Pharm, part 51: Integumentary Medications - Psoriasis, Acne, Lice/Scabies

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In this article, we wrap up our coverage of integumentary system medications with a look at medications for psoriasis and acne, as well as treatments for lice and scabies. The Nursing Pharmacology video series follows along with our Pharmacology Second Edition Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

Topical medications for psoriasis

In a previous article in this series, we looked at systemic agents that are effective against psoriasis, including cyclosporine and methotrexate. Topical medications for psoriasis include coal tar, salicylic acid, and corticosteroids.

Coal tar

Coal tar is used to help slow the growth of skin cells. It helps to decrease itching and inflammation.

Side effects of coal tar

The side effects of coal tar include photosensitivity, staining of clothes, and (with high doses) an increased risk for cancer.

Salicylic acid (keratolytic)

Salicylic acid helps to soften and remove the scales associated with psoriasis.

Side effects of salicylic acid

The side effects of salicylic acid include mild burning and stinging.

Corticosteroids

Topical corticosteroids are often used for psoriasis. These agents help to decrease the patient’s immune response and decrease inflammation.

Side effects of topical corticosteroids

The side effects of topical corticosteroids are often mild, but they can include burning, itching, and irritation.

Other treatments used for psoriasis

Systemic immunosuppressants may be used to treat psoriasis. As mentioned above, these include methotrexate and cyclosporine.

Additional treatments for psoriasis include biologic agents (most end in -mab, e.g., adalimumab, infliximab) and phototherapy, a treatment that includes exposure to outdoor daylight.

Topical medications for acne

Topical medications for acne include benzoyl peroxide, clindamycin, and tretinoin (Retin-A).

Benzoyl peroxide and clindamycin

Mode of action of benzoyl peroxide and clindamycin

These topical antibiotics are effective against P. acnes (propionibacterium acnes).

Side effects of benzoyl peroxide and clindamycin

The side effects of benzoyl peroxide and clindamycin include dryness and skin irritation.

In addition, benzoyl peroxide can cause bleaching of the hair and of fabric (it can bleach the patient’s bedding, clothes, towels, etc.).

Tretinoin (topical)

Mode of action of tretinoin

Tretinoin is a topical agent that stimulates the turnover of epithelial cells. Epithelial tissue is one of the four main types of body tissue found in the body's organs. They cover internal and external surfaces in the body. (The other three types of body tissue are: connective, muscular, and nervous system tissues.)

Side effects of tretinoin

The side effects of tretinoin include photosensitivity and skin irritation.

A key patient teaching is to alert them to avoid sun exposure and, if they must go outside, to wear sunscreen.

Isotretinoin (oral medication) for severe acne

Isotretinoin is an oral medication that is used to treat severe acne.

Mode of action of isotretinoin

Isotretinoin works by inhibiting the function of the sebaceous gland, which produces and secretes sebum. Sebum is a group of complex oils that lubricate the skin to protect against friction and makes it more impervious to moisture.

Side effects of isotretinoin

Side effects of isotretinoin include cheilitis, which is cracking and dryness at the corners of the mouth. Isotretinoin can also cause dry skin and photosensitivity.

As with tretinoin, patients should be taught to avoid sun exposure and, if they must go outside, to wear sunscreen. They should also apply skin moisturizers because of the side effect of dry skin.

Warning: isotretinoin causes birth defects

Isotretinoin is contraindicated for patients who are pregnant. A patient who is pregnant or thinks they might be pregnant should not use this medication.

Females of childbearing age must take two pregnancy tests prior to treatment with isotretinoin, and they must follow up with a monthly pregnancy test while they are on this medication.

Patients using isotretinoin should see a warning clearly marked on the medication’s packaging: on top of every pill in a blister pack, for example, is a picture of a pregnant woman with a line through it. Do not use if you are pregnant!

Topical antiparasitic medications for scabies and pediculosis

I hope this permethrin permeates my skin to get rid of these bugs!

Permethrin (Elimite) is used to treat pediculosis, another name for lice. It is also prescribed to treat scabies, an infestation of tiny mites called Sarcoptes scabiei that burrow into the outer layers of human skin.

Mode of action of permethrin

Permethrin is a neurotoxin. The medication works by paralyzing the nervous system of the insects.

Side effects of permethrin

Side effects of permethrin include skin irritation.

Patient teaching for the use of permethrin

For a patient with lice, shampoo with 1% permethrin. After shampooing, patients should use a special nit comb to make sure they remove all the nits (lice eggs) from the entire scalp.

For a patient with scabies, the patient should apply permethrin from head to toe and leave it on for 8 to 14 hours. It is important that if one member of a household is being treated for scabies, the entire household should also undergo the same treatment.

Patient teaching for the prevention of a reinfestation of scabies

To prevent a reinfestation of scabies, patients should wash all of their clothing and linens in hot water. For items that cannot be washed, patients should put these in a bag, seal the bag, and keep it tightly sealed for at least two weeks.

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Full Transcript

Hi, I'm Cathy, with Level Up RN. In this video, I'm going to wrap up my coverage of integumentary system medications. Specifically, I will be covering medications for psoriasis, for acne, and to treat lice and scabies. Be sure to stay until the end of the video because I will be giving you guys a quiz to test your knowledge of some of the key concepts I'll be covering in this video. If you have our pharmacology flashcards, definitely pull those out so you can follow along with me.

Let's start by talking about topical agents, which can be used in the treatment of psoriasis. So we previously talked about some systemic agents which are effective against psoriasis, including cyclosporine and methotrexate. Here we're just talking about topical agents. So three different medications I'd be familiar with include coal tar, salicylic acid, and topical corticosteroids.

So coal tar is used to help slow the growth of the skin cells, and it helps to decrease itching and inflammation as well.

Side effects can include photosensitivity, staining of clothes, and at high doses, it does carry an increased risk for cancer.

Salicylic acid helps to soften and remove the scales associated with psoriasis.

Side effects include mild burning and stinging, and then topical corticosteroids are often used for psoriasis as well. These agents help to decrease the patient's immune response and decrease inflammation as well.

Side effects are usually pretty mild, but can include burning, itching, or irritation.

Next, let's talk about some medications that are used to treat acne.

So we have some topical antibiotic agents, which include benzoyl peroxide as well as topical clindamycin.

These medications can cause dryness and skin irritation.

In addition, benzoyl peroxide can cause bleaching of the hair and a fabric. So it can bleach the patient's bedding, their clothes, their towels, that type of thing.

Then we have tretinoin, which is a topical agent that stimulates the turnover of epithelial cells.

Side effects of tretinoin include photosensitivity as well as skin irritation. You definitely want to teach your patient to wear sunscreen when they go out because of that side effect of photosensitivity.

Then we have an oral medication that is used to treat severe acne, which is isotretinoin.

So isotretinoin works by inhibiting sebaceous gland function. Side effects include cheilitis, which is cracking and dryness at corners of the mouth. It can also cause dry skin as well as photosensitivity.

So with this medication, you are also going to want to advise your patient to wear sunscreen and also use skin moisturizers because of the side effect of dry skin.

The other key thing about this medication is that it definitely causes birth defects. So it's going to be really important that your patient not use this when pregnant. And in fact, they make every female of childbearing age take two pregnancy tests prior to treatment with this medication, and they make them follow up with pregnancy test every single month.

So my son is on this medication for his acne. If you look at the pill container, like the blister pack, on top of every pill is a picture of a pregnant woman with a big line through it. So they are not messing around when it comes to making sure you are not pregnant when taking isotretinoin. So that's definitely a key point when it comes to this medication.

The last medication I want to cover in this video is permethrin, which is used to treat pediculosis, which is a fancy name for lice as well as scabies. So if you stay until the end of this video, I'm going to give you a little story about lice and permethrin. So definitely hang in there for that.

So this medication works by paralyzing the nervous system of the insects.

Side effects are minimal and can include skin irritation.

If your patient has lice, they will need to shampoo with 1% permethrin, and then afterwards, they should use a special nit comb to make sure they remove all the nits from the head. So nits are lice eggs.

For scabies, the patient will need to apply permethrin from head to toe and leave it on for 8 to 14 hours. And it's advised that the entire household be treated for scabies if one person has scabies.

In order to prevent re-infestation, you want to provide teaching to your patient. So they should wash all of their clothes and linens in hot water. For items that cannot be washed, they need to put them in a bag and seal that bag and keep it in there for at least two weeks.

So my little story about pedicure locusts or lice is that when my daughter was five - and this was a long time ago because she's 20 now - she was going to bed, and she's like, "Mom, my head's kind of itchy." And I'm like, "All right. Let me take a look." And I looked, and there is like three generations of lice living on her head, big guys and medium ones and little baby ones. I mean, so many lice. It was a little traumatizing.

So anyway, we treated it with permethrin shampoo. I used that nit comb, and I took hours to go through every millimeter of her head to get rid of those nits and any remaining lice. And of course, during this whole time, where I'm like washing linens in hot water and treating her head, etc., my head's itchy. I'm convinced I have lice. My head is so itchy, and I go to my husband, I'm like, "Can you please check my head?" And my husband is an amazing guy, but he's like, "Oh, yeah. No, it looks good. I don't say anything." And I'm like, "No, dude. You got to go through like every piece of my head. You can't just look at it like that." Anyway, I wasn't really satisfied with his assessment skills. So I went to my daughter's preschool director, and she did a thorough assessment on my head. Luckily, did not have lice, but it was definitely a stressful time with that whole pediculosis. And luckily, I haven't had to go through that again since then. If you have a story about lice or scabies, be sure to leave it in the comments because I definitely want to see that.

All right. Time for Quiz. I have three questions for you. First question, what topical acne treatment can cause bleaching of the hair and fabrics? The answer is benzoyl peroxide. Question number two, what key teaching do you need to provide a patient who uses topical tretinoin? The answer is you need to advise them to wear sunscreen or avoid sun exposure. Question number three, what assessment do you need to do before providing a patient with oral isotretinoin? The answer is you need to run a pregnancy test. And in fact, you're going to need two negative pregnancy tests from the patient before they start therapy. And then you will need monthly pregnancy test while they're on therapy.

All right. That is it for this video. I hope this video has been helpful. This is actually the end of our entire pharmacology video playlist as well. So I hope you learned a lot, and I hope these videos have helped you. If so, be sure to leave me a message, and definitely tell your classmates and friends in nursing school about our channel. Thank you so much for watching.