1. Drugs for Dermatologic Disorders
Chapter 50
Drugs for Dermatologic Disorders
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

2. Causes of Skin Lesions Acne vulgaris Psoriasis Eczema dermatitis
Contact dermatitis
Drug-induced dermatitis
Burn infections
Viral infections
Herpes simplex, herpes zoster
Fungal infections
Tinea pedis, tinea capitis
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

3. Types of Skin Lesions Macules Papules Vesicles Plaques
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

4. Acne Vulgaris Characteristics Nonpharmacologic approach Antiacne drugs
Keratolytics
Benzoyl peroxide
Resorcinol
Salicylic acid
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

5. Acne Vulgaris (Cont.) Antiacne drugs Topical Oral antibiotics
Tretinoin (Retin-A, Renova)
Adapalene (Differin)
Azelaic acid (Azelex)
Tazarotene (Tazorac)
Oral antibiotics
Doxycycline
Minocycline
Tetracycline
Erythromycin
Topical glucocorticoids
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

6. Acne Vulgaris (Cont.) Antiacne drugs
Systemic: isotretinoin (Amnesteem)
Side effects of isotretinoin
Skin irritation, thrombocytopenia, nosebleeds, teratogenic effects
Monitoring of blood work
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

7. iPLEDGE Risk management program for isotretinoin
Includes implications for
Patient
Health care provider
Pharmacist
Wholesaler
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

8. Psoriasis Characteristics Psoriasis drug treatment
Topical: Salicylic acid, sulfur, topical glucocorticoids, anthralin (Psoriatec), calcipotriene (Dovonex), tazarotene (Tazorac), and coal tar (Scytera)
Ultraviolet light
Systemic: Methotrexate
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

9. Psoriasis (Cont.) Biologic agents Alefacept (Amevive)
Etanercept (Enbrel)
Infliximab (Remicade)
Adalimumab (Humira)
Ustekinumab (Stelara)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

10. Verruca Vulgaris (Warts)
Characteristics
Drugs for treatment
Salicylic acid
Podophyllum resin
Imiquimod (Aldara, Zyclara)
Podofilox (Condylox)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

11. Nursing Process: Acne Vulgaris and Psoriasis
Assessment
Nursing diagnosis
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

12. Drug-Induced Dermatitis
Characteristics
Rash, urticaria, papules, and vesicles
Life-threatening: erythema multiforme (red blisters over a large portion of the body), Stevens-Johnson syndrome (large blisters in the oral and anogenital mucosa, pharynx, eyes, and viscera), toxic epidermal necrolysis (widespread detachment of the epidermis from underlying skin layers)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

13. Drug-Induced Dermatitis (Cont.)
Etiology
Penicillin hypersensitivity
Toxic epidermal necrolysis
Discoid lupus erythematosus (DLE)
Exfoliative dermatitis 
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

14. Contact Dermatitis Characteristics Causes Nonpharmacologic measures
Chemical: cosmetics, perfume
Plants: poison ivy
Nonpharmacologic measures
Pharmacologic measures
Burow’s solution (aluminum acetate)
Calamine lotion
Glucocorticoid ointments, creams, or gels
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

15. Impetigo Etiology Population affected Treatment Topical Systemic
Mupirocin (Bactroban)
Retapamulin (Altabax)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

16. Hair Loss and Baldness Etiology Treatment Family history Aging
Drug-induced
Febrile illnesses
Pregnancy
Myxedema
Treatment
Minoxidil (Rogaine)
Finasteride (Propecia, Proscar)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

17. Sunscreens Categories of sunscreen Sun protective factor (SPF)
Chemical
Physical
Sun protective factor (SPF)
UVB radiation
Preventive measures
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

18. Burns and Burn Preparations
Degrees of burns
Topical drugs for burns
Mafenide (Sulfamylon Cream)
Side effects/adverse reactions
Burning sensations, blistering, superinfection, acidosis
Silver sulfadiazine (Silvadene)
Side effects
Skin discoloration
Silver nitrate 0.5% solution
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

19. Nursing Process: Burns
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

20. Practice Question #1
Finasteride (Propecia) is used to treat male pattern baldness. The nurse knows that in higher doses, the drug is used to treat which condition?
Benign prostatic hypertrophy
Gastroesophageal reflux
Migraine headache
Impotence
Answer: A
Rationale: Finasteride (Propecia, Proscar) is an oral drug used for male baldness. It is available in 1-mg tablets. (A 5-mg tablet is prescribed for benign prostatic hyperplasia.)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

21. Practice Question #2
A patient is ordered to receive isotretinoin (Amnesteem) for acne vulgaris. What is considered priority information in teaching this patient?
Good skin hygiene
Optimal nutritional practices
Contraception or abstinence from sexual intercourse
Methods to avoid infection
Answer: C
Rationale: Isotretinoin must not be used during pregnancy because of its powerful teratogenicity. For female patients, two effective methods of contraception are required 1 month before, through the duration, and 1 month after terminating isotretinoin treatment.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

22. Practice Question #3
A patient is admitted to the emergency department with a burn that consists of pearly white skin with areas that are charred. The patient is not in pain. The nurse documents the burn as
superficial epidermal.
partial thickness superficial.
deep thickness.
full thickness.
Answer: D
Rationale: Superficial epidermal burns are red and painful; partial thickness superficial burns are blistering and very painful, and deep thickness burns are mottled and blistering with intense pain.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

23. Practice Question #4
Patients receiving extensive amounts of mafenide acetate (Sulfamylon Cream) for the treatment of burns are most at risk for the development of which imbalance?
Hypomagnesemia
Metabolic acidosis
Respiratory acidosis
Hypocalcemia
Answer: B
Rationale: If used extensively, mafenide acetate (Sulfamylon Cream) may cause metabolic acidosis. Calcium and magnesium levels are generally not affected, and respiratory alkalosis can occur as adverse reactions.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

24. Practice Question #5
Which medication does the nurse anticipate administering to a patient with venereal warts?
Salicylic acid
Podophyllum resin
Etanercept
Anthralin
Answer: B
Rationale: Podophyllum resin is indicated mainly for venereal warts and is not as effective against the common wart.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.