Medications for acne vulgaris: Nursing pharmacology

Acne vulgaris is a common skin disorder characterized by raised, red bumps that occur when hair follicles get clogged by particles like dead skin cells or oil, and it primarily occurs on the face, neck, chest, and back.

Although the exact cause of acne is not completely understood, there are a few main factors that are known to contribute to acne formation.

These include keratin plugs that block the opening of the hair follicle; increased sebum released by sebaceous glands, which sometimes occurs in response to increased androgen production during puberty; and overgrowth of bacteria like Cutibacterium acnes that trigger local inflammation.

Acne vulgaris can be categorized into different types based on specific characteristics. Mild acne usually consists of comedones, while moderate acne usually consists of pustules, and severe acne usually consists of cysts and nodules.

Depending on the severity and location of acne, there are various medications that can be used to treat acne. These include topical medications, such as keratolytics like salicylic acid, azelaic acid, and benzoyl peroxide, vitamin A derivatives like tretinoin and adapalene, and topical antibiotics like erythromycin or clindamycin; as well as systemic medications, such as oral antibiotics like the tetracyclines tetracycline and doxycycline, oral retinoids like isotretinoin, and hormonal agents like spironolactone or oral contraceptives containing a combination of estrogen and progestin.

Okay, now let’s dive deeper into the different classes of medications, starting with topical agents. Keratolytics include salicylic acid, azelaic acid, and benzoyl peroxide, and once administered, they primarily work by softening and shedding the stratum corneum, which is the outer layer of the skin.

As a result, keratolytics help decrease the skin’s thickness and improve its moisture. Next, vitamin A derivatives include tretinoin and adapalene, and they work by blunting the inflammatory process, modulating keratinization, and ultimately helping to eliminate comedones.

Lastly, the most commonly used topical antibiotic for acne is erythromycin, which works by limiting bacterial growth and proliferation and thus, reducing inflammation.

Now, let’s switch gears to systemic medications to treat acne. The most commonly used oral antibiotics include tetracycline and doxycycline, which also act by limiting bacterial growth and proliferation.

On the other hand, oral retinoids, like isotretinoin, have multiple effects. They can decrease sebum formation and secretion, blunt inflammation, and they also have keratolytic effects.

Finally, oral contraceptives, such as ethinylestradiol with levonorgestrel, can be used to treat acne because they decrease androgen levels and thus, they reduce sebum production.

The bad news is that these medications can cause side effects. Topical medications can cause local skin irritation, which can manifest as erythema, as well as a burning, itching, tingling sensation, and photosensitivity.

On the other hand, systemic medications can also lead to more widespread side effects, such as gastrointestinal disturbances like nausea, vomiting, and diarrhea.

Clients may also present with headaches, dizziness, conjunctivitis, epistaxis, and hirsutism. In addition, these systemic medications can cause photosensitivity and hepatotoxicity.

Tetracyclines can also accumulate in the bones, affecting bone growth in children under the age of 8. Oral retinoids often cause dry eyes and mouth, chapped lips, and skin peeling; they can cause increased triglycerides, increase blood glucose levels, cause visual changes, and increase the risk of depression; they are also highly teratogenic.

Finally, oral contraceptives can lead to formation of clots. As far as contraindications go, these medications should be avoided before or after sun exposure or sunburn.

These medications are also contraindicated during pregnancy and breastfeeding, which is a boxed warning for systemic retinoids!

Additionally, tetracyclines are contraindicated for children younger than 8 years old. Finally, these medications should be used with caution in clients with hepatic or renal disease.

Okay, if your client with severe acne vulgaris is prescribed an oral retinoid like isotretinoin, first perform a baseline assessment of the affected area, making note of the acne lesion characteristics, including type and location.

Then, review their most recent laboratory test results, including CBC, blood glucose, renal and hepatic function, and lipid panel.

Finally, before any client assigned female at birth who is able to become pregnant can receive the medication, confirm two negative pregnancy tests, ensure they have been registered with the iPLEDGE program, and confirm informed consent has been obtained.

Answer any questions they have about the iPLEDGE program, and reinforce key information, including the need to use two reliable forms of birth control; to obtain a negative pregnancy test before each medication refill; and to let their healthcare provider know right away if they become pregnant.Next, explain how the medication will help to treat their acne; but let them know that the lesions may get worse during the first few weeks of treatment, and that it can take 4 to 6 months for their acne to fully resolve.

Then, instruct them to take their medication two times each day with food and a full glass of water. Be sure to remind them to maintain a well-balanced diet, and stress the importance of avoiding alcohol as well as any supplements containing vitamin A during treatment.

Lastly, instruct them to wash their skin gently twice a day with a mild cleanser, and avoid the use of harsh soaps or chemicals.

Then, inform your client about some of the side effects they could experience during treatment. If they experience dry eyes or contact lens discomfort, advise them that lubricating eye drops can be helpful.

Additionally, explain that the medication can affect their ability to see in the dark, so advise them to avoid driving at night and to take precautions when it is dark.

Also let them know that because the medication can cause photosensitivity, they should avoid sunlight as much as possible and wear protective clothing along with sunscreen when spending time outside.

Now, if your client is a diabetic, advise them to check their blood glucose levels more often during treatment, and to monitor themselves for symptoms of hyperglycemia like increased thirst and hunger, along with passing a lot of urine.

Then, encourage your client to recognize and report symptoms of altered mood and behavior, including anxiety, depression or thoughts of self-harm; symptoms of liver impairment, such as fatigue, anorexia, nausea, dark urine, or yellowing of their eyes or skin; or problems with hearing which could manifest as tinnitus or a decrease in their hearing acuity.

Lastly, advise your client to avoid any procedures like skin resurfacing treatments during therapy and for 6 months afterwards, since isotretinoin can increase the risk of developing scars from these treatments.Finally, while your client is taking an oral retinoid like isotretinoin, continue to monitor your client’s hepatic function, lipid panel, as well as monthly pregnancy status.

If your client is a diabetic, keep a close eye on their blood glucose level. Additionally, monitor for any side effects they may experience, as well as for the therapeutic effects of the medication, such as a decrease in the size and number of lesions.

Alright, as a quick recap …. Acne vulgaris is a common skin disorder characterized by comedones, pustules, cysts, and nodules that occur when hair follicles get clogged by particles like dead skin cells or oil.

Depending on the severity and location of the acne, there are various medications that can be used to treat it, including topical medications like keratolytics, vitamin A derivatives, and antibiotics; as well systemic medications like oral antibiotics, retinoids, and hormones.

Topical medications can cause photosensitivity and local skin irritation, which can manifest as erythema, as well as a burning, itching, tingling sensation.

On the other hand, systemic medications can lead to gastrointestinal disturbances, headaches, photosensitivity, and hepatotoxicity.

Acne medications should be avoided during pregnancy and breastfeeding. When caring for clients who are prescribed a medication to treat acne, nursing considerations include performing a baseline assessment, monitoring for side effects, and evaluating for the therapeutic response.

Client teaching is focused on safe self-administration, as well as learning about side effects that should be