The skin forms a barrier between the outside envi-ronment and the structures located beneath the skin.The epidermis is the outermost layer of the skin.
Immediately below the epidermis is the dermis. The dermis contains small capillaries, which supply nour-ishment to the dermis and epidermis, sebaceous (oilsecreting) glands, sweat glands, nerve fibers, and hair follicles. Because of the skin’s proximity to the outside environment, it is subject to various types of injury and trauma, as well as changes in the skin itself.
TOPICAL ANTI-INFECTIVES
Localized skin infections may require the use of a topical antiinfective. The topical antiinfectives include antibiotic, antifungal, and antiviral drugs.
ACTIONS AND USES
Topical Antibiotic Drugs
Topical antibiotics exert a direct local effect on specific microorganisms and may be bactericidal or bacteriostatic. Bacitracin (Baciguent) inhibits the cell wall synthe-sis. Bacitracin, gentamicin (G-myticin), erythromycin (Emgel), and neomycin are examples of topical antibi-otics. These drugs are used to prevent superficial infec-tions in minor cuts, wounds, skin abrasions, and minor burns. Erythromycin is also indicated for treatment of acne vulgaris.
Topical Antifungal Drugs
Antifungal drugs exert a local effect by inhibiting growth of the fungi. Examples of antifungal drugs and their uses are:
• Amphotericin B (Fungizone)—used for treatment of mycotic infections (fungal
• Miconazole (Micatin), ciclopirox (Loprox), and econazole (Spectazole)—used for treatment of tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea corporis (ringworm), and superficial can didiasis
• Clioquinol—used for eczema, athlete’s foot, and other fungal infections
Topical Antiviral Drugs
Acyclovir (Zovirax) and penciclovir (Denavir) are the only topical antiviral drugs currently available. These
drugs inhibit viral replication. Acyclovir is used in the treatment of initial episodes of genital herpes, as well as
herpes simplex virus infections in immunocompromised patients (patients with an immune system inca-
pable of fighting infection). Penciclovir is used for the treatment of recurrent herpes labialis (cold sores) in
adults.
ADVERSE REACTIONS
Adverse reactions to topical anti-infectives are usually mild. Occasionally, the patient may experience a skin rash, itching, urticaria (hives), dermatitis, irritation, or redness, which may indicate a hypersensitivity (aller-gic) reaction to the drug. Prolonged use of topical antibiotic preparations may result in a superficial superinfection (an overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered).
CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS
These drugs are contraindicated in patients with known hypersensitivity to the drugs or any components of the drug. Because neomycin toxicity can cause nephrotoxicity and ototoxicity, neomycin is used cautiously in patients with extensive burns or trophic ulceration when extensive absorption can occur.
The topical antibiotics are Pregnancy Category C drugs and are used cautiously during pregnancy and lac-tation. Acyclovir and penciclovir are PregnancyCategory B drugs and are used cautiously during preg-nancy and lactation. The pregnancy categories of the antifungals are unknown except for econazole nitrate,which is Pregnancy Category C, and ciclopirox, which is Pregnancy Category B; both are used with caution dur-ing pregnancy and lactation. There are no significant interactions for the topical anti-infectives.
TOPICAL ANTISEPTICS AND
GERMICIDES
An antiseptic is a drug that stops, slows, or prevents the growth of microorganisms. A germicide is a drug that kills bacteria.
ACTIONS
The exact mechanism of action of topical antiseptics and germicides is not well understood. These drugs affect a variety of microorganisms. Some of these drugs have a short duration of action, whereas others have a long
duration of action. The action of these drugs may depend on the strength used and the time the drug is in
contact with the skin or mucous membrane.
Benzalkonium
Benzalkonium (Zephiran) is a rapid-acting preparation with a moderately long duration of action. It is active against bacteria and some viruses, fungi, and protozoa. Benzalkonium solutions are bacteriostatic (slow or retard the multiplication of bacteria) or bactericidal (destroy bacteria), depending on their concentration.
Chlorhexidine
Chlorhexidine gluconate (Hibiclens) affects a wide range of microorganisms, including gram-positive and gram-negative bacteria.
Iodine
Iodine has anti-infective action against many bacteria,fungi, viruses, yeasts, and protozoa. Povidone-iodine (Betadine) is a combination of iodine and povidone, which liberates free iodine. Povidone-iodine is often pre-ferred over iodine solution or tincture because it is less irritating to the skin. Unlike with the use of iodine,treated areas may be bandaged or taped.
USES
Topical antiseptics and germicides are primarily used to reduce the number of bacteria on skin surfaces. Some of these drugs, such as chlorhexidine gluconate, may be used as a surgical scrub, as a preoperative skin cleanser,
for washing the hands before and after caring for patients, and in the home to cleanse the skin. Others may be applied to minor cuts and abrasions to prevent
infection. Some of these drugs may also be used on mucous membranes.
ADVERSE REACTIONS
Topical antiseptics and germicides have few adverse reactions. Occasionally, an individual may be allergic to the drug, and a skin rash or itching may occur. If an allergic reaction is noted, use of the topical drug is discontinued.
CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS
These drugs are contraindicated in patients with known hypersensitivity to the individual drug or any compo- nent of the preparation. There are no significant precautions or interactions when used as directed.
Topical corticosteroids vary in potency, depending on the concentration of the drug (percentage), the vehicle in which the drug is suspended (lotion, cream, aerosol spray), and the area to which the drug is applied (open or denuded skin, unbroken skin, thickness of the skin over the treated area).
Examples of topical corticosteroids include amcinonide (Cyclocort), betamethasone dipropionate (Diprosone),fluocinolone acetonide (Flurosyn), hydrocortisone (Cort-Dome), and triamcinolone acetate (Aristocort).
ACTIONS AND USES
TOPICAL CORTICOSTEROIDS
Topical corticosteroids exert localized anti-inflamma-tory activity. When applied to inflamed skin, they reduce itching, redness, and swelling. These drugs are useful in treating skin disorders, such as psoriasis, der-matitis, rashes, eczema, insect bite reactions, and first-and second-degree burns, including sunburns.
ADVERSE REACTIONS
Localized reactions may include burning, itching, irri-tation, redness, dryness of the skin, and secondary infection.
The topical corticosteroids are contraindicated in patients with known hypersensitivity to the drug or any component of the drug; as monotherapy for bacterial skin infections; for use on the face, groin, or axilla (only the high-potency corticosteroids); and for ophthalmic use (may cause steroid-induced glaucoma or cataracts). The topical corticosteroids are Pregnancy Category C drugs and are used cautiously during pregnancy and lactation.There are no significant interactions when administered as directed.
Immediately below the epidermis is the dermis. The dermis contains small capillaries, which supply nour-ishment to the dermis and epidermis, sebaceous (oilsecreting) glands, sweat glands, nerve fibers, and hair follicles. Because of the skin’s proximity to the outside environment, it is subject to various types of injury and trauma, as well as changes in the skin itself.
TOPICAL ANTI-INFECTIVES
Localized skin infections may require the use of a topical antiinfective. The topical antiinfectives include antibiotic, antifungal, and antiviral drugs.
ACTIONS AND USES
Topical Antibiotic Drugs
Topical antibiotics exert a direct local effect on specific microorganisms and may be bactericidal or bacteriostatic. Bacitracin (Baciguent) inhibits the cell wall synthe-sis. Bacitracin, gentamicin (G-myticin), erythromycin (Emgel), and neomycin are examples of topical antibi-otics. These drugs are used to prevent superficial infec-tions in minor cuts, wounds, skin abrasions, and minor burns. Erythromycin is also indicated for treatment of acne vulgaris.
Topical Antifungal Drugs
Antifungal drugs exert a local effect by inhibiting growth of the fungi. Examples of antifungal drugs and their uses are:
• Amphotericin B (Fungizone)—used for treatment of mycotic infections (fungal
• Miconazole (Micatin), ciclopirox (Loprox), and econazole (Spectazole)—used for treatment of tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea corporis (ringworm), and superficial can didiasis
• Clioquinol—used for eczema, athlete’s foot, and other fungal infections
Topical Antiviral Drugs
Acyclovir (Zovirax) and penciclovir (Denavir) are the only topical antiviral drugs currently available. These
drugs inhibit viral replication. Acyclovir is used in the treatment of initial episodes of genital herpes, as well as
herpes simplex virus infections in immunocompromised patients (patients with an immune system inca-
pable of fighting infection). Penciclovir is used for the treatment of recurrent herpes labialis (cold sores) in
adults.
ADVERSE REACTIONS
Adverse reactions to topical anti-infectives are usually mild. Occasionally, the patient may experience a skin rash, itching, urticaria (hives), dermatitis, irritation, or redness, which may indicate a hypersensitivity (aller-gic) reaction to the drug. Prolonged use of topical antibiotic preparations may result in a superficial superinfection (an overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered).
CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS
These drugs are contraindicated in patients with known hypersensitivity to the drugs or any components of the drug. Because neomycin toxicity can cause nephrotoxicity and ototoxicity, neomycin is used cautiously in patients with extensive burns or trophic ulceration when extensive absorption can occur.
The topical antibiotics are Pregnancy Category C drugs and are used cautiously during pregnancy and lac-tation. Acyclovir and penciclovir are PregnancyCategory B drugs and are used cautiously during preg-nancy and lactation. The pregnancy categories of the antifungals are unknown except for econazole nitrate,which is Pregnancy Category C, and ciclopirox, which is Pregnancy Category B; both are used with caution dur-ing pregnancy and lactation. There are no significant interactions for the topical anti-infectives.
TOPICAL ANTISEPTICS AND
GERMICIDES
An antiseptic is a drug that stops, slows, or prevents the growth of microorganisms. A germicide is a drug that kills bacteria.
ACTIONS
The exact mechanism of action of topical antiseptics and germicides is not well understood. These drugs affect a variety of microorganisms. Some of these drugs have a short duration of action, whereas others have a long
duration of action. The action of these drugs may depend on the strength used and the time the drug is in
contact with the skin or mucous membrane.
Benzalkonium
Benzalkonium (Zephiran) is a rapid-acting preparation with a moderately long duration of action. It is active against bacteria and some viruses, fungi, and protozoa. Benzalkonium solutions are bacteriostatic (slow or retard the multiplication of bacteria) or bactericidal (destroy bacteria), depending on their concentration.
Chlorhexidine
Chlorhexidine gluconate (Hibiclens) affects a wide range of microorganisms, including gram-positive and gram-negative bacteria.
Iodine
Iodine has anti-infective action against many bacteria,fungi, viruses, yeasts, and protozoa. Povidone-iodine (Betadine) is a combination of iodine and povidone, which liberates free iodine. Povidone-iodine is often pre-ferred over iodine solution or tincture because it is less irritating to the skin. Unlike with the use of iodine,treated areas may be bandaged or taped.
USES
Topical antiseptics and germicides are primarily used to reduce the number of bacteria on skin surfaces. Some of these drugs, such as chlorhexidine gluconate, may be used as a surgical scrub, as a preoperative skin cleanser,for washing the hands before and after caring for patients, and in the home to cleanse the skin. Others may be applied to minor cuts and abrasions to prevent
infection. Some of these drugs may also be used on mucous membranes.
ADVERSE REACTIONS
Topical antiseptics and germicides have few adverse reactions. Occasionally, an individual may be allergic to the drug, and a skin rash or itching may occur. If an allergic reaction is noted, use of the topical drug is discontinued.
CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS
These drugs are contraindicated in patients with known hypersensitivity to the individual drug or any compo- nent of the preparation. There are no significant precautions or interactions when used as directed.
Topical corticosteroids vary in potency, depending on the concentration of the drug (percentage), the vehicle in which the drug is suspended (lotion, cream, aerosol spray), and the area to which the drug is applied (open or denuded skin, unbroken skin, thickness of the skin over the treated area).
Examples of topical corticosteroids include amcinonide (Cyclocort), betamethasone dipropionate (Diprosone),fluocinolone acetonide (Flurosyn), hydrocortisone (Cort-Dome), and triamcinolone acetate (Aristocort).
ACTIONS AND USES
TOPICAL CORTICOSTEROIDS
Topical corticosteroids exert localized anti-inflamma-tory activity. When applied to inflamed skin, they reduce itching, redness, and swelling. These drugs are useful in treating skin disorders, such as psoriasis, der-matitis, rashes, eczema, insect bite reactions, and first-and second-degree burns, including sunburns.
ADVERSE REACTIONS
Localized reactions may include burning, itching, irri-tation, redness, dryness of the skin, and secondary infection.
The topical corticosteroids are contraindicated in patients with known hypersensitivity to the drug or any component of the drug; as monotherapy for bacterial skin infections; for use on the face, groin, or axilla (only the high-potency corticosteroids); and for ophthalmic use (may cause steroid-induced glaucoma or cataracts). The topical corticosteroids are Pregnancy Category C drugs and are used cautiously during pregnancy and lactation.There are no significant interactions when administered as directed.
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Topical Drugs Used in the Treatment of Skin Disorders
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