Keratolytics: Nursing pharmacology

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.

Now, when your client is prescribed a keratolytic, first ask them about the onset and duration of their symptoms. Then, assess the affected area of skin, making note of its type and location, as well as the presence of drainage.

In addition, be sure to assess the affected skin for open areas, as well as problems like burns, cuts, and irritated or scraped skin.