Chapter 44: Adult Integumentary Medications

Poison ivy and various forms of dermatitis are addressed through topical remedies including calamine lotion and corticosteroids, with immunosuppressant agents like tacrolimus and pimecrolimus reserved for resistant cases, though these carry significant risks including increased malignancy and varicella zoster infection in pediatric populations. Topical glucocorticoids form a cornerstone of dermatological therapy, functioning through anti-inflammatory and antipruritic mechanisms, but require careful application due to variable absorption rates across different skin regions and potential for both local effects such as skin atrophy and systemic complications including adrenal suppression and growth retardation in children. Actinic keratosis treatment employs several topical agents that target precancerous lesions, with medications like fluorouracil and imiquimod working through distinct mechanisms over extended treatment periods. Sun protection principles emphasize broad-spectrum coverage and proper reapplication protocols to prevent photoaging and malignant transformation. Psoriasis management encompasses topical therapies including tazarotene and coal tar alongside systemic options such as methotrexate and acitretin, the latter carrying severe teratogenic risks requiring prolonged contraception. Acne treatment spans from mild topical retinoids to isotretinoin for severe cystic disease, with isotretinoin presenting substantial teratogenic concerns mandating enrollment in the iPLEDGE program and regular monitoring of triglyceride levels. Burn management utilizes specialized antimicrobial agents including silver sulfadiazine, which necessitates white blood cell monitoring, and mafenide acetate, which can precipitate metabolic acidosis through interference with renal acid excretion. Throughout all integumentary pharmacotherapy, nursing care emphasizes appropriate application techniques, monitoring for adverse effects, patient education regarding sun sensitivity, and recognition of systemic complications that may arise from topical absorption or systemic absorption pathways.