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Chapter 104Chapter 104

Drugs for the SkinDrugs for the Skin

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

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Drugs for the SkinDrugs for the Skin Topical glucocorticoids (cream, ointment, or gel)Topical glucocorticoids (cream, ointment, or gel) UsesUses

To relieve inflammation and itchingTo relieve inflammation and itching Drying agentDrying agent

Adverse effectsAdverse effects Stretch marksStretch marks PurpuraPurpura TelangiectasiaTelangiectasia HypertrichosisHypertrichosis Possible systemic toxicityPossible systemic toxicity

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Topical GlucocorticoidsTopical Glucocorticoids Adverse effectsAdverse effects

Local reactionsLocal reactions• Thinning of the skinThinning of the skin• Stretch marksStretch marks• PurpuraPurpura• TelangiectasiaTelangiectasia• HypertrichosisHypertrichosis• Possible systemic toxicityPossible systemic toxicity

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Topical GlucocorticoidsTopical Glucocorticoids Adverse effectsAdverse effects

Systemic toxicitySystemic toxicity• More likely with higher doses and long-term therapyMore likely with higher doses and long-term therapy• Growth retardation in childrenGrowth retardation in children• Adrenal suppressionAdrenal suppression

AdministrationAdministration Apply in a thin film and gently rub into the skinApply in a thin film and gently rub into the skin Do not use occlusive bandages (or tight-fitting Do not use occlusive bandages (or tight-fitting

diapers and plastic pants)diapers and plastic pants)

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Keratolytic AgentsKeratolytic Agents Promote shedding of horny layer of the skinPromote shedding of horny layer of the skin Primary agents and usesPrimary agents and uses

Salicylic acid Salicylic acid – – warts, cornswarts, corns Sulfur Sulfur – – acne, dandruff, psoriasis, seborrheic acne, dandruff, psoriasis, seborrheic

dermatitisdermatitis Benzoyl peroxideBenzoyl peroxide

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Treatment for AcneTreatment for Acne Nondrug therapyNondrug therapy

CleansingCleansing Drug therapyDrug therapy

Benzoyl peroxideBenzoyl peroxide AntibioticsAntibiotics

• Topical Topical – – clindamycinclindamycin• Oral Oral – – tetracycline antibiotics, isotretinoin, hormonal tetracycline antibiotics, isotretinoin, hormonal

agentsagents RetinoidsRetinoids

• Tretinoin (Retin-A)Tretinoin (Retin-A)• Adapalene (Differin)Adapalene (Differin)

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Topical Drugs for AcneTopical Drugs for Acne Benzoyl peroxideBenzoyl peroxide RetinoidsRetinoids

TretinoinTretinoin AdapaleneAdapalene TazaroteneTazarotene

Azelaic acidAzelaic acid DapsoneDapsone

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Oral Drugs for AcneOral Drugs for Acne AntibioticsAntibiotics

Agents of choiceAgents of choice• Doxycycline (Vibramycin), minocycline (Minocin)Doxycycline (Vibramycin), minocycline (Minocin)

Alternatives (resistance is common)Alternatives (resistance is common)• Tetracycline (Sumycin), erythromycin (Ery-Tab)Tetracycline (Sumycin), erythromycin (Ery-Tab)

Isotretinoin (Accutane)Isotretinoin (Accutane) TeratogenicTeratogenic Triglyceride levels must be monitoredTriglyceride levels must be monitored

Hormonal agentsHormonal agents

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SunscreensSunscreens Sun exposureSun exposure

Promote tanningPromote tanning UV radiation can also cause burns, premature UV radiation can also cause burns, premature

aging of the skin, skin cancer, and aging of the skin, skin cancer, and immunosuppressionimmunosuppression

Sunscreens impede the penetration of UV Sunscreens impede the penetration of UV radiation to viable cells of the skinradiation to viable cells of the skin

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

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SunscreensSunscreens Organic screensOrganic screens

Also known as chemical screensAlso known as chemical screens Absorb UV radiation and then dissipate it as heatAbsorb UV radiation and then dissipate it as heat 15 of the approved sunscreens 15 of the approved sunscreens

Inorganic screensInorganic screens Also known as physical screensAlso known as physical screens Scatter UV radiationScatter UV radiation Titanium oxide and zinc oxideTitanium oxide and zinc oxide Now micronized and are clear for applying to skinNow micronized and are clear for applying to skin

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Sun Protection FactorSun Protection Factor SPF is an index of protection against UVB SPF is an index of protection against UVB

radiationradiation SPF does not address UVA protectionSPF does not address UVA protection Methods for obtaining SPF are not preciseMethods for obtaining SPF are not precise Relationship between SPF and protection Relationship between SPF and protection

against sunburn is not linear (SPF 30 is not against sunburn is not linear (SPF 30 is not twice as much protection as SPF 15)twice as much protection as SPF 15)

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SunscreensSunscreens Water and sweat resistanceWater and sweat resistance Adverse effects of sunscreensAdverse effects of sunscreens Proposed changes regarding sunscreen Proposed changes regarding sunscreen

testing and labelingtesting and labeling UVB rating and labelingUVB rating and labeling Using a sunscreen effectivelyUsing a sunscreen effectively

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Treatment for Psoriasis Treatment for Psoriasis Psoriasis Psoriasis – – red patches with silver scalesred patches with silver scales

Common, chronic inflammatory disorder that Common, chronic inflammatory disorder that follows an erratic coursefollows an erratic course

Initial episode usually develops in early adulthoodInitial episode usually develops in early adulthood Subsequent attacks may occur spontaneously or Subsequent attacks may occur spontaneously or

in response to triggersin response to triggers Varying degrees of severityVarying degrees of severity Symptoms come from:Symptoms come from:

Accelerated maturation of epidermal cellsAccelerated maturation of epidermal cells Excessive activity of inflammatory cellsExcessive activity of inflammatory cells

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Treatment for PsoriasisTreatment for Psoriasis Topical drugsTopical drugs

GlucocorticoidsGlucocorticoids Calcipotriene (Dovonex)Calcipotriene (Dovonex) Tazarotene (Tazorac)Tazarotene (Tazorac) AnthralinAnthralin TarsTars

Biologic agentsBiologic agents Alefacept (Amevive)Alefacept (Amevive) Efalizumab (Raptiva)Efalizumab (Raptiva) Tumor necrosis factor inhibitors (Enbrel)Tumor necrosis factor inhibitors (Enbrel)

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Treatment for PsoriasisTreatment for Psoriasis Systemic drugs (conventional agents)Systemic drugs (conventional agents)

MethotrexateMethotrexate Acitretin (Soriatane)Acitretin (Soriatane) Glucocorticoids Glucocorticoids Cyclosporine (Neoral)Cyclosporine (Neoral)

ProceduresProcedures PhototherapyPhototherapy Coal tar plus ultraviolet B irradiationCoal tar plus ultraviolet B irradiation

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Actinic Keratoses (AK)Actinic Keratoses (AK) Rough, scaly, red or brown papules caused Rough, scaly, red or brown papules caused

by chronic exposure to sunlightby chronic exposure to sunlight Half of all skin cancers in U.S. begin as AKHalf of all skin cancers in U.S. begin as AK Drugs for AKDrugs for AK

FluorouracilFluorouracil Diclofenac sodiumDiclofenac sodium ImiquimodImiquimod Aminolevulinic acid plus blue lightAminolevulinic acid plus blue light

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Drugs for Atopic Dermatitis (Eczema)Drugs for Atopic Dermatitis (Eczema)

GlucocorticoidsGlucocorticoids Topical immunosuppressantsTopical immunosuppressants

May cause skin cancer or lymphomaMay cause skin cancer or lymphoma TacrolimusTacrolimus PimecrolimusPimecrolimus

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Agents Used to Remove Agents Used to Remove Venereal WartsVenereal Warts

Physical measuresPhysical measures Cryotherapy, electrodesiccation, laser surgery, Cryotherapy, electrodesiccation, laser surgery,

and conventional surgeryand conventional surgery Topical drugsTopical drugs

Podophyllin (must be applied by physician)Podophyllin (must be applied by physician) Can be applied at homeCan be applied at home

ImiquimodImiquimod PodofiloxPodofilox KunecatechinsKunecatechins

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Miscellaneous Drugs for SkinMiscellaneous Drugs for Skin Agents to remove common wartsAgents to remove common warts AntiperspirantsAntiperspirants DeodorantsDeodorants Drugs for seborrheic dermatitis and dandruffDrugs for seborrheic dermatitis and dandruff

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Drugs for HairDrugs for Hair Treat hair lossTreat hair loss

Topical minoxidilTopical minoxidil Finasteride (Propecia)Finasteride (Propecia)

Treat unwanted facial hairTreat unwanted facial hair Eflornithine (Vaniqa)Eflornithine (Vaniqa)

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ImpetigoImpetigo Most common bacterial infection of the skin Most common bacterial infection of the skin ––

Staphylococcus aureusStaphylococcus aureus is most common is most common Usually seen in children 2 to 5 years of ageUsually seen in children 2 to 5 years of age Two formsTwo forms

Bullous Bullous NonbullousNonbullous

Drugs for impetigo (see Table 104-5)Drugs for impetigo (see Table 104-5)

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Local AnestheticsLocal Anesthetics Can be applied topically to relieve pain and Can be applied topically to relieve pain and

itching associated with skin disordersitching associated with skin disorders BenzocaineBenzocaine LidocaineLidocaine PramoxinePramoxine