Systemic Therapies in Dermatology
Editor's note: This post was written by Maggie Macy, NP, who practices dermatology and occupational healthcare at the Veterans Affairs Medical Center in Boston.
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The Dermatology Nurses' Association recently held its annual conference in Denver. A session I enjoyed attending was "Systemic Therapies in Dermatology," presented by Jarod Conley, MD, at the Nurse Practitioner Forum portion of the meeting.
Conley's talk focused on the uses and important considerations of systemic retinoids, methotrexate, biologics, antimalarials, and unique drugs such as mycophenolate, motefil, azapthiprine, dapsone and cyclosporine. It was a formidable amount of information, but the talk provided many take-home messages. Below are the key points that I took from this session.
For the retinoid class of medications, Conley provided some reassuring data on the decreased likelihood of associated risks of inflammatory bowel disease (IBD). The research cited consisted of retrospective studies that only prove associations and not causes. Additionally, only one of these retrospective studies showed a significant association of oral retinoid use and IBD. This is encouraging information because these medications have substantial impact on reducing the debilitating effects of severe acne.
For all of the drugs presented, there were some helpful details on prescribing and monitoring. For example, with methotrexate, checking albumin is critical because low albumin means more free methotrexate not bound by protein and more likelihood of methotrexate's dangerous side effects.
Conley also reported on the antimalarials. These medications, for reasons not understood, provide immune suppression by decreasing the activity of inflammatory cells. They also have significant ocular side effects, which require specific history taking and monitoring.
For the biologics, some of the mystery was taken out of long cumbersome generic names by the clear explanation of some their origins.
Many other take-home messages were offered, but they are too numerous to mention in this brief post. What an informative session!