N305 - Chapter 49 Drugs for Skin Disorders

Name examples of infectious skin disorders.

• Bacterial, fungal, parasitic, and viral

Name examples for causes of inflammatory skin disorders

• Injury from sun

• Hormonal (acne)

• Dermatitis

• Psoriasis

Causes for neoplastic (abnormal growth of tissue) skin disorders:

• Skin cancers

• Benign neoplasms

How do bacterial skin infections occur? How are they typically treated?

Typically when there is a break in the skin/skin’s defenses.

They can usually be treated with topical antibiotics; for more severe infections that spread systematically, other antibiotics may be necessary.

What are common types and treatments of fungal skin infections?

Fungal infections usually occur in warm, most areas of skin.

• Fungal infections of surface skin can be treated with a topical antifungal

• Fungal infections that occur in skin and mucous membranes of immunocompromised individuals require systematic antifungal treatment.

What are treatments for viral infections?

• Topical antivirals

• Oral antiviral therapy like acyclovin (Zovirax)

What are examples of viral infections in children?

• Varicella (chickenpox)

• Rubeola (measles)

• Rubella (German measles)

What are examples of viral infections in adults?

• Herpes zoster (shingles)

• Herpes simplex (cold sores and genital lesions)

How do skin mites (scabies) infect the human body? What are common body sites affected?

Female mite burrows into skin and lays eggs → itching & inflammation

• Fingers, trunk, extremities, axillary & gluteal folds, pubic region

What is the treatment for skin mites?

Scabicides are used to kill skin mites.

• Permethrin (common medication)

How do skin parasite such as lice (pediculus) infect the body? How is it spread?

Lice infect areas with hair, laying eggs and leaving debris called “nits” → intense itching.

• Transmitted through clothing or personal contact

How are skin mites spread?

Spreads upon contact with upholstery & linens.

What is a common treatment for pediculus?

Pediculicides (kill lice)

• Permethrin (Nix)

How does scabicides and pediculicides work?

Kills head/crab lice and mites and eradicates their ova (reproductive cell).

How should permethrin be used for mites vs lice?

• 1% cream approved for lice

• 5% cream approved for mites

What are side effects of permethrin?

• Few systematic effects

• POSSIBLE local effects:

  • Puritis (itching)

  • Rash

  • Transient tingling

  • Burning

  • Stinging

  • Erythema

  • Edema

How should permethrin be used for hair & scalp?

Applied all over scalp and hair and rinsed out 10 minutes later.

How should permethrin be used for mites?

Applied all over skin, including skin folds and fingernails, washing off after 8-14 hours.

What are administrative alerts for permethrin?

• Do not use on premature infants or children younger than 2

• Do not use on areas of skin that have abrasions, rash, or inflammation

• Category B for pregnancy

What is acne vulgaris?

A disorder of hair and sebaceous glands (very common).

What is Seborrhea?

An overproduction of sebum by oil (sebaceous) glands.

What are pharmacologic interventions of acne vulgaris?

• OTC benzoyl peroxide treatments

• Antibiotics in combination with acne medication

• Oral contraceptives containing ethinyl estradiol (estrogen) and norgestimate (progestin)

What is rosacea?

A progressive disorder causing…

• Small papules w/out puss

• Flushed face around nose and cheeks

• Swelling of soft tissues of the nose (rhinophyma)

Onset: between 30-50 years old, more common in women

What can exacerbate rosacea?

• Sunlight, stress, and increased temperature

• Agents that dilate blood vessels

What is the mechanism of action of the retinoid tretinoin (cream)?

Decreases comedone formation and increase extrusion of comedones.

Define comedone:

Non-inflammatory acne lesions caused by clogged pores filled with oil, dead skin cells, and bacteria.

• Blackheads (open comedones)

• Whiteheads (closed comedones)

What is the indication of tretinoin?

• Used for treating early and control (mild to moderate) acne vulgaris

• Has antineoplastic properties (anti-cancerous) → oral form can be used to treat skin malignancies

What are the adverse effects of tretinoin?

In high doses:

• Bone pain

• Fever

• Headache

• Nausea & vomiting

• Rash & pruritus (itching)

What is the therapeutic timeline for acne when treated with tretinoin?

Acne symptoms may improve within 4-8 weeks; full therapeutic benefits may take 5-6 months.

What are administrative alerts for tretinoin?

• Pregnancy category C (topical) and category D (oral)

• Excessive dry skin can be caused with use of other OTC acne medications

• Contain fish products (contraindicated for those with fish allergies)

• Avoid direct UV exposure

What is the most common adverse effect of tretinoin?

Skin irritation: erythema, itching, scaling, crusting, and peeling of skin are common side effects.

What are nursing considerations for acne related drug therapy?

• Monitor skin for excessive dryness and irritation

• Monitor pts. taking isotretinoin for emotional/mood changes

• Monitor CBC, lipid levels, & liver function for pts. taking PO med

• Monitor for vision changes

What is isotretinoin?

Isotretinoin or Accutane is an intense drug therapy to treat acne.

• Contraindicated in pts. with a history of SI or depression and pregnant/lactating individuals

What is dermatitis?

An inflammatory skin disorder causing pain, erythema, and pruritus.

What is atopic dermatitis?

Eczema → chronic; due to genetic predisposition

What is contact dermatitis?

A hypersensitivity response.

What is seborrheic dermatitis?

Seen in newborns and teenagers after puberty.

What is stasis dermatitis?

A sign of poor venous circulation.

What is pharmacotherapy for dermatitis? What are adverse effects?

Topical glucocorticoids are most effective treatment.

• Used to relieve itching and local inflammation

• Adverse effects with long-term use include: itching, redness, thinning of skin

What is psoriasis? What are the symptoms and etiology?

Psoriasis: chronic skin disorder manifesting in red patches of skin covered in flaky scales (plaques)

Etiology: may be genetic immune reaction

• Causes extremely fast skin turnover

• Underlying skin is inflamed & irritated

What is the goal in pharmacotherapy for psoriasis?

Reduce inflammation, plaques, and scales to improve appearance. There is no pharmacologic cure for psoriasis.

What are the different kinds of topical treatments for psoriasis?

• Topical corticosteroids

• Topical immunomodulators (TIMS: suppress immune system)

• Retinoid-like compounds

What are the different kinds of systematic treatments for psoriasis?

• Methotrexate (Trexall, others)

• Cyclosporine (Sandimmune, Neoral) → immunosuppressive agent, for severe conditions

• Biologic therapies

What are risk factors and dangers for sunburn and sun exposure?

Risk factors:

• Light-skin complexion

• Lack of UV protection

Dangers:

• Skin cancer

• Cateracts

• Eye injury

How do chemical sunscreens work?

Absorb the spectrum of UV light

How do physical sunscreens work? List examples.

They work by reflecting or scattering light; prevents penetration of both UVA and UVB rays.

• Zinc oxide

• Talc

• Titanium dioxide