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Chapter 22

Drugs for Skin Conditions

Learning Objectives

Describing how topical medications are absorbed into the skin. Explaining why topical medications may have systemic effects. Discussing various classes of medications used to treat dermatologic conditions.

Learning Objectives (cont’d.)

Describing general properties of dermatologic preparations, both legend and over-the- counter (OTC), and their indications. Defining and naming typical topical keratolytics, acne preparations, ecotoparasiticidal agents, and agents for alopecia. Providing patient education for compliance with medications used to treat diseases and conditions of the skin.

Common Symptoms of Skin Disorders

 dermatologic lesions or eruptions  edema  pruritus, hives  Discomfort  inflammation  erythema

Allergic dermatitis resulting from contact with poison ivy. From Goldstein BJ, Goldstein AO (1997): Practical dermatology (2nd ed.). St. Louis: Mosby.

Skin Disorder Medications Common Side Effects burning pruritus skin dryness rashes thinning of skin irritation

Functions of the Skin

protect deeper tissues regulate body temperature form picture of environment through nerve endings excrete minerals and water absorb substances

Structure of the Skin

Figure 22-1 Structure of the skin. Medications are absorbed through the epidermis to the dermis and then absorbed into the bloodstream, as well as for local response to pain by nerve fibers. (From Young AP, Proctor DB: Kinn’s the Medical Assistant: an applied learning approach, ed 11, St Louis, 2011, Saunders.)

Dermatologic Preparations and Absorption available in many forms form selected depends on desired therapeutic effect to be effective, must be absorbed into skin skin must be clean and dry for optimal absorption Factors affecting absorption:  form of drug  hydration  size of the molecule  dressings  base of medication  thickness of skin

Types of Preparations for the Skin

 Baths—cleanse skin, lower body temperature, dry out skin  Soaps—antiseptic, made from different oils, but dry out skin, must be rinsed off  Skin cleansers—free from soap, less irritating, may contain emollients  Emollients—fatty or oily substances that smooth, soften irritated skin  Lotions—insoluble powder, suspension  Liniments and rubs—apply to intact skin for sore muscles, tend to produce external heat

Types of Preparations for the Skin

 Skin preparations used daily: soaps, disinfectants, baths, lotions, sunscreens  Soaps and baths are drying to the skin.  Skin protectants: used to protect the skin around pressure ulcers or ostomies to prevent further trauma  Rubs and liniments produce heat. External heat should never be applied to skin after a liniment or rub has been applied because of the chance of burning skin.

Various Skin Lesions

Figure 22-2 Characteristics of skin lesions. (From Young AP, Proctor DB: Kinn’s the Medical Assistant: an applied learning approach, ed 11, St Louis, 2011, Saunders.)

Various Skin Lesions

Figure 22-2 Characteristics of skin lesions. (From Young AP, Proctor DB: Kinn’s the Medical Assistant: an applied learning approach, ed 11, St Louis, 2011, Saunders.)

Various Skin Lesions

Figure 22-2 Characteristics of skin lesions. (From Young AP, Proctor DB: Kinn’s the Medical Assistant: an applied learning approach, ed 11, St Louis, 2011, Saunders.)

Class Activity: Quick Quiz

1. How are dermatologic preparations absorbed into the skin? 2. What factors affect absorption?

Antiinfective and Antiinflammatory Topicals Streptococcus pyrogenes and Staphylococcus aureus most common organisms found in skin infections; cause impetigo, furuncles, carbuncles Always perform culture and sensitivity testing in patients with skin infections before applying antiinfective medications.

Antiinfective and Antiinflammatory Topicals

Antiinfective and Antiinflammatory Topicals Antivirals Apply several times daily to herpes lesions. Use gloves or other protective equipment to prevent spread of viral infection. Avoid contact with eyes.  ointments (Zovirax, Denavir, Vira-A)  solutions (Herplex)  gels (HESper-L)  cream (Abreva)

Antiinfective and Antiinflammatory Topicals

Antiinfective and Antiinflammatory Topicals Topical Corticosteroids relieve inflammation and pruritus of:  contact dermatitis, insect bites, minor burns, seborrheic dermatitis, psoriasis, eczema creams, ointments, lotions, gels; gels better for hairy areas but irritate mucous membranes vehicle or inactive agent carries active ingredient; may be emollient or drying agent absorption high with thin skin, poor with thick skin Glucocorticosteroids can cause atrophy of dermis and epidermis with prolonged use.

Antiinfective and Antiinflammatory Topicals

Antiinfective and Antiinflammatory Topicals Topical Antifungal Medications treat fungal infection of hair, nails, skin Fungal infections thrive on feet, in axilla, perineal areas, under breasts. treat candida, tinea infections sprays, lotions, creams, ointments, powders some products combined with corticosteroids

Antiinfective and Antiinflammatory Topicals

Class Activity: Quick Quiz

1. Topical antivirals are used for what skin disorders? 2. Why does it take so long for antifungals to be effective?

Acne Vulgaris

 Caused by increased  Many acne preparations sebum and keratin on contain benzoyl peroxide face, chest, back, neck  Some medications cause skin  Appears as papules, irritation followed by peeling. pustules, comedones.

Moderate acne. From White GM (1994): Color atlas of regional dermatology. London: Times Mirror International Publishers.

Selected Acne Preparations

Acne Preparations

Keep topical treatments away from eyes, mouth, mucous membranes. Expect skin dryness and peeling; discontinue if rash or irritation occurs. Use water-based cosmetics. Do not counter-treat desired dryness of these preparations with emollients. Do not use vitamin A preparations during pregnancy.

Acne Preparations

Wait 1 hour after applying erythromycin before applying any other topical medications or cosmetics. Do not use vitamin A preparations during pregnancy. Wait 1 hour after applying topical erythromycin before applying any other topical medications or cosmetics. Topical tetracyclines may turn skin yellow or stain fabrics.

Acne Preparations

Tretinoin users are susceptible to sunburn; wear sunscreen. Wash and dry skin 15 to 30 minutes before applying tretinoin. Remove cosmetics before using Renova. Might need up to 6 months of treatment.

Keratolytic Agents promote shedding of horny layer of skin; soften scales effects: light skin peeling to extensive desquamation drugs of choice—salicylic acid, resorcinol, sulfur treat dandruff, seborrheic dermatitis, acne, psoriasis, warts, corns to enhance medication effect, soak area in warm water 5 minutes before application

Keratolytic Agents

Treatments for Seborrheic Dermatitis inflammation and scaling of the face or scalp OTC—Selsun Blue, Head and Shoulders prescription—Selsun 2%, Exsel may cause skin irritation, alopecia, hair discoloration

Topical Anesthesia and Antipruritics itching of skin, mucous membranes topical anesthetics—benzocaine, lidocaine calamine lotions, cornstarch, oatmeal baths Do not use Caladryl lotion (calamine and Benadryl) to treat chickenpox.

Topical Anesthesia and Antipruritics

Topical Treatment of Burns and Chronic Wounds depends on burn type, depth, amount of body burned sulfonamides, Silvadene, Sulfamylon to treat second- and third-degree burns ensure patient is not allergic to sulfa or silver clean and debride burns before applying sulfonamides

Topical Treatment of Burns and Chronic Wounds

Prophylactic Agents

topical agents include sunscreens, tissue protectants sunscreens measured by SPF

Medications for Scabies and Pediculosis Scabies Small parasites bore into horny layer of skin. Blisters appear between fingers, spread around wrist, elbows, buttocks. Apply Lindane lotion to entire body; leave on for 8 hours. Treat clothing and bed linens at same time skin is treated.

Scabies

From Weston WL, Lane AT, Morrelli JG (2002): Color textbook of pediatric dermatology (3rd ed.). St. Louis: Mosby.

Medications for Scabies and Pediculosis Pediculosis May infest head/pubic hair, waist, collar, axillary areas. Apply topical creams, lotions, shampoos to affected areas. Comb eggs (nits) from hair shaft to prevent reinfestation. Treat all clothing, bedding, personal items. Repeated applications may cause nervous system toxicity, especially in children.

Pediculosis

Microscopic view of a nit. From Zitelli BJ, Davis HW (2002): Atlas of pediatric physical diagnosis (4th ed). St. Louis: Mosby.

Medications for Scabies and Pediculosis

Treatment of Scabies and Lice – Patient Education Treatments not meant for face (unless specifically ordered by physician). Wear gloves for application. Do not use conditioners with lice medications. Treat household and sexual contacts concurrently. Avoid open flames, hairdryers, and smoking.