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Chapter 42

Chapter 42. Agents Used in the Treatment of Skin Conditions. The Skin. The largest organ Several functions 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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Chapter 42

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  1. Chapter 42 Agents Used in the Treatment of Skin Conditions

  2. The Skin • The largest organ • Several functions • Protective barrier—microbials and trauma • Senses temperature changes • Secretes wastes through sweat glands • Stores fat • Synthesizes vitamin D • Provides a site for drug absorption

  3. Epidermis • Outer layer • Thickness is variable • Basal layer is where new cells are formed • Old cells migrate to surface

  4. Epidermis • 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

  5. Dermis • Thicker than the epidermis • Provides support and nourishment for the epidermis • Rich supply of blood vessels, nerves, sweat glands, and hair follicles

  6. 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

  7. Skin structures • Apocrine glands are associated with a hair follicle – mainly in axillary and pubic areas • Emotional stimuli causes excretion of electrolyte solution

  8. Skin Structures • Sebaceous glands – connected to hair follicles • Large numbers on head and face • At puberty, secretes oily mixture

  9. Emollients Keratolytics Local anesthetic agents Local antipruritic agents Antibacterial agents Drug Classification of Dermatological Agents

  10. Emollients • 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

  11. Emollients • 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

  12. 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

  13. Keratolytics • 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

  14. Local Anesthetics and Antipruritic Agents • Inhibits conduction of nerve impulses from sensory nerves • Reduces pain and itching • Used topically for insect bites, burns, and plant allergies

  15. Local Anesthetics and Antipruritic Agents • Poorly absorbed through intact skin • Enhanced through damaged skin • Local or systemic adverse effects • Allergic reaction (locally or systemically)

  16. 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

  17. Local Anesthetics and Antipruritic Agents • ‘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

  18. Antibacterial Agents • Prevents infection • Treats superficial infections • Treat acne vulgaris • Associated with development of hypersensitivity

  19. 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

  20. Drug Classification of Dermatological Agents • Antiviral agents • Antifungal agents • Anti-inflammatory agents • Antiparasiticidal agents

  21. Antifungal Agents • Treats two types of fungal infections • Dermatophyte organisms • Yeastlike organisms

  22. Dermatophyte Infections • Caused by tinea or others • Most common is ringworm type • Circular pattern

  23. Dermatophyte infections • Scalp, nails, and/or skin • Always superficial • May be known as ‘athlete’s foot’ or ‘jock itch’

  24. Dermatophyte Infections • Can live only on dead keratin tissue • Affected area must be replaced with fungus-free tissue • Agents must be continued long-term

  25. Dermatophyte Infections • Relapses common • Ointment, cream, aerosol, lotion, and powder forms • If burning or irritation develops, discontinue use

  26. Dermatophyte Infections • 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

  27. Yeastlike Infections • 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

  28. Antiviral Agents • Most difficult to treat • Herpes simplex 1 and 2 • Topical agents - cannot completely eradicate • Decreases healing time and pain

  29. 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

  30. Anti-Inflammatory Agents • 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

  31. 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

  32. 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

  33. Antiparasitic Agents • 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

  34. Additional Dermatologic Agents • Debriding agents • Antineoplastic agents • Burn treatment agents • Eczema agents • Psoriasis agents • Topical hair agents • Agents for diabetic foot ulcer

  35. 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

  36. Diabetic Foot Ulcers • Needs adequate blood supply • Gel form helpful for protecting healing wounds • Long-term therapy required – Regranex promotes healing

  37. 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

  38. Antineoplastic Agents • Use nonmetallic applicators • Protect skin with rubber gloves • Wash hands immediately • Avoid contact with eyes, nose, or mouth • Avoid exposure to sunlight

  39. 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

  40. 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

  41. Minoxidil • 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

  42. Topical Debriding Agents • Purpose • Remove dead skin • Promote healing

  43. Topical Debriding Agents • 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)

  44. Debriding Agents • 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

  45. Eczema • 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.

  46. Eczema • Drug agent • Pimecrolimus (Elidel) • Topical immunomodulator • Adverse effects • Site irritation • Headache

  47. Agents Used to Treat Eczema • 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

  48. Psoriasis • 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)

  49. Psoriasis • Drug agent • Alefacept (Amevive) • Immunosuppressant • Stops the activity of T lymphocytes • Given intramuscularly • Adverse effects • Infection

  50. Agents Used to Treat Psoriasis • 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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