Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 57 Dermatologic Drugs

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Skin  Largest organ of the body  Two layers  Dermis  Epidermis

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Skin Functions  Protective barrier for the internal organs  Ability to sense changes in temperature, pressure, or pain  Regulation of body temperature  Excretion of fluid and electrolytes  Stores fat  Synthesizes vitamin D  Provides a site for drug absorption

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Types of Dermatologic Drugs  Antibacterial drugs  Antifungal drugs  Antiinflammatory drugs  Antineoplastic drugs  Antipruritic drugs (for itching)  Antiviral drugs  Drugs for treatment of burns

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Types of Dermatologic Drugs (cont’d)  Emollients (soften skin)  Keratolytics  Local anesthetics  Topical vasodilators  Debriding drugs (promote wound healing)  Sunscreens

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Dermatologic Drugs: Formulations  Aerosol foam/spray  Bar (similar to soap)  Lotion  Ointment  Powder  Many others!  Cream  Gel/jelly  Oil  Paste  Tape

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antiinfectives  Antibacterial drugs  Anti-Acne Drugs  Antifungal drugs  Antiviral drugs

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs  Used to treat:  Folliculitis  Impetigo  Furuncles  Carbuncles  Pustules  Papules  Vesicles  Cellulitis

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d)  Bacteria responsible for most common skin disorders  Streptococcus pyogenes  Staphylococcus aureus

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d)  Most common drugs  bacitracin (Baciguent)  neomycin  polymyxin B Neosporin: neomycin + polymyxin B

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d) mupirocin  New, prescription only  Used topically for Staph and Strep impetigo  Intranasal form for MRSA

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d)  silver sulfadiazine (Silvadene)  Topical antiinfective  Used to prevent or treat infection at the site of second- and third-degree burns

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d) silver sulfadiazine  Cannot be used if allergic to sulfa drugs  1% topical cream  Apply to cleansed, debrided, burned areas with sterile gloves

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acne Drugs  Acne is caused by Propionibacterium acnes  Drugs used to treat acne:  benzoyl peroxide  erythromycin  tetracycline  isotretinoin (Accutane)  clindamycin  meclocycline  retinoic acid

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acne Drugs (cont’d)  benzoyl peroxide  Causes death of the anaerobic P. acnes bacteria by slowly releasing oxygen  Antibacterial, antiseptic, drying, and keratolytic actions  Keratolytic: softens scales and loosens the outer layer of the skin  Produces improvements in 4 to 6 weeks

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acne Drugs (cont’d)  benzoyl peroxide (cont'd)  May cause peeling skin, redness, or sensation of warmth  Available in many formulations

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acne Drugs (cont’d)  clindamycin  Antibiotic  Used topically to treat acne  May cause skin reactions

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acne Drugs (cont’d)  isotretinoin (Accutane)  Oral and topical forms  Inhibits sebaceous gland activity  Pregnancy category X

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acne Drugs (cont’d)  isotretinoin (Accutane)  STRINGENT guidelines for prescribing and use  Patient counseling regarding using two forms of contraception and not becoming pregnant during use is required  “iPLEDGE”

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acne Drugs (cont’d)  tretinoin (retinoic acid, vitamin A acid)  Used to treat acne  Also used to reduce dermatologic changes associated with sun damage  Stimulates the turnover of epithelial cells, resulting in skin peeling  May result in severe irritation and skin peeling

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Fungal Infections  Difficult to eradicate  Therapy may be prolonged  Several weeks to 1 year  Topical fungal infections caused by:  Candida spp. (candidiasis)  Dermatophytes (tinea)

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antifungal Drugs  clotrimazole (Lotrimin)  Lozenge for oral candidiasis (thrush)  Vaginal form for yeast infections  Other forms used for other fungal infections  miconazole (Monistat)  Topical cream  Vaginal suppository or cream

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antiviral Drugs  acyclovir (Zovirax) and penciclovir (Denavir)  Both used to treat initial and recurrent herpes simplex infections  Do not cure viral skin infections but may reduce healing time and pain  Systemic drugs have been shown to be better for controlling viral skin conditions

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Anesthetic Drugs  Used to reduce pain or pruritus associated with:  Insect bites, sunburn, poison ivy exposure  Also used to numb the skin before a painful injection  Ointments, creams, sprays, liquids, jellies

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antipruritic Drugs  Antihistamines  Corticosteroids  Antiinflammatory effects  Antipruritic effects  Vasoconstrictor actions

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs  Antipsoriatic Drugs  tazarotene  tar-containing products  anthralin  calcipotriene

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs (cont’d)  Topical ectoparasiticidal drugs  Pediculosis (three forms)  Scabies  lindane (Kwell, Scabene)  malathion (Ovide)  crotamiton (Eurax)

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs (cont’d)  Topical hair growth drug  minoxidil (Rogaine)  Systemic hair growth drug  finasteride (Propecia)  Topical antineoplastic drug  fluorouracil (Efudex)

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs (cont’d)  Immumodulators  pimecrolimus, to treat atopic dermatitis  imiquimod, to treat actinic keratosis, basal cell carcinoma, and anogenital warts  Sunscreens

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Wound Care Drugs  Topical wound care drugs  Used to prepare wound bed for healing  Remove nonviable tissue  Antibacterial

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Wound Care Drugs (cont’d)  sodium hypochlorite (Dakin’s solution)  cadexomer iodine (Iodosorb)  collagenase (Santyl)  papain-urea (Panafil)  papain-urea and chlorophyllin (Panafil)  topical emulsion (Biafine)

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Assess for presence of contraindications, especially drug allergies  Do not apply antiinfective drugs until culture and sensitivity testing (if ordered) are completed

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Assess area affected thoroughly before applying medication  Keep in mind that systemic absorption is higher in the very young and very old because the skin may be more permeable

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  For isotretinoin (Accutane)  Strict guidelines are in place for monthly pregnancy testing and prescription renewal  Monitor liver function before and during therapy

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Follow specific manufacturer’s guidelines for administration techniques  Cleanse the area thoroughly to remove debris and residual medication—follow specific recommendations

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Wear gloves when applying drugs  Apply dressings (wet, wet-to-dry, occlusive, etc.) as ordered

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Document  Site of application  Drainage (color, amount)  Swelling, temperature  Odor, color, pain, or other sensations  Type of treatment given  Patient’s response

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Protect affected area from sunlight  Do not double up on dose if a dose is missed  Dispose of all contaminated dressings properly

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Provide patient/family teaching as necessary for self-care  Monitor for therapeutic responses  Monitor for adverse effects