40.4 Other Dermatologic Condition Drugs and Topical Anti-infectives for Burns

Cutaneous Warts

Cutaneous warts are a form of localized viral infection, resulting in the familiar raised lesions known as warts (Figure 40.5). Current therapies in the treatment of warts include medications that chemically burn these lesions, thus eliminating them. Cantharidin is one such drug. As a vesicant, cantharidin causes local tissue necrosis on those surfaces to which it is applied. This necrosis will eventually result in the sloughing of the wart and elimination of the virus.

Figure 40.5 A cutaneous wart has an irregular shape and surface. (credit: “Filiform wart on the eyelid” by Schweintechnik/Wikimedia Commons, Public Domain)

Atopic Dermatitis (Eczema)

Atopic dermatitis (eczema) is another skin condition that requires pharmacological treatment. Unlike conditions characterized solely by local irritation, atopic dermatitis is a systemic disease that has genetic predispositions, involves the immune system, and also has environmental influences. This condition has also been linked to other disorders, including asthma and hay fever (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2022). The etiology is not clearly understood, but treatment involves using oral and topical medications to relieve the characteristic lesions of atopic dermatitis (Figure 40.6). Hydrocortisone and pimecrolimus are often used topically to treat atopic dermatitis.

Figure 40.6 Atopic dermatitis/eczema characteristically appears as red, dry patches. (credit: “This image depicts a close view of a cutaneous lesion known as nummular eczema, which also goes by the names nummular dermatitis, or discoid eczema, which presents itself as round [PHIL 16526], or oval-shaped erythematous, itchy patches” by Susan Lindsley/Centers for Disease Control and Prevention, Public Domain)

Contact Dermatitis

Contact dermatitis is an acute inflammation caused by aggravating factors that results in swollen, red, itchy lesions (Figure 40.7). Substances that may cause contact dermatitis include, but are not limited to, soaps, cosmetics, jewelry, and poison ivy/oak. Treatment focuses on decreasing inflammation and providing comfort and decreased pain and itching. Hydrocortisone, when applied to areas of contact dermatitis, acts to decrease inflammation, relieving the red, warm, edematous symptoms. In addition to hydrocortisone or other corticosteroid ointments, calamine lotion also may be used to reduce itching and promote healing. This solution is made by combining zinc oxide and ferric oxide, which, when applied to the skin, soothes the affected area and reduces itching and burning at the site.

Figure 40.7 Contact dermatitis is acute inflammation resulting from direct contact with irritants. (credit: “This photograph depicts an individual’s arm with a blistering poison oak rash.”/Centers for Disease Control and Prevention, Public Domain)

Impetigo

Impetigo is a cutaneous bacterial infection that occurs on the upper surface of the skin (Figure 40.8). Typically, impetigo is seen in infants and children, although it may occasionally be seen in adults. The causative organisms are most often Staphylococcus aureus and Streptococcus pyogenes bacteria. Treatment encompasses application of mupirocin, a topical antibacterial. Retapamulin, another topical anti-infective used in impetigo, selectively inhibits protein synthesis to stop bacterial growth. Topical treatment with these agents usually clears impetigo, but if impetigo persists and is severe, oral antibiotics may be needed.

Figure 40.8 Impetigo is characterized by vesicles, pustules, or bullae that rupture, producing sores covered by honey-colored crusts. (credit: “The lesions on the volar surface of this patient’s left forearm proved to be Streptococcal impetigo, a dermatologic condition quite often caused by Staphylococcus aureus bacteria, as well” by Dr. Herman Miranda, Univ.of Trujello, Peru; A. Chambers/Centers for Disease Control and Prevention, Public Domain)

Rosacea

Rosacea is a skin condition that develops from an inflammatory process, causing redness, swelling, prominent small vessels, and papular lesions on the face (Figure 40.9). Metronidazole, an antifungal, is used in the treatment of rosacea to reduce redness and inflammatory lesions. Nurses should note that when absorbed systemically, metronidazole interacts negatively with many other medicines. When alcoholic beverages are mixed with metronidazole, a life-threatening disulfiram-like reaction may occur, resulting in palpitations, diaphoresis, flushing, nausea, and tachycardia (Stokes & Abdijadid, 2019). Sodium sulfacetamide, another treatment for rosacea, is antibacterial in function and is used to cleanse the skin and eliminate bacteria. Clients with sulfa allergies should not use sodium sulfacetamide.

Figure 40.9 Rosacea, consisting of red bumps and broken blood vessels, occurs on the face. (credit:“Rosacea. Erythema and telangiectasia are seen over the cheeks, nasolabial area and nose. Inflammatory papules and pustules can be observed over the nose. The absence of comedos is a helpful tool to distinguish rosacea from acne.” by Sand, M., Sand, D., Thrandorf, C. et al. “Cutaneous lesions of the nose.” Head Face Med 6, 7 [2010]. https://doi.org/10.1186/1746-160X-6-7/BioMed Central, CC BY 2.0)

Table 40.11 lists common miscellaneous dermatologic drugs and typical routes and dosing for adult and pediatric clients.

Adverse Effects and Contraindications

Adverse effects associated with topical medications for skin disorders include hypersensitivities. This is especially associated with mupirocin. Localized irritation, redness, and peeling may be noted with these medications as well. When covered with occlusive dressings, clients may experience systemic absorption, resulting in the likelihood of systemic effects. For this reason, occlusive dressings are contraindicated.

Steroid compounds are contraindicated in fungal infections. Long-term use of pimecrolimus, a calcineurin inhibitor, has been associated with the development of lymphomas. For this reason, long-term use is contraindicated.

Table 40.12 is a drug prototype table for common dermatologic medications featuring mupirocin. It lists drug class, mechanism of action, adult and pediatric dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.

Adverse Effects and Contraindications

Adverse effects associated with topical medications for burns include hypersensitivities, pruritis, localized irritation, redness, and peeling. When covered with occlusive dressings, clients may experience systemic absorption, resulting in the likelihood of systemic effects. For this reason, occlusive dressings are contraindicated. Contraindications include hypersensitivities to drugs or their components.

Table 40.14 is a drug prototype table for common burn treatments featuring silver sulfadiazine. It lists drug class, mechanism of action, adult and pediatric dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.

Nursing Implications

The nurse should do the following for clients who are using drugs for the treatment of burns:

• Conduct vigilant assessments for baseline, response to treatment, adverse effects, infection, and systemic absorption.
• Monitor creatinine for decreased renal function from possible effects of systemic absorption.
• Observe for hypersensitivity reactions during and after administration.
• Apply topical medications with gloves.
• Maintain aseptic technique when applying medications.
• Emphasize the importance of compliance with instructions and follow up with clients when necessary.
• Provide client teaching regarding the drug and when to call the health care provider. See below for client teaching guidelines.