Drug interactions of clinical significance for the dermatologist: recognition and avoidance

Discontinued dermatological drugs in 2014

INTRODUCTION

Dermatology is a relatively small field concerned with conditions of the hair, skin, nails and their related diseases; yet there is considerable active research and development within the field. Pharmaceutical companies seek more effective treatments through various therapeutic classes and delivery routes. However, 28 drugs have been discontinued for the treatment of dermatologic diseases in 2014.

AREAS COVERED

Herein, the authors summarize the details about each discontinued drug in 2014. The dermatological conditions covered are: psoriasis, eczema, leg ulcers, wounds, allergies, acne, scleroderma, lupus erythematosus, urticaria, mastocytosis, epidermolysis bullosa, onychomycosis and one other unspecified disease. The authors also provide suggestions for improving and accelerating the future of dermatological drug development.

EXPERT OPINION

It is clear that improved metrics, especially for early assessment, emphasizing clinical relevance, are necessary to increase success rate. Transparency and clear communication within the field is necessary to reduce and salvage the waste that accumulates from these costly studies. Focused attention on how preclinical and early clinical studies failed to indicate subsequent toxicity profiles in patients would accelerate drug development. Distinguishing between disappointing study results and business/financial factors is important when analyzing discontinuations. A reformed approach toward study design would aid both. Ultimately, relevance and practicality for the patient must be kept in mind at all times.

Systemic use of non-biologic corticosteroids in orofacial diseases

Systemic non-biologic agents have long been in clinical use in medicine - often with considerable efficacy, albeit with some adverse effects--as with all medications. With the advent of biologic agents, all of which currently are restricted to systemic use, there is a growing need to ensure which agents have the better therapeutic ratio. The non-biologic agents (NBAs) include a range of agents, most especially the corticosteroids (corticosteroids). This study reviews the corticosteroids in systemic use in management of orofacial mucocutaneous diseases; subsequent studies discuss corticosteroid-sparing agents used in the management of orofacial diseases, such as calcineurin inhibitors used to produce immunosuppression; purine synthetase inhibitors; and cytotoxic and other immunomodulatory agents.

[Local anesthetic procedures in dermatology: Part 1: principles]

Most dermatologic surgery is performed under local anesthesia. The choice of the type of anesthesia depends on the age, ability to cooperate and comorbidities of the patient. Anesthetics of the amide type are generally preferred for local infiltration. A solid anatomic background is required to perform effective peripheral nerve blocks. If the methods of action, toxic effects and potential drug interactions are considered, then local anesthetics have a low risk of complications. One must also not overlook the need for regular training in managing anesthetic emergencies for the entire operating room team, especially with the increasing age of our patients.

Psychopharmacology in psychodermatology

BACKGROUND

The management of psychodermatologic disease often involves the use of psychotropics by dermatologists. A general approach to the psychopharmacologic management of psychodermatological disease may be of assistance to the dermatologist.

OBJECTIVE

We review and provide a current psychopharmacologically based approach to management of common psychopathologies associated with psychodermatologic disorders, common side effects, and potential drug interactions that may occur with selected psychotropics.

METHODS

Using relevant MeSH terms, we performed a review of the literature from 1980 to 2006.

RESULTS AND CONCLUSIONS

Effective psychopharmacologic management of psychodermatologic disease involves identifying and basing treatment on the associated psychopathology; familiarity with a variety of psychotropic agents, including antidepressants, anxiolytics, and antipsychotics; and the involvement of a psychiatrist when possible.

Polymorphic cytochrome P450 enzymes and post-marketing drug dosage revisions: clinical relevance to dermatologic therapies

The therapeutic drug resources available to dermatologists have expanded and encompass off-label use of other drugs as well. As these new resources are employed, it is important to remain vigilant of possible drug interactions and toxicities contingent upon inter-individual variability of plasma drug levels. This article reviews the biochemistry of CYP enzymes and the clinical implications of genetic polymorphisms as relating to certain dermatologic drugs. In addition, we discuss the potential clinical function of cutaneous CYP enzymes.

Adverse drug interactions and reactions in dermatology: current issues of clinical relevance

This article highlights several adverse drug interactions and reactions relevant to current dermatologic practice. Absorption interactions between drugs and compounds containing polyvalent cations, potential interactions between herbal and conventional medicines, the meaning of sulfa allergy, and adverse cutaneous reactions caused by epidermal growth factor receptor inhibitors are discussed.