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Chapter 42 Agents Used in the Treatment of Skin Conditions.

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Presentation on theme: "Chapter 42 Agents Used in the Treatment of Skin Conditions."— Presentation transcript:

1 Chapter 42 Agents Used in the Treatment of Skin Conditions

2 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 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 4

5 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 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 7

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

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

10 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 11

12 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 13

14 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) 15

16 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 17

18 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 19

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

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

22 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’ 23

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 24

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

26 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 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 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 29

30 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 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 32

33 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 34 Additional Dermatologic Agents Debriding agents Antineoplastic agents Burn treatment agents Eczema agents Psoriasis agents Topical hair agents Agents for diabetic foot ulcer

35 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 36

37 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 38

39 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 40

41 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 42 Topical Debriding Agents Purpose Remove dead skin Promote healing

43 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 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 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 46 Eczema Drug agent Pimecrolimus (Elidel) Topical immunomodulator Adverse effects Site irritation Headache

47 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 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 49 Psoriasis Drug agent Alefacept (Amevive) Immunosuppressant Stops the activity of T lymphocytes Given intramuscularly Adverse effects Infection

50 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

51 Agents used to treat burns Topical medications more effective if blood supply to area damaged Aim to prevent infection without systemic absorption of toxins Silvadene Sulfamylon Furacin 51

52 52 Topical Application Methods Depend on the etiology of the skin problem Require thorough cleansing of the skin before the agent is applied or reapplied Must be applied appropriately or the agents will not work

53 53 Nursing Considerations Perform thorough skin assessment Minimize factors that promote skin drying in the elderly Instruct in proper use of topical medications Be aware that occlusive dressings may increase absorption

54 Nursing Considerations Good hygiene is important Assess for symptoms of infection Administer medications according to guidelines Teach diabetic patient the importance of foot care and daily assessment 54

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