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Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 104 Drugs for the Skin.

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Presentation on theme: "Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 104 Drugs for the Skin."— Presentation transcript:

1 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 104 Drugs for the Skin

2 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.2 Fig Anatomy of the skin. A, Major structures of the skin. B, Growth layers of the epidermis.

3 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.3 Drugs for the Skin  Topical glucocorticoids (cream, ointment, or gel)  Uses  To relieve inflammation and itching  Drying agent  Adverse effects  Stretch marks  Purpura  Telangiectasia  Hypertrichosis  Possible systemic toxicity

4 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.4 Topical Glucocorticoids  Adverse effects  Local reactions Thinning of the skin Thinning of the skin Stretch marks Stretch marks Purpura Purpura Telangiectasia Telangiectasia Hypertrichosis Hypertrichosis Possible systemic toxicity Possible systemic toxicity

5 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.5 Topical Glucocorticoids  Adverse effects  Systemic toxicity More likely with higher doses and long-term therapy More likely with higher doses and long-term therapy Growth retardation in children Growth retardation in children Adrenal suppression Adrenal suppression  Administration  Apply in a thin film and gently rub into the skin  Do not use occlusive bandages (or tight-fitting diapers and plastic pants)

6 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.6

7 7 Keratolytic Agents  Promote shedding of horny layer of the skin  Primary agents and uses  Salicylic acid – warts, corns  Sulfur – acne, dandruff, psoriasis, seborrheic dermatitis  Benzoyl peroxide

8 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.8 Treatment for Acne  Nondrug therapy  Cleansing  Drug therapy  Benzoyl peroxide  Antibiotics Topical – clindamycin Topical – clindamycin Oral – tetracycline antibiotics, isotretinoin, hormonal agents Oral – tetracycline antibiotics, isotretinoin, hormonal agents  Retinoids Tretinoin (Retin-A) Tretinoin (Retin-A) Adapalene (Differin) Adapalene (Differin)

9 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.9

10 10 Topical Drugs for Acne  Benzoyl peroxide  Retinoids  Tretinoin  Adapalene  Tazarotene  Azelaic acid  Dapsone

11 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.11 Oral Drugs for Acne  Antibiotics  Agents of choice Doxycycline (Vibramycin), minocycline (Minocin) Doxycycline (Vibramycin), minocycline (Minocin)  Alternatives (resistance is common) Tetracycline (Sumycin), erythromycin (Ery-Tab) Tetracycline (Sumycin), erythromycin (Ery-Tab)  Isotretinoin (Accutane)  Teratogenic  Triglyceride levels must be monitored  Hormonal agents

12 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.12 Sunscreens  Sun exposure  Promote tanning  UV radiation can also cause burns, premature aging of the skin, skin cancer, and immunosuppression  Sunscreens impede the penetration of UV radiation to viable cells of the skin

13 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.13 Fig Range of UVB and UVA protection conferred by FDA-approved sunscreens.

14 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.14 Sunscreens  Organic screens  Also known as chemical screens  Absorb UV radiation and then dissipate it as heat  15 of the approved sunscreens  Inorganic screens  Also known as physical screens  Scatter UV radiation  Titanium oxide and zinc oxide  Now micronized and are clear for applying to skin

15 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.15 Sun Protection Factor  SPF is an index of protection against UVB radiation  SPF does not address UVA protection  Methods for obtaining SPF are not precise  Relationship between SPF and protection against sunburn is not linear (SPF 30 is not twice as much protection as SPF 15)

16 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.16 Sunscreens  Water and sweat resistance  Adverse effects of sunscreens  Proposed changes regarding sunscreen testing and labeling  UVB rating and labeling  Using a sunscreen effectively

17 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.17 Treatment for Psoriasis  Psoriasis – red patches with silver scales  Common, chronic inflammatory disorder that follows an erratic course  Initial episode usually develops in early adulthood  Subsequent attacks may occur spontaneously or in response to triggers  Varying degrees of severity  Symptoms come from:  Accelerated maturation of epidermal cells  Excessive activity of inflammatory cells

18 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.18 Treatment for Psoriasis  Topical drugs  Glucocorticoids  Calcipotriene (Dovonex)  Tazarotene (Tazorac)  Anthralin  Tars  Biologic agents  Alefacept (Amevive)  Efalizumab (Raptiva)  Tumor necrosis factor inhibitors (Enbrel)

19 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.19 Treatment for Psoriasis  Systemic drugs (conventional agents)  Methotrexate  Acitretin (Soriatane)  Glucocorticoids  Cyclosporine (Neoral)  Procedures  Phototherapy  Coal tar plus ultraviolet B irradiation

20 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.20 Actinic Keratoses (AK)  Rough, scaly, red or brown papules caused by chronic exposure to sunlight  Half of all skin cancers in U.S. begin as AK  Drugs for AK  Fluorouracil  Diclofenac sodium  Imiquimod  Aminolevulinic acid plus blue light

21 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.21 Drugs for Atopic Dermatitis (Eczema)  Glucocorticoids  Topical immunosuppressants  May cause skin cancer or lymphoma  Tacrolimus  Pimecrolimus

22 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.22 Agents Used to Remove Venereal Warts  Physical measures  Cryotherapy, electrodesiccation, laser surgery, and conventional surgery  Topical drugs  Podophyllin (must be applied by physician)  Can be applied at home  Imiquimod  Podofilox  Kunecatechins

23 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.23 Miscellaneous Drugs for Skin  Agents to remove common warts  Antiperspirants  Deodorants  Drugs for seborrheic dermatitis and dandruff

24 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.24 Drugs for Hair  Treat hair loss  Topical minoxidil  Finasteride (Propecia)  Treat unwanted facial hair  Eflornithine (Vaniqa)

25 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.25 Impetigo  Most common bacterial infection of the skin – Staphylococcus aureus is most common  Usually seen in children 2 to 5 years of age  Two forms  Bullous  Nonbullous  Drugs for impetigo (see Table 104-5)

26 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.26

27 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.27 Local Anesthetics  Can be applied topically to relieve pain and itching associated with skin disorders  Benzocaine  Lidocaine  Pramoxine


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