Chapter 56
Dermatologic Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Skin


Largest organ of the body
Two layers


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)
Burn drugs
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Topical Dermatologic Drugs
(cont’d)
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Emollients (soften skin)
Keratolytics (cause softening and peeling of the
stratum corneum)
Local anesthetics
Topical vasodilators
Débriding drugs (promote wound healing)
Sunscreens
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Topical Antimicrobial Drugs



Antibacterial drugs
Antifungal drugs
Antiviral drugs
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Antibacterial Drugs

Most common bacteria are Streptococcus
pyogenes and Staphylococcus aureus

Folliculitis
 Impetigo
 Furuncles
 Carbuncles
 Cellulitis
 Pustules
 Vesicles
 Papules
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Antibacterial Drugs (cont’d)

Most common drugs

bacitracin
 neomycin
 polymyxin
 neomycin and polymyxin B (Neosporin)
 mupirocin (Bactroban)
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Antibacterial Drugs (cont’d)

mupirocin (Bactroban)

Used topically for Staph and Strep impetigo
 Intranasal form for methicillin-resistant S. aureus
(MRSA)
 Available by prescription
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Antibacterial Drugs (cont’d)

silver sulfadiazine (Silvadene)

Topical antiinfective
 Used to prevent or treat infection at the site of
second- and third-degree burns
 Adverse effects: pain, burning, and itching
 Do not use in patients who are allergic to sulfonamide
drugs
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Classroom Response Question
The nurse is assessing a patient who has been
diagnosed with MRSA on the right arm. The nurse
anticipates use of which medication to treat the
MRSA?
A. bacitracin
B. neomycin
C. polymyxin B
D. mupirocin (Bactroban)
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Antiacne Drugs


Acne is caused by Propionibacterium acnes
Drugs used to treat acne

benzoyl peroxide
 erythromycin
 tetracycline
 isotretinoin (Amnesteem)
 clindamycin (Cleocin T)
 tretinoin (Renova, Retin-A)
 Oral contraceptives (for female patients with acne)
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Antiacne Drugs (cont’d)

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
May cause peeling skin, redness, or sensation of
warmth
Produces improvement in 4 to 6 weeks
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Antiacne Drugs (cont’d)

clindamycin (Cleocin T)



Antibiotic
Used topically to treat acne
Adverse reactions are usually limited to minor local
skin reactions, including burning, itching, dryness,
oiliness, and peeling
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Antiacne Drugs (cont’d)

isotretinoin (Amnesteem, Claravis, Sotret)



Treatment of severe recalcitrant cystic acne
Inhibits sebaceous gland activity and has
antikeratinizing (anti–skin hardening) and
antiinflammatory effects
The company that produced the brand name
Accutane has withdrawn it from the market
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Classroom Response Question
A woman who is taking isotretinoin calls the office
to say that she thinks she may be pregnant. What
will the nurse instruct the patient to do first?
A. Stop the isotretinoin immediately.
B. Reduce the dosage of the isotretinoin to every
other day.
C. Switch to tretinoin (retinoic acid).
D. Consult an obstetrician.
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Antiacne Drugs (cont’d)

isotretinoin (cont’d)




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)

tretinoin (retinoic acid, vitamin A acid) (Renova,
Retin-A)



Used to treat acne
Also used to reduce dermatologic changes
associated with sun damage
Stimulates the turnover of epithelial cells, resulting in
skin peeling
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Antiacne Drugs (cont’d)


Main adverse effects are local inflammatory
reactions, which are reversible when therapy is
discontinued
Common adverse effects are excessively red
and edematous blisters, crusted skin, and
temporary alterations in skin pigmentation
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Topical Fungal Infections


Difficult to eradicate
Therapy may be prolonged


Several weeks to 1 year
Topical fungal infections caused by


Candida albicans: a yeastlike opportunistic fungus
present in the normal flora of the mouth, vagina, and
intestinal tract
Dermatophytes: tinea or ringworm infections
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Topical Antifungal Drugs

clotrimazole (Lotrimin, Mycelex-G)

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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)


Topical cream
Vaginal suppository or cream
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Topical Antiviral Drugs

acyclovir (Zovirax) and penciclovir (Denavir)



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

Used to reduce pain or pruritus associated with





Insect bites
Sunburn
Poison ivy exposure
Also used to numb the skin before a painful
injection
Ointments, creams, sprays, liquids, jellies


EMLA: lidocaine/prilocaine combination
Ela-max: lidocaine
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Topical Antipruritic Drugs


Antihistamines
Corticosteroids

Antiinflammatory effects
 Antipruritic effects
 Vasoconstrictor actions
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Other Topical
Dermatologic Drugs

Antipsoriatic drugs

tazarotene (Tazorac)
 tar-containing products
 anthralin (Anthra-derm)
 calcipotriene (Dovonex)
 etanercept (Enbrel)
 alefacept (Amevive)
 ustekinumab (Stelara)
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Other Topical
Dermatologic Drugs (cont’d)

Topical ectoparasiticidal drugs to treat
pediculosis (Phthirus pubis, Pediculus humanus
corporis, Pediculus humanus capitis) and
scabies (Sarcoptes scabiei)


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

lindane (Kwell)
malathion (Ovide)
crotamiton (Eurax)
benzyl alcohol 5% (Ulesfia)
spinosad (Natroba)
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Other Topical
Dermatologic Drugs (cont’d)

Topical hair growth drug



minoxidil (Rogaine)
For men and women
Systemic hair growth drug



finasteride (Propecia)
Finasteride is classified as a pregnancy category X
drug
Women are not to handle this drug without gloves or
crush this drug, thereby making it airborne
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Other Topical
Dermatologic Drugs (cont’d)

Sunscreens


Rated by sun protection factor (SPF), which is a
number ranging from 2 to 50 (or higher) in order of
increasing potency of UV protection
Only those with SPF of 15 or greater may state they
reduce the risk of skin cancer and early skin aging
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Other Topical
Dermatologic Drugs (cont’d)

Topical antineoplastics

fluorouracil (Efudex)
• Basal cell carcinoma
• Actinic keratosis
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Other Topical
Dermatologic Drugs (cont’d)

Immunomodulators


pimecrolimus (Elidel)
• Treats atopic dermatitis
imiquimod (Aldara)
• Treats actinic keratosis, basal cell carcinoma, and anogenital
warts
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Wound Care Drugs



Vitamin C (ascorbic acid)
Zinc
Topical wound care drugs



Used to prepare wound bed for healing
Remove nonviable tissue (débridement)
Antibacterial
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Wound Care Drugs (cont’d)





sodium hypochlorite (Dakin’s solution)
cadexomer iodine (Iodosorb)
collagenase (Santyl)
biafine topical emulsion
acetic acid (vinegar)
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Classroom Response Question
At 1300 the nurse assesses a patient who has just returned
to the oncology unit after receiving radiation therapy. The
patient tells the nurse that his skin “burns a little” in the
area that was radiated. The nurse notes an order for biafine
topical emulsion. When will the nurse apply the biafine?
A. 1315
B. 1400
C. 1530
D. 1700
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Classroom Response Question
A patient has an infected stage II pressure ulcer that
contains some necrotic tissue and some normal, healing
granulation tissue. The patient is taking warfarin
(Coumadin). Which product would be most appropriate for
wound care?
A. sodium hypochlorite (Dakin’s solution)
B. hydrogen peroxide
C. collagenase (Santyl)
D. Sterile water
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Skin Preparation Drugs




isopropyl alcohol (70%)
povidone-iodine (Betadine)
chlorhexidine (Hibiclens)
benzalkonium chloride (Zephiran)
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Herbal Products: Aloe


Used for wound healing
Adverse effects

Diarrhea
 Abdominal pain
 Dermatitis

Drug interactions

digoxin
 Antidysrhythmics
 Diuretics
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Nursing Implications


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)

For isotretinoin (Amnesteem)


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)


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)


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)


Wear gloves when applying topical drugs
Apply dressings (e.g., wet, wet-to-dry, occlusive)
as prescribed
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Nursing Implications (cont’d)

Document

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)



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)



Provide patient/family teaching as necessary for
self-care
Monitor for therapeutic responses
Monitor for adverse effects
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Case Study
Jane is a 17-year-old patient who is being seen in the dermatology
clinic for treatment of acne vulgaris. The nurse practitioner prescribes
benzoyl peroxide topically four times a day. Jane tells the nurse that
she wants take the drug more frequently so the acne will go away
quickly. What information will the nurse provide to Jane?
A. “Improvement is usually seen in 1 week.”
B. “If you want faster results, a pill form of benzoyl peroxide will be
used.”
C. “Overuse of this drug can result in painful, reddened skin.”
D. “Benzoyl peroxide causes the skin to blister or swell to clear the
acne.”
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Case Study (cont’d)
A few months later, it is determined that Jane is not responding to
treatment and is now prescribed isotretinoin. Which statement will the
nurse include when teaching Jane about isotretinoin therapy?
A. “Call your prescriber immediately if you experience any signs of
depression.”
B. “If you should become pregnant, the dose of isotretinoin will be cut
in half.”
C. “Isotretinoin is administered by subcutaneous injection directly into
the acne areas.”
D. “Isotretinoin should not be used with any form of birth control.”
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Case Study (cont’d)
During a regular follow-up visit, Jane points out a
sore that she has developed on her mouth. She is
diagnosed with herpes simplex. Which medication
does the nurse anticipate Jane will receive?
A. miconazole (Monistat)
B. acyclovir (Zovirax)
C. clotrimazole (Lotrimin)
D. anthralin (Anthra-Derm)
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