys-temic use  is based on clinical presentation. For example dermatophyte nail  infection requires prolonged oral ter-binafine whereas as isolated patch of tinea corporis  will response  repaidly  to topical treatment.

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Antivirals

Systemic  antivirals  and indicated for significant viral skin disease. For example, systemic aciclovir is given for eczema herpeticum.

Antihistamines

A range of H1 and H2 antagonist are used in dermatology. For  diseases in which histamine in the skin is rel-evant (such as urticaria), non-sedating antihistamines  should be given; for example, fexofenadine or cetirizine.For pruritic  conditions such as eczema, the sedating effect of antihistamines like hydroxyzine  is important. Leukotriene receptor antagonists,  such as montelukast, may be added to antihistamines régimes.

Retinoids

Oral retionoids are  widely used in a range of conditions , including  acne, psoriasis and other keratinisation disorders. They have several functions, including promotion of differentiation, reduction in hyperkeratosis, sebum  production and  propionibacterium acnes, and anti-inflammatory effects. Isotretinoin (13-cis-retinoic acid)is commonly given for moderate or severe acne, at a dose of 0•5-1 mg|Kg over 4 months .Low-Dose continuous isotretinoin may also  be used for longer period.Acitre-tin can be effective in psoriasis and other keratinisation .disorders, such as ichthyosis,as can alitretinoin (9-cis-retinoic acid) in hand and foot eczema, and bexarotene in cutaneous T-cell lymphoma.

Retinoids side-effects  include drying of the skin and mucous membranes, abnormalities in  liver function or hepatitis, and increase the serum triglycerides (levels  should be checked before and during therapy). Depression and suicide  have been  reported in Association with isotretinoin ,  although a causal role  has not been  establish .However, pre-drug screening for depressive symptoms  should be undertaken. Alitretinoin and bex-arotene can cause hyperthyroidism. Systemic Retinoids are teratogenic:  female must have a negative pregnancy  test before, during and after therapy. Pregnancy  must be avoided 2 months after isotretinoin,  but 2  years after acitretin, due  to difference in drug disposition.

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