Transcript Pharmacy Technician*s Course. LaGuardia Community College

Structure of the Skin
 The largest organ of the body. Its surface area is responsible for the
regulation of body temperature
 Has three layers
 Epidermis which contains keratinocytes. Keratinocytes contain keratin
which is a strong tensile protein responsible for much of the skin’s
physical barrier properties.
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
Has five inner layers of the stratum corneum at the top and the stratum basale
The stratum basale is primarily made up of stem cells keratinoblasts, melanin
producing melanocytes and merkel cells for touch perception and langerhans
cells of the immune system
 Dermis is the layer of the skin that contains blood vessels, immune cells
and fibroblasts that produce collagen and elastin. Mast cells in this
layer release histamine which produces hives in response to allergic
reaction
 Hypodermis contains a fatty layer where adipocytes are located. This is
attached to the fascia of muscles
Picture courtesy of : http://www.best-antiaging-guide.com/images/human-skin.jpg
Functions of the skin
 Provides a physical barrier to infections
 Provides a barrier to the lose of water
 Temperature regulation via sweating
 Enable the sense of touch
 Vitamin D is synthesized from cholesterol
 Medical terminology involving the skin
 Macule: flat pigmented lesion
 Papule: Slightly raised lesion (<5 mm) (pimple)
 Maculopapular: combination of the two usually the papule is
in the center of the macule. Sometimes called morbilliform
(“measle like”)
 Erythema: beffy red section of skin
 Plaque: raised area of skin with clear borders.
 Nodule : a raised lesion (> 5mm)
 Vesicle: a small raised lesion filled with clear fluid (Blister)
 Bulla: a large raised lesion filled with clear fluid
 Pustule: a raised lesion filled with pus and bacterially infected
fluids
Diseases of the skin
 Autoimmune diseases of the skin
 Psoriasis. In psoriasis the immune system of the body
attacks the cells of the upper layers of the skin. The
patient develops rashes, intense erythema that leads to
scales and blisters localized to plaques areas. Can be
painful
 T cells enter the epidermis and attack the keratinocytes
of the skin which produce chronic inflammation
Drugs used for Psoriasis
Generic Name
Brand Name
MOA
Acitretin
Soriatane
(Capsules)
Vitamin A
derivative
Calcipotrine
Dovonex (Cream
and Ointment)
Vitamin D
derivative
Cyclosporine
Neoral (Capsule,
oral solution)
Immune
Suppressant
Methotrexate
Trexall ( Tablets)
Immune
Suppressant
Pimecrolimus
Elidel (Cream)
Immune
Suppressant
Tacrolimus
Protopic
(Ointment)
Immune
Suppressant
Drugs used for Psoriasis
ATOPIC DERMATTIS (ECZEMA)
 Eczema is similar to psoriasis but less severe
 Eczema is believed to be a hereditary allergic reaction of
the skin to a normally benign antigen(s)
 Eczema is sometimes called “atopic dermatitis” and is
commonly associated with asthmatic patients
 Affected areas are itchy, red, and warm to the touch.
Lesions may enlarge and become scaly. The rash are very
itchy and the scratching can damage the skin further.
 Treatment includes:




Topical Steroids
Vitamin D derivatives (Dovonex)
Vitamin A derivatives (retinoids): Differin® (Adapalene)
Topical immune modulators: Pimecrolimus (Elidel®)
Acne Vulgaris
 Inflammatory reaction in the skin called by excessive
production of sebum in the sebaceous glands of the skin
located near hair follicles.
 Bacteria known as Propriobacterium acnes feeds on the fats
and release fatty acids which causes the skin to become
inflammed
 A severe form of acne is nodulocystic acne which can form
life long scars
 Therapy:
 Nodulocytic acne: Accutane ® (isotretinoin) A oral
medication.

Must be registered in the FDA’s iPLEDGE system
Drugs used for Acne Vulgaris
Generic
Brand (Dose
Forms)
MOA
Special
Considerations
Adapalene
Differin (Gel)
Vitamin D derivative
Washable and less
irritation
Azelaic acid
Azelex (cream)
Unknown
Apply thin film
ClindamycinBenzoyl Peroxide
Benzaclin (Gel)
Antibiotic/Oxidizing
agent
Cause dry skin
Tretinoin
Retin A (cream; gel;
lotion)
Vitamin A derivative
Photosensitivy;
severe dry skin
Benzoyl Peroxide
Oxy10, Bevoxyl (Gel)
Oxidizing agent
Dry skin
Estradiol/Progestin
Ortho Tri Cyclen
(tablets)
Antagonizes
testosterone
Use in female
patients for acne
Drugs used for Acne Vulgaris
Bacterial Infections
 Most commonly seen infections are impetigo in
children and folliculitis in adults
 Both are caused by staphylococcal infections
 Cured by penicillin type antibiotics:
 Dicloxacillin 500 mg capule three times a day for 10 days
Topical Antifungal Agents
Generic
Brand (Dose forms)
MOA
Special
Considerations
Butenafine
Mentax (Cream)
Damages fungal
membranes
Jock itch, ringworm,
Ciclopirox
Loprox (cream and
lotion)
Unknown
OTC
Clotrimazole
Lotrimin (cream, lotion,
vaginal cream)
Damages fungal
membranes
Jockitch, ringworm,
vaginal yeast infection
Griseofulvin
N/A (tablet, capsule,
solution)
Damages fungal
membranes
Use for onchomycosis
(nail bed); avoid sun
Nystatin-Triamcinolone
Mycolog (Cream,
ointment)
Damages fungal
membranes and steroid
for inflammation
N/A
Oxiconazole
Oxistat (Cream, lotion)
Damages fungal
membranes
N/A
Sertaconazole
Ertaczo (Cream)
Damages fungal
membranes
N/A
Terbinafine
Lamisil (cream, tablet)
Damages fungal
membranes
Tablets for finger and
toe nail infections
Cancers of the skin
 Any skin lesion that is large, raised, asymmetric,
changes in color, and has raggy edges should raise the
suspicion of cancer
 Malignant melanoma is a cancer of the pigment
producing cells of the skin and can be fatal if allowed to
spread to other areas of the body
 Basal Cell Carcinoma is a serious cancer; however, it can
be cured with chemotherapy
Drugs for skin cancer
 Actinic Keratosis: a small nodule on skin due to sun
exposure (may be precancerous)
Generic
Brand
MOA
Special
Considerations
Aminolevulinic
acid
Levulan
Kerestick
(topical solution)
Stop cells from
dividing
Apply every eight
weeks
Diclofenac
Solaraze (Gel)
Unknown
None
Fluorouracil
Efudex (cream,
solution)
Damages DNA
Photosensitivy;
must wash hands
Skin manifestations to drug allergy
 Skin is often the window to seeing an incipient drug allergy
 Intense itching, wheals, hives may indicate an Type 1
hypersensitivity to a drug (anaphylactic reaction)
 Penicillins and other beta lactams
 Sulfa drug
 Antiseizure drugs (Carbamazepine)
 Upon subsequent exposure a life threatening reaction can
occur
 Morbilliform reaction: Type 4 hypersensitivity to a drug.
Usually occurs with 72 hours after drug exposure
 Usually not life threatening but uncomfortable to the patient
 Stevens Johnson Syndrome and Toxic Epidermal
Necrolysis
 SJS and TEN represent a dermatological emergency
 The reaction involves confluent separation of the
epidermis from the dermis and a denuding of the skin
 Therapy involves that used for severe third degree burns
 Common drug precipants: Penicillins, Sulfasalazine,
phenytoin, lamotrigine, Levetiractam , allopurinol,
phenobarbital, ibuprofen
http://www.youtube.com/watch?v=BC-OLAoqCk4
Topical Corticosteroids
 Used for various autoimmune (acne, dermatitis) and
allergic reactions of the skin
Generic
Brand
MOA
Special
Considerations
Betametasone
0.05%
Diprolene
(cream, gel,
ointment)
Immune
suppressant
Creams and
ointments not
interchangeable
Clobetasol 0.05%
Temovate
(cream,
ointment)
Immune
suppressant
Use with extreme
caution on the
face
Halobetasol
0.05%
Ultravate (cream,
ointment)
Immune
suppressant
Use with extreme
caution on the
face
Hydrocortisone
butyrate
Locoid (cream,
ointment,
solution)
Immune
suppressant
None
Hydrocortisone
Valerate
Westcort
(Cream,
ointment)
Immune
suppressant
none