Medications for acne vulgaris: Nursing pharmacology

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Notes

ACNE MEDICATIONS, PART 1/2
DRUG NAMEsalicylic acid, azelaic acid (Azelex, Finacea), benzoyl-peroxide
tretinoin (Retin-A, Avita), adapalene (Differin)
erythromycin (Ery, Erygel), clindamycin (Cleocin, Clindesse), tetracycline, doxycycline(Oracea)
CLASSKeratolytics
Vitamin A derivatives
Antibiotics
MECHANISM OF ACTION
Soften and shed stratum corneum → decrease skin thickness and improve skin moisture
Blunt inflammatory process, modulate keratinization → help eliminate comedones
Inhibit bacterial overgrowth → reduce inflammation
INDICATIONS
  • Acne
ROUTE(S) OF ADMINISTRATION
  • TOP
  • TOP 
  • PO
SIDE EFFECTS
  • Skin irritation, erythema, burning, itching, tingling sensation, photosensitivity



  • Skin irritation, erythema, burning, itching, tingling sensation, photosensitivity
  • GI disturbances (e.g., nausea, vomiting, diarrhea)
  • Hepatotoxicity
  • Headache, dizziness 
  • Conjunctivitis 
  • Epistaxis 
  • Hirsutism
  • Tetracyclines: bone accumulation in children < 8 yo
CONTRA-INDICATIONS AND CAUTIONS
  • Sun exposure
  • Sun exposure 
  • Hepatic or renal disease
  • Pregnancy
  • Breastfeeding
  • Children < 8 yo


ACNE MEDICATIONS PART 2/2
DRUG NAME
isotretinoin (Absorica, Accutane, Zenatane)
spironolactone (Aldactone, CaroSpir), estrogen with progestin Ortho-Cyclen, Yaz)
CLASS
Retinoids
Hormonal agents
MECHANISM OF ACTION
Decrease sebum formation and secretion, blunt inflammation, keratolytic effects
Decrease androgen levels → reduce sebum production
ROUTE OF
ADMIN.
  • PO
SIDE EFFECTS
  • Skin irritation, erythema, burning, itching, tingling sensation, photosensitivity, skin peeling
  • Dry eyes 
  • Dry mouth, chapped lips
  • GI disturbances (e.g., nausea, vomiting, diarrhea)
  • Hepatotoxicity
  • Headache, dizziness 
  • Conjunctivitis 
  • Epistaxis 
  • Hirsutism
  • Cheilitis 
  • Teratogenic
  • Skin irritation, erythema, burning, itching, tingling sensation, photosensitivity
  • GI disturbances (e.g., nausea, vomiting, diarrhea)
  • Hepatotoxicity
  • Headache, dizziness 
  • Conjunctivitis 
  • Epistaxis 
  • Hirsutism
  • Clot formation 
CONTRA-INDICATIONS AND CAUTIONS
  • Sun exposure
  • Hepatic or renal disease 
  • Boxed warning: Pregnancy, breastfeeding
  • Sun exposure 
  • Hepatic or renal disease 
NURSING CONSIDERATIONS: ACNE MEDICATIONS
ASSESSMENT AND MONITORING
Assessment and monitoring: isotretinoin 
Assess
  • Affected area: acne lesion characteristics, type location
  • Laboratory test results: CBC, blood glucose, renal and hepatic function, and lipid panel
  • For female clients of childbearing age
    • Two negative pregnancy tests
    • Registered with the iPLEDGE program
    • Confirm informed consent 

Monitor
  • Hepatic function, lipid panel, monthly pregnancy status, blood glucose level
  • Side effects
  • Desired therapeutic effects of the medication: decrease in size and number of lesions
CLIENT EDUCATION
  • Purpose of medication: treat severe acne
  • Take medication two times each day with food and a full glass of water
  • Maintain a well-balanced diet
  • Avoid alcohol
  • Avoid  supplements containing vitamin A
  • Wash skin gently twice a day with a mild cleanser; avoid the use of harsh soaps or chemicals
  • Side effects
    • Dry eyes, contact lens discomfort 
      • Lubricating eye drops
    • Decreased night vision
      • Caution at night; avoid night driving
    • Photosensitivity
      • Avoid sunlight; wear protective clothing, use sunscreen
    • Diabetic clients
      •  Check blood glucose levels more often; monitor themselves for symptoms of hyperglycemia
    • Report symptoms of altered mood and behavior, liver impairment, hearing problems 
  • Avoid skin resurfacing treatments during therapy and for six months afterwards

Transcript

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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.

Sources

  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  6. "Davis's Drug Guide for Nurses" F.A. Davis (2020)
  7. "Vitamin A" MedlinePlus
  8. "Isotretinoin" Medline Plus (2018)
  9. "The effect of isotretinoin on insulin resistance and adipocytokine levels in acne vulgaris patients" Turkish Journal of Medical Sciences (2018)
  10. "Acne Vulgaris" Merck and the Merck Manuals (2020)