Keratolytics: Nursing pharmacology

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Notes

Notes

KERATOLYTICS
DRUG NAME
salicylic acid (Compound W, Avosil, Betasal), pyrithione zinc (DermaZinc, Zincon), coal tar (Fototar, Medotar, Betatar), tretinoin (Retin-A), acitretin (Soriatane, Neotigason), 
glycolic acid, lactic acid
CLASS
Keratolytics
MECHANISM OF ACTION
Soften and shed the stratum corneum
INDICATIONS
  • Mild to moderate acne
  • Seborrheic keratosis
  • Warts
  • Dandruff
  • Psoriasis
  • Skin hyperpigmentation
ROUTE(S) OF ADMINISTRATION
TOP
SIDE EFFECTS
  • Erythema
  • Burning
  • Itching
  • Tingling
  • Dry eyes and mouth, chapped lips, skin peeling (retinoids)
  • Photosensitivity (retinoids and alpha-hydroxy acids)
CONTRAINDICATIONS AND CAUTIONS
  • Open wounds
  • Burnt, cut, irritated or scraped skin areas
  • Sensitive areas (e.g., near the eyes or mouth)
  • Boxed warning (retinoids): pregnancy
NURSING CONSIDERATIONS: KERATOLYTICS
ASSESSMENT AND MONITORING
  • Symptom onset and duration
  • Assess affected area
  • Retinoids: confirm negative pregnancy test
  • Side effects
  • Therapeutic effect
CLIENT EDUCATION
Application
  • Apply to affected area only; avoid mucous membranes
  • Wear gloves
  • Wash hands afterwards
  • May experience effects like blistering, burning, stinging, itching, redness, dryness, peeling
  • Avoid scratching or touching the affected area
  • Wash their skin gently with a mild cleanser; avoid the use of harsh soaps or chemicals
  • Retinoid or an alpha-hydroxy acid: increased risk of a sunburn
    • Avoid sunlight as much as possible
    • Wear protective clothing and sunscreen while outside
  • Therapeutic effect may take two to three weeks

Transcript

Keratolytics are a group of medications used to treat rough or scaly skin, which can be caused by a variety of skin conditions, such as mild to moderate acne, seborrheic keratosis, warts, dandruff, psoriasis, and skin hyperpigmentation as a result of other conditions like eczema.

Now, commonly used keratolytics include salicylic acid, pyrithione zinc, coal tar, retinoids like tretinoin and acitretin, and alpha-hydroxy acids, like glycolic and lactic acid.

These medications are applied topically on the skin, while retinoids can also be taken orally. Once administered, keratolytics primarily work by softening and shedding of the stratum corneum, which is the outer layer of the skin, decreasing the skin’s thickness and improving its moisture.

Unfortunately, this shedding of the stratum corneum may result in side effects, such as skin irritation, which can manifest as erythema, as well as a burning, itching or tingling sensation.

In addition, retinoids often cause dry eyes and mouth, chapped lips, and skin peeling. Finally, retinoids and alpha-hydroxy acids cause photosensitivity, so clients must avoid exposure to sunlight.

As far as contraindications go, keratolytics should not be used on open wounds or any areas of burnt, cut, irritated or scraped skin. In addition, sensitive areas such as near the eyes or mouth should also be avoided.

Acitretin has an important boxed warning for hepatotoxicity. Finally, retinoids have a very important boxed warning for pregnancy.

Sources

  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology: A patient-centered nursing process approach (8e)" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference (34e)" Mosby (2020)
  4. "Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e" McGraw-Hill Education (2018)
  5. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2019)
Elsevier

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