Drug Therapy for Disorders of the Skin

LEARNING OBJECTIVES

After studying this chapter, the learner should be able to:

  1. Identify Various Skin Disorders
       - Understand the clinical features of different skin disorders, including how to differentiate between them.
       - Recognize symptoms (such as rashes or itching) and triggers (such as allergens or irritants) associated with inflammatory disorders like dermatitis, psoriasis, and urticaria.

  2. Recognize Age-Related Considerations
       - Understand how skin disorders, such as acne vulgaris, can vary in presentation and treatment needs based on age, particularly in children and teenagers.
       - Identify hormonal changes during puberty that may affect acne severity and discuss the psychological impacts (like self-esteem issues) that can arise.

  3. Identify Drug Therapy Options
       - Learn about different drug therapies (medications) used for skin disorders:      - Topical Treatments: Medications applied directly to the skin; know their mechanisms and examples (e.g., creams, gels).      - Systemic Treatments: Medications taken orally (by mouth) that affect the whole body; know in what situations these are used and their potential side effects.

  4. Describe the Prototype Retinoid Drug
       - Understand how the primary drug in the retinoid class, isotretinoin, works:      - Mechanism of Action: How it reduces oil production in the skin and helps normalize skin cell growth.      - Common Uses: Situations for which it is prescribed, especially for severe acne.      - Adverse Effects: List potential side effects like dry skin or mood changes.      - Contraindications: Situations where it should not be used, especially concerning pregnancy to avoid serious birth defects.      - Nursing Implications: Key considerations for nurses in educating patients and monitoring their health during therapy.

  5. Implement the Nursing Process
       - Use the nursing process effectively in caring for patients with skin disorders:      - Assessment: Comprehensive methods for evaluating skin conditions, including visual inspection and patient history.      - Outcomes: Setting measurable goals related to symptom improvement and patient education.      - Interventions: Personalized care strategies, including hygiene education and nutritional support.      - Evaluation: How to assess treatment success and adapt care plans as necessary.

CLINICAL APPLICATION CASE STUDY
Gerard Aylward Case Study

  • Patient Background: Gerald is a 16-year-old boy with asthma who has been receiving regular allergy shots. He now has severe acne vulgaris, which is characterized by swollen, red spots on the skin that can lead to scars.

  • Initial Treatment: He was started on tetracycline (an oral antibiotic) 500 mg taken every 12 hours.

  • Challenge: Despite this treatment, Gerard's acne did not improve significantly.

  • New Treatment Plan: The dermatologist prescribed isotretinoin 35 mg, taken twice daily for 15 weeks, needing careful observation for side effects due to the medication's potential risks during treatment.

KEY TERMS

  • Acne vulgaris: A very common condition where excess oil and dead skin clog hair follicles, leading to pimples and cysts.

  • Dermatitis: A general term for skin inflammation, commonly known as eczema, which can arise from various irritants or allergens.

  • Erythema: Redness of the skin, often due to inflammation or irritation.

  • Pruritus: The medical term for itching, which often accompanies inflammatory skin disorders.

  • Psoriasis: A chronic condition that causes rapid skin cell growth, leading to thick, red, scaly patches on the skin.

  • Rosacea: A long-lasting skin condition that results in facial redness, flushing, and occasionally acne-like bumps.

  • Tinea pedis: A fungal infection, often termed athlete’s foot, affecting the skin between the toes and on the feet.

  • Toxic epidermal necrolysis: A severe skin reaction causing extensive skin peeling and mucosal ulcers, often reaction to medications.

  • Urticaria: Also known as hives, it features raised, itchy welts on the skin due to an allergic reaction.

INTRODUCTION
This chapter provides important insights into the various skin disorders and their treatments while particularly focusing on acne vulgaris (a common condition among teenagers) and other skin issues.

DISORDERS OF THE SKIN

Classification of Dermatologic Disorders

  • Primary Disorders: These skin conditions arise directly from the skin or mucous tissues. Examples include:    - Acne: Bumps and lesions due to oil clogging pores.    - Dermatitis: Inflammation caused by allergies or irritants.

  • Secondary Disorders: These conditions are a result of a systemic disorder or the effects of drugs. Examples include:    - Drug-induced Rashes: Skin reactions to medication or diseases such as measles that present on the skin.

Inflammatory Disorders

  • Dermatitis
      - Definition: Refers to inflammation of the skin, which can occur for various reasons, such as allergies or skin irritants.
      - Common Symptoms:      - Red, itchy skin.
         - Vesicles or weeping lesions in severe cases.   - Types:     - Atopic Dermatitis: Often linked with allergies and characterized by itchy, dry patches of skin.
        - Contact Dermatitis: Skin irritation or rash resulting from contact with allergens like soaps or metals (e.g., nickel).
        - Seborrheic Dermatitis: Chronic condition often affecting areas rich in oil glands, marked by greasy scales and reddened skin.

  • Urticaria (Hives)
      - Description: Raised itchy welts on the skin, which can be triggered by allergens like certain foods or medications.

  • Psoriasis
      - Etiology: Chronic skin condition resulting from abnormal immune function that leads to rapid skin cell growth and thickened areas of red, flaky skin.

  • Rosacea
      - Characteristics: Most common in adults, typically around the face, leading to flushing, redness, and occasionally spots resembling acne.

TOXIC EPIDERMAL NECROLYSIS AND STEVENS-JOHNSON SYNDROME

  • Toxic Epidermal Necrolysis: A severe skin condition where major areas of skin slough off, presenting serious health risks and often requiring hospitalization.

  • Stevens-Johnson Syndrome: Characterized by painful blisters that develop over the skin and mucous membranes due to severe reactions to medications; requires immediate medical intervention.

DERMATOLOGIC INFECTIONS

Bacterial Infections

  • Common Pathogens: Usually caused by bacteria like Streptococcus and Staphylococcus.

  • Types of Infections:    - Cellulitis: Skin infection that appears as red, swollen areas leading to fever if systemic; needs antibiotics.
       - Folliculitis: Infection of hair follicles that can cause red bumps or pus-filled pockets.    - Impetigo: Contagious skin infection leading to sores and crusts; commonly treated with topical antibiotics.

Fungal Infections

  • Commonly Caused By: Yeasts like Candida yielding conditions like oral thrush, and dermatophyte infections such as tinea pedis (athlete's foot).
       

Viral Infections

  • Includes common conditions like herpes simplex (cold sores) and varicella (chickenpox), each requiring specific treatment management.

TRAUMA AND ULCERATIONS

  • Trauma: Physical damage to the skin can lead to infections, particularly when the skin barrier is broken.

  • Ulcerations: Open sores that can result from poor blood flow, commonly seen in bedridden or elderly individuals.

ACNE VULGARIS

  • Etiology: A common skin issue among adolescents characterized by overproduction of oil by sebaceous glands, leading to clogged pores and pimples.

  • Pathogenesis (Process):    1. Hormonal stimulation (especially during puberty) causes sebaceous glands to produce more oil.
       2. Skin cells may die off and clog the hair follicles (holes that house hair).
       3. Bacteria (P. acnes) that normally live on the skin can grow in these clogged follicles, resulting in inflammation and redness.

  • Common Sites: Frequently affects the face, chest, and back.

  • Risk Factors: Hormonal changes, certain medications, stress levels, and family history of acne conditions.

DRUG THERAPY

General Considerations

  • The main goals of drug therapy are symptom relief, clear existing lesions, and prevent future occurrences.

Topical Antimicrobials

  • Examples: These include benzoyl peroxide or topical antibiotics like clindamycin. They are often used directly on the affected area of the skin.

Systemic Antibiotics

  • Used For: Moderate to severe acne to address inflammation and bacterial issues. Common examples include tetracycline, doxycycline, and azithromycin.

Retinoids

  • Isotretinoin: This is a powerful oral medication used for severe acne.
      - How It Works: Reduces oil production in the skin and prevents clogged pores.
       - Adverse Effects: Patients need to be monitored for dry skin, elevated blood lipids (fats), and any mood changes.   - Contraindications: Not to be used in pregnant women due to the risk of serious birth defects.
      - Nursing Duties: Nurses must examine and educate patients regarding the medication's use, potential side effects, and need for routine blood tests to monitor liver function and lipid levels.

NURSING PROCESS

Assessment

  • Nurses should conduct a thorough assessment: visually inspect the skin, obtain a detailed patient history, and learn about any underlying conditions or lifestyle factors that may worsen skin issues.

Outcomes

  • Goals should be set, such as successfully managing symptoms, adhering to treatment plans, and enhancing patient understanding regarding skincare.

Interventions

  • Nursing actions may include advice on maintaining good hygiene, dietary recommendations, and providing strategies to avoid known skin irritants or allergens.

Evaluation

  • Continuous monitoring of symptoms is crucial. The effectiveness of treatments should be evaluated regularly, and care plans adapted as required based on the patient's progress and feedback.