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APPLICATION OF DRUGS TO THE SKIN

APPLICATION OF DRUGS TO THE SKIN. APPLICATION OF DRUGS TO THE SKIN. TOPICAL TRANSCUTANEOUS. APPLICATION OF DRUGS TO THE SKIN. TOPICAL Provides a local effect Provides a systemic effect Some do both and may inadvertently cause adverse systemic effects and / or toxicity.

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APPLICATION OF DRUGS TO THE SKIN

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  1. DNATION/CSHALDERS/2008 APPLICATION OF DRUGS TO THE SKIN

  2. APPLICATION OF DRUGS TO THE SKIN • TOPICAL • TRANSCUTANEOUS

  3. APPLICATION OF DRUGS TO THE SKIN • TOPICAL • Provides a local effect • Provides a systemic effect • Some do both and may inadvertently cause adverse systemic effects and / or toxicity

  4. APPLICATION OF DRUGS TO THE SKIN • Medications applied to the skin need to penetrate the superficial cells. • For drugs to be carried into the cells the keratin layer of the epidermis must be penetrated, however where this is broken excessive absorption can occur.

  5. APPLICATION OF DRUGS TO THE SKIN • Transcutaneous dressings • Keratin waterproofs the skin • To enhance drug absorption some medications are placed under an occlusive dressing • ie plastic • Brainstorm some other ways of providing an occlusive dressing to the skin

  6. APPLICATION OF DRUGS TO THE SKIN • Skin layers to be crossed • Stratum corneum • Thickest layer • Provides strongest barrier • Passage across it is the rate limiting step • Emolients, moisturisers keratolytics may moisten this layer & remove dead cells • Brainstorm examples in workplace

  7. APPLICATION OF DRUGS TO THE SKIN • Factors affecting transcutaneous absorption • Slow • Incomplete • Variable • Depends on patient’s • Age • Condition of skin • Metabolism & circulation • Hydration of skin • Vehicle in which the drug is administered

  8. APPLICATION OF DRUGS TO THE SKIN • Formulations & medications for topical application • Important to use the appropriate base (vehicle) form. • Common forms • Ointments • Creams • Lotions

  9. APPLICATION OF DRUGS TO THE SKIN • Topical agents • Antipruritics • Astringents • Baths & soaks • Cleansers • Creams & ointments • Emollients

  10. APPLICATION OF DRUGS TO THE SKIN • Lotions • Liquid preparation, ususally cooling and antiseptic action • Many contain some alcohol. • Care should be taken not to over applicate lotions, esp in the elderly as a result of excessive cooling can occur

  11. APPLICATION OF DRUGS TO THE SKIN • Calamine lotion • An emulsion of zinc oxide, rose water and glycerine. • It is a convenient way of applying a powder to the skin with added cooling effect

  12. APPLICATION OF DRUGS TO THE SKIN • Creams • Generally of low viscosity, tend to disappear quickly due to evaporation of the water, any fats present is taken up by the superficial cells of the epidermis.

  13. APPLICATION OF DRUGS TO THE SKIN • Gels • Generally translucent preparations • Less messy than creams • Popular vehicles of anti inflammatory agents

  14. APPLICATION OF DRUGS TO THE SKIN • Ointments • High fat content/ high viscosity • They adhere to the skin acting as occlusive • Can lead to skin maceration, useful in dry scaly conditions

  15. APPLICATION OF DRUGS TO THE SKIN • Skin Cleansers • Used for accumulation of cell debris • Removal of scaly skin • Mild soaps with the addition of an antiseptic eg, cetrimide,or chlorhexidine • Useful prophylaxis of acne and reducing risk of nonsocomial infections

  16. APPLICATION OF DRUGS TO THE SKIN • Barrier creams • Most effective when applied after bathing • Reapplied at regular intervals • When applying creams in conjunction with barrier apply at different times

  17. APPLICATION OF DRUGS TO THE SKIN • Desloughing agents • Remove cell debris and exudate. • Keratolytic soften and loosen the outer layer of the skin. • Which allows for deeper penetration of drugs into the skin

  18. APPLICATION OF DRUGS TO THE SKIN • Topical agents (cont) • Gels • Keratolytics • Keratoplastics • Liniments & rubs • Lotions & solutions • Pastes • Patches • Powders

  19. APPLICATION OF DRUGS TO THE SKIN • Topical agents (cont) • Preservatives • Protectants • Psoralens • Soaps • Sprays • Tars • Tinctures • Wet dressings

  20. APPLICATION OF DRUGS TO THE SKIN • Exercise • Work in groups and look at two or three of these drugs as they are used in your facility • Determine how you would evaluate the effectiveness or ineffectiveness of the preparations used

  21. TYPES OF DRUGS AFFECTING THE SKIN • Many preparations are available as OTC’s and on prescriptions. Ones of note are: • Sunscreens • Topical anti-microbials • Corticosteroids • Retinoids & other drugs used to treat acne • Agents used for burns & pressure ulcers

  22. APPLICATION OF DRUGS TO THE SKIN • Retinoids • Derivatives of Vit A, have an effect on the epithelial cells • Tretinoin compound used topically, may exaccerbate acne or reddening initially

  23. APPLICATION OF DRUGS TO THE SKIN • Retinoids • Isotretinoin is an oral retinoid reserved for treatment of severe acne • Is tetragenic, not given to womwn unless on appropriate contraceptives • Given under strict supervision prescribing rights for dermatologists only

  24. APPLICATION OF DRUGS TO THE SKIN • Sunscreens - Phototoxicity & photoallergy • Phototoxic reactions can be caused by • Dyes • Suntanning preparations • Tetracyclines • Oestrogens, • Sulphonamides • Thiazides • Phenothiazines • Plants • Cosmetics • Soaps

  25. APPLICATION OF DRUGS TO THE SKIN • Ultraviolet radiation damage • Extended exposure to sun from • Sunbathing • Outdoor occupations • Results from this exposure • Useful effect in activating sterols to Vitamin D • ( used to treat acne, neonatal jaundice)

  26. APPLICATION OF DRUGS TO THE SKIN • Ultra violet radiation • Damage • Can damage DNA strands by causing thiamine bases to link with dimers • May inactivate viruses • May cause skin damage • Minor irritations • Blisters • skin darkening & thickening • Skin cancers - most serious one is a melanoma

  27. APPLICATION OF DRUGS TO THE SKIN • UVR divided into • UVA • Long wave radiation, closest to visible light • Produces darkening of preformed melanin – suntan • Responsible for many photosensitivity reactions

  28. APPLICATION OF DRUGS TO THE SKIN • UVB • Causes • erythema • Sunburn • Photoageing • Associated with vitamin D3 synthesis • Determined to be responsible for skin cancer induction which appears to be augmented by UVA • Holes in ozone layer allow passage of greater proportions of solar UBV and increase incidence of skin cancers

  29. APPLICATION OF DRUGS TO THE SKIN • UBC • Most of this ray does not reach earth from the sun • Exposure is usually from artificial sources such as • Mercury lamps • Arc welding • Can cause some erythema • Will not stimulate tanning • Is very damaging to the retina

  30. APPLICATION OF DRUGS TO THE SKIN • Sunscreen preparations • Absorb or reflect UVR • Absorbents block at least 85% of UVB • Absorbing agents are • PABA derivatives, benzophenones, some salicylates and anthranilites • Sunblocks scatter UBV & UBA • Reflectors include • Titanium dioxide, zinc oxide • Refer to Bryant et al table 56-3 p 856

  31. APPLICATION OF DRUGS TO THE SKIN • Acne • Treatments • Antimicobial agents, retinoids, skin cleansers, benzyl peroxide

  32. APPLICATION OF DRUGS TO THE SKIN • Acne • Triclosan broad spectrum topical antibacterial • Well tolerated, many household cleansers also contain this ? development of drug resistance

  33. APPLICATION OF DRUGS TO THE SKIN • Bezyl Peroxide • Powerful oxidising agent, bacterialcidal action • Start with lower strengths and increase to higher • Cause minor skin reddening

  34. APPLICATION OF DRUGS TO THE SKIN • Topical antimicrobial agents • Agents include • Antibacterial • Antiviral • Antifungal • Antiparasitic • There is world wide concern about the increasing resistance of organisms to these preparations

  35. APPLICATION OF DRUGS TO THE SKIN Antibacterial treament improvement may be apparent after six weeks, however treatment often required up to six months

  36. APPLICATION OF DRUGS TO THE SKIN • Antibacterials • Neomycin • Broad spectrum treatment of skin and mucous membrane infections • Resistance can occur • If used in pregnancy may cause ototoxicity or renal toxicity in foetus • Risk and side effects should be considered and understood

  37. APPLICATION OF DRUGS TO THE SKIN • Antibacterials • Bacitracin • Useful in local treatment of lesions • Odourless • Non-staining • Seldom results in sensitising • Some allergic contact dermatitis may occur

  38. APPLICATION OF DRUGS TO THE SKIN • Antibacterials • Mupirocin • Topical anti-bacterial preparation • Indicated in S. aureus and beta - haemolytic streptococci • Effective in eradicating the carrier status for S. aureus • Usually applied TDS

  39. APPLICATION OF DRUGS TO THE SKIN • Anti-virals • Aciclovar & Idoxuridine • Used for treatment of cutaneous herpes simplex on • Lips • genitalia • Inhibits viral DNA polymerase & inhibits further viral replication • May be used topically or taken systemically • Most effective as soon as virus is detected

  40. APPLICATION OF DRUGS TO THE SKIN • Anti-virals • Treatment of warts (human papilloma virus) • Usually not treated with specific drugs • Ano-genital warts usually transmitted sexually • May go under malignant transformation • Linked with cervical cancer • Other non medicated treatments may be used

  41. APPLICATION OF DRUGS TO THE SKIN • Fungal skin infectons • Three pathogenic fungi • Microsporum • Trichophyton • Epidermophyton • Fungi thrive in • Warm , moist environment • Spread communally • Public showers swimming pools etc • Treated with anti-fungal preparations • ie; canestan

  42. APPLICATION OF DRUGS TO THE SKIN • Topical ectoparasiticidal drugs (parasites) • Pediculosis (head and body lice) • Treated topically with preparations • Permethrin, malathion • Scabies ( mites) • Treated topically with preparations • Permathrin, malathion

  43. APPLICATION OF DRUGS TO THE SKIN • Scabies • Crotamiton • Kills mites and has antipruritic effect • Less toxic requires daily treatment

  44. DNATION/CSHALDERS/GOTAFE/2008 APPLICATION OF DRUGS TO THE SKIN • Corticosteroids • Indicated for relief of inflammatory & pruritic dermatoses • Are available in a wide range of formulations • Easy to apply • Monitoring important as large continuous use may cause Cushingoid effects • (look up these effects and discuss in classroom)

  45. APPLICATION OF DRUGS TO THE SKIN • Corticosteroids • Should not be used for more than a few days or weeks • Some may cause staining need to wear gloves

  46. APPLICATION OF DRUGS TO THE SKIN • Retinoids and acne vulgaris treatment • Retinoids (Vitamin A analogues) • Now drugs of choice in treating acne • Topical retinoids • Treatment for mild acne • Oral retinoids • Treatment for more severe acne • Special precautions in pregnancy

  47. APPLICATION OF DRUGS TO THE SKIN • Other acne products • Keralytics • Creams & lotions containing benzoyl & azelaic acid • Antiseptics • Alcohol based cleansers, sulphas • Antibiotics • Acne not contagious/ used to decrease colonisation of P.ances decreasing formation of fatty by products. Used when other treatments not working • Hormones • Acne associated with excess androgen production, women can be treated with antiandrogenic agents & oestrogens

  48. APPLICATION OF DRUGS TO THE SKIN • Burns • Caused by any extreme heat or cryogenic activity which damages and / or destroys from superficial to deep tissue and nerve tissues over a small or large body surface area • Aim of treatment is to • Reduce pain and shock, • Replace plasma loss • Heal the proportion of body surface damaged • Minimise infection

  49. APPLICATION OF DRUGS TO THE SKIN • Burns • First aid management essential • Treatment consistent with degree of burn and damage caused • May be occlusive dressing • Topical preparations • Skin grafts • Require pain relief, aseptic conditions, psychological support

  50. APPLICATION OF DRUGS TO THE SKIN • Pressure sores • Pressure sores from inactivity / being bedridden • Classification • Stage 1 – redness over an area which remains when pressure is removed • Stage 2 – some superficial skin loss • Stage 3 – full thickness skin loss • Stage 4 – deep lesions exposing underlying structures • Bones, tendons, muscles

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