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Orals

Orals

Oral therapy is a very effective treatment option utilized by dermatologists either in combination with or in place of topical treatments in many conditions. Several categories of oral therapies are available that your Advanced Dermatology provider can take advantage of to treat your skin. Below is a list of several common classes of these oral therapeutics and there uses.

Steroids: oral corticosteroids (OCS) are an excellent therapeutic option for significant flares of numerous inflammatory skin conditions like eczema, dermatitis, autoimmune skin disease, blistering skin diseases and many others. OCS have some of the quickest and most effective immunosuppressive and anti-inflammatory properties to deliver real relief. Several different formulations are available that have different effects throughout the body, so a thorough knowledge of these treatments is required before prescribing these. Thankfully your advanced dermatology provider has extensive knowledge of these treatments to help get your skin condition under control. Don’t let your skin continue to suffer, call for an appointment today.

Antibiotics: these are particles that either kill or inhibit the growth of microorganisms. Several classifications of microorganisms exist, with different antibiotics targeting each class.

Antibacterials: these work by inhibiting several components of bacterial organisms, either directly killing them (bactericidal) or inhibiting their proliferation (bacteriostatic). Oral antibioticis are not just used for skin infections or wound care, they also have a role in inflammatory skin conditions like acne, rosacea and even blistering skin conditions amongst others. Common classes include Penicillins (Penicillin, Augmentin, etc), Cephalosporins (Keflex, Ceclor, Omnicef, etc), Macrolides (Erythromycin, Azithromycin, etc), Fluoroquinolones (Cipro, Levaquin, Avelox, etc), Tetracyclines (Doxycycline, Minocycline, etc), and others (Metronidazole, Rifampin, Bactrim DS, Clindamycin and Zyvox).

Antifungals: these work by disrupting fungus cell wall synthesis, with the exception of griseofulvin. The commonly prescribed classes of anti-fungal medications include the azoles (Itraconazole, Fluconazole, Ketoconazole, Voriconazole, Posaconazole), allylamines (Terbinafine) and griseofulvin (which inhibits fungus cells from multiplying). Recently ketoconazole has fallen out of favor due to a harsh review from the FDA, while griseofulvin is used today mostly in children for scalp fungal infections. A comprehensive knowledge of these treatments is required, which your Advanced Dermatology provider has for you at your appointment.

Antivirals: these work via destroying the virus (viricidal) or inhibiting its ability to function, and serve as treatments for human herpes virus (HHV) infections (Acyclovir, Valacylovir, Famciclovir and valganciclovir), common warts (HPV) and HIV infections (over 20 drugs available with at least 6 different combination pills currently). For herpes infections, treatment can be episodic or suppressive, depending on several factors of the patient’s infection. For common warts in certain situations, oral retinoids are used to inhibit the proliferation of these lesions and prevent transformation to skin cancer.

Antiparasitics: there are four common treatments available for treating the more common parasitic infections including scabies, lice (pediculosis) and larva migrans. These include ivermectin, albendazole, thiabendazole and doxycycline. Ivermectin is the most common treatment option and has effectiveness for scabies, lice and larva migrans. It also has been used for numerous rare infestations world-wide. Both albendazole and thiabendazole are used for the treatment of many rare infections not usually encounter in the US. Lastly, doxycycline has been shown to have some efficacy with worm infections.

Retinoids: retinoids are extremely effective forms of vitamin A that work to normalize how the skin functions and renews itself. Systemic (oral) forms include the first generation treatments isotretinoin and tretinoin, newer forms etretinate (hardly used anymore) and acitretin, and the newest ones bexarotene and alitretinoin (not approved in the USA for anything yet). Isotretinoin (more commonly known as “Accutane” despite that brand name being removed from the market), is FDA-approved for the treatment of acne vulgaris. Acitretin (soriatane) is FDA-approved for psoriasis while bexarotene (Targretin) has FDA-approval for select cases of mycosis fungoides (cutaneous lymphoma). Many off-label skin conditions are effectively treated with these medications. Make an appointment today to ask your Advanced Dermatology provider about the benefits of these wonderful treatments.

Immunosuppressives: there are many options available for treatment of skin diseases caused by a dysfunction of the immune system. Many of these are used for the “steroid-sparing” effects, to help achieve long-term control without significantly damaging the body. The following medications are commonly used in dermatology for control of inflammatory skin conditions:

Methotrexate: this medication has been used for over 40 years with FDA-approval for psoriasis, along with approval from rheumatoid arthritis. This substance works by inhibiting the ability for the immune system to proliferate, providing both chemotherapeutic and immunosuppressive properties. It also has FDA approval for advanced cutaneous lymphoma. It is used off-label in many skin conditions ranged from proliferative, blistering, autoimmune, inflammatory (including of blood vessels) and atopic dermatitis. A special knowledge of the side effects is required to effectively use this medication in select patients who would benefit from treatment. Find an advanced dermatology medical provider with expertise in prescribing this potentially life-saving therapy today.

Azathioprine: used by many specialists for various inflammatory and autoimmune diseases, dermatologists have been using this medication for several decades to treat this ailments in addition to blistering conditions and atopic dermatitis. For all skin conditions, treatment is off-label. It works by inhibiting the function of the immune system cells responsible for these different skin conditions, providing both immunosuppressive and anti-inflammatory properties. A special knowledge of the side effects is required to effectively use this medication in select patients who would benefit from treatment. Find an advanced dermatology medical provider with expertise in prescribing this potentially life-saving therapy today.

Cellcept: also known as mycophenolate mofetil, this immunosuppressive medication is increasing in usage as a treatment option for several inflammatory skin conditions. Although only FDA-approved for transplant rejection, it is gaining popularity with dermatologists in inflammatory, blistering, autoimmune and various other skin conditions. It has demonstrated long-term safety and tolerability that is propelling it to become a first-line option for many dermatologists treating patients with such conditions. It works by inhibiting the proliferation of the immune system cells responsible for these skin conditions, along with other cellular processes in the skin. A special knowledge of the side effects is required to effectively use this medication in select patients who would benefit from treatment. Find an advanced dermatology medical provider with expertise in prescribing this potentially life-saving therapy today.

Cyclosporine: originally discovered while searching for treatments of fungal infections, it was fortuitously discovered to have potent immunosuppressive effects. It works by inhibiting the proliferation of certain immune system cells responsible for inflammatory skin conditions like psoriasis, for which it has FDA-approval for. It is used off label for many other conditions include other inflammatory conditions (including hives and conditions of the hair), autoimmune disease, and blistering conditions. While it has certain benefits compared to other steroid-sparing immune suppressors, it has several side effects that require a special knowledge of to effectively use this medication in select patients who would benefit from treatment. Find an advanced dermatology medical provider with expertise in prescribing this potentially life-saving therapy today.

Cytotoxic medications: several other less commonly used medications that inhibit the immune system in specific ways can be used for select skin conditions. These include the antimetabolites thioguanine (no FDA-approved dermatologic indications) and hydroxyurea (FDA-approved for metastatic and gastrointestinal melanoma), along with the alkylating agents cyclophosphamide (FDA-approved for advanced cutaneous lymphoma), chlorambucil (no FDA-approved dermatologic indications), and melphalan (no FDA-approved dermatologic indications). A special knowledge of the side effects is required to effectively use this medication in select patients who would benefit from treatment. Find an advanced dermatology medical provider with expertise in prescribing these potentially life-saving therapies today.

Dapsone: discovered over 100 years ago, this wonderful treatment has well-documented antimicrobial activity and more recently discovered benefits for certain inflammatory skin disorders. FDA-approved for the treatment of leprosy and dermatitis herpetiformis, an extremely itchy blistering skin condition, dapsone has efficacy in many other conditions that are closely associated with neutrophils (a specific immune system cell). A special knowledge of the side effects is required to effectively use this medication in select patients who would benefit from treatment. Find an advanced dermatology medical provider with expertise in prescribing this potentially life-saving therapy today.

Anti-Malarials: available at treatments for select skin conditions for over 50 years, these wonderful and safe medications have several mechanisms thru which they act. FDA-approved for the treatment of cutaneous lupus, other off-label uses include photosensitive, inflammatory other various skin conditions. A special knowledge of the side effects is required to effectively use this medication in select patients who would benefit from treatment. Find an advanced dermatology medical provider with expertise in prescribing this potentially life-saving therapy today.

Anti-histamines: these are extremely effective for the sensation of itch, along with being 1st-line treatment for several skin conditions. Many are available over-the-counter but there remains a prescription-strength option in Atarax (hydroxyzine). This is usually started at bedtime to assess how drowsy it causes people to become, but have more efficacy than over-the-counter similar products.

Hair Growth: hair thinning or loss is a huge social problem to many people, especially on the scalp. There are a few oral treatment options available that your Advanced Dermatology provider can use to help treat this problem. Originally used as a blood pressure medication, oral minoxidil is extremely effective for growing hair on the body. However, this is not localized to any specific area of need, which is why this is not used much anymore. More common oral options include finasteride (propecia) and dutasteride (Avodart), along with lesser used options including cimetidine and ketoconazole.

Pain control: with the exception of a few rare skin conditions, most pain from the skin (including surgical procedures) can be managed with topical anesthesia (see topical pain control) in combination with over-the-counter anti-inflammatory pain control medications. The most commonly use pain-control options include acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, etc). The medications are generally safe and tolerated quite well, when required.

Sunscreen: while not recommended to replace external sun protection measures (in particular sun-safe behaviors and sunscreen), several oral products have been developed claiming to promote protection from harmful ultraviolet damage from the sun. Several products currently on the market include heliocare, fernblock, sunpill, and a different product called harmonized H2O. Despite several studies showing some mild efficacy, it is strongly recommended these not be relied upon as the sole source of sun protection in skin cancer prevention.