New drugs are available for managing several common skin disorders. For psoriasis, topical corticosteroids remain the first-line therapy, but topical vitamin D3 analogs, such as calcipotriene, now have a role. They are as effective as medium-potency topical steroids but without steroid side effects, though they can induce hypercalcemia if the dose exceeds 100 g/week. For more severe cases, methotrexate has been widely used, but other drugs now also are prescribed. They include calcineurin inhibitors, such as cyclosporine, and more recently, biologic agents, such as tumor necrosis factor inhibitors. For children and pregnant women, in whom the previously discussed drugs are not appropriate, narrowband UV-B light often is the first-line treatment. For eczema, patients requiring steroid-sparing topical drugs can be treated with calcineurin inhibitors (ie, pimecrolimus or tacrolimus); between the 2, tacrolimus is the first choice for adults and children older than 2 years. When systemic management is needed, oral calcineurin inhibitors (eg, cyclosporine) are appropriate, though oral steroids often are needed for severe cases. The need for systemic management can sometimes be delayed with use of diluted bleach baths. For acne vulgaris, standard treatments with topical benzoyl peroxide and topical or systemic antibiotics are used widely, as are oral contraceptives, but oral isotretinoin is the most effective treatment.
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