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Chapter 104

Chapter 104. Drugs for the Skin. Fig. 104-1. Anatomy of the skin. A, Major structures of the skin. B, Growth layers of the epidermis. . Drugs for the Skin. Topical glucocorticoids (cream, ointment, or gel) Uses To relieve inflammation and itching Drying agent Adverse effects

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Chapter 104

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  1. Chapter 104 Drugs for the Skin

  2. Fig. 104-1. Anatomy of the skin. A, Major structures of the skin. B, Growth layers of the epidermis.

  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. Topical Glucocorticoids • Adverse effects • Local reactions • Thinning of the skin • Stretch marks • Purpura • Telangiectasia • Hypertrichosis • Possible systemic toxicity

  5. Topical Glucocorticoids • Adverse effects • Systemic toxicity • More likely with higher doses and long-term therapy • Growth retardation in children • 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. 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

  7. Treatment for Acne • Nondrug therapy • Cleansing • Drug therapy • Benzoyl peroxide • Antibiotics • Topical – clindamycin • Oral – tetracycline antibiotics, isotretinoin, hormonal agents • Retinoids • Tretinoin (Retin-A) • Adapalene (Differin)

  8. Topical Drugs for Acne • Benzoyl peroxide • Retinoids • Tretinoin • Adapalene • Tazarotene • Azelaic acid • Dapsone

  9. Oral Drugs for Acne • Antibiotics • Agents of choice • Doxycycline (Vibramycin), minocycline (Minocin) • Alternatives (resistance is common) • Tetracycline (Sumycin), erythromycin (Ery-Tab) • Isotretinoin (Accutane) • Teratogenic • Triglyceride levels must be monitored • Hormonal agents

  10. 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

  11. Fig. 104-2. Range of UVB and UVA protection conferred by FDA-approved sunscreens.

  12. 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

  13. 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)

  14. Sunscreens • Water and sweat resistance • Adverse effects of sunscreens • Proposed changes regarding sunscreen testing and labeling • UVB rating and labeling • Using a sunscreen effectively

  15. 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

  16. Treatment for Psoriasis • Topical drugs • Glucocorticoids • Calcipotriene (Dovonex) • Tazarotene (Tazorac) • Anthralin • Tars • Biologic agents • Alefacept (Amevive) • Efalizumab (Raptiva) • Tumor necrosis factor inhibitors (Enbrel)

  17. Treatment for Psoriasis • Systemic drugs (conventional agents) • Methotrexate • Acitretin (Soriatane) • Glucocorticoids • Cyclosporine (Neoral) • Procedures • Phototherapy • Coal tar plus ultraviolet B irradiation

  18. 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

  19. Drugs for Atopic Dermatitis (Eczema) • Glucocorticoids • Topical immunosuppressants • May cause skin cancer or lymphoma • Tacrolimus • Pimecrolimus

  20. 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

  21. Miscellaneous Drugs for Skin • Agents to remove common warts • Antiperspirants • Deodorants • Drugs for seborrheic dermatitis and dandruff

  22. Drugs for Hair • Treat hair loss • Topical minoxidil • Finasteride (Propecia) • Treat unwanted facial hair • Eflornithine (Vaniqa)

  23. 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)

  24. Local Anesthetics • Can be applied topically to relieve pain and itching associated with skin disorders • Benzocaine • Lidocaine • Pramoxine

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