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, pyrothione zinc, coal tar, retinoids like retinoin 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.

Lastly, if a female client is prescribed a retinoid, be sure to confirm a negative pregnancy test before administering the medication.

Next, teach your client that they should always wear gloves when they're applying their topically prescribed medication, and they should always wash their hands afterwards.

Stress the importance of applying their medication to the affected area only, and to avoid mucous membranes like the eyes and nose.

Let your client know that they may experience blistering, burning, stinging, itching, and redness, as well as dry and peeling skin after application.

And advise them to avoid scratching or touching the affected area during treatment. Then instruct them to wash their skin gently twice a day with a mild cleanser and avoid the use of harsh soaps or chemicals.

If your client is being treated with a retinoid or an alpha hydroxy acid, be sure to let them know that these medications can increase the risk of a sunburn.

So, instruct them to avoid sunlight as much as possible and to wear protective clothing along with sunscreen while outside.

Lastly, let them know that it may take 2 to 3 weeks before they start seeing any changes in their skin. Finally, monitor your client for any side effects they may experience, as well as the therapeutic effects of the medication, such as a decrease in the size and number of lesions.

All right, it's a quick recap. Keratolytics are a group of medications that treat skin conditions that cause rough or scaly skin, such as acne, seborrheic keratosis, warts, dandruff, psoriasis, and eczema.

These medications work by softening and shedding the outer layer of the skin, which decreases the skin's thickness and improves its moisture.

Nursing considerations include performing a skin assessment, providing client teaching about correct application of the medication topically, as well as side effects they may experience, and monitoring them for therapeutic effects of the medication.