17 Dermatologic Drugs.

17 Dermatologic Drugs

Learning Objectives Explain the rationale behind using topical versus systemic drugs to treat skin diseases. Compare and contrast the therapeutic effects of the various categories of drugs used to treat acne vulgaris and acne rosacea. Compare and contrast the therapeutic effects of the various categories of drugs used to treat psoriasis, inflammation, and itching. continued on next slide

Learning Objectives Explain how drugs are used to treat alopecia and wrinkles. Compare and contrast the therapeutic effects of antibiotic drugs, antifungal drugs, and antiviral drugs. Describe the difference between the parasitic infections scabies and pediculosis, and the drugs used to treat them. continued on next slide

Learning Objectives Describe various types of drugs used to treat skin pain, burns, skin ulcers, and wounds. When given the name of a well-known dermatologic generic drug, identify its trade name. When given the generic and trade names of a dermatologic drug, identify what drug category it belongs to and what disease it is used to treat. continued on next slide

Learning Objectives When given a dermatologic drug category, identify several generic and trade name drugs in that category. When given an ending common to several generic drugs, identify the related drug category.

Dermatologic Drugs Because of superficial nature and location of most dermatologic diseases, they respond well to topical drug therapy. Includes many OTC as well as Rx drugs

Dermatologic Drugs Some dermatologic diseases become: Widespread
Severe Deeply penetrated below the skin Oral drugs that act systemically are given.

Drugs Used to Treat Acne Vulgaris
Form of acne that is commonly seen during adolescence Characterized by large amounts of oil that harden and block the hair pore, forming reddish papules As bacteria feeds on the oil, they cause infection. This draws white blood cells to the area, forming pustules (whiteheads) continued on next slide

Characterized by large amounts of oil that harden and block the hair pore, forming reddish papules As bacteria feeds on the oil, they cause infection. Hardened oil turns black as it is exposed to air, forming comedos (blackheads).

Topical drugs Cleanse away oil and dead skin (keratolytic action) Close the pores (astringent action) Kill skin bacteria (anti-infective action) Ointments are not used to treat acne vulgaris because their high oil content clogs the pores.

Topical keratolytic drugs for acne vulgaris Salicyclic acid (Clearasil, Fostex, Stri-Dex) OTC drug has a keratolytic effect that removes oil and dead skin to cleanse the pores.

Did You Know? Salicylic acid is used in stronger concentrations to remove corns, calluses, and warts from the skin.

Topical antibiotic drugs for acne vulgaris Antibiotic drugs kill bacteria on the skin, used to treat the pustules of acne vulgaris. Prescription drugs Azelaic acid (Azelex, Finacea) Benzoyl peroxide (Benzac, Desquam, PanOxyl) continued on next slide

Topical antibiotic drugs for acne vulgaris Antibiotic drugs kill bacteria on the skin, used to treat the pustules of acne vulgaris. Prescription drugs Clindamycin (Cleocin T) Erythromycin (Emgel, Eryderm)

Topical combination drugs for acne vulgaris Contain a keratolytic drug and an antibiotic drug Rx drugs BenzaClin (benzoyl peroxide, clindamycin) Benzamycin (benzoyl peroxide, erythromycin) continued on next slide

Topical combination drugs for acne vulgaris Rx drugs Clenia (sodium sulfacetamide, sulfur) Duac (benzoyl peroxide, clindamycin) Plexion (sodium sulfacetamide, sulfur) Sulfoxyl (benzoyl peroxide, sulfur)

Oral antibiotic drugs for acne vulgaris Provide systemic treatment for cases of severe acne vulgaris Travel through the blood to kill bacteria in the deeper layers of the skin Belong to the tetracycline antibiotic drug category continued on next slide

Oral antibiotic drugs for acne vulgaris Doxycycline (Vibramycin, Vibra-Tabs) Minocycline (Dynacin, Minocin) Tetracycline (Sumycin)

Topical vitamin A-type drugs for acne vulgaris Vitamin A Known as retinoic acid Deficiency can produce abnormal changes in the epithelial cells of the skin, such as those that occur with acne vulgaris. continued on next slide

Topical vitamin A-type drugs for acne vulgaris Vitamin A Retinoid drugs are structurally similar to vitamin A or similar to metabolites of vitamin A. continued on next slide

Topical vitamin A-type drugs for acne vulgaris Cause epidermal cells to multiply more rapidly, preventing the pores from becoming clogged Decrease the inflammation associated with acne vulgaris continued on next slide

Topical vitamin A-type drugs for acne vulgaris Rx drugs Adapaline (Differin) Tazarotene (Tazorac) Tretinoin (Retin-A)

Figure 17–1 Tretinoin (Retin-A)
Figure 17–1 Tretinoin (Retin-A). This is a retinoid drug that is derived from vitamin A, and these two facts are reflected in the trade name of the drug, Retin-A. Tretinoin (Retin-A) comes as a topical cream or gel to treat acne vulgaris. Tretinoin is also used to treat wrinkles under the trade name Renova. Source: James Keyser/Contributor/The LIFE Images Collection/Getty Images

Did You Know? Oral contraceptive drugs (birth control pills) have been found to be effective in treating acne vulgaris. Drug manufacturers advertise this desirable effect along with the drugs' main therapeutic effect of birth control, and YAZ is FDA approved fro treating acne.

Oral vitamin A-type drugs for severe acne vulgaris Severe cystic acne vulgaris that is unresponsive to other drugs is treated systemically. Isotretinoin (Accutane) Causes epithelial cells to multiply more rapidly continued on next slide

Oral vitamin A-type drugs for severe acne vulgaris Isotretinoin (Accutane) Prevents clogged pores from becoming infected and forming cysts Only used to treat severe cystic acne vulgaris, not common acne vulgaris

Drug Alert Isotretinoin (Accutane) has been linked to the unusual and severe adverse effects of depression and suicide. The FDA has mandated that these adverse effects be brought to the attention of the physician and patient with large warning boxes included with all literature on the drug.

Drug Alert On that snowy January day, Brandon Troppman seemed to be loving life. He put on a new shirt and combed his hair just so before heading to the mall to hang out with his high school sweetheart. At 6:30 that evening, he talked on the phone with his best friend, laughing and making his friend laugh, as always. continued on next slide

Drug Alert An hour later, Brandon hanged himself from a rod in his bedroom closet. "[He] hadn't appeared depressed, never abused drugs or alcohol, never talked of suicide." continued on next slide

Drug Alert In the months after his death, his parents reached a conclusion that now seems inescapable to them: the popular acne drug Accutane, they believe, led to their son's suicide. continued on next slide

Drug Alert [Congressman Bart Stupak from Michigan] also publicly blamed the drug for his 17-year old son's suicide. [During his own investigation], he found an internal 1988 FDA memo that stated: "Given all the pieces of evidence available, it is difficult to avoid the conclusion that Accutane use…is associated with severe psychiatric disease in some patients." Gately, Gary, "A Drug's Dark Side." The Baltimore Sun. March 4, 2001, p. N1

Drugs Used to Treat Acne Rosacea
Adult form of acne Characterized by: Constant blotchy redness Dilated superficial blood vessels Excessive amounts of oil on the face continued on next slide

Exacerbated by: Heat Stress Skin irritation

Alpha receptor agonist drugs for acne rosacea Antibiotic drugs for acne rosacea Azelaic acid (Azelex, Finacea) Clindamycin (Cleocin T) Metronidazole (MetroCream, MetroGel) Corticosteroid drugs for acne rosacea Dexamethasone (Maxidex)

Did You Know? Metronidazole has both antibiotic and antiprotozoal actions and has many different uses. Topically, it is also used to treat infected decubitus ulcers. Metronidazole (Flagyl) is taken orally to treat dysentery and intestinal infections caused by protozoal organisms. continued on next slide

Did You Know? Metronidazole (MetroGel-Vaginal) is applied topically in the vagina to treat vaginal infections caused by the bacteria Hemophilus and Gardnerella. continued on next slide

Did You Know? Metronidazole in combination with bismuth and tetracycline (Helidac) is used to treat peptic ulcers caused by Helicobacter pylori, a spiral bacteria that is resistant to other antibiotic drugs.

Drugs Used to Treat Psoriasis
Chronic, autoimmune skin disorder Scaly, raised, silvery-red patches on the skin Often resistant to treatment continued on next slide

The skin is abnormal at the cellular level. Abnormally accelerated rate of epithelial cell division Abnormality of the epithelial cells that produce keratin (keratinocytes)

Topical coal tar drugs for psoriasis Balnetar, Neutrogena T/Gel, Zetar Decrease the rate of epithelial production Correct abnormalities of keratinocytes Cleanse away dead skin (keratolytic action) Decrease itching (antipruritic action) OTC drug

Did You Know? Coal tar, a by-product of the processing of bituminous coal, contains over 10,000 different chemical ingredients. It has been used since the 1800 to treat psoriasis.

Topical vitamin A-type drugs for psoriasis Deficiency of vitamin A can produce abnormal changes in the epithelial cells of the skin, such as those that occur with psoriasis. Tazarotene (Avage, Tazorac) Rx retinoid drug Normalizes the abnormal production of epithelial cells

Oral vitamin A-type drugs for psoriasis Acitretin (Soriatane) Rx drug Acts systemically to treat severe psoriasis that cannot be controlled with topical drugs

Topical vitamin D-type drugs for psoriasis The red, scaly patches of psoriasis are caused by abnormal keratinocytes within the skin Synthetic vitamin D-type drugs activate vitamin D receptors in the keratinocytes and slow their abnormal growth Calcipotriene (Dovonex)

Topical and oral corticosteroid drugs for psoriasis Decrease the inflammation and itching associated with psoriasis For severe itching

Immunosuppressant drugs for psoriasis Rx to treat moderate-to-severe, chronic psoriasis that has not responded to other drugs Monocolonal antibodies Adalimumab (Humira) Infliximab (Remicade) Ustekinumab (Stelara)

Immunosuppressant drugs for psoriasis Drugs that suppress overactive immune response Alefacept (Amevive) Cyclosporine (Neoral, Gengraf, Sandimmune) Sirolimus (Rapamune) Given orally continued on next slide

Immunosuppressant drugs for psoriasis Immunomodulator drug Etanercept (Enbrel) Chemotherapy drug Methotrexate (Trexall)

Psoralen drugs for psoriasis Severe, disabling psoriasis may also be treated by exposure to ultraviolet light in combination with a psoralen drug that sensitizes the skin to the effects of ultraviolet light. Methoxsalen (Oxsoralen) continued on next slide

Psoralen drugs for psoriasis The treatment is known as psoralens/ultraviolet wavelength A (PUVA). This combined treatment damages cellular DNA and decreases the rate of cell division.

Did You Know? The drug category psoralen is derived from the name of the herb Psoralea corylifolia, which is known to cause sensitivity to light when eaten. The combining form phot/o- in photochemotherapy means light.

Other topical drugs for psoriasis Topical drugs for psoriasis either inhibit the production of cellular DNA or are toxic to epithelial cells. Either action decreases the rate at which epithelial cells divide. continued on next slide

Other topical drugs for psoriasis Anthralin (Dritho-Scalp, Psoriatec) Calcitrol (Vectical) Pyrithione zinc (Denorex, Head and Shoulders) Available OTC

Combination drugs for psoriasis Topical prescription combination drugs contain: Vitamin D-type drug (calcipotriene) to slow the rate of abnormal epithelial cell growth Corticosteroid drug (betamethasone) to control inflammation in psoriasis continued on next slide

Combination drugs for psoriasis Neutrogena T/Sal (coal tar, salicylic acid) Taclonex (calcipotriene, betamethasone)

Drugs Used to Treat Inflammation and Itching
Topical corticosteroid drugs are indicated to treat inflammation and itching caused by: Contact dermatitis Poison ivy Insect bites Psoriasis continued on next slide

Topical corticosteroid drugs are indicated to treat inflammation and itching caused by: Seborrhea Eczema Yeast or fungal infections

Topical corticosteroid drugs Alclometasone (Aclovate) Betamethasone (Diprolene, Diprosone, Maxivate) Clobetasol (Temovate) Clocortolone (Cloderm) Desonide (DesOwen) Desoximetasone (Topicort) continued on next slide

Topical corticosteroid drugs Dexamethasone (Decadron, Decaspray) Diflorasone (Maxiflor, Psorcon E) Fluocinolone (Capex) Fluocinonide (Lidex) Flurandrenolide (Cordan) Fluticasone (Cutivate) Halcinonide (Halog) continued on next slide

Topical corticosteroid drugs Halobetasol (Ultravate) Hydrocortisone (Dermolate, Westcort) Available in both OTC and Rx strength Mometasone (Elocon) Prednicarbate (Dermatop E) Triamcinolone (Kenalog)

Figure 17–2 Hydrocortisone
Figure 17–2 Hydrocortisone. This prescription generic hydrocortisone cream comes in a 2.5% strength, whereas over-the-counter generic hydrocortisone cream comes in a 1% strength. Hydrocortisone, introduced in 1952, was the first topical corticosteroid drug. In 1983, hydrocortisone was the first topical corticosteroid drug to be approved in a nonprescription strength for over-the-counter sales.

Drug Alert The generic corticosteroid drugs fluocinolone and fluocinonide have sound-alike names that are easily confused.

Drug Alert The topical corticosteroid drug mometasone (Elocon) used to treat skin inflammation is also used to treat asthma under the trade name Asmanex Twisthaler; it is also used intranasally as a spray to treat allergic rhinitis under the heavily advertised trade name Nasonex.

Antihistamine drugs for inflammation and itching Inhibit inflammation, redness, and itching due to the release of histamine Released during an allergic reaction such as contact dermatitis As a group, these drugs are known as antipruritic drugs (pruritus is a Latin word that means itching). continued on next slide

Antihistamine drugs for inflammation and itching Diphenhydramine (Benadryl) Doxepin (Zonalon) Hydralazine (Vistaril) Levocetirizine (Xyzal) Promethazine (Phenergan)

Figure 17–3 Levocetirizine
Figure 17–3 Levocetirizine. This prescription antihistamine drug can be used to treat nasal allergy symptoms but is most effective in treating severe itching of the skin caused by allergies.

Other topical drugs for inflammation and itching Available OTC Colloidal oatmeal (Aveeno) Burow's solution Created by Dr. Karl Burow, German surgeon in the mid-1800s Calamine Ainc oxide

Topical combination drugs for inflammation and itching A topical antihistamine drug (diphenhydramine) to decrease itching An astringent drug (calamine, zinc oxide) to decrease oozing and exudates A topical anesthetic drug (benzocaine) to relieve itching and numb the skin continued on next slide

Topical combination drugs for inflammation and itching Caladryl Calamine Diphenhydramine Calamycin Benzocaine Zinc oxide continued on next slide

Topical combination drugs for inflammation and itching Ziradryl Diphenhydramine Zinc oxide

Drugs Used to Treat Alopecia
Alopecia usually begins in middle age. Inherited tendencies cause it to occur at an earlier age. In women Onset of menopause Levels of estradiol lower than levels of androgens cause the hair to thin. continued on next slide

Alopecia usually begins in middle age In men Lowered testosterone Decreased blood flow to the scalp Cause hair follicles to shrink Male pattern baldness The hair on the top of the head eventually disappears. Fringe of hair at the back of the head

Drugs are used to treat mild-to-moderate alopecia Not effective in all cases Must be continued indefinitely to maintain any new hair growth Two different therapeutic effects

Finasteride (Propecia) This drug blocks an enzyme that must be present in order to produce DHT. Healthy scalp hair follicles contain small amount of the substance DHT. Shrinking hair follicles on balding scalp contain an increased amount of DHT.

Minoxidil (Rogaine) Dilates the arteries in the scalp to increase blood flow Stimulates hair growth

Figure 17–4 Finasteride (Propecia)
Figure 17–4 Finasteride (Propecia). This drug is given orally and works systemically, going through the blood to hair follicles in the scalp, to treat male pattern baldness. Interestingly, finasteride, under the trade name Proscar, is also given orally to treat an enlarged prostate gland in men.

Drug Alert The oral drug finasteride (Propecia) is not approved for use in women because of its connection with the male hormone testosterone. Women are advised not to take finasteride. continued on next slide

Drug Alert They are also warned not to handle finasteride tablets when they are pregnant because of the risk of birth defects in a male fetus. However, the topical drug minoxidil (Rogaine) is approved to treat both male and female alopecia and does not cause birth defects. continued on next slide

Historical Notes Minoxidil (Rogaine) was the first medicine scientifically shown to stimulate hair growth. For thousands of years, men have smeared smelly stuff on their scalps in vain to attempt to treat baldness. continued on next slide

Historical Notes Cleopatra reportedly put a concoction of bear grease, burned mice, deer marrow, and horse teeth on Caesar's bald head. continued on next slide

Historical Notes Other baldness remedies have included pigeon droppings, horseradish, and buffalo dung. –Joe Graedon and Teresa Graedon, "People's Pharmacy," The Baltimore Sun, April 15, 1997, 3F.

Drugs Used to Treat Wrinkles
Topical vitamin A-type drugs Muscle relaxant drugs to relax the muscles that pull the skin into wrinkle lines Filler drugs to plump up the skin to minimize wrinkles continued on next slide

Drugs injected under the skin, effects last several months Sometimes given simultaneously Botulinum toxin type A (Botox) Calcium hydroxalapatite (Radiesse) Human collagen (CosmoDerm, CosmoPlast) continued on next slide

Hyaluronic acid (Juvederm, Restylane) Poly-L-lactic acid (Sculptra) Tazarotene (Avage) Tretinoin (Renova)

Figure 17–5 Botulinum toxin type A (Botox)
Figure 17–5 Botulinum toxin type A (Botox). The toxin in Botox relaxes the underlying muscle, and this allows the skin to become smooth. Botox is used to treat frown lines between the eyebrows or around the mouth. Botox was first used to treat wrinkles in 1999 by a Canadian dermatologist. The trade name Botox is made up of the initial letters of botulinum toxin. Onabotulinum toxin A (Botox Cosmetic) is a lower strength drug and is used to treat crow's feet wrinkles around the eyes. Source: Bloomberg/Contributor/Getty Images

Figure 17–6 Tretinoin. Tretinoin is a retinoid (vitamin A-type) drug that increases blood flow when applied and stimulates the production of collagen to plump the skin and fill the wrinkle.

Did You Know? The toxin in Botox that relaxes muscles in the face is the same toxin produced by Clostridium botulinum, the bacterium that causes food poisoning. Eating spoiled food that contains this bacterium results in muscle paralysis and eventually death from respiratory arrest. continued on next slide

Did You Know? Human collagen is a highly purified product from human sources. Hyaluronic acid occurs naturally in the skin, but the amount decreases with age. The drug hyaluronic acid used to be manufactured from the combs of chickens, but is now manufactured from nonanimal sources. continued on next slide

Did You Know? Hyaluronic acid, under the trade names Hyalgan and Synvisc, is also injected into the joints to improve the thickness and lubricating quality of the synovial fluid in patients with osteoarthritis.

Drugs Used to Treat Bacterial Infections of the Skin
Bacterial infections of the skin occur anytime the skin is broken. Bacteria are always on the surface of the skin. Superficial abrasions, cuts, and burns that become infected are treated with topical antibiotic drugs.

Used to treat skin infections that develop as a result of: Skin diseases, such as acne vulgaris, contact dermatitis Bacterial invasion into areas of fungal or viral skin infections

Topical anti-infective and antibiotic drugs OTC and Rx Treat superficial bacterial skin infections Inhibit growth of bacteria (bacteriostatic action) or kill bacteria (bactericidal action) by blocking their ability to maintain a cell wall continued on next slide

Topical anti-infective and antibiotic drugs Bacitracin Gentamicin Mupirocin (Bactroban) Retapamulin (Altabax) Sulfacetaminde (Ovace)

Figure 17–7 Bacitracin. This over-the-counter antibiotic ointment is inexpensive and readily available. An ointment has a thicker consistency than creams or lotions that allows it to cling to the irregular and often wet surfaces of a cut in the skin.

Historical Notes Bacitracin was developed from a strain of Bacillus subtilis, a bacterium found growing in fluid draining from a wound in a patient named Margaret Tracy. The drug name bacitracin is a combination of the bacterium's name and the patient's name: Bacillus subtilis + Tracy + in.

Topical antibiotic combination drugs OTC combination drugs contain two or three topical antibiotic drugs (bacitracin, neomycin, polymyxin B). Neosporin Original Bacitracin, neomycin, polymyxin B Polysporin Bacitracin, polymyxin B continued on next slide

Topical antibiotic combination drugs OTC combination drugs contain two or three topical antibiotic drugs (bacitracin, neomycin, polymyxin B). Triple Antibiotic Bacitracin, neomycin, polymyxin B

Figure 17–8 Tubes of antibiotic ointment
Figure 17–8 Tubes of antibiotic ointment. These combination over-the-counter trade name antibiotic drugs—Neosporin, Triple Antibiotic, and Polysporin—contain two or three different generic antibiotic drugs in the form of an ointment. Using several antibiotic drugs together provides more complete coverage against various types of bacteria.

Topical antibiotic combination drugs These OTC combination drugs contain three antibiotic drugs (bacitracin, neomycin, polymyxin B) and an anesthetic drug (lidocaine, pramoxine) to treat bacterial skin infections and control pain Lanabiotic Bacitracin, neomycin, polymyxin B, lidocaine continued on next slide

Topical antibiotic combination drugs These OTC combination drugs contain three antibiotic drugs (bacitracin, neomycin, polymyxin B) and an anesthetic drug (lidocaine, pramoxine) to treat bacterial skin infections and control pain Neosporin Plus Pain Relief Bacitracin, neomycin, polymyxin B, pramoxine

Systemic antibiotic drugs For serious or widespread bacterial infections of the skin, oral or intravenous antibiotic drugs that work systemically are prescribed.

Drug Controversy The Soap and Detergent Association reports that 45 percent of hand and body wash products contain antibacterial compounds. One study showed that 75 percent of liquid soaps and 30 percent of bar soaps contain antibacterial compounds.

Drug Controversy Widespread use of antibacterial compounds and the routine use of antibiotic drugs in animal feed are believed to have contributed to the rise of antibiotic-resistant bacteria.

Drugs Used to Treat Fungal or Yeast Infections of The Skin
Fungi and yeast Grow in areas that are: Dark Warm Moist

Fungi and yeast Areas at risk Feet Perineal area Groin area Underarms Scalp

Fungus infections include: Ringworm (tinea capitis, tinea corporis) Athlete's foot (tinea pedis) Jock itch (tinea cruris) Fungal infections of the nails (onychomycosis)

Caused by Candida albicans Most frequently occur in the: Mouth Vagina Skin (diaper rash)

Fungal and yeast infections can be effectively treated with topical antifungal and antiyeast drugs. Alter the cell wall of the fungus or yeast Disrupt its enzyme activity resulting in cell death

Some drugs used to treat fungal infections also to treat yeast infections, because they are closely related (biologically) to each other.

Topical antifungal drugs OTC and RX drugs used to treat superficial fungal infections of the skin or nails Butenafine (Lortimin Ultra) Ciclopirox (Loprex, Penlac Nail Lacquer) Clotrimazole (Cruex Cream, Desenex Cream, Lotrimin AF 1%) Econazole (Spectazole) continued on next slide

Topical antifungal drugs OTC and RX drugs used to treat superficial fungal infections of the skin or nails Efinaconazole (Jublia) Ketoconazole (Nizoral A-D, Xolegel) Luliconazole (Luzu) Miconazole (Lotrimin AF 2%, Micatin, Ting 2%) continued on next slide

Topical antifungal drugs OTC and RX drugs used to treat superficial fungal infections of the skin or nails Naftifine (Naftin) Oxiconazole (Oxistat) Sertaconazole (Ertaczo) Sulconazole (Exelderm) continued on next slide

Topical antifungal drugs OTC and RX drugs used to treat superficial fungal infections of the skin or nails Terbinafine (DesenexMyax, Lamisil AT) Tolnaftate (Aftate, Tinactin, Ting 1%) Undecylenic acid (Cruex, Desenex)

Figure 17–9 Ciclopirox (Penlac Nail Lacquer)
Figure 17–9 Ciclopirox (Penlac Nail Lacquer). Penlac is a clear liquid drug that is applied under the nail, around the cuticle, and on the nail surface, as shown in this clever and informative patient information card. Penlac is used to treat fungal infections of the fingernails or toenails. The generic antifungal drug ciclopirox also comes as a cream or gel to treat fungal infections on the skin.

Figure 17–10 Ketoconazole. Ketoconazole is a generic antifungal drug that is used topically to treat fungal infections of the skin. This drug form is a 2% cream. The box and tube have a warning that this drug is "not for ophthalmic use." Ketoconazole is also available as a gel under the trade name Xolegel.

Drug Alert All of these over-the-counter trade name antifungal drugs are used topically to treat fungal infections. Even though their trade names are very similar, they are actually completely different generic drugs. This can cause confusion on the part of the healthcare workers and consumers.

Figure 17–11 Clotrimazole (Lotrimin AF) cream
Figure 17–11 Clotrimazole (Lotrimin AF) cream. This over-the-counter antifungal drug is clotrimazole (Lotrimin AF), and it comes as a cream. The box and tube advertise that it is for ringworm, a fungal infection of the scalp and body. Ringworm is caused by the fungus that also causes jock itch and athlete's foot.

Figure 17–12 Miconazole (Lotrimin AF) powder spray and powder
Figure 17–12 Miconazole (Lotrimin AF) powder spray and powder. These two over-the-counter drugs both contain the antifungal drug miconazole (Lotrimin AF); the one on the left is a spray powder to treat jock itch in the genital area, and the one on the right is a powder that is sprinkled on to treat athlete's foot. Both jock itch (tinea cruris) and athlete's foot (tinea pedis), as well as ringworm (tinea capitas), are caused by the same fungus.

Systemic antifungal drugs When fungal infections penetrate deeply into the skin or nails, cover large areas, or are particularly severe, they are treated with drugs that act systemically

Drugs Used to Treat Viral Infections of the Skin
Several different types of viruses can cause skin infections Herpes simplex virus, type 1 Cold sores Herpes simplex virus, type 2 Genital herpes continued on next slide

Several different types of viruses can cause skin infections Herpes zoster virus Chicken pox, shingles Human papilloma virus (HPV) Common warts and genital warts

Drugs for herpes simplex virus type 1 Infection only involves the face and mouth. Known as cold sores continued on next slide

Drugs for herpes simplex virus type 1 Drugs interfere with cellular DNA synthesis and keep the virus from reproducing. Rx Drugs Acyclovir (Zovirax) Famciclovir (Famvir) Penciclovir (Denavir) Valacyclovir (Valtrex) continued on next slide

Drugs for herpes simplex virus type 1 Drugs interfere with cellular DNA synthesis and keep the virus from reproducing. OTC drug Docosanol (Abreva)

Figure 17–13 Acyclovir. Acyclovir is a generic antiviral drug used to treat cold sores. It is available as a topical cream or an ointment, but oral acyclovir capsules act systemically to reduce the frequency and severity of outbreaks of cold sores. Oral acyclovir is also used to treat the sexually transmitted disease of genital herpes and the herpes varicella-zoster skin infection known as shingles. Part of the ending –cyclovir reminds that this drug is effective against viruses.

Drugs for herpes simplex virus type 2 Infections are sexually transmitted. Also known as genital herpes Drugs (Rx only) Acyclovir (Zovirax) Famciclovir (Famvir) Valacyclovir (Valtrex)

Drugs for herpes varicella-zoster virus Due to reemergence of the same virus that first caused chickenpox After initial infection as a child, virus remains dormant in the body Later in life when stress or illness triggers its emergence Lesions are particularly painful. Also known as shingles continued on next slide

Drugs for herpes varicella-zoster virus Oral drugs Keep the virus from reproducing Working systemically through the blood and in the deeper tissues of the skin Rx drugs Acyclovir (Zovirax) Famciclovir (Famvir) Valacyclovir (Valtrex) continued on next slide

Drugs for herpes varicella-zoster virus Topical drugs Do not treat the viral infection, but only treat the pain associated with lesions Exert a local anesthetic effect Capsaicin (Capsin, Zostrix) OTC drug Lidocaine (Lidoderm Patch) Rx drug

Figure 17–14 Capsaicin. The drug capsaicin is a derivative of the habanero hot pepper plant. The amount of capsaicin in a hot pepper is measured in Scoville units, a measurement invented in 1912 by pharmacist Thomas Scoville. Habanero hot peppers are rated the highest of all peppers—up to 300,000 Scoville units.

Drugs for human papillomavirus HPV causes both: Common warts (veruccae) Genital warts (condylomata acuminata) continued on next slide

Drugs for human papillomavirus OTC and Rx keratolytic drugs are applied topically. Treat common warts and plantar warts (verrucae) Remove dead layers of skin, which then removes the wart Also used to remove corns, calluses, and skin plaques associated with psoriasis continued on next slide

Drugs for human papillomavirus OTC and Rx keratolytic drugs are applied topically. Monochloroacetic acid (Mono-Chlor) Salicylic acid (Compound W, Dr. Scholl's) continued on next slide

Drugs for human papillomavirus Prescription drugs applied topically or injected to treat genital warts (condylomata acuminata) Imiquimod (Aldara) Interferon alfa-2b (Intron A) Interferon alfa-n3 (Alferon N) Monochloroacetic acid (Mono-Chlor) continued on next slide

Drugs for human papillomavirus Prescription drugs applied topically or injected to treat genital warts (condylomata acuminata) Podofilox (Condylox) Podophyllum (Podocon-25) Trichloroacetic acid (Tri-Chlor)

Figure 17–15 Salicylic acid (Dr. Scholl's)
Figure 17–15 Salicylic acid (Dr. Scholl's). These topical pads contain the over-the-counter keratolytic drug salicylic acid that acts to strip away layers of skin, including a plantar wart on the bottom of the foot.

Did You Know? Podofilox is derived from juniper evergreen trees.
Podophyllum contains an extract of May apple plant as its active ingredient.

Drugs Used to Treat Scabies And Pediculosis
These drugs are used to treat parasites that cause infections in the skin. Scabies is treated with scabicides. Pediculosis is treated with a pediculocide drug.

Caused by tiny, barely visible parasites called mites Tunnel under the skin and cause itchy lesions Lay eggs under the skin which then hatch within a week and continue the cycle continued on next slide

Lesions occur on the trunk, pubic area, and in skin folds; the scalp is rarely affected. Can be transmitted through contact with furniture, clothing, bedsheets, towels, or close personal contact, or sexual intercourse

Topical Rx drugs used to treat scabies Crotamiton (Eurax) Lindane Permethrin (Acticin, Elimite)

Caused by an infestation of lice and their eggs (nits) Can be found on the scalp, body, and pubic area Lice feed on human blood. Bites cause severe itching. Eggs are attached to body hair, particularly on the scalp and pubic area. continued on next slide

Lice easily transmitted from one person to another Hairbrushes Combs Hats Headphones continued on next slide

Lice easily transmitted from one person to another Towels Clothing Upholstery Carpets Close personal contact Sexual intercourse

Topical prescription drugs used to treat pediculosis Ivermectin (Sklice) Lindane Malathion (Ovide) Permethrin (Elimite) Spinosad (Natroba)

Combination topical drugs to treat pediculosis OTC drugs contain two pediculocide drugs (pyrethrin, piperonyl). RID Tisit

Focus on Health Care A child who has had lice and has been treated must be examined by a school health aide or nurse before being readmitted to school.

Focus on Health Care Many school districts have a guideline as to how many nits (eggs) can be found in the hair before the child must be treated again. The phrase nit-picking, which means to point out tiny details, comes from the process of picking through the hair looking for lice eggs.

Focus on Health Care A special LiceMeister Comb, a fine-tooth comb, is helpful in removing nits from the hair.

Did You Know? Scabies in humans is caused by the same parasite (Sarcoptes scabiei) that causes mange in dogs. In pediculosis, a single parasite or louse is shaped like a crab, and so laypersons often refer to an infestation of lice as crabs. continued on next slide

Did You Know? The over-the-counter drug pyrethrin is derived from chrysanthemums. This drug acts on the nervous system of the parasite to paralyze it. Pyrethrin is a common ingredient in flea powder for dogs as well. continued on next slide

Drug Controversy The prescription drug lindane is used to treat both scabies and lice, but only if other drugs have been ineffective. Lindane is never the first choice of treatment. continued on next slide

Drug Controversy In the past, lindane was an agricultural pesticide, but its use was discontinued by the Environmental Protection Agency (EPA) in 2006 because runoff from the fields causes toxic stream pollution. continued on next slide

Drug Controversy However, despite reports of causing illness and even death, the Food and Drug Administration (FDA) allowed lindane to remain on the market as a drug. continued on next slide

Drug Controversy Lindane is not prescribed for pregnant women, children under two years of age, or the elderly because of its possible effect on the central nervous system (seizures). This drug is stored in the fat and can be present in breast milk.

Drugs Used for Topical Anesthesia
Provide brief periods of anesthesia Limited depth in the skin Block movement of sodium ions across the cell membrane, part nerve impulse transmission

Provide temporary symptomatic relief to treat: Pain of herpes zoster (shingles) Postherpetic neuralgia Abrasions Minor burns Cold sores continued on next slide

Provide temporary symptomatic relief to treat: Rashes Sunburn Eczema Insect bites

Benzocaine (Dermoplast) Dibucaine (Nupercainal) Lidocaine (Lidoderm, Xylocaine, Zingo) Pramoxine (Tronothane)

Topical combination anesthetic drugs These combination drugs contain two or three topical anesthetic drugs. Used to prevent pain during procedures that involve the skin Biopsy Removal of a skin lesion Insertion of an intravenous line continued on next slide

Topical combination anesthetic drugs Cetacaine Benzocaine Butamben Tetracaine EMLA Lidocaine Prilocaine continued on next slide

Topical combination anesthetic drugs Synera Comes in the form of a patch Lidocaine Tetracaine

Figure 17–16 Lidocaine with prilocaine
Figure 17–16 Lidocaine with prilocaine. This combination drug contains the topical generic anesthetic drugs lidocaine and prilocaine in the form of a cream. This drug was prescribed for a patient who was fearful of having blood drawn. The cream was applied to the skin several hours prior to the procedure. In the hospital, this cream is also applied to the skin before a patient has an intravenous line inserted. This combination drug has a trade name of EMLA.

Drugs Used to Treat Burns, Skin Ulcers, and Wounds
Burns, skin ulcers, and deep wounds present unique problems in medical management They may contain a large amount of necrotic (dead) tissue that must be removed (debrided) before new tissue can form (granulation). continued on next slide

Burns, skin ulcers, and deep wounds present unique problems in medical management The affected area may produce a large amount of exudate (drainage) that can become infected and must be removed before healing can occur.

Topical drugs for debridement Topical enzymes Dissolve necrotic tissue and scar tissue Allow new tissue to begin to form at the base of a burn, skin ulcer, or wound continued on next slide

Topical drugs for debridement Rx drugs Collagenase (Santyl) Papain (Accuzyme, Panafil) Trypsin (Granulex) OTC drug Dextranomer (Debrisan)

Topical drugs to absorb exudate OTC topical drugs absorb the tissue fluid that flows from damaged tissues and wounds. DuoDerm Sorbsan

Topical drugs to stimulate granulation Becaplermin (Regranex) Particularly for skin ulcers in diabetic patients Growth factor derived from human platelets and produced with recombinant DNA technology

Topical anti-infective drugs for burns Specifically to treat extensive burns and keep them from being infected Mafenide (Sulfamylon) Nitrofurazone (Furacin) Silver sulfadiazine (Silvadene)

Did You Know? The active ingredient in silver sulfadiazine (Silvadene) is actually the chemical element of silver in an ion form.

Other topical drugs for burns and wounds Chlorophyll derivative (Chloresium) OTC drug that promotes healing and neutralizes the odor from wounds Manuka honey (Medihoney) Taken from actual honey

17 Dermatologic Drugs.

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17 Dermatologic Drugs.

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