Pharmacy 201
The skin is the largest organ of the body it:
Regulates body temperature
Senses pain
Keeps substances from entering the body
Shields the sun's harmful effects
Each layer of skin has a specific task
Top-epidermis-protects against harmful substances. Gives skin color from melanin.
Dermis-contains pain & touch receptors, sweat glands, sebaceous glands (oil) and hair follicles
Below Dermis-where fat is stored to help insulate from heat & cold
Most skin problems can be identified by looking at the size, shape, color and location. This tells the practitioner what it is.
Treatments
Topical-apply directly to the skin
Systemic-taken orally
Topical
Formulations include
ointments-tick oil in water, hard to wash off, better delivery since medication stays on
Creams-oil in water, easy to apply, vanishes into skin
Lotions-just more water than in creams, easy to apply, easy to wash off
Solutions-liquid in which drug is dissolved. Tend to dry rather than moisture
Powders-dried form of a substance, finely pulverized, absorbs moisture
Gels-water based, thickened without oil or fat, alcohol causes a drying effect
Sunburn
Sun induced skin damage ranges from sunburn to photoaging to pigmentary changes to solar keratosis to cancer.
Three types of radiation
UVC-germicidal radiation, not much reaches the earth, causes redness no tanning
UVB-sunburn radiation, skin cancer radiation, 10am-3pm peak exposure
UVA-after UVB most damaging range, goes deeper than UVB
The amount of UV rays reaching the skin depend on the season, location of the earth (equator), time of day (10am-3pm), clouds, snow, sand, fog, haze and humidity.
Tanning got its popularity in the 1950s. Tanned skin=good health. Prior to this tanned skin meant poor, laborer or farming.
Definition: Tan=uv radiation stimulates the melanocytes to generate more melanin this oxidizes in the epidermis to a tan
Sunburn-result of an inflammatory reaction. 1st degree is mild redness, tenderness, pain, edema
2nd degree is blisters, fever, chills, weakness
Beyond Sunburn is sun induced skin damage
photoaging (Premature aging)-wrinkles & yellowing of skin, dryness, visible veins, up to 80% of the damage occurs by age 20
Photodermatoses-skin eruptions caused by UVA & UVB **Lupus
Drug Photosensitivity-Tetracyclines, sulfa drugs, hypoglycemics, thiazides, St. John's Wort, NSAIDS (ibuprofen), Cipro. Avoid the sun-use sunscreens
Skin Cancer
basal cell (face upper body, scalp, neck)
most at risk: blue or green eyes, light skin, blonde to red hair, English, Scandinavan, Scot-Irish ancestors. Childhood exposure with at least two major sunburns
Squamous cell-risk always burn never tan, freckles
Melanoma-less common but more deadly
ABCD
a-asymmetry of the lesion
b-irregular border
c-color variation, black, brown, bluish-red
d-diameter > 6mm
Be aware of any changes on head, neck, upper back
Sunscreens
SPF-Sun Protection Factor
The higher the SPF the more effective to a point
**If you burn in 30 minutes, then an SPF of 2 will give you an hour, SPF 4 gives you 2 hours
**however, applying SPF of 4 twice does not give you an SPF of 8
SPF of 15 blocks 93% of UVB
30 blocks only 96.7%
40 blocks only 97.5%
How to apply
Apply at least 30 min prior to sun exposure
Reapply often especially if swimming or sweating
Big Mistake is missing spots
Use ample amounts
Children < 6 months
American Academy of Pediatrics recommends using on hands, and exposed areas only. Cover the child. Just sitting under the umbrella is not enough
Seven Steps to Safer Sunning
Avoid the sun between 10am & 3pm even on cloudy days
Use sunscreen-broad spectrum covering UVA & UVB
Wear a hat
Wear sunglasses (wrap-arounds) check label for 99% blockage
Cover up-avoid wet clothes-choose tightly woven
Avoid tanning beds
Check skin regularly
Fungal Infections
Over-the-counter products help prevent and treat symptoms. Can actually cure the problem
Tineas-skin, hair/scalp, nails
Tinea pedis-athlete's foot
Occurs in up to 70% of adults
More commons in white patients
More common in males
Intense itching, scaly, peeling skin, red skin
May have an odor, may have tiny blisters
Skins cracks and peels
Try topical products first
Imidazoles
Clotrimazole 1% Lotrimin AF
Miconazole 2% Micatin
Tolnaftate 1% Tinactin, Aftate
Used regularly may prevent recurrences
Undecylenic acid Cruex
May have an unpleasant odor
Terbinafine Lamisil
Shorter treatment period, seven days, others are 14 days
Choose appropriate dosage form: ointment, cream, lotion, gels, powder, sprays, solutions
Prevent AF
Keep feet clean & dry
Dry between toes
Go barefoot whenever possible
Use shower shoes
Change socks daily, rotate shoes, use cotton not synthetics
Never share footwear
If nail is involved, check with practitioner
Tinea Corporis (Ringworm)
Ringworm-oval scaly patch, red border, treat topically first
For prevention and treatment
Use fresh washcloths & towels
Avoid the cat or dog
Avoid lesions from other infected people
Loose weight if obese, dry areas under the skin fat
Wear long sleeves & garden gloves when in the yard/garden
Wrestlers=mats at the gym high source of infection
Tinea Cruris-jock itch
Groin area, thighs, buttocks, intense itching, pain if sweat, secondary infection from scratching
Try OTC treatment first
Wash & dry area carefully, wear fresh clothes
Avoid direct skin to skin contact with infected person
Wear underwear that doesn't allow moisture to accumulate
Tinea Capatis-ringworm of the scalp
Circular patch of scaling skin with hair loss. May have inflamed weeping lesion
Self OTC treatment is ineffective. These products can't penetrate the hair follicles. See practitioner for oral treatment. Don't share hats.
Tinea Unguium (nail fungus)
Dull, opaque or yellow nails, nail thicken, brittle, crumble.
OTC ineffective, topicals don't penetrate the nail bed. Need RX oral and long term treatment.
Tinea Versicolor
Irregular blotches, chest, abdomen, upper extremities
Does not respond well to OTC topicals
CONTACT DERMATITIS
Skin reaction that results form contact with some substance.
Those more prone to CD have fair skin, advanced age or certain occupations.
Poison Ivy-poison oak-sumac
Most common cause of CD at least 50 to 70% of the population is sensitive
Plants-small bush or tree like or vines "Leaves of Three, let it be"
If you are allergic to one then you will be to all three.
Person must come in contact with the plant, can't just "look at the plant"
Urushiol is the allergenic mixture. When plants are damaged, they are fragile, the sap leaks out. The sap contains the allergens.
Treatments:
hydrocortisone-helps relieve the itching, use no more than 7 days
diphenhydramine-DO NOT USE. May cause severe adverse effects if used on open blisters
calamine, zinc oxide, kaolin, aluminum hydroxide-helps to dry the lesions
coloidal oatmeal (Aveeno) and baking soda added to bath water helps relieve itching
Wet dressings-Aluminum acetate-Domboro Solution
Oral corticosteroids-RX only
Best advice
Avoid the plants even dead ones
Wear protective clothing and gloves
If exposed wash area with soap and water immediately
Wash clothes with soap and water
Avoid fumes from burning plants
Field Test-break a stem or leaf. Touch the end with sap to white paper. Within 30 minutes the sap will oxidize to a brown-red to black color. "Black spot sign". Confirms identity of the plant
In most cases
First exposure to plant. No reaction
Second exposure, 5-21 days after get reaction
Future exposure-48-72 hrs reaction
Cats & Dogs may transfer the allergen. Blisters don't transfer.