Dermatologic system

Dermatological system (erythroderma, icthyosis, Stevens-Johnson syndrome, Behcet s disease, acute blistering diseases)... 

Several drugs marketed currently have exhibited problems with toxicity or tetratoge-nicity. Hepatotoxicity, aplastic anemia, Stevens-Johnson syndrome, and neurotoxicity have been concerns cited frequently. Idiosyncratic reactions involving hematologic and dermatologic systems have proved fatal in a few cases. Considerable research effort has been directed toward identifying novel pharmaceutical moieties with a broad spectrum of efficacy and fewer side effects. 

Lupus erythematosus, acute rheumatic carditis, systemic dermatomyositis DERMATOLOGIC DISEASES... 

The ghicocorticoids are used as replacement therapy for adrenocortical insufficiency, to treat allergic reactions, collagen diseases (eg, systemic lupus erythematosus), dermatologic conditions, rheumatic disorders, shock, and other conditions (see Display 50-1). The anti-inflammatory activity of these hormones make them valuable as anti-inflammatories and as immunosuppressants to suppress inflammation and modify the immune response... 

Alimentary tract and metabolism Blood and blood-forming organs Cardiovascular system Dermatologicals... 

Czirjak L, Schlammadinger J, Szegedi G. 1993. Systemic sclerosis and exposure to trichloroethylene. Dermatology 186 236. 

We tend to think of them being much the same, but the functioning of semisolid dermatological products stands in stark contrast with that of transdermal delivery systems. To begin with, most topical applications... 

V. P. Shah, J. S. Elkins, and R. L. Williams, Evaluation of the test system used for in vitro release of drugs for topical dermatological drug products, Pharm. Dev. Tech., 4, 377 (1999). 

Systemic therapy with a variety of (3-lactams, macro-lides and lincosamides (clindamycin) has been the cornerstone of skin infection therapy for many years [17]. However, topical antibiotics can play an important role in both treatment and prevention of many primary cutaneous bacterial infections commonly seen in the dermatological practice [18], Indeed, while systemic antimicrobials are needed in the complicated infections of skin and skin structure, the milder forms can be successfully treated with topical therapy alone [18], The topical agents used most often in the treatment of superficial cutaneous bacterial infections are tetracyclines, mupirocin, bacitracin, polymyxin B, and neomycin. 

The oral contraceptive norethisterone (norethindrone, 129) has been shown to produce the 4/ ,5/ -epoxide (130) over a 30 min irradiation at 300 nm in aqueous buffer at pH 7.4. The possibility that this reactive species is responsible for the non-dermatological side-effects of oral contraceptives containing norethisterone was noted. One serious systemic effect of the drug which could be caused... 

Daptomycin can give quite a few adverse reactions. The primary toxicities associated with daptomycin use are myopathies. Significant rates of cardiovascular, central nervous system, dermatological, gastrointestinal and hematological side effects have also been reported. 

Systemic antimicrobials are indicated for the treatment of sever or wide-spread infections of the skin, for infections which are accompanied with systemic symptoms and for dermatological infections that did... 

Antibiotics are used in dermatology for both infectious and noninfectious skin eruptions. Noninfectious skin eruptions, such as acne vulgaris and acne rosacea, are often treated with systemic antibiotics. The mechanism of action is not clear, although tetracycline inhibits lipases derived from resident flora in the sebaceous follicle Staphylococcus epidermidis, Propionibacterium ac-nes). These lipases cleave irritating fatty acids from triglycerides in sebum, presumably contributing to cutaneous inflammation. 

Ketoconazole was the first oral azole introduced into clinical use. It is distinguished from triazoles by its greater propensity to inhibit mammalian cytochrome P450 enzymes that is, it is less selective for fungal P450 than are the newer azoles. As a result, systemic ketoconazole has fallen out of clinical use in the USA and is not discussed in any detail here. Its dermatologic use is discussed in Chapter 61. 

Because of the effectiveness of systemic tacrolimus in some dermatologic diseases, a topical preparation is now available. Tacrolimus ointment is currently used in the therapy of atopic dermatitis and psoriasis. 

Diseases of the skin offer special opportunities to the clinician. In particular, the topical administration route is especially appropriate for skin diseases, although some dermatologic diseases respond as well or better to drugs administered systemically. 

Wakelin S, Maibach HI Systemic Drugs in Dermatology. Manson, 2004. 

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