CHAPTER 56
Dermatologic Drugs
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Skin
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Largest organ of the body
Two layers
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Dermis
Epidermis
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Functions of the Skin
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Protective barrier for the internal organs
Senses changes in temperature, pressure, or
pain
Regulates body temperature
Excretes fluid and electrolytes
Stores fat
Synthesizes vitamin D
Provides a site for drug absorption
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Topical Dermatologic Drugs
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Antimicrobial drugs
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Antibacterial drugs
Antifungal drugs
Antiviral drugs
Antiinflammatory drugs
Antineoplastic drugs
Antipruritic drugs (for itching)
Drugs for burn treatment
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Topical Dermatologic Drugs
(cont’d)
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Emollients (soften skin)
Keratolytics
Local anesthetics
Topical vasodilators
Debriding drugs (promote wound healing)
Sunscreens
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Topical Antimicrobial Drugs
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Antibacterial drugs
Antifungal drugs
Antiviral drugs
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Antibacterial Drugs
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Most common bacteria are Streptococcus
pyogenes and Staphylococcus aureus

Folliculitis
 Impetigo
 Furuncles
 Carbuncles
 Cellulitis
 Others
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Antibacterial Drugs (cont’d)
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Most common drugs
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bacitracin
neomycin
polymyxin B
Neosporin: neomycin + polymyxin B
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Antibacterial Drugs (cont’d)
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mupirocin (Bactroban)
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New; by prescription only
Used topically for Staph and Strep impetigo
Intranasal form for MRSA
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Antibacterial Drugs (cont’d)
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silver sulfadiazine (Silvadene)
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Topical antiinfective
Used to prevent or treat infection at the site of
second- and third-degree burns
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Antibacterial Drugs (cont’d)
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silver sulfadiazine (cont’d)
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Cannot be used if allergic to sulfa drugs
1% Topical cream
Apply to cleansed, debrided, burned areas with
sterile gloves
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Antiacne Drugs
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Acne is caused by Propionibacterium acnes
Drugs used to treat acne
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benzoyl peroxide
erythromycin
tetracycline
isotretinoin (Accutane)
clindamycin (Cleocin-T)
tretinoin (Renova-Retin A)
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Antiacne Drugs (cont’d)
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benzoyl peroxide
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Causes death of the anaerobic P. acnes bacteria
by slowly releasing oxygen
Antibacterial, antiseptic, drying, and keratolytic
actions
Keratolytic: softens scales and loosens the outer
layer of the skin
Produces improvement in 4 to 6 weeks
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Antiacne Drugs (cont’d)
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benzoyl peroxide (cont’d)
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
May cause peeling skin, redness, or sensation of
warmth
Available in many formulations
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Antiacne Drugs (cont’d)
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clindamycin (Cleocin T)
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Antibiotic
Used topically to treat acne
May cause skin reactions
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Antiacne Drugs (cont’d)
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isotretinoin (Accutane)
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Oral
Inhibits sebaceous gland activity
Pregnancy category X
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Antiacne Drugs (cont’d)
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isotretinoin (Accutane) (cont’d)
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STRINGENT guidelines for prescribing and use
Required patient counseling regarding use of two
forms of contraception and not becoming pregnant
during use
Required “iPLEDGE” program for safety
Monitor for signs of depression, suicidal ideations
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Antiacne Drugs (cont’d)
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tretinoin (retinoic acid, vitamin A acid)
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Used to treat acne
Also used to reduce dermatologic changes
associated with sun damage
Stimulates the turnover of epithelial cells, resulting
in skin peeling
May result in severe irritation and skin peeling
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Topical Fungal Infections
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
Difficult to eradicate
Therapy may be prolonged
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Several weeks to 1 year
Topical fungal infections caused by
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Candida spp. (candidiasis)
Dermatophytes (tinea)
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Topical Antifungal Drugs
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clotrimazole (Lotrimin)
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Lozenge for oral candidiasis (thrush)
Vaginal suppository or cream for yeast infections
Other forms used for other fungal infections
miconazole (Monistat)
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Topical cream
Vaginal suppository or cream
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Topical Antiviral Drugs
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acyclovir (Zovirax) and penciclovir (Denavir)
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Both used to treat initial and recurrent herpes
simplex infections
Do not cure viral skin infections, but may
reduce healing time and pain
Systemic drugs have been shown to be better
for controlling viral skin conditions
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Topical Anesthetic Drugs
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Used to reduce pain or pruritus associated
with
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Insect bites
Sunburn
Poison ivy exposure
Also used to numb the skin before a painful
injection
Ointments, creams, sprays, liquids, jellies
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EMLA: lidocaine/prilocaine combination
Ela-max: lidocaine
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Topical Antipruritic Drugs
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Antihistamines
Corticosteroids
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Antiinflammatory effects
Antipruritic effects
Vasoconstrictor actions
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Other Topical
Dermatologic Drugs
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Antipsoriatic drugs
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tazarotene (Tazorac)
 tar-containing products
 anthralin (Anthra-derm)
 calcipotriene (Dovonex)
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Other Topical
Dermatologic Drugs (cont’d)
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Topical ectoparasiticidal drugs to treat
pediculosis (three forms) and scabies
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lindane (Kwell)
 malathion (Ovide)
 crotamiton (Eurax)
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Other Topical
Dermatologic Drugs (cont’d)
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Topical hair growth drug
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Systemic hair growth drug
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minoxidil (Rogaine)
For men and women
finasteride (Propecia)
Topical antineoplastic drug
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fluorouracil (Efudex)
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Other Topical
Dermatologic Drugs (cont’d)
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Immunomodulators
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pimecrolimus (Elidel)
• Treats atopic dermatitis
imiquimod (Aldara)
• Treats actinic keratosis, basal cell carcinoma, and
anogenital warts

Sunscreens
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Wound Care Drugs
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Topical wound care drugs
Used to prepare wound bed for healing
Remove nonviable tissue
Antibacterial
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Wound Care Drugs (cont’d)
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sodium hypochlorite (Dakin’s solution)
cadexomer iodine (Iodosorb)
collagenase (Santyl)
Topical emulsion (Biafine)
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Skin Preparation Drugs
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isopropyl alcohol
povidone iodine (Betadine)
chlorhexidine (Hibiclens)
benzalkonium chloride (Zephiran)
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Herbal Products: Aloe
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Used for wound healing
Adverse effects
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Diarrhea
Abdominal pain
Dermatitis
Drug interactions
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digoxin
Antidysrhythmics
Diuretics
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Nursing Implications
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Assess for presence of contraindications,
especially drug allergies
Do not apply antiinfective drugs until culture
and sensitivity testing (if ordered) are
completed
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Nursing Implications (cont’d)
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For isotretinoin (Accutane)
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
Ensure that strict guidelines are in place for
monthly pregnancy testing and prescription
renewal
Monitor liver function before and during therapy
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Nursing Implications (cont’d)
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
Assess area affected thoroughly before
applying medication
Keep in mind that systemic absorption is
higher in the very young and very old
because the skin may be more permeable
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Nursing Implications (cont’d)
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
Follow specific manufacturer’s guidelines for
administration techniques
Cleanse the area thoroughly to remove debris
and residual medication; follow specific
recommendations
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Nursing Implications (cont’d)
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Wear gloves when applying topical drugs
Apply dressings (e.g., wet, wet-to-dry,
occlusive) as ordered
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Nursing Implications (cont’d)
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Document
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Site of application
 Drainage (color, amount)
 Swelling, temperature
 Odor, color, pain, or other sensations
 Type of treatment given
 Patient’s response
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Nursing Implications (cont’d)
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Protect affected area from sunlight
Do not double up on dose if a dose is missed
Ensure proper disposal of contaminated
dressings
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Nursing Implications (cont’d)
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Provide patient/family teaching as necessary
for self-care
Monitor for therapeutic responses
Monitor for adverse effects
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