Pharmacotherapy - Dermatology II Wounds, Burns, Sunburns

Key vocabulary terms and definitions covering wound care, burn management, and sun protection from the lecture notes. Topics include wound care basics, wound classification and exclusions, dressings, burns and their treatment, pharmacologic options, sunscreen ingredients, SPF, UV risk factors, sun protection strategies, and regulatory considerations.

Wound irrigants

Solutions used to clean surface wounds with dirt or debris; options include cool clean tap water or normal saline; saline irrigation products do not have a demonstrated advantage over tap water.

First aid antiseptics

Antiseptics applied to intact skin up to the wound edge to reduce bacterial load; examples include ethyl alcohol, isopropyl alcohol, povidone-iodine, iodine tincture, hydrogen peroxide, chlorhexidine; should dry before dressing; alcohols can dry skin; not all are ideal for large wounds.

Chlorhexidine

Preferred topical antiseptic agent due to broad spectrum; may cause severe allergic reactions in some individuals; not always suitable for all wounds.

Povidone-iodine (complex)

Iodine-based antiseptic used for wounds; may stain skin and is generally a second-line option; avoid on very large wounds.

Hydrogen peroxide (0.13%)

Topical antiseptic with limited bactericidal activity and potential tissue toxicity; not favored for routine wound cleansing.

Iodine tincture / iodine topical solution

Iodine-based antiseptics used for wound cleansing; may stain skin; used cautiously and not on large wounds.

Antimicrobial creams/ointments (Neosporin, SSD)

Topical antibiotics (e.g., bacitracin, polymyxin B, neomycin) sometimes with pramoxine; efficacy unclear and allergy dermatitis (especially to bacitracin/neomycin) can occur.

Gauze dressings

Inexpensive and absorbent; nonocclusive and adaptable but may require a moist environment, can cause pain on removal, and often needs a secondary dressing.

Adhesive bandages

Convenient, affordable dressings; may not maintain a moist wound environment; removal can cause bleeding or pain; may require frequent changes.

Hydrocolloid dressings

Dressings that maintain a moist environment; long wear time; impermeable to fluids and bacteria; not ideal if wound is infected; higher cost.

Transparent adhesive films

Semi-occlusive, gas-permeable dressings that maintain a moist environment; not absorptive; can reinjure wound on removal; often costlier.

Liquid adhesive bandages

Flexible, cosmetically appealing dressings with some antimicrobial/antiseptic properties; may cause burning when applied; suitable for simple cuts/lacerations.

Moist wound healing environment

Maintaining moisture at the wound site helps reduce scarring and infection risk and promotes healing; guides dressing choice.

Minimizing scarring (silicone therapy)

Silicone sheets and gels are considered a gold standard for reducing scarring; applied after healing; benefits include durability and ease of use; may be difficult on large areas.

Abrasions

Wounds that involve only the epidermal skin layer, usually from rubbing or friction.

Punctures

Wounds where a sharp object pierces the epidermis and enters the dermis or deeper tissues.

Lacerations

Cuts caused by sharp objects that penetrate multiple layers of skin.

Self-care exclusions for wounds

Wounds/conditions needing medical care: bleeding that persists after 10 minutes of pressure; cuts >½ inch; bites or wounds with foreign matter after irrigation; infection signs; wounds on face, hands, feet, major joints, genitalia; chronic non-healing wounds; conditions affecting healing (e.g., diabetes); suspected non-accidental injury.

General wound treatment steps

Cleanse the wound; apply moist wound care; relieve pain; use appropriate dressings; consider additional pharmacologic options as needed (often discussed under burns separately).

Wound cleansing products vs antiseptics

Cleansing products (irrigants) remove debris; antiseptics kill or inhibit microorganisms; use depends on wound status and location.

Types of burns (overview)

Thermal (heat), electrical, chemical, and UVR exposure burns.

Burn classifications (replacing old degrees)

Superficial, superficial partial-thickness, deep partial-thickness, and full-thickness burns; correlate with depth, healing, and need for care; superficial may self-care.

Self-care exclusions for minor burns

Exclude self-care for deep partial-thickness or full-thickness burns, burns >3 inches, chemical/electrical/inhalation burns, signs of infection, wounds that worsen or fail to heal in 7 days, burns around critical areas (face, hands, feet, joints, genitals, perineum).

Non-pharmacologic burn care

Do not use ice; use cool water; avoid neutralizing chemicals; irrigate chemical burns; eye irrigation with plain tap water for 15–30 minutes; cool compresses for sunburns.

After a burn: wound care principles

Cool the burn, then use a water-based disinfectant; apply hypoallergenic dressing; do not remove intact skin; if weeping, soak in cool tap water 3–6 times daily.

Skin protectants (burns/wounds)

Agents such as allantoin, cocoa butter, petrolatum, shark liver oil, white petrolatum; vitamins A & D may be used; provide barrier and reduce drying; symptomatic relief.

Systemic analgesics for burns

NSAIDs preferred for pain and inflammation; acetaminophen (APAP) for pain; NSAIDs help reduce erythema and edema; use as directed.

Topical anesthetics for burns

Benzocaine (5–20%), lidocaine (0.5–4%), etc.; provide short-term pain relief (15–45 minutes); risk of toxicity if misused; use with caution.

Antimicrobial use in burns

SSD historically used but less effective now; Neosporin contains bacitracin, polymyxin B, neomycin; products may include pramoxine; efficacy varies; monitor for allergies.

Counterirritants

Menthol and camphor; not recommended for wounds/burns due to irritation potential.

Hydration & vitamins in wound healing

Vitamins A and C support wound healing; B vitamins if deficient; excessive vitamin E may delay healing; routine supplementation not necessary if not deficient.

Selecting burn products (topical)**

Ointments provide moisture protection; creams/emulsions for non-intact skin; aerosols require distance and technique; consider patient needs and skin condition.

Complementary therapies (burns/wounds)

Aloe vera, Calendula, Arnica montana, honey show potential benefits; evidence varies; avoid if allergic to related plants; honey shows promise in some wound care products.

Sunscreen purpose and usage

Used to prevent UVR damage; apply to prevent sunburn and photoaging; select appropriate SPF and type; reapply as recommended.

UVR bands (UVA, UVB, UVC)

UVC largely blocked by the atmosphere; UVB causes sunburn and vitamin D synthesis; UVA penetrates deeply, contributes to aging and skin damage.

UV Index

EPA-developed scale 1–11+ indicating daily risk of UV exposure; categories: low, moderate, high, very high, extreme.

UV risk factors

Fair skin; history of blistering sunburns; red/blonde hair; blue/green eyes; freckles; large/many moles; personal or family history of skin cancer; immunosuppression; high lifetime UV exposure.

ABCDE criteria for melanoma

A: Asymmetry; B: Border irregularity; C: Color variation; D: Diameter >6 mm; E: Evolution/elevated changes.

Physical sunscreen ingredients

Zinc oxide and titanium dioxide; reflect and scatter UVR; generally well tolerated but can cause miliaria or folliculitis; considered broad spectrum.

Chemical sunscreen ingredients

Filters such as avobenzone, octocrylene, oxybenzone, octisalate, octinoxate, and others; absorb UVR; coverage varies across UVA/UVB wavelengths.

PABA and derivatives

Aminobenzoic acid (PABA) historically used; not widely used now due to safety concerns; derivatives like padimate O may cause staining; less staining than PABA.

Oxybenzone and environmental concerns

Common chemical UV filters with potential allergenicity; associated with coral reef/environment concerns leading to bans in some areas.

Sunscreen application guidelines

Apply about 1 ounce to full body; 15–30 minutes before sun exposure; reapply every 2 hours or after swimming/sweating/towel-drying; spray sunscreens should be rubbed in.

Water resistance definitions

Water resistant: SPF maintained after 40 minutes in water; very water resistant: SPF maintained after 80 minutes in water.

Special populations for sunscreen

Sunscreens recommended for those over 6 months old; pregnancy/lactation guidance favors physical sunscreens due to absorption concerns; consult for individual situations.

Choosing sunscreen formulations

Consider risk factors, lifestyle, and preferences; options include sprays (easy for kids), tinted formulas, noncomedogenic, fragrance-free, hypoallergenic; the best sunscreen is the one used correctly.

Sunscreen labeling / regulation (FDA context)

Regulatory changes emphasize broad spectrum coverage, SPF testing, and labeling; some combinations with insect repellent may not be GRASE; ongoing updates to rules.