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C HAPT E R 4 3
Integumentary Medications
 Clinical Judgment; Safety

1. Poison Ivy Treatment

A. Treatment of lesions includes calamine lotion and commercial

products that soothe lesions, compresses and solutions that are
astringent and antiseptic, and/or colloidal oatmeal baths to relieve
discomfort.

B. Topical corticosteroids are effective to prevent or relieve

inflammation, especially when used before blisters form.

C. Oral corticosteroids may be prescribed for severe reactions, and

an antihistamine such as diphenhydramine may be prescribed.
2 . Medications to Treat Dermatitis
TABLE OF CONTENTS
A. Description

1. Superficial inflammatory process involving primarily

the epidermis; there are many types, some of which
include atopic dermatitis, contact dermatitis, and
stasis dermatitis.

2. May be treated with moisturizer and topical

glucocorticoids (preferred treatment); systemic
immunosuppressants may need to be prescribed if
topical treatment is ineffective.
B. Topical immunosuppressants

1. Tacrolimus and pimecrolimus creams

2. Side and adverse effects include redness, burning, and

itching; causes sensitization of the skin to sunlight.
Treated areas should be protected from direct
sunlight.

3. Tacrolimus may increase the risk of contracting

varicella zoster infection in children.
4. Tacrolimus may increase the risk of developing skin
cancer and lymphoma.
3. Topical Glucocorticoids

A. Description
1. Antiinflammatory, antipruritic, and vasoconstrictive
actions

2. Preparations vary in potency and depend on the

concentration and type of preparation and method of
application (occlusive dressings enhance absorption,
increasing the effects).

3. Systemic effects are more likely to occur with

prolonged therapy and when extensive skin surfaces
are treated.
B. Contraindications

1. Clients demonstrating previous sensitivity to

corticosteroids

2. Clients with current systemic fungal, viral, or bacterial

infections

3. Clients with current complications related to

glucocorticoid therapy
C. Local side and adverse effects

1. Burning, dryness, irritation, itching

2. Thinning of the skin, striae, purpura, telangiectasia (causes thread-like red lines on the
skin)
3. Skin atrophy
4. Acneiform eruptions
5. Hypopigmentation
6. Overgrowth of bacteria, fungi, and viruses

D. Systemic adverse effects

1. Growth retardation in children

2. Adrenal suppression
3. Cushing’s syndrome
4. Ocular effects (glaucoma and cataracts)
E. Interventions

1. Wear gloves; wash the area just before application to

ensure cleanliness and to increase medication
penetration.
2. Apply sparingly in a thin film, rubbing gently.
3. Avoid the use of a dry occlusive dressing unless
specifically prescribed by the primary health care
provider (PHCP).
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4. Instruct the client to report signs of adverse effects to
the PHCP.
5. Monitoring plasma cortisol levels may be prescribed if
prolonged therapy is necessary.
4. Medications to Treat Actinic Keratosis

Description :
1. Actinic keratoses are caused by prolonged exposure to the sun and appear as rough, scaly, red or
brown lesions usually found on the face, scalp, arms, and back of the hands.
2. Lesions can progress to squamous cell carcinoma.
3. Treatment includes medications and therapies such as excision, cryotherapy, curettage, and laser
therapy.

5. Medications to Treat Psoriasis

Description :
1. Psoriasis is a chronic inflammatory disorder that has
varying degrees of severity.
2. Treatment is based on the severity of symptoms and aims to
suppress the proliferation of keratinocytes or suppress the activity
of inflammatory cells.
6. Sunscreens

A.Ultraviolet (UV) light can damage the skin and cause premalignant actinic
keratoses and some types of skin cancer.
B. Sunscreens prevent the penetration of UV light and protect the skin.
C. Organic (chemical) sunscreens absorb UV light; inorganic (physical) sunscreens
reflect and scatter UV light.
D. A sunscreen that protects against both UVB and UVA rays and one that has a sun
protection factor (SPF) of at least 15 should be used.
E. Sunscreens are most effective when applied at least 30 minutes
before exposure to the sun (sunscreens containing paraaminobenzoic
acid or padimate O require application 2 hours
before sun exposure).
F. Sunscreen should be reapplied every 2 to 3 hours and after
swimming or sweating; otherwise, the duration of protection is
reduced.
G. Products containing para-aminobenzoic acid need to be avoided
by individuals allergic to benzocaine, sulfonamides, or thiazides.
H. Sunscreens can cause contact dermatitis and photosensitivity
7. Acne Products

Description :
1. Acne lesions that are mild may be treated with nonpharmacological measures such as
gentle cleansing 2 or 3 times daily (oil-based moisturizing products need to be avoided),
dermabrasion, or comedo extraction.
2. Mild acne is usually treated pharmacologically with topical agents (antimicrobials and
retinoids).
3. Moderate acne is usually treated with oral antibiotics and comedolytics.
4. Severe acne is usually treated with isotretinoin.
5. Hormonal medications may be prescribed to treat acne in female clients.

Topical antibiotic products :

1. Benzoyl peroxide
2. Salicylic acid and sulfur/sulfacetamide can be used as well.
3. Clindamycin and erythromycin
4. Dapsone: Side and adverse effects include oiliness, peeling, dryness, and erythema of the
skin (oral form of medication is used to treat leprosy).
Poison Ivy Treatment Products

▪ Bentoquatam—for preventive use

▪ Calamine lotion
▪ Hydrocortisone
▪ Zinc acetate; isopropanol
▪ Zinc acetate; isopropanol; benzyl alcohol

Medications to Treat Dermatitis

1. Systemic Immunosuppressants
▪ Azathioprine
▪ Cyclosporine
▪ Methotrexate
▪ Oral glucocorticoids

2. Topical Immunosuppressants
▪Pimecrolimus 1% cream, Tacrolimus
Medications to Treat Actinic Keratosis
▪ Diclofenac sodium 3% gel
▪ Fluorouracil
▪ Imiquimod 5% cream
▪ Ingenol mebutate

Medications and Treatments for Psoriasis

1. Topical Medications
▪ Calcipotriene
▪ Coal tar
▪ Glucocorticoids
▪ Keratolytics (topical salicylic acid; sulfur)
▪ Tazarotene

2. Systemic Medications
▪ Acitretin
▪ Cyclosporine
▪ Methotrexate
Acne Products

1. Topical Antibiotics
▪ Benzoyl peroxide
▪ Clindamycin and erythromycin
▪ Clindamycin/tretinoin combination gel
▪ Dapsone
▪ Fixed dose combinations: Clindamycin/benzoyl peroxide and
erythromycin/benzoyl peroxide

2. Topical Retinoids
▪ Adapalene
▪ Azelaic acid
▪ Tazarotene
▪ Tretinoin
Burn Products

▪ Mafenide acetate
▪ Silver sulfadiazine
▪ Bacitracin topical ointment (first-degree burns only)
▪ Povidone-iodine
TERIMAKASIH