Chp 36 Pharma

Immunosuppressants can

downregulate the body's response to allergens and irritants

Immunosuppressants and Antimetabolites: MOA Cyclosporine

interferes with T-cell proliferation and interleukin production

Immunosuppressants and Antimetabolites: MOA Methotrexate

interferes with normal DNA synthesis

Immunomodulators: Calcineurin Inhibitors Tacrolimus:

moderate to severe atopic dermatitis that has not responded to corticosteroid treatment

Immunosuppressants and Antimetabolites: MOA Azathioprine

suppresses T-cell-mediated immune response, blocks synthesis of RNA and DNA

Vitamin D Analogs ØCalcipotriene:

synthetic analog of vitamin D

Methotrexate is an antimetabolite that is indicated for

the treatment of moderate to severe chronic psoriasis and psoriatic arthritis

Azathioprine is used for

the treatment of severe psoriasis, although not FDA approved

Topical corticosteroids are categorized into seven groups based on potency:

ØClass I agents (e.g., diflorasone diacetate) are super-high potency ØClass VII agents include hydrocortisone, which is mild enough for OTC use

Factors that may exacerbate symptoms of eczema

ØStress ØContact with environmental pollutants and household cleaning products ØFood allergy ØWearing wool or clothing that rubs and irritates skin ØFactors that cause dry skin (low-humidity environments, not applying moisturizers, and hot baths) and scratching

Immunomodulators: Calcineurin Inhibitors Pimecrolimus:

: treatment of mild to moderate eczema

Vitamin D Analogs

Approved for treatment of psoriasis ØCalcitriol ØCalcipotriene

Nonpharmaceutical Treatment of Eczema and Psoriasis

Avoid hot baths or showers Air-dry or gentle pat skin dry after bathing Avoid vigorous rubbing Phototherapy

Calcineurin Inhibitors: Adverse Reactions

Can include local burning and stinging of the skin FDA require warning: may increase the risk for development of lymphoma

Cause of Atopic Dermatitis

Cause is unknown Higher incidence in dry climates, large cities Heredity Malfunction of immune system

Immunomodulators: Calcineurin Inhibitors

Control inflammation and reduce immune response to allergens Pimecrolimus: Tacrolimus:

Corticosteroids: MOA

Topical corticosteroids possess antiinflammatory and immunosuppressive properties and produce vasoconstriction Topical corticosteroids Øreduce the number of inflammatory cells Ødecreasing redness Øswelling Øinflammation

Pharmaceutical Treatment of Eczema and Psoriasis: Corticosteroids

Topical corticosteroids: mainstay of therapy Also used for the treatment of psoriasis, seborrhea, and other skin conditions involving inflammation

Common Irritants

Wool or synthetic fibers Soaps and detergents Perfumes and cosmetics Cleaning solvents, mineral oil, and chlorine Dust Sand

Eczema

a general term that describes several types of skin inflammation. ØAtopic dermatitis ØAllergic contact eczema ØContact eczema ØDyshidrotic eczema ØNeurodermatitis ØNummular eczema ØSeborrheic eczema ØStasis dermatitis

Vitamin D Analogs: MOA

Inhibits the rapid and repeated production of new skin cells Inhibits the proliferation of T cells and inhibits the release of mediators of inflammation

Symptoms of Atopic Dermatitis

Intense itching Redness (from scratching) Skin irritation Inflammation

Corticosteroids: Adverse Reactions

Long-term use can result in a variety of skin disorders Adverse reactions increase when high-potency corticosteroids are applied to large body surface area

Furanocoumarins: MOA

Methoxsalen acts on pyramidine bases of the DNA molecule to suppress DNA synthesis Reduces cell replication and proliferation May be administered orally, topically, or parenterally

Atopic Dermatitis

Most common form of eczema A chronic disease that often develops in infancy and may continue throughout adulthood Up to 75% of children with atopic dermatitis are prone to developing asthma and hay fever

Immunosuppressants and Antimetabolites: Adverse Reactions

Nausea and vomiting Dangerous drop in red and white blood cells Kidney or liver toxicity Weight gain, hypertension

Psoriasis with Atopic Dermatitis

Increased levels and hyperactivity of T cells in skin with atopic diseases Psoriasis associated with rapid turnover of skin cells Thick, silvery, scaly patches; redness and swelling Contributors: stress, dry skin, environmental factors, infections, some medications

Cyclosporine is

FDA approved for the short-term treatment of severe atopic dermatitis and psoriasis

Miscellaneous Agents

Otezla (apremilast) Indicated for the treatment of: Ømoderate to severe plaque psoriasis Øadult patients with active psoriatic arthritis

Calcineurin Inhibitors: MOA

Pimecrolimus and tacrolimus inhibit T-cell activation Inhibit production of cytokines, interleukins, and interferons

Furanocoumarins

Psoralens are a class of drugs that increase photosensitivity Methoxsalen is the only drug in this class It is approved for the treatment of atopic dermatitis and psoriasis along with UV light therapy Psoralens plus ultraviolet light A therapy is also known as PUVA

Tumor Necrosis Factor-α Inhibitors

TNF-α inhibitors include etanercept, infliximab, and adalimumab used for psoriasis Drugs block the inflammatory process triggered by high concentrations of TNF MOA: Prevent cell destruction and release of substances that cause inflammation

Vitamin D Analogs ØCalcitriol:

active form of vitamin D3

Atopic diseases are an

autoimmune disorder, and persons with atopic dermatitis have a hyperactive dermal response to irritants