Topical immunosupressants

Question 1

Topical CS

Answer 1

• Topical form: inhibits epidermal mitosis and DNA synthesis, ↓ collagen cross-linking
• Vasoconstriction directly proportional to anti-inflammatory potency of agent
• SE: atrophy, striae, acneiform eruption, hypertrichosis, hypopigmentation
• Tachyphylaxis: efficacy of topical lost over time, and structurally different steroid required
• Pregnancy category C

Question 2

Topical Calcineurin Inhibitors

Answer 2

1% pimecrolimus (Elidel) Cream
0.1% and 0.03% tacrolimus (Protopic) Ointment
ihibits calcineurin -> blocks T cell activation
calcineurin is enzyme in T cells that -> cytokine production
(IL-2/3/4, and TNF-alpha) -> inflammation; calcineurin inhib->rdcd Tcell activatin and redcd inflamm
>2 yo

Question 3

Class 1TCS (superpotent)

Answer 3

• Clobetasol propionate gel - ointment, cream, lotion, foam, spray and shampoo 0.05%
• Betamethasone dipropionate gel and ointment 0.05%
• Diflorasone diacetate ointment 0.05%
• Fluocinonide cream 0.1%
• Flurandrenolide tape 4 mcg/cm2
• Halobetasol propionate ointment and cream 0.05% and lotion 0.01%

Question 4

Class 2 (high potency)

Answer 4

• Amcinonide ointment 0.1%
• Betamethasone dipropionate 0.05% cream, lotion*, gel and ointment
• Clobetasol propionate solution (“scalp application”) 0.05%
• Desoximetasone ointment and cream 0.25% and gel 0.05%
• Diflorasone diacetate ointment and cream 0.05%
• Fluocinonide gel, ointment, cream and solution 0.05%
• Halcinonide ointment, cream and solution 0.1%
• Mometasone furoate ointment 0.1%
• Triamcinolone acetonide ointment 0.5%

Question 5

Class 3 (high potency)

Answer 5

• Amcinonide cream and lotion 0.1%
• Betamethasone dipropionate cream, lotion, and spray 0.05%
• Betamethasone valerate ointment 0.1%
• Diflorasone diacetate cream 0.05%
• Fluticasone propionate ointment 0.005%
• Triamcinolone acetonide ointment 0.1% and cream 0.5%

Question 6

Class 4 (medium potency)

Answer 6

• Betamethasone valerate foam 0.12%
• Desoximetasone cream 0.05%
• Fluocinolone acetonide ointment 0.025%
• Flurandrenolide ointment 0.05%
• Hydrocortisone valerate ointment 0.2%
• Mometasone furoate cream and lotion 0.1%
• Triamcinolone acetonide ointment (Kenalog®) and cream 0.1% or spray 0.2%

Question 7

Class 5 (medium potency)

Answer 7

• Betamethasone dipropionate lotion 0.05%
• Betamethasone valerate cream and lotion 0.1%
• Clocortolone pivalate cream 0.1%
• Fluocinolone acetonide cream 0.025% or oil and shampoo 0.01%
• Fluticasone propionate cream and lotion 0.05%
• Flurandrenolide cream and lotion 0.05%
• Hydrocortisone butyrate ointment, cream and lotion 0.1%
• Hydrocortisone probutate cream 0.1%
• Hydrocortisone valerate cream 0.2%
• Prednicarbate ointment and cream 0.1%
• Triamcinolone acetonide ointment 0.025% and lotion 0.1%

Question 8

Class 6 (low potency)

Answer 8

• Alclometasone dipropionate ointment and cream 0.05%
• Triamcinolone acetonide cream 0.1% (Aristocort®)
• Betamethasone valerate lotion 0.1%
• Desonide gel, ointment, cream, lotion and foam 0.05%
• Fluocinolone acetonide cream and solution 0.01%
• Triamcinolone acetonide cream and lotion 0.025%

Question 9

Class 7 (low potency)

Answer 9

• Topicals with hydrocortisone, dexamethasone and prednisolone