UNIT 7

Drugs used in
Treatment of
Integumentary
Disorders
ANTIHISTAMINE AND ANTIPRURITICS
Antihistamine is used for the treatment of allergies. Drugs that

inhibit itching are called antipruritic drugs. They are available

in form of topical preparation like creams and sprays.

Antihistaminic Drugs
Antihistamines are a class of medications used to treat histamine-
mediated diseases. Histamine receptors are:
❖Classified into two types: H-1 receptors and H-2 receptors.
❖In general, antihistamines that bind to H-1 receptors are used to treat
allergies and allergic rhinitis.
❖H-2 receptor agonists help treat upper gastrointestinal disorders
caused by increased stomach acid.
Classification/Dose/Route of Antihistaminic Drugs
First Generation Antihistaminics
Highly Sedative
❑Diphenhydramine (Oral/IM/IV)
For adults and children over 12 years old: The usual oral dose for
diphenhydramine is 25 to 50 mg every 4 to 6 hours, not to exceed 300 mg
per day. For children under 12 years old: The usual pediatric dose for
diphenhydramine is 1 to 2 mg/kg every 4 to 6 hours, with a maximum daily
dose of 300 mg.
❑Promethazine (Oral/IV/IM)
For adults and children over 12 years of age, the usual dose of
promethazine for allergies is 25 mg taken orally, 2 to 3 times a day.
Moderately Sedative
❑Pheniramine (Oral/IV/IM/Rectal/Opthalmic)
• The usual adult dose for pheniramine is 25 mg to 50 mg taken orally
every 4 to 6 hours as needed, with a maximum daily dose of 150 mg.
❑Cyproheptadine (Oral/IM/IV/Topical)
• The typical adult dose of cyproheptadine for allergic reactions is 4 mg
to 20 mg per day, divided into 2-4 doses, taken orally.
❖Cinnarizine (Oral/Topical)

The typical adult dose of cinnarizine for off-label allergy treatment is 25

mg taken once or twice daily. It's important to note that cinnarizine is
not a first-line treatment for allergies and should only be used under the
guidance of a healthcare professional.
Mild Sedatives
❑Chlorpheniramine (Oral/IM/IV)
For adults and children over 12 years of age, the typical recommended
dose of chlorpheniramine is 4 mg to 8 mg every 4 to 6 hours, not to
exceed 32 mg per day.
❑Cyclizine (Oral)
In rare cases, cyclizine may be used off-label to treat itching or hives
caused by an allergic reaction or other skin conditions. The recommended
dose of cyclizine for treating itching or hives will depend on the
individual's age, weight, and the severity of their symptoms.
❑Clemastine (Oral/IM/IV)
The recommended dose of clemastine for adults is usually 1.34 mg (2
tablets of 0.67 mg) every 12 hours.
Second Generation Antihistaminic
❑Terfenadine (Oral): 60 mg twice daily.
❑Fexofenadine (Oral): The recommended dose of fexofenadine for
adults is 180 mg once daily.
❑Astemizole (Oral): 10 mg once daily.
❑Loratadine (Oral): The usual recommended dose of loratadine for
adults and children over 12 years old is 10 mg once daily,
❑Desloratidine (Oral): For adults and children 12 years of age and
older the recommended dose is 5 mg once a day.
❑Cetrizine (Oral): For adults and children over 12 years of age, the
usual recommended oral dose of cetirizine is 10 mg once daily.
 Mechanism of
Action

H-1 Antihistamines
Histamine (an endogenous chemical
messenger) induces an increased level of
vascular permeability, which leads to fluid
moving from capillaries into the
surrounding tissues. The overall outcome
of this is increased swelling and dilation of
vessels. Antihistamines stop this effect by
acting as antagonists at the H-1 receptors.
The clinical benefit is a reduction in
allergy symptoms and any related
symptoms.
Antiallergic Action
Immediate hypersensitivity suppressed in Type I hypersensitivity which
have symptoms like urticaria, angioedema, itching.
H-2 Antihistamines
When histamine binds to the H-2 receptors on parietal cells, cyclic
adenosine monophosphate (cAMP) increases, inducing protein kinase A.
This action then leads to phosphorylation of the proteins that take part in
the transport of hydrogen ions. Thus increased histamine leads to
increased stomach acid, e.g., HCl secretion.
The use of antihistamines specific to the H-2 receptor blocks the entire
process and reduces stomach acid secretion.
Indications
H-1 Antihistamines
❖Allergic rhinitis
❖Allergic conjunctivitis
❖Allergic dermatological reaction(s)
❖Sinusitis
❖Urticaria
❖Angioedema
H-2 Antihistamines
❖Peptic ulcer
❖Acid reflux
❖Gastritis
❖Zollinger Ellison syndrome
Side Effects and Toxicity

❖Sedation, diminished alertness and concentration, light headedness,

motor incoordination, fatigue, and tendency to fall asleep, impairment
of psychomotor performance.

❖Anticholinergic effects, epigastric distress and headache, contact

dermatitis, caution in pregnancy.
 ANTIPRURITICS

Antipruritics, also known as anti-itch drugs, are medications that inhibit

the itching that is often associated with sunburns, allergic reactions,
eczema, psoriasis, chickenpox, fungal infections, insect bites etc.
Mechanism of Action
The exact mechanism of action depends on the type of antipruritic drug used.
Here are some examples of how antipruritic drugs work.
• Topical Corticosteroids
These medications work by reducing inflammation and suppressing the
immune response. They help to reduce itching by reducing the inflammation
that can cause it.
• Antihistamines
These medications work by blocking the action of histamine, a chemical that is
released by cells in response to an allergic reaction. Histamine causes itching
and other allergy symptoms, so blocking its action can help reduce itching.
• Opioid Agonists
These medications work by binding to opioid receptors in brain and spinal
cord, reducing the perception of pain and itching. They can be used to treat
severe itching associated with conditions such as cancer, kidney disease, or
liver disease.
 INDICATIONS

Infections
Skin conditions
(Certain
(Eczema,
infections, such as
psoriasis, and
chickenpox, can
dermatitis etc.)
cause itching)

Insect bites and

Allergic reactions.
stings.
 Contraindications

Allergy
Pregnancy
Breast feeding
Liver and kidney disease:
Some antipruritic drugs may not
be safe for people with liver or
kidney disease, as they can cause
further damage to these organs.
Glaucoma
 Role of Nurse
❖Nurses should assess the patient's skin condition and itching severity
before administering any antipruritic medication. They should also
review the patient's medical history, including allergies and current
medications.

❖Nurses should monitor the patient's response to the antipruritic

medication, including any changes in itching severity or skin
condition.
 TOPICAL APPLICATIONS FOR SKIN MUCOUS
MEMBRANE
Demulcents
❑These are inert substances that soothe inflamed/ denuded mucosa/skin by
preventing contact with surroundings.
❑ High molecular weight.
❑Thick viscous solution in water.
❑ Methylcellulose–Bulk purgative, contact lens solution Examples are
Glycerin–Gum/throat paints.
Emollients
❑Oily substances used to: soften and soothe/protect the skin and used as
vehicle for ointment.
❑ Form an occlusive film, preventing evaporation → restore elasticity of
cracked and dry skin
Absorbents and Protectives

Finely powdered, inert and insoluble solids capable of binding noxious

substances and irritants to their surface and provide physical protection.

Astringents

❖Drugs which precipitate surface protein of mucous membrane and

abrade skin and protect the underlying surface.

❖It makes surface mechanically stronger.

Irritants and Counter Irritants Irritants
Substances that produce inflammation at site of application.
Classification
Rubefacient–Mild; Vesicant-Stronger
Counter Irritants
❖Drugs that relief deep pain by the local application of irritants to the
skin.
❖Area of the skin supplied by the nerves from the same spinal segment
as internal/deeper organs.
❖Headache, muscular pain, joint pain, pleural/ peritoneal pain etc.
Anti–Seborrheic
❖Seborrheic dermatitis–scalp, face and trunk.
❖Erythematous, scaling lesion.
❖Yeast Pityrosporum ovale.
Melanizing Agent
❖These agents increase sensitivity of skin to solar radiation and
promote repigmentation of vitiliginous areas of skin and induce
melanocytes. Example Psoralens.
❖Demelanizing Agent Inhibit melanin formation.
Indication
Cholasma of pregnancy.
These agents inhibit melanin formation and are used to treat cholasma
of pregnancy
 SUNSCREENS

Chemical Sunscreens absorb and

scatter UV rays that are responsible
for sunburn and phototoxicity.
Efficacy of sunscreens are
quantified by Sun Protection Factor
(SPF) i.e., dose of UVB radiation
that produce minimal erythema on
protected skin to dose required on
unprotected skin.
Drugs for Acne Vulgaris
❖Most common in adolescent .
❖Acne Vulgaris is most common in adolescent. Androgenic stimulation
of sebaceous follicles of face and neck produce excess of sebuma which
lead to colonization of Propionibacterium acne, Staph epidermidis,
Pityosporum ovale.
Topical Therapy
Benzoyl Peroxide
❖ Antibacterial activity against acnes and it has a keratolytic action.
❖It is mild irritant hence must avoid contact with eyes, lips, denuded
skin.
Vit. A Derivatives: (Tretinoin)
• It has keratolytic action which unblocks the pilosebaceous follicles.
• Adverse reactions include erythema and scaling.
Adapalene
Produce less irritation to skin
Topical Antibiotics

❖ Clindamycin, erythromycin, tetracycline.

❖ These agents are Less effective than oral, but have less side effects.
Azelaic Acid

Antibacterial action against propionibacteria

Systemic Therapy
Indication
Severe cases
Oral Antibiotics
❖Tetracyclines, ciprofloxacin and cotrimoxazole).
❖These agents are used for inflammatory acne.
❖ Penetration into sebaceous follicles is poor, so treatment requires 4-6
months.
Antiandrogen Cyproterone Acetate
In women with moderate or severe acne, improvement can take 2-4
months
Topical Steroids
Examples
❖ Beclomethasone
❖ Betamethasone
❖ Mometasone
❖Hydrocortisone
Vitiligo
Vitiligo is a chronic (long-lasting) autoimmune disorder that causes
patches of skin to lose pigment or color. This happens when
melanocytes – skin cells that make pigment – are attacked and
destroyed, causing the skin to turn a milky-white color.
Treatment
• No single effective treatment available.
• Topicals: Corticosteroids, Immunomodulators are used.
• Light therapy:
1. UVA or UVB.
2. UVA + Psoralen = PUVA.
3. UVB = Laser.
• Surgical treatment
BENZYL BENZOATE
It is used to treat pediculosis and scabies.
It is oily liquid, applied to the scalp and hair and left for 24 hrs prior to
hair wash. Applied twice daily (after a hot scrub bath) over the entire
body below the chin for scabies. It is minimally absorbed via skin.
Topical application is the most common route for benzyl benzoate.
 GAMMA BHC
❖Gamma benzene hexachloride also known as Lindane. It is broad
spectrum insecticide.

❖Lindane is a medication used to treat lice and scabies infestations. It

belongs to a class of drugs called pediculicides and scabicides, which
are used to kill the parasites that cause these infections.
Indications
• It is used for treatment of head lice and scabies and should only be used
topically.
Application Procedure
• While avoiding the contact to eyes, it is applied to the hair and scalp and is
left for 12-24 hours. After that hair can be washed. This application can be
repeated after 1 week.
Contraindications
• Hypersensitivity.
• Broken or irritated skin, or on areas with skin
• conditions such as eczema or psoriasis.
Adverse Effects
• It is lipid soluble and produces systemic toxicity – CNS, vertigo,
Convulsion, Arrhythmia. Hair loss, erythematous rash, drowsiness,
headache, itching, paresthesia.
ANTIFUNGAL DRUGS

Miconazole
Miconazole, an antifungal medication belongs to the azole class of
antifungal drugs and works by inhibiting the synthesis of ergosterol, a
component of fungal cell membranes, leading to cell death. Miconazole
is available in various formulations, including creams, powders, and
oral tablets or capsules.
Contraindications
❖Hypersensitivity
❖Hepatic impairment
❖Liver disease
❖Pregnancy and breastfeeding
 Role of Nurse
❑Nurses should practice good infection control techniques to prevent
the spread of fungal infections.
❑This includes proper hand hygiene, wearing gloves when handling
contaminated items etc.
❑Nurses have to monitor the patient's response to medication and report
any adverse reactions to the physician like rash, itching, swelling, or
difficulty breathing.
Clotrimazole
Clotrimazole is an antifungal drug used to treat a variety of fungal
infections which belongs to the class of drugs known as imidazoles and
works by inhibiting the growth and reproduction of fungi.
Indications
Drug can be given orally and applied topically as well.
❑Ringworm
❑Athlete's foot
❑Vaginal yeast infections
❑Oral thrush
Drug Toxicity
❖Erythema
❖Blistering
❖ Peeling
❖ Edema
❖ Burning
Drug Interactions
❖ Warfarin
❖ Cyclosporine
Adverse Effects
Local irritation, stinging
Ketoconazole
Taken orally for dermatophytosis and deep mycosis.
It is older, more toxic, is replaced by Itraconazole, but is less costly.
Therapeutic Use
(Available as ointment, shampoo, cream and 20 mg tab).
❑ Coccidiomycosis
❑ Histoplasmosis if not severely ill or Immunocompromised.
❑ Oral, esophageal, mucocutaneous-candidiasis
 Adverse Effects

❑Nausea, vomiting, anorexia

❑Endocrine: menstrual abnormalities, gynaecomastia, azoospermia,

decreased libido

❑ Hypertension

❑ Hepatitis (rare-fatal)
Triazoles

❑Itraconazole (100 mg twice daily), voriconazole: Histoplasmosis,

sporotrichosis, aspergillosis, blastomycosis.

❑Fluconazole (400-800 mg/day): Cryptococcal meningitis, candidiasis,

coccidioidomycosis.

❑Posaconazole: For invasive candidiasis, aspergillosis and

Zygomycetes infections.
SILVER SULFADIAZINE (1% CREAM)
Silver sulfadiazine/mafenide is used on burn surface. This drug belongs
to sulfonamides group of antimicrobial drugs.
Spectrum and Mechanism of Action
❖ Primarily bacteriostatic: Bactericidal concentration obtained in
urine.
❖ Sensitive pattern: Strep. pyogenes, H.influenzae, H. ducreyi, V.
Cholerae, Staph aureus, E coli, chlamydia, actinomyces, nocardia,
toxoplasma.
❖ Mechanism of action: Inhibits bacterial folate synthase which is
structural analogue of para amino benzoic acid (PABA) and folic acid
not formed and metabolic reactions suffers and stops the growth of
bacteria.
Indications

❖Used as topical antibiotic for partial and full thickness burns to

prevent infection of the open wound.

Contraindications

❖Hypersensitivity

❖G6PD deficiency

❖Porphyria
ROLE OF NURSE