<img alt="The University of Western Australia logo."/>
THE UNIVERSITY OF
WESTERN
AUSTRALIA
DENT 3005:Introduction to
Pharmacology
**Dermatological drugs**
Dr Thuy Linh Truong
thuy.truong@uwa.edu.au
THE UNIVERSITY OF
WESTERN
AUSTRALIA
# **DENT 3005: Introduction to Pharmacology**
## **Dermatological drugs**
**Dr Thuy Linh Truong**
thuy.truong@uwa.edu.au
**Learning Outcomes**
**Learning objectives**
1) Understand the classes and mechanisms of
major classes of dermatological drugs
2) Recognise common dermatological
conditions relevant to dentistry
3) Recognise oral and dental side effects of
dermatological drugs
4) Understand drugs interactions with dental
medications
5) Applied knowledge to clinical scenarios
![]()
A set of 15 icons representing various aspects of health, medicine, and dermatology.
# **Learning Outcomes**
## **Learning objectives**
1) Understand the classes and mechanisms of major classes of dermatological drugs
2) Recognise common dermatological conditions relevant to dentistry
3) Recognise oral and dental side effects of dermatological drugs
4) Understand drugs interactions with dental medications
5) Applied knowledge to clinical scenarios
An image depicting the layers of the skin and associated structures.
Stratum
corneum
Stratum lucidum
Stratum granulosum
Stratum
spinosum
Stratum
basale
Hair follicles
Erector pili
muscle
Epidermis
Dermis
Subdermis
Sebaceous
glands
Arteriole
Capillaries
Eccrine
glands
Sensory nerve
Fat, collagen, fibroblasts
# **Skin Anatomy**
An image depicting the layers of the skin and associated structures.
- **Epidermis**
- Stratum corneum
- Stratum lucidum
- Stratum granulosum
- Stratum spinosum
- Stratum basale
- **Dermis**
- **Subdermis**
**Associated Structures:**
- Hair follicles
- Erector pili muscle
- Sebaceous glands
- Arteriole
- Capillaries
- Eccrine glands
- Sensory nerve
- Fat, collagen, fibroblasts
**Drugs for eczema**
* Aka dermatitis
* Characterized by skin inflammation & itching
* Most common: atopic eczema
* **MOA:** anti-inflammatory, immunosuppressive &
anti-mitotic activity against cutaneous
fibroblasts
* **Adverse reactions:** depends on potency, length
of tx, age, site & extent of disease
| Drug therapy | Generic name |
|---|---|
| Moisturizers | ☺ |
| Corticosteroids | Betamethasone |
| | Clobetasol |
| | Clobetasone |
| | Desonide |
| | Hydrocortisone |
| | Methylprednisolone |
| | Mometasone |
| | Traimcinolone |
| Tars | Coal tar |
| | Ichthammol |
| | Wood tars |
| Calcinuerin inH | Pimecrolimus |
# **Drugs for Eczema**
- Aka dermatitis
- Characterized by skin inflammation & itching
- Most common: atopic eczema
- **MOA:** anti-inflammatory, immunosuppressive & anti-mitotic activity against cutaneous fibroblasts
- **Adverse reactions:** depends on potency, length of tx, age, site & extent of disease
| Drug therapy | Generic name |
| :--- | :--- |
| Moisturizers | ☺ |
| Corticosteroids | Betamethasone |
| | Clobetasol |
| | Clobetasone |
| | Desonide |
| | Hydrocortisone |
| | Methylprednisolone |
| | Mometasone |
| | Traimcinolone |
| Tars | Coal tar |
| | Ichthammol |
| | Wood tars |
| Calcinuerin inH | Pimecrolimus |
Therapeutic
Guidelines
Topical corticosteroid preparations
| Drug (brand examples) | Strength | Preparations |
| :--- | :--- | :--- |
| Mild corticosteroids [NB1][NB2] | | |
| desonide (Desowen) | 0.05% | lotion |
| hydrocortisone (DermAid) | 0.5%, 1% | cream, ointment, topic liquid, spray |
| hydrocortisone acetate (Cortic DS, HydroCortic, Hysoderm, Sigmacort) | | |
| **Moderate corticosteroids [NB1][NB2]** | | |
| betamethasone valerate (Antroquoril, Betnovate 1/5, Celestone-M, Cortival 1/5) | 0.02% | cream |
| betamethasone valerate (Betnovate 1/2, Cortival 1/2) | 0.05% | cream, ointment |
| clobetasone butyrate (Eumovate, Kloxema) | 0.05% | cream |
| triamcinolone acetonide (Aristocort, Tricortone) | 0.02% | cream, ointment |
| **Potent corticosteroids [NB1][NB2]** | | |
| betamethasone dipropionate (Diprosone, Eleuphrat) | 0.05% | cream, ointment, lotion |
| betamethasone valerate (Betnovate) | 0.1% | cream, ointment |
| methylprednisolone aceponate (Advantan) | 0.1% | cream, ointment, fatty ointment, lotion |
| mometasone furoate (Elocon, Momasone, Novasone, Zatamil) | 0.1% | cream, ointment, hydrogel, lotion |
| **Very potent corticosteroids [NB1][NB2]** | | |
| betamethasone dipropionate (Diprosone OV) | 0.05% in optimised vehicle | ointment in optimised vehicle |
| clobetasol propionate (Clobex) | 0.05% | cream, ointment, lotion, shampoo [NB3] |
**OV** = optimised vehicle
**NB1**: Potency classification for each drug is based on the results of vasoconstrictor studies. Potency classifications based on vasoconstrictor effect typically correlate with therapeutic potency; however, many other factors determine therapeutic potency in a patient (eg area of application, frequency and duration of treatment).
**NB2**: Formulation of a drug can affect potency; a topical drug prepared as a cream is less potent than the same drug prepared as an ointment.
**NB3**: A commercial product is available for clobetasol propionate as a shampoo. Clobetasol propionate as a cream, ointment or lotion is not registered for use in Australia, but is available through the Special Access Scheme (for certain indications) or from compounding pharmacies; only use these under specialist supervision.
**Eczema**
![]()
A hand and a section of a back/neck with eczema rashes.
## **Topical Corticosteroid Preparations (Therapeutic Guidelines)**
| Drug (brand examples) | Strength | Preparations |
| :--- | :--- | :--- |
| **Mild corticosteroids** [NB1][NB2] | | |
| desonide (Desowen) | 0.05% | lotion |
| hydrocortisone (DermAid) | 0.5%, 1% | cream, ointment, topic liquid, spray |
| hydrocortisone acetate (Cortic DS, HydroCortic, Hysoderm, Sigmacort) | | |
| **Moderate corticosteroids** [NB1][NB2] | | |
| betamethasone valerate (Antroquoril, Betnovate 1/5, Celestone-M, Cortival 1/5) | 0.02% | cream |
| betamethasone valerate (Betnovate 1/2, Cortival 1/2) | 0.05% | cream, ointment |
| clobetasone butyrate (Eumovate, Kloxema) | 0.05% | cream |
| triamcinolone acetonide (Aristocort, Tricortone) | 0.02% | cream, ointment |
| **Potent corticosteroids** [NB1][NB2] | | |
| betamethasone dipropionate (Diprosone, Eleuphrat) | 0.05% | cream, ointment, lotion |
| betamethasone valerate (Betnovate) | 0.1% | cream, ointment |
| methylprednisolone aceponate (Advantan) | 0.1% | cream, ointment, fatty ointment, lotion |
| mometasone furoate (Elocon, Momasone, Novasone, Zatamil) | 0.1% | cream, ointment, hydrogel, lotion |
| **Very potent corticosteroids** [NB1][NB2] | | |
| betamethasone dipropionate (Diprosone OV) | 0.05% in optimised vehicle | ointment in optimised vehicle |
| clobetasol propionate (Clobex) | 0.05% | cream, ointment, lotion, shampoo [NB3] |
**OV** = optimised vehicle
**NB1**: Potency classification for each drug is based on the results of vasoconstrictor studies. Potency classifications based on vasoconstrictor effect typically correlate with therapeutic potency; however, many other factors determine therapeutic potency in a patient (eg area of application, frequency and duration of treatment).
**NB2**: Formulation of a drug can affect potency; a topical drug prepared as a cream is less potent than the same drug prepared as an ointment.
**NB3**: A commercial product is available for clobetasol propionate as a shampoo. Clobetasol propionate as a cream, ointment or lotion is not registered for use in Australia, but is available through the Special Access Scheme (for certain indications) or from compounding pharmacies; only use these under specialist supervision.
**Eczema**
# Drugs for psoriasis
* **Chronic inflammatory disease:** plaque psoriasis is most common form
* Affecting elbows, knees, buttocks, scalp
* **Drug therapy rationale:** induce remission, reduce severity & extent, relieve sx
* If possible, minimise & eliminate triggers
* Stress, trauma, smoking, alcohol, infections, drugs induced
* Topical tx adjunct to photo-therapy
* Systemic tx guided by dermatologists due to serious side effects
| Drug therapy | Generic name |
| :--- | :--- |
| **Topical treatment** | Moisturisers |
| | Corticosteroids |
| | Calcipotriol |
| | Salicylic acid |
| | Coal tars |
| | Dithranol |
| **Systemic treatment** | MTX |
| | Cyclosporin |
| | Acitretin |
| | **Injectable cytokine modulators** |
| | IL inH |
| | TNF-alpha antagonists |
| **Other drugs** | Methoxsalen |
# **Drugs for Psoriasis**
- **Chronic inflammatory disease:** plaque psoriasis is most common form
- Affecting elbows, knees, buttocks, scalp
- **Drug therapy rationale:** induce remission, reduce severity & extent, relieve sx
- If possible, minimise & eliminate triggers
- Stress, trauma, smoking, alcohol, infections, drugs induced
- Topical tx adjunct to photo-therapy
- Systemic tx guided by dermatologists due to serious side effects
| Drug therapy | Generic name |
| :--- | :--- |
| **Topical treatment** | Moisturisers |
| | Corticosteroids |
| | Calcipotriol |
| | Salicylic acid |
| | Coal tars |
| | Dithranol |
| **Systemic treatment** | MTX |
| | Cyclosporin |
| | Acitretin |
| | **Injectable cytokine modulators** |
| | IL inH |
| | TNF-alpha antagonists |
| **Other drugs** | Methoxsalen |
**Drugs for acne**
* **Acne vulagris**: common skin condition
* **Rationale of tx**: improve complexion, px scarring, limit disease duration, reduce psychological stress
* **Endocrine evaluation**
* **Topical tx choice**
* Retinoids, benzoyl peroxide & azelaic acid,
* Antibacterials
* **Oral tx choice**
* Antibacterials
* Hormonal tx
* Isotretinoin
| Drug therapy | Generic name |
|---|---|
| **Retinoids (top)** | Adapalene |
| | Isotretinoin |
| | Tazarotene |
| | Tretinoin |
| **Retinoids (oral)** | Acitretin |
| | Isotretinoin |
| **Other** | Azelaic acid |
| | Benzoyl peroxide |
| Drug therapy | Generic name |
|---|---|
| **Antibacterial (top)** | Clindamycin |
| | Erythromycin |
| | Metronidazole |
| | Mupyrocin |
| | Silver sulfadiazine |
| | Sodium fusidate |
| **Antibacterial (oral)** | Doxycycline 1$^{\text{st}}$ line |
| | Erythromycin |
# **Drugs for Acne**
- **Acne vulagris**: common skin condition
- **Rationale of tx**: improve complexion, px scarring, limit disease duration, reduce psychological stress
- **Endocrine evaluation**
- **Topical tx choice**
- Retinoids, benzoyl peroxide & azelaic acid,
- Antibacterials
- **Oral tx choice**
- Antibacterials
- Hormonal tx
- Isotretinoin
| Drug therapy | Generic name |
| :--- | :--- |
| **Retinoids (top)** | Adapalene |
| | Isotretinoin |
| | Tazarotene |
| | Tretinoin |
| **Retinoids (oral)** | Acitretin |
| | Isotretinoin |
| **Other** | Azelaic acid |
| | Benzoyl peroxide |
| Drug therapy | Generic name |
| :--- | :--- |
| **Antibacterial (top)** | Clindamycin |
| | Erythromycin |
| | Metronidazole |
| | Mupyrocin |
| | Silver sulfadiazine |
| | Sodium fusidate |
| **Antibacterial (oral)** | Doxycycline 1$^{\text{st}}$ line |
| | Erythromycin |
**Excess oils**
The oily substance that
protects your skin can
contribute to acne
when too much is
produced.
**Slower skin cell
turnover**
Dead skin cells that
normally just fall off can
get stuck in skin oils
instead and clog your
pores.
**Bacterial growth**
A specific bacteria that
is normally harmless
begins to multiply if it
gets trapped in a
clogged pore.
**Inflammation**
Multiplying bacteria
trigger inflammation
that results in red,
swollen, painful, and
pus-filled pimples.
![]()
Diagram illustrating the stages of acne formation.
## **Factors Contributing to Acne**
- **Excess oils**
- The oily substance that protects your skin can contribute to acne when too much is produced.
- **Slower skin cell turnover**
- Dead skin cells that normally just fall off can get stuck in skin oils instead and clog your pores.
- **Bacterial growth**
- A specific bacteria that is normally harmless begins to multiply if it gets trapped in a clogged pore.
- **Inflammation**
- Multiplying bacteria trigger inflammation that results in red, swollen, painful, and pus-filled pimples.
```markdown
| | **Mild** | **Moderate** | **Moderate to severe** | **Severe** |
| :--- | :--- | :--- | :--- | :--- |
| | **Comedonal** | **Papular/pustular** | | |
| **First line therapy** | Topical retinoid | Topical retinoid + BPO or BPO/topical AB | BPO/topical AB or Topical retinoid + BPO | Topical AB + BPO + topical retinoid or Oral AB + BPO + topical retinoid | Oral isotretinoin |
| **Alternatives** | Salicylic acid | | | Oral isotretinoin | Oral AB + topical retinoid + BPO or BPO/topical AB |
| **Alternatives for female patients** | | | Hormonal therapy $\pm$ BPO/topical AB or Topical retinoid | Hormonal therapy $\pm$ BPO/topical AB or Topical retinoid | Hormonal therapy + oral AB + topical retinoid $\pm$ BPO or BPO/topical AB |
| **Maintenance therapy** | Topical retinoid $\pm$ BPO or BPO/topical AB | | Topical retinoid $\pm$ BPO or BPO/topical AB | Topical retinoid $\pm$ BPO or BPO/topical AB | Topical retinoid $\pm$ BPO or BPO/AB |
| | | | | |
```
## **Acne Treatment Guidelines**
| | **Mild** | **Moderate** | **Moderate to severe** | **Severe** |
| :--- | :--- | :--- | :--- | :--- |
| | **Comedonal** | **Papular/pustular** | | |
| **First line therapy** | Topical retinoid | Topical retinoid + BPO or BPO/topical AB | BPO/topical AB or Topical retinoid + BPO | Topical AB + BPO + topical retinoid or Oral AB + BPO + topical retinoid | Oral isotretinoin |
| **Alternatives** | Salicylic acid | | | Oral isotretinoin | Oral AB + topical retinoid + BPO or BPO/topical AB |
| **Alternatives for female patients** | | | Hormonal therapy $\pm$ BPO/topical AB or Topical retinoid | Hormonal therapy $\pm$ BPO/topical AB or Topical retinoid | Hormonal therapy + oral AB + topical retinoid $\pm$ BPO or BPO/topical AB |
| **Maintenance therapy** | Topical retinoid $\pm$ BPO or BPO/topical AB | | Topical retinoid $\pm$ BPO or BPO/topical AB | Topical retinoid $\pm$ BPO or BPO/topical AB | Topical retinoid $\pm$ BPO or BPO/AB |
**Pharmacological Management of Acne – Key Points**
* Benzoyl Peroxide: Kills *P. acnes*, reduces inflammation, unclogs pores; use with antibiotics to reduce resistance
* Topical Retinoids (Tretinoin, Adapalene): Increase cell turnover, prevent comedones; Adapalene = fewer side effects
* COCs + Spironolactone: Reduce androgen-driven sebum production; ideal for hormonal acne
* Oral Antibiotics (Doxycycline, Erythromycin): Antibacterial + anti-inflammatory; avoid long-term monotherapy
* Isotretinoin: Reduces sebum, bacteria, and inflammation; reserved for severe/refractory acne
* **Important Interactions & Considerations**
* Use **benzoyl peroxide (AM) + retinoids (PM)** to avoid inactivation
* Avoid **vitamin A supplements and tetracyclines** during isotretinoin therapy
* Avoid **same-class oral + topical antibiotics** to prevent resistance
## **Pharmacological Management of Acne – Key Points**
- **Benzoyl Peroxide:** Kills *P. acnes*, reduces inflammation, unclogs pores; use with antibiotics to reduce resistance
- **Topical Retinoids (Tretinoin, Adapalene):** Increase cell turnover, prevent comedones; Adapalene = fewer side effects
- **COCs + Spironolactone:** Reduce androgen-driven sebum production; ideal for hormonal acne
- **Oral Antibiotics (Doxycycline, Erythromycin):** Antibacterial + anti-inflammatory; avoid long-term monotherapy
- **Isotretinoin:** Reduces sebum, bacteria, and inflammation; reserved for severe/refractory acne
### **Important Interactions & Considerations**
- Use **benzoyl peroxide (AM) + retinoids (PM)** to avoid inactivation
- Avoid **vitamin A supplements and tetracyclines** during isotretinoin therapy
- Avoid **same-class oral + topical antibiotics** to prevent resistance
**Drugs for skin infections**
* Tinea: superficial fungal infection
* Azoles & other antifungal
* [Azoles]: lots of drug interactions
* Antibacterials
* Indication: acne vulgaris, rosacea, impetigo, px infection in burns staph infection
* Antivirals
* Indication: mild herpes simplex
| Drug class | Generic name |
|---|---|
| **Azoles** | Bifonazole |
| | Clotrimazole |
| | Econazole |
| | Ketoconazole |
| | Miconazole |
| **Other antifungals** | Amorolfine |
| | Ciclopirox |
| | Nyastatin |
| | Terbinafine |
| | Tonaftate |
| Indication | Generic name |
|---|---|
| **Herpes labialis** | Acyclovir |
| | Penciclovir |
| **Cutaneous herpes simplex** | Idoxuridine & lignocaine |
# **Drugs for Skin Infections**
- **Tinea:** superficial fungal infection
- Azoles & other antifungal
- [Azoles]: lots of drug interactions
- **Antibacterials**
- Indication: acne vulgaris, rosacea, impetigo, px infection in burns staph infection
- **Antivirals**
- Indication: mild herpes simplex
| Drug class | Generic name |
| :--- | :--- |
| **Azoles** | Bifonazole |
| | Clotrimazole |
| | Econazole |
| | Ketoconazole |
| | Miconazole |
| **Other antifungals** | Amorolfine |
| | Ciclopirox |
| | Nyastatin |
| | Terbinafine |
| | Tonaftate |
| Indication | Generic name |
| :--- | :--- |
| **Herpes labialis** | Acyclovir |
| | Penciclovir |
| **Cutaneous herpes simplex** | Idoxuridine & lignocaine |
**Scabicides & pediculicides**
* Scabies: permethrin $1^{st}$ line
* Head lice: pediculosis (infestation by louse)
* Drug & non-drug tx available
**Drugs for warts**
* Caused by HPV
* Classified according to location & morphology
* Cutaneous: flat planter & palmar warts
* Anogenital: involves vulva, vagina, cervix, penis, scrotum, urethra & rectum
* Extracutaneous: oral & laryngeal lesions
<table>
<thead>
<tr>
<td colspan="2"><b>Scabicides & pediculicides</b></td>
</tr>
<tr>
<td><b>Head lice</b></td>
<td><b>Scabies</b></td>
</tr>
</thead>
<tbody>
<tr>
<td>Benzyl alcohol</td>
<td>Benzyl benzoate</td>
</tr>
<tr>
<td>Dimeticone</td>
<td>Crotamiton</td>
</tr>
<tr>
<td>Isopropyl myristate</td>
<td>Permethrin</td>
</tr>
<tr>
<td>Maldison</td>
<td>Ivermectin</td>
</tr>
<tr>
<td>Permethrin</td>
<td></td>
</tr>
</tbody>
</table>
<table>
<thead>
<tr>
<td colspan="2"><b>Drugs for wart</b></td>
</tr>
<tr>
<td><b>Generic name</b></td>
<td><b>Brand name</b></td>
</tr>
</thead>
<tbody>
<tr>
<td>Glutaraldehyde</td>
<td>Diswart</td>
</tr>
<tr>
<td>Imiquimod</td>
<td>Aldara</td>
</tr>
<tr>
<td>Podophyllotoxin</td>
<td>Wartec</td>
</tr>
<tr>
<td>Pophyllum resin</td>
<td>Extemporaneous preps</td>
</tr>
<tr>
<td>Salicylic acid</td>
<td></td>
</tr>
</tbody>
</table>
# **Scabicides & Pediculicides**
- **Scabies:** permethrin $1^{st}$ line
- **Head lice:** pediculosis (infestation by louse)
- Drug & non-drug tx available
<table>
<thead>
<tr>
<td colspan="2"><b>Scabicides & pediculicides</b></td>
</tr>
<tr>
<td><b>Head lice</b></td>
<td><b>Scabies</b></td>
</tr>
</thead>
<tbody>
<tr>
<td>Benzyl alcohol</td>
<td>Benzyl benzoate</td>
</tr>
<tr>
<td>Dimeticone</td>
<td>Crotamiton</td>
</tr>
<tr>
<td>Isopropyl myristate</td>
<td>Permethrin</td>
</tr>
<tr>
<td>Maldison</td>
<td>Ivermectin</td>
</tr>
<tr>
<td>Permethrin</td>
<td></td>
</tr>
</tbody>
</table>
# **Drugs for Warts**
- Caused by HPV
- Classified according to location & morphology
- Cutaneous: flat planter & palmar warts
- Anogenital: involves vulva, vagina, cervix, penis, scrotum, urethra & rectum
- Extracutaneous: oral & laryngeal lesions
<table>
<thead>
<tr>
<td colspan="2"><b>Drugs for wart</b></td>
</tr>
<tr>
<td><b>Generic name</b></td>
<td><b>Brand name</b></td>
</tr>
</thead>
<tbody>
<tr>
<td>Glutaraldehyde</td>
<td>Diswart</td>
</tr>
<tr>
<td>Imiquimod</td>
<td>Aldara</td>
</tr>
<tr>
<td>Podophyllotoxin</td>
<td>Wartec</td>
</tr>
<tr>
<td>Pophyllum resin</td>
<td>Extemporaneous preps</td>
</tr>
<tr>
<td>Salicylic acid</td>
<td></td>
</tr>
</tbody>
</table>
**Imiquimod**
* **MOA:** Stimulates immune response via interferon and cytokines
* **Indications:** Genital/perianal warts, superficial BCC (non-surgical), facial/scalp actinic keratoses
* **ADR:** Local skin reactions (e.g. redness, burning, erosion, pigment changes)
* **Brands:** Aldara, Aldiq
**Podophyllotoxin**
* **MOA:** binds to tubulin, arresting mitosis in metaphase and leading to epithelial cell death
* **Indication:** anogenital warts
* **Brand name:** condyline paint
# **Key Dermatological Drugs: Detailed Profiles**
## **Imiquimod**
- **MOA:** Stimulates immune response via interferon and cytokines
- **Indications:** Genital/perianal warts, superficial BCC (non-surgical), facial/scalp actinic keratoses
- **ADR:** Local skin reactions (e.g. redness, burning, erosion, pigment changes)
- **Brands:** Aldara, Aldiq
## **Podophyllotoxin**
- **MOA:** binds to tubulin, arresting mitosis in metaphase and leading to epithelial cell death
- **Indication:** anogenital warts
- **Brand name:** condyline paint
**Drugs for actinic keratosis**
* Is a precursor for SCC
* Typically affecting elderly
* Rough, scaly patch on skin cause by prolonged sun exposure
<table style="width: 100%;">
<thead>
<tr>
<td colspan="2" style="background-color: darkcyan; color: white; text-align: center;">**Drugs for actinic keratosis**</td>
</tr>
<tr>
<td style="font-weight: bold;">Generic name</td>
<td style="font-weight: bold;">Brand Name</td>
</tr>
</thead>
<tbody>
<tr>
<td>Diclofenac</td>
<td>Solaraze</td>
</tr>
<tr>
<td>5-fluorouracil</td>
<td>Efudix</td>
</tr>
<tr>
<td>Imiquimod</td>
<td>Aldara</td>
</tr>
<tr>
<td>Ingenol mebutate</td>
<td>Picato</td>
</tr>
<tr>
<td>Methyl aminolevulinate</td>
<td>Metvix</td>
</tr>
</tbody>
</table>
**Drugs for alopecia**
* Androgenic alopecia
* May marginally stimulate hair growth
* Benefit stops when tx stops 🙁
* 3-4 mo to notice effect
<table style="width: 100%;">
<thead>
<tr>
<td colspan="2" style="background-color: darkcyan; color: white; text-align: center;">**Drugs for alopecia**</td>
</tr>
<tr>
<td style="font-weight: bold;">Generic name</td>
<td style="font-weight: bold;">Brand Name</td>
</tr>
</thead>
<tbody>
<tr>
<td>Finasteride</td>
<td>Finapen, Propecia</td>
</tr>
<tr>
<td>Minoxidil</td>
<td>Regaine</td>
</tr>
</tbody>
</table>
# **Drugs for Actinic Keratosis**
- Is a precursor for SCC
- Typically affecting elderly
- Rough, scaly patch on skin cause by prolonged sun exposure
<table style="width: 100%;">
<thead>
<tr>
<td colspan="2" style="background-color: darkcyan; color: white; text-align: center;"><b>Drugs for actinic keratosis</b></td>
</tr>
<tr>
<td style="font-weight: bold;">Generic name</td>
<td style="font-weight: bold;">Brand Name</td>
</tr>
</thead>
<tbody>
<tr>
<td>Diclofenac</td>
<td>Solaraze</td>
</tr>
<tr>
<td>5-fluorouracil</td>
<td>Efudix</td>
</tr>
<tr>
<td>Imiquimod</td>
<td>Aldara</td>
</tr>
<tr>
<td>Ingenol mebutate</td>
<td>Picato</td>
</tr>
<tr>
<td>Methyl aminolevulinate</td>
<td>Metvix</td>
</tr>
</tbody>
</table>
# **Drugs for Alopecia**
- Androgenic alopecia
- May marginally stimulate hair growth
- Benefit stops when tx stops 🙁
- 3-4 mo to notice effect
<table style="width: 100%;">
<thead>
<tr>
<td colspan="2" style="background-color: darkcyan; color: white; text-align: center;"><b>Drugs for alopecia</b></td>
</tr>
<tr>
<td style="font-weight: bold;">Generic name</td>
<td style="font-weight: bold;">Brand Name</td>
</tr>
</thead>
<tbody>
<tr>
<td>Finasteride</td>
<td>Finapen, Propecia</td>
</tr>
<tr>
<td>Minoxidil</td>
<td>Regaine</td>
</tr>
</tbody>
</table>
5-Flurouracil (skin)
* **MOA**: Antimetabolite that blocks DNA/RNA synthesis by inhibiting thymidylate synthase and disrupting RNA function
* **Effect**: Cytotoxic to abnormal skin cells
* **Indications**: Actinic keratoses, Bowen’s disease (intra-epidermal SCC)
* **Brands**: Efudix, Tolak
## **5-Flurouracil (skin)**
- **MOA**: Antimetabolite that blocks DNA/RNA synthesis by inhibiting thymidylate synthase and disrupting RNA function
- **Effect**: Cytotoxic to abnormal skin cells
- **Indications**: Actinic keratoses, Bowen’s disease (intra-epidermal SCC)
- **Brands**: Efudix, Tolak
**Dermatological drugs Dental implications**
* Corticosteroids: ADRs!!!
* **Systemic drugs for psoriasis**
* Cyclosporin: overgrown, thickened, swollen, bleeding gums
* MTX & adalimumab: mouth ulcers & blisters, bleeding gum
* **Patient education**
* Routine visits, OH, fluoride
* **Retinoids ADR**
* Dry lips, mouth & skin: scaling, redness, burning, pain
* Dry throat: hoarse voice
* Bleeding and swollen gums
# **Dermatological Drugs: Dental Implications**
- **Corticosteroids:** ADRs!!!
- **Systemic drugs for psoriasis**
- **Cyclosporin:** overgrown, thickened, swollen, bleeding gums
- **MTX & adalimumab:** mouth ulcers & blisters, bleeding gum
- **Patient education**
- Routine visits, OH, fluoride
- **Retinoids ADR**
- Dry lips, mouth & skin: scaling, redness, burning, pain
- Dry throat: hoarse voice
- Bleeding and swollen gums
**Corticosteroids**
**ADRs**
* Infection
* Delayed wound healing
* Steroid rosacea
* Perioral dermatitis
* Skin atrophy
* Bruising
* Acne
* Facial flushing
* Pupura
* Depigmentation
* Telangiectasia
* Steroid induced crushing's
![]()
Images showing different dermatological side effects of corticosteroids, including steroid rosacea, perioral dermatitis, and facial fat redistribution (moon face).
## **Corticosteroids: Adverse Drug Reactions (ADRs)**
- Infection
- Delayed wound healing
- Steroid rosacea
- Perioral dermatitis
- Skin atrophy
- Bruising
- Acne
- Facial flushing
- Pupura
- Depigmentation
- Telangiectasia
- Steroid induced crushing's
**Dermatological conditions**
**Dental implications**
Cold Sores (Herpes Simplex Virus Type 1)
* Highly contagious, especially during blistering/early stages
* Risk of transmission to patients and practitioners even with gloves
* Reschedule non-urgent dental treatments until healed
* Avoid aerosol-generating procedures during active lesions
Extracutaneous Warts
* May be present in the oral cavity
* Refer to oral medicine specialists for persistent or atypical lesions
Actinic Keratosis
* Rough, scaly lesions due to sun exposure
* Potential to progress to squamous cell carcinoma
* Refer for dermatological assessment if identified
Key Takeaways
* Dentists often spot conditions with broader health implications
* Prioritize infection control and early detection in practice
# **Dermatological Conditions: Dental Implications**
### **Cold Sores (Herpes Simplex Virus Type 1)**
- Highly contagious, especially during blistering/early stages
- Risk of transmission to patients and practitioners even with gloves
- Reschedule non-urgent dental treatments until healed
- Avoid aerosol-generating procedures during active lesions
### **Extracutaneous Warts**
- May be present in the oral cavity
- Refer to oral medicine specialists for persistent or atypical lesions
### **Actinic Keratosis**
- Rough, scaly lesions due to sun exposure
- Potential to progress to squamous cell carcinoma
- Refer for dermatological assessment if identified
### **Key Takeaways**
- Dentists often spot conditions with broader health implications
- Prioritize infection control and early detection in practice
![]()
Cluster of oral and facial lesions including sores on lips, gums, nose, and tongue, suggesting viral or infectious pathologies
**References**
* Ritter JM, Flower RJ, Henderson G, Loke YK, MacEwan D, Robinson E, editors. *Rang & Dale's pharmacology*. 10th ed. Edinburgh: Elsevier; 2023
* Australian Medicines Handbook Online [Internet]. Adelaide (AU): Australian Medicines Handbook Pty Ltd;2000. Dermatologcicals; [updated 2025; cited 2025]. Available from: UWA Onesearch
* Pharmaceutical Society of Australia. Australian Pharmaceutical Formulary and Handbook: A Guide to Best Practice. 25th ed. Canberra: Pharmaceutical Society of Australia; 2021
* Ali K. Clinical dental pharmacology. 1st ed. Oxford: Wiley-Blackwell; 2023
* Bullock S, Manias E. *Fundamentals of pharmacology*. 8th ed. Frenchs Forest, NSW: Pearson Australia; 2017
* MIMS Australia. *eMIMSelite: Consumer medicine information, specific clinical monograph* [Internet]. Sydney: MIMS Australia; [updated 2025; cited 2025 Apr 17]. Available from: UWA Onesearch
![]()
A woman suffering from illness with medication bottles and loose pills, and a separate image of pill bottles with scattered pills.
# **References**
- Ritter JM, Flower RJ, Henderson G, Loke YK, MacEwan D, Robinson E, editors. *Rang & Dale's pharmacology*. 10th ed. Edinburgh: Elsevier; 2023
- Australian Medicines Handbook Online [Internet]. Adelaide (AU): Australian Medicines Handbook Pty Ltd;2000. Dermatologcicals; [updated 2025; cited 2025]. Available from: UWA Onesearch
- Pharmaceutical Society of Australia. Australian Pharmaceutical Formulary and Handbook: A Guide to Best Practice. 25th ed. Canberra: Pharmaceutical Society of Australia; 2021
- Ali K. Clinical dental pharmacology. 1st ed. Oxford: Wiley-Blackwell; 2023
- Bullock S, Manias E. *Fundamentals of pharmacology*. 8th ed. Frenchs Forest, NSW: Pearson Australia; 2017
- MIMS Australia. *eMIMSelite: Consumer medicine information, specific clinical monograph* [Internet]. Sydney: MIMS Australia; [updated 2025; cited 2025 Apr 17]. Available from: UWA Onesearch
[[L12 Dermatological 2025.pdf#page=1|L12 Dermatological 2025, p.1]]
[[L12 Dermatological 2025.pdf#page=2|L12 Dermatological 2025, p.2]]
[[L12 Dermatological 2025.pdf#page=3|L12 Dermatological 2025, p.3]]
[[L12 Dermatological 2025.pdf#page=4|L12 Dermatological 2025, p.4]]
[[L12 Dermatological 2025.pdf#page=5|L12 Dermatological 2025, p.5]]
[[L12 Dermatological 2025.pdf#page=6|L12 Dermatological 2025, p.6]]
[[L12 Dermatological 2025.pdf#page=7|L12 Dermatological 2025, p.7]]
[[L12 Dermatological 2025.pdf#page=8|L12 Dermatological 2025, p.8]]
[[L12 Dermatological 2025.pdf#page=9|L12 Dermatological 2025, p.9]]
[[L12 Dermatological 2025.pdf#page=10|L12 Dermatological 2025, p.10]]
[[L12 Dermatological 2025.pdf#page=11|L12 Dermatological 2025, p.11]]
[[L12 Dermatological 2025.pdf#page=12|L12 Dermatological 2025, p.12]]
[[L12 Dermatological 2025.pdf#page=13|L12 Dermatological 2025, p.13]]
[[L12 Dermatological 2025.pdf#page=14|L12 Dermatological 2025, p.14]]
[[L12 Dermatological 2025.pdf#page=15|L12 Dermatological 2025, p.15]]
[[L12 Dermatological 2025.pdf#page=16|L12 Dermatological 2025, p.16]]
[[L12 Dermatological 2025.pdf#page=17|L12 Dermatological 2025, p.17]]
[[L12 Dermatological 2025.pdf#page=18|L12 Dermatological 2025, p.18]]
[[L12 Dermatological 2025.pdf#page=19|L12 Dermatological 2025, p.19]]
[[L12 Dermatological 2025.pdf#page=20|L12 Dermatological 2025, p.20]]