Alert Tetracycline is contraindicated during pregnancy because it discolors the teeth of the fetus. Erythromycin and ampicillin are alternatives for these patients. Exacerbation of pustules or abscesses during either type of antibiotic therapy requires a culture to identify a possible secondary bacterial infection.
Oral isotretinoin combats acne by inhibiting sebaceous gland function and keratinization. However, because of its severe adverse effects, the 16- to 20-week course of isotretinoin is limited to those with severe papulopustular or cystic acne who don’t respond to conventional therapy. Because this drug is known to cause birth defects, the manufacturer, with Food and Drug Administration approval, recommends the following precautions: pregnancy testing before dispensing; dispensing of only a 30-day supply; repeat pregnancy testing throughout the treatment period; effective contraception during treatment; and informed consent of the patient or parents regarding the drug’s adverse effects.
A serum triglyceride level should be measured before therapy with isotretinoin begins and at intervals throughout its course.
Females may benefit from the administration of estrogens to inhibit androgen activity. Improvement rarely occurs before 2 to 4 months, and exacerbations may follow its discontinuation. Unfortunately, the high estrogen doses that are required present a major risk of severe adverse effects.
Other treatments for acne vulgaris include intralesional or oral corticosteroids, vitamin A and zinc supplements, exposure to ultraviolet light (but never when a photosensitizing agent such as tretinoin is being used), cryotherapy, and surgery.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Papular rash:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Advise the patient to keep his skin clean and dry, to wear loose-fitting, nonirritating clothing, and to avoid scratching the rash. Instruct him to promptly report changes in the rash’s color, size, or configuration as well as the onset of itching or bleeding. Tell him to avoid excessive exposure to direct sunlight and to apply a protective sunscreen before going outdoors.
Warn patients with chronic conditions (such as SLE, psoriasis, or sarcoidosis) about the typical skin rashes that can develop. Tell them that these rashes can be an early sign of disease flare-up and that they should seek prompt treatment to prevent serious complications.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Acne vulgaris:
Treatment
(Handbook of Diseases)
Commonly, acne is treated topically with an antibacterial (such as benzoyl peroxide, clindamycin, or erythromycin), alone or in combination with tretinoin (retinoic acid), a keratolytic, or salicylic acid. Benzoyl peroxide and tretinoin may irritate the skin.
Systemic therapy consists primarily of an antibiotic, usually tetracycline, to decrease bacterial growth until the patient is in remission; then a lower dose is used for long-term maintenance. Tetracycline is contraindicated during pregnancy and childhood because it discolors developing teeth. Erythromycin is an alternative for these patients. Exacerbation of pustules or abscesses during either type of antibiotic therapy requires a culture to identify a possible secondary bacterial infection.
Oral isotretinoin combats severe acne by inhibiting sebaceous gland function and abnormal keratinization. Because of its severe adverse effects, the 16- to 20-week course of isotretinoin is limited to those with severe papulopustular or cystic acne who don’t respond to conventional therapy. (See Risks of isotretinoin therapy.)
Females may benefit from taking birth control pills (such as Ortho Tri-Cyclen) or spironolactone because these drugs produce antiandrogenic effects. (See Hormonal therapy.)
Other treatments for acne vulgaris include intralesional corticosteroid injections, exposure to ultraviolet light (but never when a photosensitizing agent, such as tretinoin, is being used), cryotherapy, and acne surgery.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Papular rash:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Advise the patient to keep his skin clean and dry, to avoid scratching the rash, and to wear loose-fitting, nonirritating clothing. Instruct him to promptly report any change in the rash’s color, size, or configuration as well as the onset of itching or bleeding. Also tell him to avoid excessive exposure to direct sunlight and to apply a protective sunscreen before going outdoors.
Warn patients with chronic conditions (such as SLE, psoriasis, or sarcoidosis) about the typical skin rashes that can develop. Tell them that these rashes can be an early sign of disease flare-up and that they should seek prompt treatment to prevent serious complications.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pustular rash:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to keep his bathroom articles and linens separate from those of other family members. Associated pain and itching, altered body image, and the stress of isolation may result in anxiety, depression, and loss of sleep. Give medications to relieve pain and itching, and encourage the patient to express his feelings.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Papular rash:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Apply cool compresses or an antipruritic lotion.
▪ Administer an antihistamine for allergic reactions and an antibiotic for infection.
Patient teaching
▪ Teach the patient appropriate skin care measures.
▪ Explain ways to reduce itching.
▪ Discuss signs and symptoms that require medical attention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pustular rash:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Observe wound and skin isolation procedures until infection is ruled out by a Gram stain or culture and sensitivity test of the pustule's contents.
▪ If the organism is infectious, don't allow drainage to touch unaffected skin.
▪ Give medications to relieve pain and itching, and encourage the patient to express his feelings.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Explain methods to prevent the spread of infection.
▪ Discuss ways to relieve pain and itching.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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