Drugs Acting on the Skin

Antibacterial

Bacitracin

It is one of the ingredients in Neosporin, which is an antibiotic ointment.

Mechanism of action:

• Bacitracin inhibits the dephosphorylation process.

• It either inhibits bacterial growth or kills the bacterium.

Indication:

• It inhibits the growth of gram-positive bacteria such as staphylococci and streptococci.
• Prevention or treatment of bacteria-caused superficial skin infections or eye infections.

Dose:

 Apply to the wounds: 1 - 4times / day

Contraindication:

• If you have hypersensitivity, avoid using topical ointment in your eyes.

Side effect:

• Itching, rash, sweating, and swelling of the lips and face are all symptoms of hypersensitivity.

Nursing consideration:

• First, clean the wound, and then apply to it.

• Avoid the pus first, then apply to the wound.

• This product should not be applied to large portions of the body.

• Daily dressing is essential.

• Bacitracin topical should not be used for more than one week.

• Use only as directed by your doctor.

• Keep this drug away from your eyes, nose, and mouth.

• Apply cure on a regular basis.

Silver Sulphadiazine

It is a local anti-infective medication. It comes as a 1% topical cream.

Mechanism of action:

• Silver ions are the primary cause of its activity.

• It kills bacteria by acting on the cell membrane and cell wall.

Indication:

• Burn case (drug of choice): used to prevent and cure infection in 2nd and 3rd degree burns.

• Gram-negative infections, such as pseudomonas, are also treated, as are persistent infected leg ulcers and pressure sores.

Dose:

• Use a sterile gloved hand to apply once or twice daily.

• Apply to a 1/16" thickness.

• The burned area should always be covered with cream.

Contraindication:

• Pregnancy, neonates, hypersensitive to sulphonamides

Side effect:

• In extended use, rashes, burning, itching, skin discoloration, discomfort, burning, serum hyperosmolality, and eryria may occur.

Nursing consideration:

• Inform patients about skin discolouration.

• First, clean the wound, and then apply to it.

• Use a sterilized gloved hand to apply. Only for external use.

• Avoid the pus first, then apply to the wound.

• Daily dressing is essential.

• Use only as directed by your doctor.

• Take cure in terms of application frequency.

Polymyxin

• It is generated from the Bacillus polymyxa bacteria. It is harmful when administered parenterally.

• It is also an antibiotic ointment and a component of the Neosporin ointment. It is available as a topical ointment and as a powder.

Mechanism of action:

• It is effective against gram negative pseudomonas bacteria, including Pseudomonas aeruginosa.
• It binds to the phospholipids in the bacterial cell membrane, causing a disruptive physicochemical effect that leads to changes in cell membrane permeability and, eventually, cell death.

Indication:

• Gram-negative infections cause acute infections.
• Pseudomonas aeruginous is treated topically with wound irrigation and bladder instillation.

Dose:

• Use twice a day.
• Continuous irrigant or rinse in the urinary bladder for up to 10 days using 20mg (equivalent to 200,000 units) given to 1 litter of Normal saline, normally no more than 1 litter of irrigant is used per day unless urine flow rate is high, administration rate is adjusted to patient's pee out

Contraindication:

• Hypersensitivity

Side effect:

• Hypersensitivity, rash, urticaria, nephrotoxicity, neurotoxicity

Nursing consideration:

• Inform them of the price, as it is slightly more expensive than other ointments.

• First, clean the wound, and then apply to it.

• Avoid the pus first, then apply to the wound.

• Daily dressing is essential.

• Take cure in terms of application frequency.

• It is rendered inactive by acidic or alkaline solutions.

Framycetin

It is antiseptic ointment and famous for soframycin ointment.

Mechanism of action:

• By binding to ribosomal subunits, framycetin appears to inhibit protein synthesis in susceptible bacteria. It has bactericidal properties.

Indication:

• Topical treatment for ulcers, skin transplant sites, burns, wounds, and infected damaged skin.

• Infection of the eyes and skin on the surface.

• Blepharitis, conjunctivitis, corneal injuries, corneal ulcers, and eye infections are all treated locally.

Dose:

• Skin infection: twice daily.
• In case of an eye infection, apply 1 or 2 drops to the afflicted eye.

Contraindication:

• Hypersensitivity to framycetin and aminoglycosides

Side effect:

• Irritation, burning, rash, stinging, itching at application site.

• Inflammation, dry skin, sensitive skin.

Nursing consideration

• Soframycin (popular brand) ointment is another name for it.

• First, clean the wound, and then apply to it.

• Avoid the pus first, then apply to the wound.

• Daily dressing is essential.

• Apply cure on a regular basis.

• Avoid contacting any portion of the eye when administering.

• To administer opthalmic meditation, wash your hands and put on gloves.

Neomycin

It is also a type of antibiotic ointment. As with neomycin, it is a single molecule. It comes as lotions, ointments, and ocular drops.

Mechanism of action:

• Neomycin is a bactericidal agent that inhibits protein synthesis by binding to the bacterial 30S ribosomal subunit.

Indication:

• Superficial infection and also for skin purposes

Dose:

• Apply a thin layer of 0.5% cream or ointment to the afflicted area 1- 4 times per day.
• Apply 1-2 drops of eye drops 1-3 times per day.
• Apply eye ointment before going to bed.

Contraindication:

• Hypersensitivity

Side effect:

• Contact dermatitis, irritation

Nursing consideration

• First, clean the wound, and then apply to it.

• Avoid the pus first, then apply to the wound.

• Daily dressing is essential.

• Take cure in terms of application frequency.

• When applying eye drops or ointment, take care not to touch the dropper or tube tip to any surface or the eye.

• After each drop, apply gentle pressure to the inside corner of the eye to prevent the liquid from leaking down the tear duct.

• After applying eye drops or ointment to the eye, you may have temporary blurred vision. Do not drive or operate machinery until the effects of this have worn off.

Nitrofurazone

It is conventional type of medicine and used in burn and infected wound.

Mechanism of action:

• Second degree and third degree burn, mucus membrane infection.

Indication:

• Antiseptic

Dose:

• Three times a day

Contraindication:

• Hypersensitivity

Side effect:

• Skin irritation, urticaria, burning

Nursing consideration:

• First, clean the wound, and then apply to it.

• Avoid the pus first, then apply to the wound.

• Daily dressing is essential.

• Use only as directed by your doctor.

• Apply cure on a regular basis.

Chloramphenicol

It is antibiotic ointment. 'Apply cap' contains the chloramphenicol.

Mechanism of action:

• It is a broad-spectrum antibiotic topical skin/eye ointment, as well as eye/ear drops.

• Bacterial growth is halted. It can also kill germs in large concentrations.

Indication:

• Bacterial infection, conjunctivitis

Dose:

• Eye / ear : 2-3 drops 4-6 times

Contraindication:

• Viral infection

Side effect:

• Ear and eye burning and itching, eye ointment more irritating and uncomfort of eye.

Nursing Considerations:

• First, clean the wound, and then apply to it.

• The concentration of the eye (0.5%) and the ear (5%), however, differs.

• "Apply cap" is another name for chloramphenicol eye ointment (KIRO JASTO MALHAM)

• Use only as directed by your doctor: Apply the cap to the single-dose ointment.

• It is preferable to discard after 7 days.

Tetracycline

Basically Oxytetracycline ointment is used in eyes.

Mechanism of action:

• It is broad spectrum ointmet. It stops the growth of bacteria

Indication:

• Superficial infection of eyes, conjunctivitis

Dose:

• 2-3 drops 4-6 times a day or eye ointment is to be applied in to the lid/eyes

Contraindication:

• Hypersensitivity

Side effect:

• Dermatitis, staining

Nursing consideration:

• Clean the eyes with clean water before applying to the eyes/wound.

• First, avoid the pus, then apply to the wound.

• Tetracycline is also known as Oxytetracycline eye ointment.

• Use only as directed by a doctor.

• Eye ointment is applied as a single dose.

Gentamycin

Gentamycin antibiotic is used for eye/ear drops and ointment for eczema.

Mechanism of action:

• It falls under aminoglycosides group and it stops the growth of bacteria

Indication:

• Used as bacterial infection of eyes/ears,conjuctivitis

Doses:

• 2-3 drops 4 times a day (eye/ ear), ointment apply smoothly in the skin

Contraindication:

• Hypersensitivity

Side effect:

• Contact dermatitis and burning pain in eye

Nursing consideration

• Cleanse the skin first, and then apply the skin ointment.

• The concentration of the eyes and ears is the same (0.5%).

• After 7 days, throw away the eye/ear drops.

• Use the dosage form prescribed by your doctor.

• Gentamycin should not be used in conjunction with steroids unless prescribed by a doctor.

Antifungal

Whitfield's Ointment

• It has fungistatic and keratolytic properties.

• It is named after Whitfield, a scientist (hence the name Whitfield's ointment).

• It is made up of Benzoic acid and 5 Salicylic acid.

The composition of whitfield's ointment is as belows:

Composition: Each 100-gram contains:

• Benzoic acid---6% (6 gram)

• Salicylic acid -3% (3gram)

• Vaselline-91 gram

Mechanism of Action:

• This keratolytic solution is extremely effective against dermatophytes. Fungi are killed using benzoic acid. It disrupts fungus cell membranes (permeability or leaking of components of cells).

Indication:

• It is used against fungi, patches of ringworm.
• Dermatophyte infection of the scalp (tinea capitis). in combination with a systemic antifungal
• Dermatophyte infection of the glabrous skin and skin folds:
  • Alone, if lesions are localised, non-extensive.
  • In combination with a systemic antifungal, if the lesions are extensive.

.Dose:

• Apply two times a day in skin, sparingly, to clean and dry skin.

Side effect:

• Skin irritation, local benign inflammation

Nursing consideration:

• Because soap is fungi's nourishment, the affected area should not be washed with soap.

• After cleaning the skin with clean water, apply the skin ointment on the skin.

• Because of the presence of benzoic acid, the odor is unpleasant.

• Whitfield's ointment is less expensive than clotrimazole.

• Consult a doctor if you have hypersensitivity.

• It is free and available at health posts.

Clotrimazole

Mechanism of action:

• It stops the ergosterol synthesis of micro organism.It stops the growth of fungi.also it can kill the fungi.

Indications

• Vaginal candidiasis

Dose:

• 500 mg vaginal tablet, with applicator

• Also comes in 100 mg vaginal tablets.

• 500 mg vaginal tablet.

• Adult: one vaginal tablet as a single dose, at bedtime

• 100 mg vaginal tablet.

• Adult: one vaginal tablet/day for 6 days at bedtime

Contraindication:

• Hypersensitivity

Side effects:

• May cause: local irritation; allergic reactions.

Nursing consideration:

• Place the tablet on the applicator. Insert the applicator high into the vagina. Push the plunger then remove the applicator.
• For the 6 day treatment schedule (100 mg tab):
• Do not interrupt treatment during menstruation.
•  Clean the applicator with water after each use.

Econazole

It is also used against the fungi and not so popular as clotrimazole

Mechanism of action:

• It stops the ergo sterol synthesis of micro organism. It stops the growth of fungi. Also it can kill the fungi.

Indication:

• Tinea pedis, vaginal candidiasis and fungal infection

Dose:

• It can be applied 2-3 times a day and for 14 days

Contraindication:

• Hypersensitivity

Side effect

• Urticaria, Erythema,Pruritis

Nursing consideration:

• Cleanse the skin first, and then apply the skin ointment.

• It is also available as a pessary and can be used with an applicator.

• The dose must be finished.

• Use the dosage form prescribed by your doctor.

• Use only as directed by a dermatologist or a gynecologist.

Ketoconazole

It is also anti fungal ointment. Ketoconazole shamphoo is famous in market.

Mechanism of action:

• It alters the cell wall permeability by inhibition of ergosteral synthesis of fungi

Indication:

• Candida, aspergillus, fungi, athlete's foot

Dose:

• It can be applied two times a day.

Contraindication:

• Hypersensitivity

Side effect:

• Maceration, irritation

Nursing consideration:

• Clean the skin first and then apply to the skin ointment to the skin
• It is suggested not to wash the skin with soaps
• Clean the skin with warm and clean water
• Also Shamphoo is available as it can be used in dandruff (fungal disease)
• Don't used haphazardly but only advised by physicians
• Use the dosage form as per doctor's advice

Tolnafate

It is also used as anti fungal ointment and ineffective in infection due to candida

Mechanism of action:

• It is effective against dermatophytes

Indication:

• Tinea pedis, T. cruris T. corports

Dose:

• Apply gently in affected parts

Contraindication:

• Hypersensitivity

Side effect:

• Slight skin irritation

Nursing consideration:

• Cleanse the skin first, and then apply the skin ointment.
• Soap should not be used on the afflicted area.
• The medication is ineffective against candida.
• If you develop an allergy, see a dermatologist.
• Not to be used haphazardly, but only when advised by a physician.

Zinc oxide

It is basically used for bed sores and pruritis.

Mechanism of action:

• It prevents the skin burn and it also absorbs the ultraviolet light

Indication:

• Sun burn, pruritis

Dose:

• Applied gently in to affected parts

Contraindication:

• Staining, Hypersensitivity

Side effect:

• Contact dermatitis

Nursing consideration:

• Clean the skin first and then apply to the skin ointment to the skin
• It is also used in bed sores
• The dose should be completed
• Use the dosage form as per doctor's advice
• If allergy occurs, consult to doctors

Miconazole

It is old and parent molecule for fungi

Mechanism of action:

• It alters the cell wall permeability by inhibition of ergosterol synthesis of fungi

Indication:

• Candida, aspergillus, fungi, athelete's foot, ring worm

Dose:

• It can be applied two times a day

Contraindication:

• Hypersensitivity

Side effect:

• Maceration, irritation

Nursing consideration:

• Cleanse the skin first, and then apply the skin ointment.
• It is advised not to use soap on the skin.
• Warm, clean water should be used to clean the skin.
• It is the original or parent molecule, and it is efficient against fungal infection.
• Use the dosage form prescribed by your doctor.
• Not to be used haphazardly, but only when advised by a physician.

Antivirials

Acyclovir

It is the drug of choice for Viral infection. It is available in 3% ointment tube.

Mechanism of action:

• It interferes with viral DNA polymerase and stops the viral replication.

Indication:

• Lips simplex infection
• Treatment of herpes keratitis
• Prevention of herpes keratitis in neonate born to a mother suffering from genital herpes at the moment of childbirth.

Dose:

• At least five times per day
• Herpes keratitis treatment: 5 applications per day into the conjunctival sac of both eyes for 14 days or 3 days after lesions have healed.
• Neonatal herpes keratitis prevention: Wash the eyes with sterile sodium chloride 0,9% immediately after birth, then inject a single dose of acyclovir into the conjunctival sac of both eyes.

Contraindication:

• Hypersensitivity

Side effect:

• Transient burning, allergy

Nursing consideration:

• Clean the skin first and then apply to the skin
• The more we use earlier the faster relief
• Clean the skin with warm and clean water time to time
• When allergy occurs, consult to doctors
• Use the ointment dosage form along with solid dosage form (tablets) as per doctor's advice
• Don't used haphazardly. It is not effective for bacterial infections

Corticosteroids

Corticosteroids are any steroids-containing medications. Hormones include steroids. Hormones are chemical groups that have a wide range of impacts on the body.

Corticosteroids are commonly used to:

• Reduce inflammation,
• Suppress the immune system, and
• Replace hormones in the body.

Examples:

• Sprays and inhalers: inhaled corticosteroids,
• Creams and lotions: topical corticosteroids, and
• Injections: these can be injected into the (intravenous corticosteroids) or into an affected muscle or joint.

Betamethasone 

Mechanism of action:

• It diffuses across cell membranes to form the complexes with specific cytoplasmic receptors

Indication:

• (available: eye/ear drops, ointment, lotion, inj,nasal spray etc). It is used as anti allergy and anti inflammatory action.

Dose:

• Apply gently in to affected areas

Contraindication:

• Hypersensitivity and infection

Side effect:

• Hair growth, delayed healing, skin irritation

Nursing consideration:

• Cleanse the skin first, and then apply the skin ointment.
• It should be used in very small amounts or it will absorb into the blood and have a systemic effect.
• Warm, clean water should be used to clean the skin.
• It can help with bug bites and allergies.
• Use the dosage form prescribed by your doctor.
• Use with caution and only as directed by a physician.

Dexamethasone

Dexona is the popular brand of it and used as steroid.

Mechanism of action:

• It diffuses across cell membranes to form the complexes with specific cytoplasm receptors.

Indication:

• (available: eye/ear drops, ointment, inj). It is used as anti allergy and anti inflammatory action and mainly used in anaphylactic shock.

Dose:

• Apply gently in to affected areas

Contraindication:

• Hypersensitivity and infection

Side effect:

• Hair growth, delayed healing, skin irritation

Nursing consideration:

• It is mainly used in anaphylactic shock and used in ICU
• It should be used gently at the affected areas; Max dose is absorbed in to blood
• It should not be used in infected area
• It is useful in insect bites and allergy, it delay the wound healing
• Use the drug as directed by physician
• Don't used haphazardly but only used as per advise by physicians

Hydrocortisone

• This is a steroid that is also available as an injectable as Hydrocortisone succinate and as a cream and ointment.
• 1% and can be used in conjunction with a physician consultation.

Mechanism of action:

• It diffuses across cell membranes to form the complexes with specific cytoplasmic receptors.

Indication:

• Available: ointment, injection etc
• It is used as anti allergy and anti inflammatory action.
• Atopic eczema, contact seborrhoeic dermatitis.
• Reactions to insect bites.

Dose:

• Ointment should be used apply in to affected areas.
• Apply a thin layer to the affected area only, once or twice daily for 7 days maximum.

Contraindication:

• Hypersensitivity and in case of acne, rosacea, perioral dermatoses, untreated bacterial (impetigo, etc.), fungal (candidiasis and dermatophytosis) and viral (herpes) skin infections.

Side effect:

• Hair growth, delayed healing, skin irritation, pruritus, burning sensations, skin eruptions, hypopigmentation, contact eczema, Urticaria, skin atrophy, dilation of small blood vessels (telangiectasia), stretch marks, skin fragility.

Nursing consideration:

• Cleanse the skin first, then apply an ointment to the skin (n Hydrocortisone 1% is a standard potency that can be used on the face).
• It should be used in very small amounts because it will absorb into the blood and cause systemic effects.
• Dettol should not be used on infected locations. It causes the infection/eczema.
• It is a very useful medicine for patients who have allergies.
• Use the ointment or injection as directed by your doctor.
• Use with caution and only as directed by a physician.

Anti Inflammtory

Inflammation is the body's protective response to cell injury. Exogenous stimuli can cause direct cell injury, as well as a complex reaction in vascularized call inflammation.

Inflammation can be characterized by 5 main features, these are:

• Swelling (tumour)
• Heat (calor)
• Redness (rubor)
• Pain (dolor)
• Loss of function (functio laesa)

Ibuprofen

It is the ointment used to relieve pain or inflammation.

Mechanism of action:

• It inhibits the secretion of prostaglandin and relieves the pain.

Indication:

• Pain and inflammation

Dose:

• Apply ointment (not in broken wound)

Contraindication:

• Hypersensitivity and skin infection

Side effect:

• Skin irritates

Nursing consideration:

• Apply gently in affected areas
• It should not be used in huge quantity
• If allergy, consult to doctors
• Use the dosage form (ointment) as per doctor's advice
• Use only if necessary, otherwise habit formation may occur

Diclofenac

It is also popular medicine and falls under NSAIDS

Mechanism of action:

• It inhibits the secretion of prostaglandin and relieves the pain

Contraindication:

• Hypersensitivity and skin infection

Dose:

• apply ointment (not in broken wound)

Indication:

• pain and inflammation

Side effect:

• Skin irritates

Nursing consideration:

• Apply carefully to affected areas (MOOV is a popular brand).
• It is primarily utilized in sports venues.
• It should not be used in large amounts.
• Consult a doctor if you have an allergy.
• Use the dosage form (ointment) as directed by your doctor.
• Use only when absolutely necessary; otherwise, habit formation may occur.