40.4: Other Dermatologic Condition Drugs and Topical Anti-infectives for Burns
By the end of this section, you should be able to:
- 40.4.1 Identify the characteristics of drugs used to treat miscellaneous dermatologic disorders and burns.
- 40.4.2 Explain the indications, actions, adverse reactions, and interactions of drugs used to treat miscellaneous dermatologic disorders and burns.
- 40.4.3 Describe nursing implications of drugs used to treat miscellaneous dermatologic disorders and burns.
- 40.4.4 Explain the client education related to drugs used to treat miscellaneous dermatologic disorders and burns.
In addition to acne and psoriasis, there are other common skin conditions for which clients may receive treatment. In this chapter they are divided into miscellaneous dermatologic conditions and burns.
Miscellaneous Dermatologic Disorders
This section focuses on the most common dermatological disorders not yet discussed, including cutaneous warts, atopic dermatitis (eczema), contact dermatitis, impetigo, and rosacea.
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.
Safety Alert
Topical Steroids
When using topical steroids , the application sites should not be covered with an occlusive dressing. Breathable gauze dressings may be used. Topical corticosteroids are meant to exert a local effect; however, when these medications are covered with an occlusive dressing, systemic absorption may occur, leading to systemic side effects of the drug.
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.
|
Drug Class
Topical antibiotic Mechanism of Action Bactericidal; binds RNA transcription |
Drug Dosing
Adults and children >2 months: Apply ointment (2%) to area 2–3 times daily. |
|
Indications
Impetigo Therapeutic Effects Eradication of impetigo lesions |
Drug Interactions
Other topical medications used concurrently Food Interactions No significant interactions |
|
Adverse Reactions
Atopic dermatitis Contact dermatitis Pruritis Hypersensitivities including anaphylaxis |
Contraindications
Hypersensitivity Caution: Avoid occlusive dressings to prevent systemic absorption |
Topical Anti-infectives for Burns
The greatest risk from minor burns is infection. Because a burn removes layers of skin, an open lesion forms, breaking the skin’s integrity and allowing bacteria and other organisms to enter the client’s body. Silver sulfadiazine and mafenide acetate are two topical anti-infectives used in the treatment and prevention of infection for localized second- and third-degree burns. As with sodium sulfacetamide, these medications are sulfa compounds that should not be administered to those with sulfa allergies. The nurse should take care to maintain a sterile environment when applying these medications to aid in preventing bacterial transfer to the client. To remain effective, burns should be completely covered with cream at all times to prevent bacterial colonization (DailyMed, Sulfamylon, 2023).
Table 40.13 lists common topical medications used in treating burns with typical routes and dosing for adult and pediatric clients .
| Drug | Routes and Dosage Ranges |
|---|---|
|
Mafenide acetate
( Sulfamylon ) |
Adults and children >2 months: Apply cream once or twice daily, to a thickness of approximately inch. |
|
Silver sulfadiazine
( Silvadene ) |
Adults and children >2 months: Apply cream once or twice daily, to a thickness of approximately inch. |
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.
|
Drug Class
Topical antibiotic Mechanism of Action Bactericidal; disrupts cell wall |
Drug Dosing
Adults and children >2 months: Apply cream once or twice daily, to a thickness of approximately inch. |
|
Indications
Second- and third-degree burns Therapeutic Effects Absence of infectious organisms in wound bed |
Drug Interactions
Other topical medications used concurrently Cimetidine Food Interactions No significant interactions |
|
Adverse Reactions
Hypersensitivities Necrosis Erythema multiforme Skin discoloration Burning sensation Rashes Interstitial nephritis Leucopenia |
Contraindications
Hypersensitivity Sulfa allergy Pregnant clients approaching or at term Premature infants or newborn infants during the first 2 months of life |
Safety Alert
Silver Sulfadiazine
Silver sulfadiazine is widely used for burns with low risk of adverse effects. Overdose is uncommon, but systemic absorption can still occur. Care should be taken when applying the medication near mucosal or ocular areas or when it is used over a large body surface area.
(Source: Oaks & Cindass, 2023)
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.
Client Teaching Guidelines
The client using a topical medication for burns should:
- Take prescribed medications exactly as directed.
- Wash hands well before and after application.
- Report side effects such as skin redness, excessive dryness, or peeling to the primary provider.
- Report drainage, odor, temperature above 100.4°F, or other unusual symptoms to the primary provider.
- Cleanse skin thoroughly before applying medication.
- Avoid contact with eyes and mucous membranes.
The client using a topical medication for burns should not:
- Cover the medication with occlusive dressings.
FDA Black Box Warning
Pimecrolimus
Pimecrolimus cream has been associated with skin malignancies and lymphoma. Continuous long-term use should be avoided in any age group. Its use is not indicated for children less than 2 years of age.
Case Study
Read the following clinical scenario to answer the questions that follow.
Within the last year, Melissa Allen, a 27-year old patient, has gotten married, moved to a new city, and begun graduate school. Recently, she has noticed feeling a little more tired than usual and has experienced generalized joint pain.
History
Right ankle fracture
Seasonal sinusitis
Current Medications
Ibuprofen, 400 mg every 4 hours as needed
Yasmin birth control pill (drospirenone 3 mg/ethinyl estradiol 0.03 mg)
| Vital Signs | Physical Examination | |
|---|---|---|
| Temperature: | 97.4°F |
|
| Blood pressure: | 126/64 mm Hg | |
| Heart rate: | 88 beats/min | |
| Respiratory rate: | 14 breaths/min | |
| Oxygen saturation: | 100% on room air | |
| Pain: | 3/10 | |
| Height: | 5'5" | |
| Weight: | 144 lb |
Based on Melissa’s subjective and objective assessment data, what diagnosis should the nurse anticipate from the health care provider?
- Answer
-
Psoriasis
The health care provider prescribes topical coal tar. Which statement by Melissa indicates a need for further teaching from the nurse regarding the use of topical coal tar?
- Answer
-
“I should cover the surrounding margins of lesions with a thick coat of medication.”