Transient Acantholytic Dermatosis Medication

Updated: Jun 07, 2018
  • Author: Edward J Zabawski, Jr, DO; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Fluocinonide gel 0.05% should be applied twice a day. Never apply to the face, the axillae, or the genital areas. Desoximetasone may be used in place of fluocinonide. High potency (class I) topical steroids, such as Temovate or Diprolene, are limited to 2 weeks' use. They can cause atrophy if used longer and, therefore, should be avoided.

Hydroxyzine 10-30 mg can be used every 6 hours as needed for itching. As a substitute, Benadryl 25-50 mg may be used every 6 hours as needed. Both may cause drowsiness.

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Retinoid-like Agents

Class Summary

These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes, and they may reduce the potential for malignant degeneration. They also affect keratinocyte differentiation.

Isotretinoin (Amnesteem, Claravis, Myorisan, Sotret)

Isotretinoin is a synthetic 13-cis isomer of the naturally occurring tretinoin (trans- retinoic acid). Both agents are structurally related to vitamin A.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Prednisone

Prednisone is an immunosuppressant used for the treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Antineoplastics, Antimetabolite

Class Summary

These agents regulate cell growth and differentiation.

Methotrexate (Trexall, Rheumatrex)

Methotrexate is an antimetabolite that inhibits DNA synthesis and cell reproduction in malignant cells. It has an unknown mechanism of action in the treatment of inflammatory reactions; it may affect immune function. Methotrexate ameliorates symptoms of inflammation (eg, pain, swelling, stiffness).

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Vitamins

Class Summary

Vitamins are are used to meet necessary dietary requirements and are used in metabolic pathways, as well as DNA and protein synthesis.

Vitamin A (Aquasol A, A-Natural-25, A-25)

Vitamin A is a cofactor in many biochemical processes. For refractory disease, vitamin A may be administered at 50,000 U 3 times a day for 2 weeks then daily for up to 12 weeks.

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