Transcript Agents Used in the Treatment of Skin Disorders

Chapter 42
Agents Used in the Treatment of
Skin Conditions
The Skin
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The largest organ
Several functions
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Protective barrier—microbials and trauma
Senses temperature changes
Secretes wastes through sweat glands
Stores fat
Synthesizes vitamin D
Provides a site for drug absorption
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Epidermis
 Outer
layer
 Thickness is variable
 Basal layer is where new cells
are formed
 Old cells migrate to surface
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Epidermis
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Prickle layer
Protein projections connect adjacent
cells
Cells become flat and press together
Compressed cells become the keratin
layer
Keratin layer is the protective barrier
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Dermis
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Thicker than the epidermis
Provides support and nourishment for
the epidermis
Rich supply of blood vessels, nerves,
sweat glands, and hair follicles
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Structures of The Skin
Hair and nail tissue
 Eccrine and apocrine sweat glands
 Sweat contains water and waste
products
 Eccrine glands are located
throughout the body
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Skin structures
 Apocrine
glands are associated
with a hair follicle – mainly in
axillary and pubic areas
 Emotional stimuli causes
excretion of electrolyte solution
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Skin Structures
Sebaceous glands – connected to
hair follicles
 Large numbers on head and face
 At puberty, secretes oily mixture
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Drug Classification of
Dermatological Agents
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Emollients
Keratolytics
Local anesthetic agents
Local antipruritic agents
Antibacterial agents
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Emollients
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Dry skin causes discomfort, itching,
cracking, and predisposition to skin
disorders
Treatment is use of emollients
Oily in nature: some skin lotions are
emollients
Prevents loss of additional skin
moisture
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Emollients
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Forms occlusive barrier
Most contain waxes, fats, and/or oils
Most effective when applied after
shower or bath
Do not use on skin lesions that are
moist or exudative
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Keratolytics
Some disorders cause a thickening
of the keratin layer
 Skin becomes brittle and easily
cracked
 Causes itching and discomfort
 Salicylic acid, lactic acid, and
acetic acid
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Keratolytics
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Applied after area has been bathed or
soaked
More effective if covered with occlusive
dressing
Kept on skin overnight; removed in
morning
Repeated applications are effective
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Local Anesthetics and Antipruritic
Agents
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Inhibits conduction of nerve impulses from
sensory nerves
Reduces pain and itching
Used topically for insect bites, burns, and plant
allergies
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Local Anesthetics and
Antipruritic Agents
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Poorly absorbed through intact skin
Enhanced through damaged skin
Local or systemic adverse effects
Allergic reaction (locally or
systemically)
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Local Anesthetics and Antipruritic
Agents
Topical anesthetics should only be
used when absolutely necessary
 Avoid in patients with previous
hypersensitivity reactions
 Avoid in severely traumatized skin
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Local Anesthetics and
Antipruritic Agents
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‘caine’ types
Ointment, cream, spray, liquid or gel
forms
Some antipruritic products contain
antihistamines
Can be associated with development of
local irritation and hypersensitivity
reactions
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Antibacterial Agents
Prevents infection
 Treats superficial infections
 Treat acne vulgaris
 Associated with development of
hypersensitivity
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Antibacterial Agents
Topical antibiotic agents are not
usually ones that are used
systemically
 Combination therapy is popular
 Caution when applying to large
areas
 Systemic effects may be possible
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Drug Classification of
Dermatological Agents
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Antiviral agents
Antifungal agents
Anti-inflammatory agents
Antiparasiticidal agents
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Antifungal Agents
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Treats two types of fungal infections
Dermatophyte organisms
Yeastlike organisms
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Dermatophyte Infections
 Caused
 Most
by tinea or others
common is ringworm type
 Circular
pattern
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Dermatophyte infections
 Scalp,
nails, and/or skin
 Always superficial
 May be known as ‘athlete’s
foot’ or ‘jock itch’
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Dermatophyte Infections
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live only on dead keratin
tissue
 Affected area must be replaced
with fungus-free tissue
 Agents must be continued longterm
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Dermatophyte Infections
 Relapses
common
 Ointment,
cream, aerosol,
lotion, and powder forms
 If
burning or irritation develops,
discontinue use
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Dermatophyte Infections
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Oral treatment may be effective
Deposits in newly formed skin cells
When new cells reach keratin layer, they
are resistant to fungus
Best absorbed with or after a fatty meal
Monitor for hypersensitivity
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Yeastlike Infections
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Involves warm, moist areas and mucous
membranes
Moisture promotes yeast growth
Ventilation of area is important
Treatment should be continued for 1
week following lesion disappearance
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Antiviral Agents
 Most
difficult to treat
 Herpes simplex 1 and 2
 Topical agents - cannot
completely eradicate
 Decreases healing time and
pain
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Antiviral agents
Topical, oral, or parenteral forms
 Topical form can cause burning,
stinging, itching, or rash
 Caution in patients with renal
impairment
 Monitor for hypersensitivity
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Anti-Inflammatory Agents
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Topically applied corticosteroids
Alleviates inflammatory symptoms
Irritation or allergic disorders
Useful in controlling psoriasis
Interferes with normal immunological
responses
Reduces redness, itching, and edema
Slows rate of skin cell production
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Anti-Inflammatory Agents
Effectiveness depends on potency
of drug, vehicle used, skin
thickness and integrity, and
presence of moisture
 Damaged skin may increase
amount of drug absorbed
systemically
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Anti-Inflammatory Agents
Increases systemic side effects
 Occlusive dressings increase
absorption
 Potent agents must be used with
caution on thin skin
 Do not use in the presence of
fungal infection
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Antiparasitic Agents
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Parasites live on outer surfaces
Lice and scabies
Lice is transmitted person to person
Lives on head, body, or pubic area
Scabies is a mite; burrows under the skin and lays
eggs
Drug of choice is lindane
Do not use in children under 2
Can cause seizures if applied to open skin
CNS toxicity
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Additional Dermatologic Agents
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Debriding agents
Antineoplastic agents
Burn treatment agents
Eczema agents
Psoriasis agents
Topical hair agents
Agents for diabetic foot ulcer
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Diabetic Foot Ulcers
Leading cause of amputations
 Microvascular and neurological
changes due to long-term elevated
blood sugar levels
 Increases migration of cells
responsible for wound healing to
site of ulcer
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Diabetic Foot Ulcers
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Needs adequate blood supply
Gel form helpful for protecting healing
wounds
Long-term therapy required – Regranex
promotes healing
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Antineoplastic Agents
Destroys cells that grow rapidly
 Topical treatment of solar or actinic
keratosis
 Premalignant skin lesions
 Develops in fair skinned people
exposed to heavy sunlight
 Also used to treat basal cell
carcinomas
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Antineoplastic Agents
Use nonmetallic applicators
 Protect skin with rubber gloves
 Wash hands immediately
 Avoid contact with eyes, nose, or
mouth
 Avoid exposure to sunlight
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Agents Used to Treat Burns
Treatment aimed at preventing
infection
 Important to prevent toxic
absorption into systemic circulation
 Blood supply is impaired
 Topical products may be only way
to prevent infection
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Agents used to treat burns
Occludes site to prevent
contamination
 Applied to burn after cleaning and
debriding
 Therapy continued until healing
well or ready for grafts
 Monitor for hypersensitivity and
adverse effects
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Minoxidil
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Systemically used as an antihypertensive
Topically promotes hair growth
Dilates local blood vessels
Long-term use
Caution with patients with heart disease
May cause tachycardia, fluid retention, and/or
weight gain
Systemic effects more likely if applied to
broken skin
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Topical Debriding Agents
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Purpose
• Remove dead skin
• Promote healing
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Topical Debriding Agents
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Made of enzymes
General action
• Digest dead necrotic tissue
Specific action
• Made of enzymes that digest:
•Collagen: collagenase (Santyl)
•Fibrin in a blood clot: fibrinolysin
(Elase)
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Debriding Agents
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Promotes removal of dead tissue
Removal of dead tissue enhances formation of
new tissue
Wound healing occurs more quickly
Second- and third-degree burns and decubitus
ulcers
Enzymes selectively digest dead tissue
Specific in action
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Eczema
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S & S of acute or chronic conditions
• Area appears inflamed
• Skin may be dry and may include wet or
weepy drainage
• Definition
• Inflammatory skin condition. Symptoms are
pustules, redness, vesicles, crusts, skin
thickening, and persistent itching and
burning.
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Eczema
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Drug agent
• Pimecrolimus (Elidel)
• Topical immunomodulator
• Adverse effects
•Site irritation
•Headache
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Agents Used to Treat Eczema
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Eczema is a chronic inflammatory disease of the skin
Itching and scaling of the skin
Piecrolimus
- short-term and intermittent long-term use
- adverse effects include site irritation and
headache
Tacrolimus
- not a steroid
- adverse effect is an increased risk for skin infections
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Psoriasis
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A chronic skin condition
• Consists of painful reddened papules that form
plaques with distinct borders
• Other patches appear as silvery yellow-white
scales
• Usually located
• Elbows, scalp, knees, and genitalia
• Amevive (alefacept)
• Raptiva (efalizumab)
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Psoriasis
 Drug agent
• Alefacept (Amevive)
•Immunosuppressant
•Stops the activity of T lymphocytes
•Given intramuscularly
•Adverse effects
•Infection
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Agents Used to Treat Psoriasis
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Psoriasis is an autoimmune chronic skin
disorder
Plaques on the skin – itching, bleeding,
cracking
Alefacept – promotes longer remissions
Efalizumab – stimulates body’s immune
response
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Agents used to treat burns
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Topical medications more effective if
blood supply to area damaged
Aim to prevent infection without
systemic absorption of toxins
• Silvadene
• Sulfamylon
• Furacin
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Topical Application Methods
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Depend on the etiology of the skin
problem
Require thorough cleansing of the
skin before the agent is applied or
reapplied
Must be applied appropriately or the
agents will not work
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Nursing Considerations
Perform thorough skin assessment
 Minimize factors that promote skin
drying in the elderly
 Instruct in proper use of topical
medications
 Be aware that occlusive dressings
may increase absorption
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Nursing Considerations
Good hygiene is important
 Assess for symptoms of infection
 Administer medications according
to guidelines
 Teach diabetic patient the
importance of foot care and daily
assessment
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