Topical Therapy |
Broad-spectrum sunscreens/tinted sunscreens | DI, RE, BL, PE, SE, IN, LI | Ultraviolet light + visible light blocker | SPF > 50 applied daily | Skin irritation | None | IIB1 |
Medium to high potency topical steroids | DI, RE, BL, PE, SE, IN, LI | Anti-inflammatory | Medium potency: 0.1% mometasone furoate cream applied twice daily High potency: 0.1% betamethasone valerate ointment applied twice daily | Skin irritation, atrophy, withdrawal symptoms | None | IV2,3 |
Tacrolimus 0.03%-0.1% or 1% pimecrolimus ointment | DI, RE, BL, PE, SE, IN, LI | Anti-inflammatory | Application twice daily | Burning, pruritis, erythema | None | IIB4 |
Hydroquinone 4% cream | DI, RE, BL, PE, SE, IN, LI | Tyrosinase inhibition | Application twice daily | Contraindicated in pregnancy; skin irritation, contact dermatitis, PIH, ochronosis | None | IV5 |
Modified Kligman’s formula (Tretinoin 0.025%–0.05%, hydroquinone 4%, 0.1% dexamethasone | DI, RE, BL, PE, SE, IN, LI | Anti-inflammatory, tyrosinase inhibition, keratolytic | Application once or twice daily | Skin irritation, atrophy, PIH | None | IV6 |
Kojic acid cream | DI, RE, BL, PE, SE, IN, LI | Tyrosinase inhibition | Application twice daily | Allergic contact dermatitis, erythema | None | IV6,7 |
Systemic Therapy |
Oral corticosteroids | DI, RE, BL, PE, SE, IN, LI | Anti-inflammatory | Dexamethasone 2.5 mg 2 d per week for 12 wk IN: Deflazacort 45 mg/QD and tapering after 2 mo to 6 mg/d. | Increased appetite, mood changes, hyperglycemia, osteoporosis, withdrawal symptoms | None | IV8 |
Dapsone | DI, RE, BL, PE, SE, IN, LI | Anti-inflammatory | 100 mg daily for 4 mo | Hemolysis, GI upset, DRESS syndrome | G6PD at baseline, serial CBCs (weekly for first month, monthly thereafter), LFT 3-6 monthly | IV9 |
Isotretinoin | DI, RE, BL, PE, SE, IN, LI | Anti-inflammatory | 20 mg daily for 6-12 mo | Elevated LFTs and lipids, GI upset, teratogenicity | Serial LFTS (baseline, 2 mo), serial lipids (baseline, 2 mo), pregnancy tests in females (baseline, qm) | IIB10 |
Mycophenolate mofetil | DI, RE, BL, PE, SE, IN, LI | Anti-inflammatory | 2 g daily for 24 wk | Leukopenia, transaminitis, hyperbilirubinemia | Serial CBCs, LFTs baseline, 1 mo, every 3 mo thereafter | IIB11 |
Tranexamic acid | DI, RE, BL, PE, SE, IN, LI | Plasmin inhibitor | 250 mg daily for 4-6 mo | Contraindicated in patients ... |