Darma medicines
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The user skipped clarification. I'll interpret "Darma medicines" as Derma(tology) medicines and provide a broad overview of the main drug classes used in dermatology. This is a medical query, so I'll invoke the medical library skill first.
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Good. Let me now read the key topical therapy sections from both Fitzpatrick's and Andrews' to get comprehensive drug information.
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These sections are specific to BCC and dermatomyositis. Let me search more broadly for the main dermatology drug overview sections.
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Let me read the key sections from Andrews' (topical therapy overview) and Fitzpatrick's (retinoid therapy), which are the most comprehensive dermatology textbooks for drug coverage.
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I now have solid content from the major dermatology textbooks. Let me also quickly read the Andrews' topical therapy section (block 3, earlier offset) to capture the broader overview of topical medications.
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I now have excellent source material. Here is a comprehensive overview of dermatology medicines organized by drug class.
Dermatology Medicines — Overview
1. Topical Corticosteroids
The most widely used class in dermatology. They reduce erythema, scaling, and pruritus by suppressing local inflammation.
- Potency classes: Class I (superpotent, e.g., clobetasol propionate) → Class VII (mild, e.g., hydrocortisone 1%)
- Class I–II (high potency): Used on thick skin — elbows, knees, hyperkeratotic palms. Can be used with occlusion (plastic wrap at night) to increase penetration.
- Class IV–VI (mid-potency): Face, flexures — lower risk of atrophy.
- Caution: Prolonged use on the face risks skin atrophy and hypopigmentation; avoid in peri-orbital area.
- Used adjunctively in conditions like dermatomyositis, psoriasis, eczema, lichen planus, and many others.
— Fitzpatrick's Dermatology, Vol. 1 & 2
2. Topical Calcineurin Inhibitors (TCIs)
Non-steroidal anti-inflammatories; safe for face and skin folds.
| Drug | Formulation | Notes |
|---|---|---|
| Tacrolimus | 0.1% ointment | Moderate–strong efficacy |
| Pimecrolimus | 1% cream | Milder; better tolerated |
- Comparable to low-to-mid potency corticosteroids (Class IV–VI)
- Key advantage: No atrophy or hypopigmentation — safe for facial use
- Used in: atopic dermatitis, cutaneous dermatomyositis, rosacea (erythemato-telangiectatic type)
- Note: In rosacea, brief pretreatment (≤1 week) with a potent topical corticosteroid improves initial tolerability
— Andrews' Diseases of the Skin, Clinical Dermatology
3. Retinoids
Topical Retinoids
- Tretinoin (all-trans retinoic acid): acne, photoaged skin, rosacea (nighttime use, after moisturizer to reduce irritation)
- Adapalene, tazarotene: acne, psoriasis
Oral Retinoids
| Drug | Main Indication | Dose | Key Side Effects |
|---|---|---|---|
| Isotretinoin | Severe/cystic acne, rosacea, gram-negative folliculitis, pyoderma faciale | 0.5–1 mg/kg/day; total course 120–150 mg/kg | Teratogenicity (Category X), cheilitis, dry eyes/skin, hypertriglyceridemia |
| Bexarotene | Cutaneous T-cell lymphoma (CTCL) | 300 mg/m²/day | Hypertriglyceridemia, hypercholesterolemia, central hypothyroidism, neutropenia |
| Acitretin | Psoriasis, ichthyoses | Variable | Teratogenicity, liver toxicity |
Isotretinoin key facts:
- Only acne therapy that offers long-term remission (40–60% of patients remain acne-free after one course)
- Lower doses (0.1 mg/kg/day) are effective but less likely to produce prolonged remission
- Patients under 16 have higher relapse rates (~40% need retreatment within 1 year)
- Most serious risk: severe fetal teratogenicity — mandatory contraception required
— Andrews' Diseases of the Skin
4. Topical Antibiotics & Antimicrobials
Used in acne, rosacea, and skin infections.
| Drug | Use |
|---|---|
| Clindamycin (1% gel/lotion) | Acne — anti-Cutibacterium acnes |
| Erythromycin (2% gel) | Acne — (resistance increasing) |
| Benzoyl peroxide | Acne, rosacea (glandular/nodular type); bactericidal, reduces antibiotic resistance |
| Metronidazole (0.75–1% cream/gel) | Rosacea — anti-inflammatory & antimicrobial |
| Azelaic acid (15–20%) | Rosacea, acne — anti-inflammatory, comedolytic |
| Sodium sulfacetamide + sulfur | Rosacea — anti-inflammatory |
| Mupirocin | Impetigo, S. aureus decolonization |
5. Oral Antibiotics (Dermatological Uses)
| Drug | Indication | Notes |
|---|---|---|
| Doxycycline | Acne, rosacea, periorificial dermatitis | Sub-antimicrobial dose 40 mg ER for rosacea |
| Minocycline | Acne | Risk of drug-induced lupus, pigmentation |
| Azithromycin | Acne (alternative) | |
| Trimethoprim-sulfamethoxazole | Acne (resistant cases), MRSA skin infections | |
| Cephalexin / dicloxacillin | Cellulitis, impetigo |
6. Topical Antifungals
| Drug | Use |
|---|---|
| Clotrimazole, miconazole | Tinea corporis/pedis/cruris, candidiasis |
| Terbinafine (cream/gel) | Tinea (fungicidal — shorter courses) |
| Ketoconazole (shampoo/cream) | Seborrheic dermatitis, pityriasis versicolor |
| Ciclopirox | Onychomycosis, tinea, seborrheic dermatitis |
7. Systemic Immunosuppressants / Immunomodulators
Used for severe inflammatory/autoimmune skin diseases (psoriasis, eczema, dermatomyositis, etc.).
| Drug | Conditions | Notes |
|---|---|---|
| Methotrexate | Psoriasis, dermatomyositis | Weekly dosing; hepatotoxic |
| Cyclosporine | Severe psoriasis, atopic dermatitis | Nephrotoxic; short-term use |
| Mycophenolate mofetil | Dermatomyositis, pemphigus | Well-tolerated |
| Azathioprine | Dermatomyositis, pemphigus | Monitor TPMT genotype |
| Hydroxychloroquine / Chloroquine | Cutaneous lupus, dermatomyositis | |
| Dapsone | Dermatitis herpetiformis, leprosy, vasculitis | G6PD screening needed |
| Thalidomide | Refractory cutaneous lupus, prurigo nodularis | Teratogenic; strict REMS |
8. Biologics & Targeted Therapies
| Drug | Class | Indication |
|---|---|---|
| Dupilumab | IL-4Rα antagonist | Atopic dermatitis |
| Secukinumab, ixekizumab | IL-17A inhibitors | Psoriasis |
| Ustekinumab | IL-12/23 inhibitor | Psoriasis |
| Guselkumab, risankizumab | IL-23 inhibitors | Psoriasis |
| Vismodegib, sonidegib | Hedgehog pathway inhibitors | Advanced basal cell carcinoma |
| Brentuximab vedotin | Anti-CD30 ADC | CTCL (CD30+) |
| Alemtuzumab | Anti-CD52 | CTCL |
| Tofacitinib | JAK inhibitor | Alopecia areata, dermatomyositis |
9. Rosacea-Specific Vasoactive Agents
| Drug | Mechanism | Use |
|---|---|---|
| Brimonidine 0.33% gel | α₂-adrenergic agonist | Facial erythema — vasoconstriction for up to 12 hours |
| Oxymetazoline 1% cream | α₁A-adrenoceptor agonist | Persistent facial erythema |
| Propranolol / carvedilol / clonidine | Beta-blocker / alpha-blocker | Symptomatic flushing (used cautiously) |
10. Topical Immunomodulators for Skin Cancer
| Drug | Use |
|---|---|
| Imiquimod 5% | Superficial BCC, actinic keratosis, warts (toll-like receptor agonist) |
| 5-Fluorouracil (5-FU) 5% | Superficial BCC, actinic keratosis |
For superficial BCC: imiquimod (3–5×/week × 6 weeks) is preferred; 5-FU is an alternative (twice daily × ≥6 weeks). Cure rate ~80% for thin tumors. Surgical excision has higher cure rates for nodular BCC.
— Andrews' Diseases of the Skin
This overview covers the major drug classes used across dermatology. If you want detail on any specific condition (acne, psoriasis, eczema, rosacea, skin cancer, etc.) or a specific drug's mechanism, dosing, or side effects, just ask.
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