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Appendix I. Formulary

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Appendix I. Formulary Appendix I. Formulary This section briefly summarizes the wide vari­ text. Before prescribing any of these products, ety of products used by dermatologists. It is be sure to check the latest manufacturer's rec­ designed to provide a single source of inform a­ ommendations. tion for products mentioned throughout the Table of Contents I. Acne therapy 330 VI. Cosmetics 335-336 II. Antimicrobial agents 331-333 VII. Light-related products 336 III. Antiparasitic agents 333 VIII. Miscellaneous topical 337-339 IV. Antipruritic agents 333-334 IX. Miscellaneous systemic 339-340 V. Corticosteroids 334-335 Category Trade name Form, size, or % Comments I. Acne therapy A. "Classic" products 1. Sulfur Hundreds of well-known prod­ 2%-5% Nonprescription pastes or lotions, either white or flesh-tinted, con­ 2. Resorcinol ucts 1%-2% taining combinations of these three ingredients to primary cause 3. Salicylic acid 1%-2% drying and peeling. B. Antibiotics 1. Topical agents All are applied b.i.d.-t.i.d. a. Tetracycline Topicycline Solution Causes green color and glows under black light. b. Meclocycline Meclan Cream The only cream, therefore less drying. c. Erythromycin Staticin, ATS Solution d. Clindamycin Cleocin T Solution Cleocin T avoids the GI problems of systemic clindamycin. 2. Systemic agents a. Tetracycline 250-1000 mglday Must be taken on empty stomach. Use in daily or b.i.d. dosage; stains teeth, so not to be used in children or pregnant females. b. Erythromycin 250-1000 mglday Use similar to tetracycline; avoid estolate for long-term use. c. Minocycline Minocin 50-100 mglday May help in severe nodulocystic acne; can be taken with meals. C. Benzoyl peroxide Many brands, e.g., Panoxyl, 5%-10% in water and alcoholic Antibacterial and causes peeling; use b.i.d. or t.i.d. Benzagel, Desquam-X, Persa­ vehicles Gel D. Vitamin A compounds 1. Tretonoin (vitamin A acid) Retin A Half & full strength cream Best agent against comedones; photosensitizer so use at night; causes (0.05%,0.1%) initial worsening; use gel on oily skin, cream on dry skin. Half & full strength gel (0.01 %, 0.025%) 2. 13-cis-Retinoic acid Accutane 10 mg & 40 mg capsules Useful in severe nodulocystic acne; 0.5-2.0 mglkg daily; side eft'ects include dry skin, inflamed lips E. Soaps and cleansers Most acne patients insist on using something "special" to clean the face, even though it is rarely needed. 1. Abrasive cleansers Cream soaps with permanent or Use b.i.d.; decreases scale, increases irritation. dissolving particles 2. Cleansing pad Buf-Puf Same eft'ect as abrasive cleanser. 3. Benzoyl peroxide soaps Panoxyl Bar All leave film of benzoyl peroxide when used for washing; good Desquam-X, Benzac Liquid for large areas, e.g., the back. Category Trade name Form, size, or % Comments II. Antimicrobial agents A. Antibiotics 1. Topical agents All are applied 4-6 X daily to superficial infections. Wise to avoid a. Bacitracin Ointment (for gram positives) sensitizers (neomycin) or drugs you may need internally (gentami­ b. Erythromycin Ilosone Ointment (for gram positives) cin) if possible. Atopics: 1% hydrocortisone & Ilosone; crusted c. Gentamicin Garamycin Ointment or cream (for gram impetigo: add 5% salicylic acid to any. positives and negatives) d. Neomycin Ointment (for gram negatives) e. Silver sulfadiazine Silvadene Cream "Burn butter" active against gram positives and negatives, and Can­ dida; apply b.i.d. or t.i.d. Do not use in newborns. 2. Systemic agents a. Dicloxacillin 250-500 mg q.i.d. Use against penicillase-producing Staph. b. Erythromycin 250 mg q.i.d. Superficial infections with Staph and Strep. c. Penicillin VK 250-500 mg q.i.d. Strep infections. d. Sulfonamides 500 mg-1.0 g q.i.d. Used primarily for venereal diseases (Chapter 9). e. Tetracycline Used primarily for acne. The antibiotic dosages recommended for venereal diseases are not repeated here. B. Antiviral agents 1. Topical agents a. Idoxuridine Stoxil, Herplex Ointment, solution Both made for use against herpes simplex keratitis; may help against b. Adenine arabinoside Vira-A Ointment other herpes virus infections of skin and mucous membranes. c. Acyclovir Zovirax Ointment Approved for use in primary genital herpes simplex. 2. Systemic agents a. Adenine arabinoside Vira-A Approved for biopsied herpes simplex encephalitis; probably helpful for neonatal herpes simplex, neonatal varicella, varicella-zoster in immunosuppressed host. b. Acyclovir Being studied for the same conditions as adenine arabinoside. c. VZIG (varicella-zoster im­ Patients exposed to varicella-zoster with impaired immunity: immu­ mune globulin) nosuppressed patients, neonates. d. Methisazone Marboran May be helpful in complications of vaccinia. e. Vaccines: human herpes sim­ Lupidon H HSV I No viral vaccines are approved for dermatologic use in USA. Lupi­ plex Lupidon G HSV II don has provided improvement for some patients in Europe. C. Antifungal, anticandidal agents 1. Topical a. Clotrimazole Lotrimin, Mycelex Cream, solution, vaginal tablet All three are effective against dermatophytes, Candida. and tinea Haloprogin Halotex versicolor. Apply b.i.d. Vaginal tablets can be used as lozenges Miconazole Monistat-Derm for oral candidasis. Lotion and solution may help on scalp and nails. Category Trade name Form, size, or % Comments b. Nystatin Mycostatin, Candex Cream, ointment, powder, oral Mainstay of anticandidal therapy. The cream or ointment can be suspension applied t.i.d. or q.i.d. for diaper rash, as can the powder. One teaspoon of the suspension swished qj.d. is useful for oral candi­ diasis. c. lodochlorhydroxyquin Vioform Cream, ointment, lotion Somewhat antibacterial, antifungal, anticandidal, often mixed with 1% hydrocortisone; useful for diaper rash; discolors skin and clothes greenish yellow. d. Whitfield's ointment 12% Benzoic acid, 6% salicylic acid-potent keratolytic; apply bj.d. or t.i.d. for superficial dermatophytes. e. Castellani's paint Carbol fuchsin solution; use bj.d. or t.i.d. for intertrigo. f. Gentian violet 1%-3% solution Good anticandidal agent; turns skin purple; useful for oral candidia­ sis. g. Selenium sulfide Selsun, Exsel, losel Tinea versicolor: lather up, let dry for several minutes, then rinse; use daily for 1 week, then weekly for 6 weeks. Photodeveloper that kills tinea versicolor; paint on bj.d; let dry h. Sodium thiosulfate Tinver for 3-5 min. Odoriferous. 2. Systemic a. Griseofulvin Fulvicin, Grisactin, Gris-PEG Microsize 250 mg; ultramicro­ Works against dermatophytes, absorbed better with meal, interferes size 125 mg; suspension 125 with anticoagulants; 250 mg microsize and 125 mg Gris-PEG mgl5 ml dosage is 1-2 pills daily. b. Ketoconazole Nizoral 200 mg Approved for deep fungal infections, systemic candidiasis; also works against tinea versicolor, dermatophytes; dosage usually 200 mg daily. c. Amphotericin B Used intravenously in hospital for deep fungal infection, dissemi­ nated candidiasis. d. Nystatin 500 ()()() unit tablets Not absorbed, may help oral and perianal candidiasis by sterilizing 500 ()()() unitl5 ml solution the two ends of the GI tract; give 500 ()()() units t.i.d. or q.i.d. e. Potassium iodide SSKI-super saturated solution Used in sporotrichosis, various granulomas; give up to 10 drops q.i.d. D. Antiseptics All used for burn, wound, and ulcer care, as well as for preoperative scrubs. 1. Chlorhexidine gluconate Hibiclens Alcoholic cleanser Cumulative effect against gram positives and negatives. 2. Povidone-iodine Betadine Many forms Slowly releases iodine, effective against all microorganisms. 3. Hexachlorophene pHisoHex Liquid soap Cumulative effect against gram positives; CNS toxicity when used in infants or on non-intact skin. E. Astringents Used in baths and with wet dressings. 1. Aluminum acetate Burow's solution, Domeboro 1:20-1:40 in H20 Nonstaining, antiseptic. Category Trade name Form, size, or % Comments 2. Potassium permanganate 65 mg in 500-1000 ml H 20 Stains brown, undissolved fragments bum, antiseptic. 3. Silver nitrate 0.025%-10% Stains brown, 0.025% used in soaks; I % for aphthae; 10% for cracks and fissures (expensive). 4. Acetic acid 1% solution Good against Pseudomonas about the nails and toe webs. III. Antiparasitic agents A. Insect repellants 1. Diethyltoluamide (DEET) Off, Cutter Lotion, spray, stick DEET usually more effective than EH; look for a lotion with the highest percent of DEET; sprays are weaker 2. Ethyl hexanediol (EH) 6-12 Lotion, spray, stick B. Scabicides 1. Lindane (gamma-benzene hexa- Kwell Lotion, shampoo Scabies: apply lotion to entire body at night, wash in morning, repeat chloride) in I week; only children need the shampoo. Lice: pubic = lotion bj.d. X 3 days; scalp = shampoo daily X 3 days. Lindane may be neurotoxic in small children and should not be used repeatedly. 2. Crotamiton Eurax Lotion, cream Scabies: apply either form to entire body at night 2 days in a row, repeat in I week; also antipruritic. 3. Precipitated sulfur 6% in thin cream or Cetaphil Scabies: apply bj.d. to entire body for 3 days; safe for infants and cleanser pregnant females. C. Other 1. Pyrethrins A-200, Pyrinate, RID Cream, gel Lice: apply, rinse after 10 min; repeat in 24 h. 2. Thiabendazole Mintezol Oral suspension, 300 mg/5 ml Creeping eruption: apply oral suspension bj.d. X 4-7 days; can (topical solutions not sold in also use in scabies and dermatophyte infections. USA) IV. Antipruritic agents A. Topical anesthetics All work best on mucous membranes and broken skin (Chapter 24). I. Amide-ester: lidocaine Xylocaine Viscous solution 2%, jelly, oint- Useful to numb aphthae and other oral sores. ment 2%-5% 2. Aminoester: benzocaine Most topical "numbing agents" Creams, ointments Potent topical sensitizers-avoid! 3. Dyclonine Dyclone Solution Useful in mouth. 4. Dimethisoquin, pramoxine Prax Creams, lotions Fairly effective on intact skin; use bj.d. or t.i.d.; pramoxine available with I % hydrocortisone. B. Other topical antipruritics I.
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