Topical treatment in dermatology (antibiotics, imiquimod, steroids, calcineurin inhibitors,
vitamin D analogues, retinoids)
Adverse effects of glicocorticosteroides.
Group Drug Mechanism Indication Side effects Contraindication Notes
Topical Gentamicin Against Small Sensitization Cream,
antibiotics Staphylococci wounds or Ototoxicity ointment
Proteus superficial Nephrotoxicity
Klebsiella pyodermas;
Topical Oxytetracycline Against Acne vulgaris Pregnancy Ointment,
antibiotics Staphylococci Skin cream,
Propionibacterium discoloration solution,
acnes problems ophthalmic
ointment
Terramycin
ointment is
mixture with
polymyxin B
Topical Erythromycin Against Acne Allergy Cream,
antibiotics Staph Rosacea Community- ointment or gel
Strep Erythrasma based resistant Zineryt for acne
Propionibacterium Infections strains is with zinc
acnes (ex impetigo) development acetate
(all antibiotics)
Topical Fusidic acid Against Wound care Best
antibiotics Staphylococcus Pyoderma (ex antibiotic* for
Enterococci Impetigo) topical use
Secondarily Cream,
infected ointment, gel,
dermatitis powder,
Ulcers impregnated
gauze
Topical Metronidazole Trichomonas Creams, gels
antibiotics Rosacea
Also Gram-
bacteria
Topical Imiquimod Toll-like receptor 7 Condyloma Local irritation CA is treated
antiviral stimulation on acuminata & 3x/week &
dendritic cells & other washed off
cytokines mucosal after 6-10h
induction (IFN-α, warts Expensive
IL-6, IL-8, & TNF) Also for
Leading to Actinic
removal of warts keratoses &
superficial
BCC
, - Topical GCS
▪ Pharmacology:
▪ Resorption is very dependent on application site & is also grater in
infants & children.
▪ Tachyphylaxis may develop if GCS are given over long period.
Application is best 1x/day (or at most 2x/day)
▪ Used in derma for their anti-inflammatory, immunosuppressive &
anti-proliferative actions. OBS topical GCS therapy is always
symptomatic, never curative
▪ Indications
▪ Topical: ACD & ICD, AD, other forms of dermatitis, Psoriasis, cutaneous lupus
erythematosus, lichen planus, sarcoidosis
▪ Intralesional: granuloma annulare, alopecia areata, hypertrophic scars & keloids.
▪ Systemic: many different, including bullous autoimmune diseases, collagen-vascular
disorders, severe forms of dermatitis and others
▪ Contraindications: bacterial, viral or fungal infections, wounds, ulcers, atrophy
▪ Side effects
▪ High-potency topical GCS can cause Cushing syndrome (especially in infants).
Conversely, if high-potency GCS are abruptly stopped, there may be suppression of
pituitary-adrenal axis, causing Addisonian crisis
▪ Local effects: atrophy, striae, telangiectasias, purpura, hypertrichosis, infections &
perioral dermatitis
▪ Use – GCS are divided into 4 classes based on potency in EU (I-weakest → IV-strongest).
▪ It is impossible to remember all agents. Pick 1-2 and use them.
▪ Potency ranges are; ointment > gel > cream > lotion
▪ Maximum effect can be achieved by intralesional injection (usually triamcinolone
acetonide).
▪ Another effective approach is to use GCS-impregnated tape, containing
flurandrenolide
▪ Use with care on face & intertriginous areas (exceeding class II only in localized
bullous pemphigoid, non-responsive chronic cutaneous lupus erythematosus)
▪ Never go above class II in children.
▪ Avoid use in infectious processes (pyoderma, tinea) unless underlying disease is
simultaneously treated
▪ Always think about steroid-sparing approaches (phototherapy, tar, retinoids, vit D
analogues, calcineurin inhibitors, dithranol, urea)
▪ What is glucocorticoid pulse therapy? (not for topical)
▪ The term pulse therapy refers to intermittent IV infusion of very high doses of drugs
over a short time. Methylprednisolone (and dexamethasone in some countries) is the
glucocorticoid most frequently administered this way. Steroids pulse therapies are
used in inflammatory and autoimmune conditions as they are cumulatively less toxic.
▪ Pulse therapy is the administration of supra therapeutic administration of steroids in
intermittent manner. This form of therapy has given excellent treatment response with
very few side-effects.
▪ It is useful in conditions where rapid immunosuppression and anti-inflammatory
effect is desired, as in SLE, pemphigus, renal transplantation, steroid resistant
nephrotic syndrome and crescentic glomerulonephritis.
vitamin D analogues, retinoids)
Adverse effects of glicocorticosteroides.
Group Drug Mechanism Indication Side effects Contraindication Notes
Topical Gentamicin Against Small Sensitization Cream,
antibiotics Staphylococci wounds or Ototoxicity ointment
Proteus superficial Nephrotoxicity
Klebsiella pyodermas;
Topical Oxytetracycline Against Acne vulgaris Pregnancy Ointment,
antibiotics Staphylococci Skin cream,
Propionibacterium discoloration solution,
acnes problems ophthalmic
ointment
Terramycin
ointment is
mixture with
polymyxin B
Topical Erythromycin Against Acne Allergy Cream,
antibiotics Staph Rosacea Community- ointment or gel
Strep Erythrasma based resistant Zineryt for acne
Propionibacterium Infections strains is with zinc
acnes (ex impetigo) development acetate
(all antibiotics)
Topical Fusidic acid Against Wound care Best
antibiotics Staphylococcus Pyoderma (ex antibiotic* for
Enterococci Impetigo) topical use
Secondarily Cream,
infected ointment, gel,
dermatitis powder,
Ulcers impregnated
gauze
Topical Metronidazole Trichomonas Creams, gels
antibiotics Rosacea
Also Gram-
bacteria
Topical Imiquimod Toll-like receptor 7 Condyloma Local irritation CA is treated
antiviral stimulation on acuminata & 3x/week &
dendritic cells & other washed off
cytokines mucosal after 6-10h
induction (IFN-α, warts Expensive
IL-6, IL-8, & TNF) Also for
Leading to Actinic
removal of warts keratoses &
superficial
BCC
, - Topical GCS
▪ Pharmacology:
▪ Resorption is very dependent on application site & is also grater in
infants & children.
▪ Tachyphylaxis may develop if GCS are given over long period.
Application is best 1x/day (or at most 2x/day)
▪ Used in derma for their anti-inflammatory, immunosuppressive &
anti-proliferative actions. OBS topical GCS therapy is always
symptomatic, never curative
▪ Indications
▪ Topical: ACD & ICD, AD, other forms of dermatitis, Psoriasis, cutaneous lupus
erythematosus, lichen planus, sarcoidosis
▪ Intralesional: granuloma annulare, alopecia areata, hypertrophic scars & keloids.
▪ Systemic: many different, including bullous autoimmune diseases, collagen-vascular
disorders, severe forms of dermatitis and others
▪ Contraindications: bacterial, viral or fungal infections, wounds, ulcers, atrophy
▪ Side effects
▪ High-potency topical GCS can cause Cushing syndrome (especially in infants).
Conversely, if high-potency GCS are abruptly stopped, there may be suppression of
pituitary-adrenal axis, causing Addisonian crisis
▪ Local effects: atrophy, striae, telangiectasias, purpura, hypertrichosis, infections &
perioral dermatitis
▪ Use – GCS are divided into 4 classes based on potency in EU (I-weakest → IV-strongest).
▪ It is impossible to remember all agents. Pick 1-2 and use them.
▪ Potency ranges are; ointment > gel > cream > lotion
▪ Maximum effect can be achieved by intralesional injection (usually triamcinolone
acetonide).
▪ Another effective approach is to use GCS-impregnated tape, containing
flurandrenolide
▪ Use with care on face & intertriginous areas (exceeding class II only in localized
bullous pemphigoid, non-responsive chronic cutaneous lupus erythematosus)
▪ Never go above class II in children.
▪ Avoid use in infectious processes (pyoderma, tinea) unless underlying disease is
simultaneously treated
▪ Always think about steroid-sparing approaches (phototherapy, tar, retinoids, vit D
analogues, calcineurin inhibitors, dithranol, urea)
▪ What is glucocorticoid pulse therapy? (not for topical)
▪ The term pulse therapy refers to intermittent IV infusion of very high doses of drugs
over a short time. Methylprednisolone (and dexamethasone in some countries) is the
glucocorticoid most frequently administered this way. Steroids pulse therapies are
used in inflammatory and autoimmune conditions as they are cumulatively less toxic.
▪ Pulse therapy is the administration of supra therapeutic administration of steroids in
intermittent manner. This form of therapy has given excellent treatment response with
very few side-effects.
▪ It is useful in conditions where rapid immunosuppression and anti-inflammatory
effect is desired, as in SLE, pemphigus, renal transplantation, steroid resistant
nephrotic syndrome and crescentic glomerulonephritis.
