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Imiquimod is available as 5% cream for the treatment of external genital and perianal warts in adults, actinic keratoses on the face and scalp, and biopsy-proven primary superficial basal cell carcinomas on the trunk, neck, and extremities. Tacrolimus and pimecrolimus are macrolide immunosuppressants. Both agents inhibit T-lymphocyte activation and prevent the release of inflammatory cytokines and mediators from mast cells.
Permethrin is used for the treatment of scabies. A single application of 5% cream is applied to the body from the neck down. Spinosad suspension is approved for the topical treatment of head lice in patients 4 years of age. Lindane is available as a 1% shampoo or lotion. For pediculosis capitis or pubis, 30 ml of shampoo is applied to dry hair. Crotamiton is a scabicide with some antipruritic properties. Malathion is an organophosphate cholinesterase inhibitor and is available as a 0.5% lotion.
Agents Affecting Pigmentation
Hydroquinone, monobenzone, and mequinol are used to reduce hyperpigmentation of the skin by inhibiting the enzyme tyrosinase. Trioxsalen and methoxsalen are psoralens used for the repigmentation of depigmented macules of vitiligo. Retinoic acid, acid form of vitamin A, is an effective topical treatment for acne vulgaris. Azelaic acid is effective in the treatment of acne vulgaris and acne rosacea. Brimonidine is indicated for the treatment of persistent facial erythema of rosacea.
Drugs for Psoriasis
Acitretin is effective in the treatment of psoriasis, especially pustular forms. Tazarotene is a topical acetylenic retinoid prodrug that is hydrolyzed to its active form by an esterase. Its precise mechanism of action in psoriasis is unknown. Apremilast is an oral phosphodiesterase 4 (PDE4) inhibitor that is effective in treating moderate to severe plaque psoriasis. Dimethyl fumarate has recently been approved by the FDA for treatment of multiple sclerosis.
Other Important Drugs
Salicylic acid has been extensively used in dermatologic therapy as a keratolytic agent. Sinecatechins ointment is indicated for the topical treatment of external genital and perianal warts in immunocompetent patients 18 years and older. Ingenol mebutate induces keratinocyte cell death and has recently been approved for the topical treatment of actinic keratoses. Topical doxepin hydrochloride 5% cream may provide significant antipruritic activity.