The skin is our protective outer layer, and a wide range of conditions can affect it, from simple rashes to chronic diseases. Dermatological medications are used to treat these issues, often applied directly to the skin to target the problem area.

This lesson focuses on common types of skin medications and the essential nursing care involved in their administration and patient education.

Topical Medications: Applied to the Skin

Most skin conditions are treated with medications applied directly to the affected area.

• Reducing Skin Inflammation & Itching:

  • Medications: Topical Corticosteroids (e.g., Hydrocortisone – low potency, Triamcinolone – medium, Clobetasol – high).

  • Uses: Eczema, psoriasis, contact dermatitis, allergic rashes.

  • Nursing Focus:

    • Administration: Apply a thin layer only to the affected skin. Potency matters! Use low potency on face/groin/children. Avoid applying to unaffected skin.

    • Monitoring: Watch for reduced redness, swelling, itching. Monitor for local side effects with overuse: skin thinning (atrophy), stretch marks, easy bruising, increased infection risk. Systemic effects are rare with proper use but possible with high potency/large areas/occlusion.

    • Education: Use correct amount (e.g., fingertip unit). Avoid prolonged use of potent steroids. Report skin changes.

• Treating Skin Infections:

  • Medications: Topical Antibiotics (e.g., Mupirocin, Neomycin), Topical Antifungals (e.g., Clotrimazole, Terbinafine, Nystatin), Topical Antivirals (e.g., Acyclovir).

  • Uses: Bacterial infections (impetigo), fungal infections (ringworm, athlete’s foot, thrush), viral infections (cold sores).

  • Nursing Focus:

    • Administration: Cleanse affected area first (if directed). Apply thin layer.

    • Monitoring: Watch for reduced redness, swelling, pus (bacterial), clearing of rash/scales (fungal), healing of lesions (viral). Monitor for local irritation.

    • Education: Complete the full course, even if symptoms improve, to prevent recurrence/resistance. Proper hygiene to prevent spread. Keep fungal areas clean and dry.

• Treating Acne:

  • Medications: Topical Retinoids (e.g., Tretinoin), Benzoyl Peroxide, Topical Antibiotics (e.g., Clindamycin).

  • Uses: Reduce oil, unclog pores, kill bacteria, reduce inflammation.

  • Nursing Focus:

    • Administration: Apply thin layer as directed (often once daily, evening for retinoids).

    • Monitoring: Expect initial dryness, peeling, redness. May worsen initially. Watch for photosensitivity (retinoids).

    • Education: Expected side effects. Use sunscreen (retinoids). Takes weeks/months to see full effect. Consistency is key. Benzoyl peroxide can bleach fabrics.

• Managing Psoriasis (Topical):

  • Medications: Topical Corticosteroids, Topical Vitamin D analogs (e.g., Calcipotriene), Topical Calcineurin Inhibitors (e.g., Tacrolimus).

  • Uses: Reduce inflammation and slow skin cell growth in mild-moderate psoriasis.

  • Nursing Focus:

    • Administration: Apply thin layer as directed. Avoid applying Vitamin D analogs to face/folds.

    • Monitoring: Watch for reduced scaling, redness, thickness. Monitor for local irritation.

    • Education: Use consistently. Takes time to see effects.

Systemic Medications: Affecting the Whole Body

For severe, widespread, or resistant skin conditions, medications taken orally or by injection may be needed.

• For Severe Acne:

  • Medications: Oral Isotretinoin (very potent), Oral Antibiotics (e.g., Doxycycline).

  • Uses: Severe acne unresponsive to topical treatments.

  • Nursing Focus:

    • Monitoring: Isotretinoin: Numerous serious side effects (severe dryness, muscle pain, liver issues, mood changes, severe birth defects). Requires strict monitoring (labs, pregnancy tests) and adherence to risk management programs. Oral Antibiotics: Photosensitivity, GI upset.

    • Education: Isotretinoin: Absolute necessity of avoiding pregnancy. Educate on all side effects. Oral Antibiotics: Photosensitivity precautions, complete full course.

• For Severe Psoriasis or Inflammatory Conditions:

  • Medications: Methotrexate, Cyclosporine (Immunosuppressants), Biologic Agents (e.g., Infliximab, Adalimumab).

  • Uses: Moderate to severe psoriasis, severe eczema.

  • Nursing Focus:

    • Monitoring: Significant side effects: increased risk of infection (immunosuppressants, biologics), liver/kidney problems (Methotrexate, Cyclosporine). Requires regular lab monitoring.

    • Education: Increased risk of infection – report fever/illness. Importance of lab tests. Biologics may require screening for latent infections (TB, Hepatitis B) before starting.

Key Nursing Responsibilities

• Skin Assessment: Thoroughly examine the skin before applying medications and at follow-up, noting appearance, location, and symptoms.

• Proper Topical Application: This is fundamental. Teach and demonstrate the correct technique, amount, and frequency.

• Monitoring: Watch for improvement, local side effects, signs of infection, and systemic side effects (especially with potent topicals or systemic drugs).

• Patient Education: Clear, step-by-step instructions on medication use, expected effects, side effects (local and systemic), when to report issues, and relevant general skin care (gentle cleansing, moisturizing, sun protection).

• Adherence: Emphasize the importance of using medications consistently, especially for chronic conditions.

• Psychosocial Support: Skin conditions can impact self-esteem. Provide support.