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Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
20
Drugs Used to
Treat Skin
Conditions
Multimedia Directory
Slide 8
Slide 25
Eczema Video
Acne Video
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Integumentary System
• Largest of all organs
• Consists of skin, hair, nails, sweat
glands, oil glands
• Skin: barrier against environment
• Helps regulates temperature, retards
water loss, houses sensory receptors,
synthesizes biochemicals, excretes
small quantities of wastes
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Figure 20-1
The two layers of the skin.
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Skin Layers
• Epidermis: 4 or 5 sublayers; contains
melanocytes
• Dermis: binds epidermis to underlying
tissues; composed of dense irregular
connective tissue; contains nerve cells,
blood vessels, hair follicles, oil glands,
sweat glands
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Skin Layers
• Subcutaneous: loose connective and
adipose tissue; helps conserve body
heat; contains major blood vessels that
supply skin
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Eczema
• Most common inflammatory skin
disorder
• Includes dermatitis (inflammation of
skin) and seborrheic dermatitis
• Characterized by erythema, vesicles,
scales, itching
• Mainstay of treatment is topic or oral
corticosteroids.
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Table 20-1
Selected Topical Corticosteroids
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Table 20-1 (continued) Selected Topical Corticosteroids
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Eczema in Pediatric Patients
• Atopic dermatitis (eczema) is common
in pediatric patients.
• May be caused by sensitivity to milk,
orange juice, or other foods
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Topical Corticosteroids: Uses
• Prevent accumulation of inflammatory
cells at sites of infection and inhibit
phagocytosis
• Used to treat skin disorders such as
eczema, dermatitis, psoriasis, insect
bites, burns (first and second degree)
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Topical Corticosteroids:
Adverse Effects
• Common: dryness, redness, itching,
irritation, burning of skin
• May produce secondary infections
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Topical Corticosteroids:
Contraindications
• Contraindicated in bacterial skin
infections
• Use cautiously in patients with
hypersensitivity and in pregnant or
lactating women.
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Topical Corticosteroids:
Patient Information
• Advise patients to follow directions
regarding covering affected area or
exposing it to air.
• Instruct patients to keep medication
away from eyes.
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Psoriasis
• Chronic, relapsing inflammatory skin
disorder
• Unknown cause with a hereditary
component; onset occurs by age 20
• Greatly increased rate of cellular
proliferation; causes thickening of
dermis and epidermis
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Psoriasis
• Characterized by rounded plaques
covered by silvery white, scaly patches
• Common areas are elbows, knees,
gluteal cleft, and scalp
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Preventing Recurrence of Psoriasis
•
•
•
•
•
Keeping skin moist and lubricated
Avoiding cold and dry climates
Avoiding stress and anxiety
Limiting alcohol intake
Avoiding scratching
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Table 20-2
Antipsoriatic Drugs
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Topical Antipsoriatics: Uses
• Some agents inhibit keratinocytes;
others have photosensitizing effects;
others have unknown mechanism
• Used to treat moderate to severe forms
of psoriasis in adults
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Topical Antipsoriatics:
Adverse Effects
• Common: alopecia, skin peeling, dry
skin, pruritus, rash, skin atrophy,
abnormal skin odor
• Serious: Severe edema (methoxsalen)
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Topical Antipsoriatics:
Contraindications
• Patients with hypercalcemia or vitamin
D toxicity should not use calcipotriene.
• Contraindicated in pregnancy and
lactation
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Topical Antipsoriatics:
Patient Information
• Instruct patients to avoid additional
exposure to UV light for 8 hours after
using.
• Warn patients to discontinue drug and
report visual problems.
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Acne
• An inflammatory disorder of sebaceous
glands, commonly occurring during
puberty.
• Sebum blocks duct of gland, bacteria
become trapped, and small abscess
occurs.
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Zinc and Acne
• A variety of natural products are used
to treat acne. The most common are
zinc, niacinamide gel, and tea tree oil.
• Zinc can be toxic at high dosages,
primarily because it causes copper
deficiency.
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Table 20-3
Major Drugs Used to Treat Acne
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Table 20-3 (continued) Major Drugs Used to Treat Acne
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Antiacne Agents: Uses
• May inhibit microbial cellular protein
synthesis and may normalize
keratinization
• Used to treat mild to moderate
inflammatory acne vulgaris
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Antiacne Agents:
Adverse Effects
• Common: pruritus, burning, erythema,
stinging
• Allergic dermatitis can occur with
benzoyl peroxide
• Rare: bloody diarrhea and abdominal
pain (clindamycin)
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Antiacne Agents:
Contraindications
• Hypersensitivity
• Pregnancy
• Lactation
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Antiacne Agents:
Patient Information
• Instruct patients to apply according to
directions.
• Warn patients to avoid eye or mucous
membrane contact.
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Keratoses
• Characterized by thickening of keratin
layer of skin
• Seborrheic: result from proliferation of
epidermis; oval elevation that is
smooth or rough, and dark in color
• Actinic: occur on skin exposed to UV
radiation; appear as pigmented, scaly
patches; may develop into skin cancer
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Table 20-4
Selected Keratolytic Agents
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Keratolytics: Uses
• Promote shedding of horny layer of
epidermis and softening of scales
• Used to treat corns, calluses, plantar
warts, acne, eczema, psoriasis,
seborrheic dermatitis
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Keratolytics:
Adverse Effects
•
•
•
•
•
Burning
Local irritation
Rash
Dry skin
Scaling
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Keratolytics:
Contraindications
• Contraindicated for moles, warts with
hair, genital or facial warts, birthmarks,
or infected skin
• Salicylic acid may cause salicylate
toxicity with prolonged use.
• Use cautiously in pregnant or lactating
women.
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Keratolytics:
Patient Information
• Instruct patients to use externally only.
• Tell patients to avoid contact with eye,
face, mucous membranes and normal
skin around warts.
• Instruct patients to soak the area in
warm water for 5 minutes prior to
applying medication.
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Corns and Calluses
• Corns and calluses are extremely
common, localized hyperplastic areas of
the stratum corneum layer of the
epidermis.
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Bacterial Skin Infections
• Staphylococci and beta-hemolytic
streptococci are common causative
microorganisms.
• Impetigo, cellulits, folliculitis
• Treated with topical antibiotics
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Table 20-5
Topical Antibiotic Drugs
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Table 20-5 (continued) Topical Antibiotic Drugs
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Fungal Infections
• Dermatophytes are fungi that infect
skin, hair, and nails.
– Tinea pedis: athlete’s foot
– Tinea unguium: nail fungus
– Tinea cruris: jock itch
– Tinea capitis: inflammation of scalp with
hair loss
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Fungal Infections
• Candidiasis: infection of oral cavity;
also of vulvovaginal area
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Table 20-6
Topical Antifungal Drugs
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Table 20-6 (continued) Topical Antifungal Drugs
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Table 20-6 (continued) Topical Antifungal Drugs
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Scabies and Pediculosis
• Scabies: caused by mites that burrow
into skin anywhere on trunk or
extremities
• Pediculosis: lice infestation primarily of
hairy areas of body
• Pubic lice
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Table 20-7
Drugs Used to Treat Lice
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Anti-Lice Drugs: Uses
• Mechanism of action related to direct
absorption of agent by the parasite;
stimulate nervous system of parasite
causing death
• Used topically to treat Pediculus
humanus infestations
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Anti-Lice Drugs: Adverse Effects
•
•
•
•
•
•
•
Irritation
Pruritus
Burning or stinging
Numbness
Erythema
Edema
Rash
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Anti-Lice Drugs:
Contraindications
• Contraindicated in premature neonates
and patients with seizure disorders
• Do not use pyrethrins with dyes.
• Avoid use in acute inflammation of
scalp and in pregnant and lactating
women.
• Use cautiously in children younger than
2 years.
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Anti-Lice Drugs:
Patient Information
• Instruct patients that drugs are highly
toxic if swallowed, inhaled, or used
topically in excess.
• Advise patients to use a fine-toothed
comb to remove dead lice after hair is
dry.
• Warn patients not to share combs,
brushes, or other grooming equipment
with other people.
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