What are the common medications used to treat dermatologic conditions?

Common Medications Used to Treat Dermatologic Conditions

Topical corticosteroids are the cornerstone of treatment for many inflammatory skin conditions, with selection based on potency, location, and condition severity, while other medication classes including biologics, immunosuppressants, and targeted therapies are essential for specific dermatologic diseases.

Topical Corticosteroids

Topical corticosteroids are classified by potency into seven classes, from ultra-high potency (class 1) to low potency (classes 6-7) 1:

High to Ultra-High Potency (Classes 1-2)

• Clobetasol propionate 0.05%
• Augmented betamethasone dipropionate 0.05%
• Halobetasol propionate 0.05%
• Fluocinonide 0.1%

Medium to High Potency (Classes 3-4)

• Triamcinolone acetonide 0.1%
• Fluticasone propionate 0.05%
• Mometasone furoate 0.1%
• Betamethasone valerate 0.1%

Low Potency (Classes 5-7)

• Hydrocortisone 1-2.5%
• Desonide 0.05%

Application Guidelines

• Choose potency based on location, severity, and patient age
• Lower potency for face, genitals, and intertriginous areas
• Higher potency for palms, soles, and thick plaques
• Monitor for skin atrophy, striae, and telangiectasia with prolonged use 2, 3

Psoriasis Medications

First-line Treatments

• Topical corticosteroids (classes 2-5 for initial therapy in adults) 1
• Topical vitamin D analogs (calcipotriene) 4
• Coal tar preparations (extremely safe option) 1

Systemic Treatments for Moderate-Severe Disease

• Methotrexate
• Cyclosporine
• Biologics (TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors) 1
• Oral retinoids (isotretinoin) 1

Eczema/Atopic Dermatitis Medications

First-line Treatments

• Topical corticosteroids (appropriate potency based on location)
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) for steroid-sparing 4, 5
• Moisturizers and gentle cleansers (essential for all patients) 5

Systemic Treatments for Severe Disease

• Oral immunosuppressants (cyclosporine)
• Dupilumab and upadacitinib for severe chronic atopic dermatitis 5
• Azathioprine (evidence supports use in severe, recalcitrant atopic dermatitis) 1

Rosacea Medications

First-line Treatments by Phenotype 1

• Transient erythema: α-adrenergics (topical), beta blockers (oral), PDL
• Persistent erythema: Brimonidine (topical), IPL, metronidazole (topical)
• Papules/pustules:
  • Mild: Azelaic acid, ivermectin, metronidazole (all topical)
  • Moderate: Same as mild plus doxycycline (oral)
  • Severe: Ivermectin (topical), doxycycline (oral), isotretinoin (oral)
• Telangiectasia: Electrodessication, IPL, lasers

Autoimmune Dermatoses Medications

Bullous Pemphigoid/Pemphigus

• Azathioprine (as steroid-sparing agent) 1
• Topical corticosteroids (very potent for localized/mild disease) 2
• Rituximab (anti-CD20) for severe disease 1

Systemic Sclerosis (Scleroderma)

• Mycophenolate mofetil (MMF) - first-line for skin manifestations
• Methotrexate - alternative first-line treatment
• Rituximab, tocilizumab, cyclophosphamide - for worsening disease 1

Acne Medications

• Topical benzoyl peroxide
• Topical and systemic antibiotics
• Oral contraceptives
• Oral isotretinoin (most effective treatment for severe acne) 4

Special Considerations

Medication Selection Principles

1. Location-based selection: Lower potency for face, intertriginous areas; higher potency for thick-skinned areas
2. Formulation selection:
   • Ointments: Most potent, best for dry/thick lesions
   • Creams: Less greasy, cosmetically acceptable
   • Lotions/solutions: For scalp and hairy areas
   • Gels: For hairy areas
   • Tapes/occlusive dressings: For localized lesions 2, 6

Common Pitfalls to Avoid

• Prolonged use of high-potency steroids on face or intertriginous areas
• Abrupt discontinuation of systemic corticosteroids
• Failure to monitor for side effects with immunosuppressants
• Drug interactions (e.g., azathioprine with allopurinol can cause myelosuppression) 1
• Using lithium, beta-blockers, or chloroquine in patients with psoriasis (may worsen condition) 1

Medication Dosing Guidance

• For topical corticosteroids: Use the fingertip unit method (one fingertip unit covers approximately 2% body surface area) 6
• For systemic medications: Dosing should be based on weight, renal function, and TPMT status (for azathioprine) 1

Off-label prescribing is common in dermatology (32% of prescriptions on average), particularly for conditions like acne rosacea (73%) and actinic keratosis (52%) 7, highlighting the importance of understanding the full range of medication options beyond their FDA-approved indications.