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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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