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MindMap Gallery Dermatology and Venereology 002 Treatment of Dermatology and Venereology

Dermatology and Venereology 002 Treatment of Dermatology and Venereology

This is a mind map about the treatment of Dermatology and Venereology 002 Dermatology and Venereology, which summarizes oral drug therapy, topical drug therapy, and other therapies.

Edited at 2024-03-25 15:12:53

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Dermatology and Venereology 002 Treatment of Dermatology and Venereology

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Outline

Dermatology and Venereology 010 Other Skin Diseases
- 55
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Dermatology and Venereology 009 Autoimmune Bullous Disease
- 40
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Dermatology and Venereology 007 Erythema, papule, and scaly skin disease
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Dermatology and Venereology 006 Drug Rash
- 41
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Dermatology and Venereology 005 Allergic Skin Diseases
- 39
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Dermatology and Venereology 004 Biogenic Skin Diseases Section 4
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Dermatology and Venereology 004 Biogenic Skin Diseases Section 3
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Dermatology and Venereology 004 Biogenic Skin Diseases Section 2
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Dermatology and Venereology 004 Biogenic Skin Diseases Section 1
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Dermatology and Venereology 002 Symptoms and Diagnosis of Skin Diseases
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Chapter 3 Treatment of skin and venereal diseases

Section 1 Oral Drug Therapy

1. Antihistamines

1.H1 receptor antagonist

(1) Pharmacological effects: Polypolyamine and histamine have the same ethylamine structure, and can compete with histamine for receptors to eliminate telangiectasia, increased vascular permeability, smooth muscle contraction, increased respiratory secretions, blood pressure caused by histamine Decline, erythema, wheals and other effects; also has varying degrees of anticholinergic and anti-5-HT effects

(2)Example

First generation: antihistamine sedation, anticholinergic local anesthesia and antiemetic; such as chlorpheniramine (chlorpheniramine), diphenhydramine (long-term use can cause anemia), doxepin, cyproheptadine, Chlorohydroxyzine, promethazine, ketotifen; adverse reactions: ① can pass through BBB → fatigue, drowsiness, dizziness, inability to concentrate; ② anticholinergic → dry mucous membrane, difficulty urinating, mydriasis; contraindications : ① High-altitude operations, precision workers, drivers; ② Glaucoma and prostatic hypertrophy

Second generation: The biggest advantage is that the drug does not easily penetrate the BBB and has little anticholinergic effect. The chemical structures of the drugs are not exactly the same. Most of them are absorbed quickly and have a long action time (generally taken once a day); such as Astemizole (astemizole), terfenadine, loratadine (Claritan), cetirizine, mequitazine, mizolastine

2. H2 receptor antagonists: have the effect of resisting histamine vasodilation, lowering blood pressure and increasing gastric juice secretion; such as cimetidine; they can also enhance cellular immune function and have anti-androgen-like effects (treating acne, hirsutism, Herpes zoster); adverse reactions: headache, dizziness, elevated serum aminotransferases, impotence, decreased sperm, pregnant and breastfeeding women should use with caution

2. Glucocorticoids

1. Mechanism of action

(1) Suppress immunity: ① Accelerate the destruction of lymphocytes and cause lymphoid tissue to atrophy; ② Inhibit the antigen presentation function of macrophages and inhibit the production of cytokines; ③ Reduce complement and antibody levels

(2) Anti-inflammatory and anti-proliferative effects: ① Inhibit neutrophil chemotaxis and phagocytosis; ② Stabilize lysosomal enzymes; ③ Inhibit the formation and release of inflammatory mediators such as prostaglandins; ④ Reduce capillary permeability; ⑤Inhibit the formation of granulation tissue

(3) Antitoxic and anti-shock effects: ① Inhibit the formation of myocardial inhibitory factors; ② Reduce the sensitivity of blood vessels to vasoconstrictor substances and improve microcirculation; ③ Maintain the integrity of blood vessel walls and reduce the occurrence of DIC; ④ Reduce myocardial oxygen consumption, Improve heart function

(4) Anti-tumor effect: ① Inhibit lymphocyte DNA synthesis and mitosis; ② Inhibit fibroblasts and epithelial cell proliferation

2.Indications

(1) Allergic skin diseases: such as drug eruption, erythema multiforme, severe acute urticaria, anaphylactic shock, contact dermatitis

(2) Autoimmune diseases: such as SLE, dermatomyositis, acute phase of systemic scleroderma, bullous skin disease, Behcet's disease

(3) Some serious infectious diseases: such as Staphylococcus aureus scald syndrome and leprosy reaction; but they need to be used for a short period of time under the premise of effective antibiotic use

3. Commonly used preparations: 0.75 mg dexamethasone = 5 mg prednisone = 4 mg methylprednisolone = 20 mg hydrocortisone

(1) Inefficient: hydrocortisone

(2) Moderately effective: prednisone (prednisone), prednisolone (prednisolone), methylprednisolone (methylprednisolone), triamcinolone (3) Highly effective: dexamethasone, betamethasone

4. Dermatological application methods

(1) Short-term: such as the acute stage of allergic reaction; multiple intravenous infusions are started. After the symptoms are significantly improved, the dosage can be reduced quickly and then discontinued.

(2) Mid-course: Used for patients with a long course of disease and easy recurrence (such as unusual psoriasis); take more orally, and it will take 2 to 3 months after the symptoms are controlled to stop taking the drug.

(3) Long-term: used for patients with chronic relapse and multi-system involvement (such as SLE); adequate, early, and continuous administration. Intravenous infusion is required when the condition is severe. After the condition is controlled, the dosage is slowly reduced (10% reduction in 1 week). Maintain after stabilization (5~7.5mg prednisone amount)

(4) Shock therapy: used for critically ill patients (such as anaphylactic shock); methylprednisolone 0.5~1.0g is added to 5% or 10% glucose solution for intravenous infusion, and the infusion is completed within 3~10 hours, once a day, for 3 consecutive days After ~5 days, switch to oral prednisone 30~60mg daily

(5) Intralesional injection: used for alopecia areata, lichen planus, keloids, cystic acne, nodular prurigo, discoid lupus erythematosus, etc.; commonly used is 1% triamcinolone suspension equivalent to 1% procava due to injection

5. Side effects: seen during long-term use

(1) Relatively mild: moon face, central obesity, atrophic striae, subcutaneous bleeding, acne, hirsutism

(2) Serious cases: Inducing/aggravating diabetes, hypertension, cataracts, infection, gastrointestinal ulcer/bleeding/perforation, osteoporosis, fracture, adrenal insufficiency, water/electrolyte imbalance, ischemic osteonecrosis, mental and neurological disorders System symptoms

3. Antibiotics

4. Antiviral drugs

Such as acyclovir (inhibits DNA polymerase; side effects: phlebitis, temporary serum creatinine ↑), ribavirin (broad spectrum), interferon, interferon inducer (most commonly used in polysarcoma)

5. Antifungal drugs

1. Griseofulvin: similar in structure to guanine → interferes with DNA synthesis and can bind to tubulin → prevent cell division; narrow spectrum (effective for tinea capitis, generalized tinea corporis, tinea versicolor, deep Fungal diseases are ineffective); side effects: gastrointestinal reactions, dizziness, photosensitive drug eruption, liver damage, leukopenia

2. Polyenes: bind to ergosterol on the fungal cell membrane and change its permeability.

(1) Amphotercin B (amphotercin B): broad spectrum (effective for a variety of deep fungal diseases, but not effective for superficial fungal diseases); it can only be intravenously infused, but often causes chills, fever, loss of appetite, kidney damage, and hypokalemia. , phlebitis and other side effects (needs to be combined with dexamethasone) (2) Nystatin (nystatin): has inhibitory effect on Candida and Cryptococcus; taken orally for gastrointestinal candidiasis

3.5-Fluocytosine (5-Fc): artificially synthesized, can interfere with nucleic acid synthesis; can be used for cryptococcosis, candidiasis, chromoblastomycosis, and aspergillosis; has a synergistic effect with amphotericin B and can reduce Drug resistance occurs; side effects: nausea, loss of appetite, leukopenia, thrombocytopenia

4. Azoles: artificially synthesized, can inhibit the synthesis of cytochrome P450-dependent enzymes and ergosterol; they are bacteriostatic drugs

(1) External use: clotrimazole, miconazole, econazole, etc.

(2) Taking medicine internally

A. Ketoconazole: suitable for systemic candidiasis, chronic mucocutaneous candidiasis, coccidioidomycosis, paracoccidioidomycosis, histoplasmosis, aspergillosis, generalized tinea corporis, Tinea versicolor, etc.; gastric acid is required for absorption (take medication on an empty stomach); Side effects: nausea, dizziness, decreased androgen, palpitations, anaphylactic shock, cytopenia, rash, teratogenesis

B. Itraconazole: highly lipophilic and keratophilic; suitable for sporotrichosis, cryptococcosis, candidiasis, aspergillosis, chromoblastomycosis, superficial mycosis; onychomycosis and Frequent shock therapy for fungal infections of skin and mucous membranes

C. Fluconazole: suitable for deep fungal infections of the kidneys and central nervous system

5. Allylamines: such as terbinafine (inhibits ergosterol synthesis); a bactericidal drug

6. Potassium iodide: the drug of choice for treating sporotrichosis; it should not be used in patients with tuberculosis.

6. Retinoids/retinoic acid

1. Pharmacological effects: ① Regulate the growth and differentiation of epithelial cells and other cells, and inhibit malignant growth; ② Influence the immune system and inflammatory process; ③ Change intercellular adhesion

2. Side effects: teratogenesis, hyperlipidemia, hypercalcemia, early bone closure, dry skin and mucous membranes, abnormal liver function

3.Type

(1) First generation: all-trans retinoic acid and non-aromatic synthetic derivatives, such as isotretinoin (Tiersi), retinoid; suitable for cystic acne, Darier's disease, lamellar ichthyosis, Palmoplantar keratosis

(2) Second generation: monoaromatic retinoic acid, such as etretinate; suitable for severe psoriasis

(3) Third generation: polyaromatic retinoic acid, such as aromatic retinoic acid ethyl ester; suitable for psoriasis, ichthyosis, and keratosis pilaris

7. Immunosuppressants

Such as cyclophosphamide (CTX) (alkylating agent; strong inhibitory effect on humoral immunity), azathioprine (AZP) (strong inhibitory effect on cellular immunity), methotrexate (MTX) (antagonist of folate metabolism), Cyclospora CSA (selective T cell inhibitor), tacrolimus (mechanism similar to CSA), mycophenolate mofetil (MMF) (highly selective hypoxanthine mononucleotide dehydrogenase (IMPDH) inhibitor)

8. Immunomodulators

Such as Bacillus Calmette-Guérin (BCG), levamisole, interferon, transfer factor, thymosin, IVIg

9. Other categories

1. Chloroquine and hydroxychloroquine: can reduce skin sensitivity to ultraviolet rays, stabilize lysosomal membranes, inhibit neutrophil function, inhibit the binding of denatured DNA and antibodies, inhibit cellular immunity and complement activity; suitable for lupus erythematosus , polymorphic light eruption, porphyria, lichen planus; side effects: gastrointestinal reactions, leukopenia, drug rash, corneal pigmentation, retinal macular area damage, liver and kidney damage

2. Dapsone (DDS): can inhibit lysosomal enzymes and neutrophil function; used for leprosy, dermatitis herpetiformis, pemphigoid, and vasculitis; iron and vitamin B12 are required for long-term use. Can be teratogenic

3. Thalidomide: used for leprosy, polymorphous light eruption, discoid lupus erythematosus, nodular prurigo; can cause teratogenesis

4. Metronidazole and tinidazole: suitable for Demodex folliculorum and anaerobic bacterial infections, and have certain effects on rosacea.

5. Vitamins

6. Calcium: commonly used for acute eczema, urticaria, and drug eruptions

7. Sodium thiosulfate: commonly used for chronic urticaria and certain metal poisoning

8. Occluded therapy: suitable for psoriasis, eczema, and chronic lichen simplex

9. Tripterygium wilfordii: immunomodulatory, anti-inflammatory, anti-tumor, anti-fertility functions, suitable for SLE, dermatomyositis, etc.

Section 2 External Drug Therapy

1. Types of external drugs

1. Cleaning agent: normal saline, 3% boric acid solution, 1:1000 nitrofurazone solution, vegetable oil, liquid paraffin

2. Protective agent: talcum powder, zinc oxide powder, calamine, vegetable oil, starch

3. Antipruritic agents: 5% benzocaine, 1% thymol, 1% carbolic acid, various tar preparations, glucocorticoids

4. Antibacterial agents: 3% boric acid solution, 0.1% refenol, 5~10% benzoyl peroxide, 0.5~3% erythromycin, 1:2000 chlormethionine, 1% clindamycin, 0.1% coptis 1% tetracycline, 2% mupirocin

5. Antifungal agents: 2~3% clotrimazole, 1% econazole, 1% terbinafine, nystatin, amphotericin B

6. Antiviral agents: 3~5% acyclovir, 5~10% herpes net, 10~40% podophyllate

7. Pesticides: 5~10% sulfur, 2% metronidazole, 20~30% rhizome tincture

8. Keratin enhancer: 2~5% coal tar, 3% salicylic acid, 3~5% sulfur, 2~5% resorcin

9. Exfoliating agent: 5~10% salicylic acid, 10% resorcin, 10% sulfur, 20~40% urea, 5~10% lactic acid, 10~30% glacial acetic acid

10. Astringent: 0.2~0.5% silver nitrate, 2% alum, 5% formaldehyde

11. Corrosive (canstic): 30~50% trichloroacetic acid, pure carbolic acid, 5~20% lactic acid, >20% salicylic acid, >30% glacial acetic acid

12. Topical cytotoxic drugs: 0.5~5% fluorouracil ointment

13. Sunscreen agent: 5% titanium dioxide, 10% zinc oxide, 5~10% para-aminobenzoic acid, 5% quinine

14. Decolorizing agent: 3% hydroquinone, 20% azelaic acid

15. Topical glucocorticoids

(1)Type

Weakly effective: 1% hydrocortisone acetate, methylprednisolone acetate

Medium effect: 0.05% dexamethasone acetate, prednisone acetate, clobetazone, triamcinolone, 0.01% fluocinolone acetonide, fludrocortisone acetate, deschloridexamethasone

Powerful: hydrocortisone butyrate, beclomethasone dipropionate, betamethasone dipropionate, dexamethasone dipropionate, 0.05% betamethasone valerate, 0.025% fluocinolone acetonide, 0.025% chlorofluoride Shusong

Super potent: clobemethasone propionate, 0.1% clofluxazone, 0.1% betamethasone valerate, halometasone

(2) Side effects: local skin atrophy, telangiectasia, purpura, hirsutism, acne, folliculitis, pigment abnormalities; causing hormone-dependent dermatitis and increasing the chance of fungal infection

2. Dosage forms of topical drugs

1. Solution: aqueous solution of drugs; moisture absorption, heat dissipation, anti-inflammatory, and cleaning; suitable for acute dermatitis with large amounts of secretions (exudation/erosion) (wet compress 2 to 3 times/d)

2. Powder: zinc oxide, talc, starch, medicine; drying, protecting, heat dissipating, astringent; suitable for acute/subacute dermatitis without secretion, especially suitable for intertriginous areas

3. Water powder/lotion: powder water; heat dissipation, anti-inflammatory, drying, protection, and anti-itching; suitable for acute dermatitis without secretion, but not suitable for hairy areas

4. Tincture/spiritus: ethanol medicine (non-volatile/volatile); anti-inflammatory, sterilizing, antipruritic; suitable for chronic dermatitis without secretions/thick scabs/damage, pruritus

5. Paste: ointment, powder, medicine; anti-inflammatory, protective, drying, medicine with little irritation; suitable for acute/subacute dermatitis with a small amount of exudate, but not suitable for hair areas

6. Ointment: petroleum jelly, lanolin, drugs; lubricates, softens scabs, anti-inflammatory, protects, relieves itching, has strong skin penetration effect; suitable for chronic dermatitis without discharge/ulcer

7. Emulsion (fat, cream): It has the same effect as ointment but has low skin penetration effect; suitable for subacute/chronic dermatitis without discharge or pruritus

8. Gel: suitable for subacute/chronic dermatitis

9. Oil: suitable for subacute dermatitis with thick scabs but no discharge

3. Therapeutic Principles of External Drugs

1. Correct selection of drugs: based on the cause, pathological changes, and subjective symptoms

2. Choose the correct dosage form

(1) Acute dermatitis: no exudate → powder, water powder; a small amount of exudate → paste; a large amount of exudate → wet compress with solution

(2) Subacute dermatitis: little exudation → paste, oil; no exudation → powder, water powder, emulsion; no erosion → emulsion, paste

(3) Chronic dermatitis: emulsions, ointments, plasters, tinctures, and coating agents

(4) Simple itching without skin lesions: emulsion, tincture, ointment

3. Precautions: ① The patient must be asked whether he or she has a history of drug allergy, and informed that the drug should be discontinued immediately if it causes allergic reactions/irritation; ② The patient/family member should be informed of the usage in detail; ③ Gender, age, and location of the lesion should be taken into consideration when using the drug; ④ Strongly irritating drugs should not be used on infants, faces, and wrinkles; ⑤ The concentration of external drugs should be from low to high. Long-term use of drugs can easily lead to tolerance → Frequent changes of drugs are required

Section 3 Other treatments

1. Physical therapy

electrotherapy

Electrolysis, electrodesiccation/electrocautery, electrocoagulation, electrocautery

light therapy

Infrared ray: wavelength 760~1500nm (low energy); can expand blood vessels, improve local blood circulation and nutrition, promote the resolution of inflammation, and accelerate tissue repair

UV rays

 Mainly medium wave (UVB) (wavelength 280~320nm) and long wave (UVA) (wavelength 320~400nm); can accelerate blood circulation, improve metabolism, analgesia, relieve itching, promote pigment production and epithelial regeneration, and sterilize; but It is contraindicated for those with active pulmonary tuberculosis, hyperthyroidism, heart, liver and kidney insufficiency, advanced psoriasis, and photosensitivity.

Photochemotherapy (psoralen-ultraviolet, PUVA)

Mechanism: Photosensitizer (such as 8-MOP) is taken orally or applied externally and then irradiated with UVA, inducing a phototoxic reaction and inhibiting DNA synthesis.

Indications: Psoriasis, vitiligo, mycosis fungoides, alopecia areata, atopic dermatitis

Side effects: cataracts, skin aging, toxic hepatitis, rash, headache, mental symptoms

Precautions: Wear anti-UV glasses within 12 to 48 hours after taking the medicine to protect the lens and avoid sun exposure; during treatment, limes, coriander, mustard, carrots, celery, figs, and other photosensitive drugs and phenothiazines are prohibited.

Photodynamic therapy (PDT)

Mechanism: Photosensitizers (such as 5-aminolevulinic acid (5-ALA)) enter the body and accumulate in tumor tissue. They are excited under light/laser irradiation of a specific wavelength, generate reactive oxygen species, and cause tumor tissue necrosis. Minimize damage to normal tissue

Indications: Bowen's disease, basal cell carcinoma, squamous cell carcinoma

Laser: good monochromaticity, strong coherence and high power

Laser surgery: carbon dioxide laser produces high-power laser; suitable for common warts, genital warts, plantar warts, corns, pyogenic granulomas, and benign tumors

Laser physiotherapy: Helium-neon laser produces low-power laser; suitable for folliculitis, boils, paronychia, herpes zoster, alopecia areata, skin ulcers, etc.

Selective laser

Photorejuvenation technology

cryotherapy

Liquid nitrogen is the most commonly used; it is suitable for common warts, plantar warts, condyloma acuminata, pyogenic granulomas, nodular prurigo, keloids, and superficial benign tumors; but it is often easy to lose pigment after treatment.

Spa

Utilizes the temperature and cleanliness of water, as well as the effects of added drugs, to treat skin diseases; suitable for psoriasis, chronic eczema, pruritus, and erythroderma

radiotherapy

Indications: Various proliferative skin diseases, pruritic skin diseases, malignant tumors

Methods: Malignant tumors should be treated with high doses at short intervals, and 50-70Gy should be given within 4 to 6 weeks; benign tumors should be treated with small doses at long intervals, and 6-15Gy should be given within 4 to 6 weeks.

2. Surgical treatment

1. Indications: benign and malignant skin tumors, trauma and inflammation, biopsy, etc.

2. Surgical procedures: ① Grinding; ② Cutting; ③ Hair transplantation; ④ Extracorporeal surgery; ⑤ Surgical therapy for underarm odor; ⑥ Mohs surgical resection