- The skin is the largest organ of the human body. It performs many vital functions such as (a) protecting the body against injury, physical agents, and UV radiation; (b) regulating body temperature; (c) preventing dehydration, thus helping to maintain fluid balance; (d) acting as a sense organ; and (e) acting as an outpost for immune surveillance. Skin also has a role in vitamin D production and absorption.
- There are age-related factors affecting the epidermis and dermis. Pediatric skin is thinner and better hydrated, which enhances topical drug absorption and potential drug toxicities. Elderly skin is drier, thinner, and more friable, which may predispose to external insults.
- Patients presenting with a skin condition should be interviewed thoroughly regarding signs and symptoms, urgency, medication history, etc. The skin eruption should be carefully assessed to help distinguish between a disease condition and a drug-induced skin reaction.
- Drug-induced skin reactions can be irritant or allergic in nature.
- Allergic drug reactions can be classified into exanthematous, urticarial, blistering, and pustular eruptions. Exanthematous reactions include maculopapular rashes and drug hypersensitivity syndrome. Urticarial reactions include urticaria, angioedema, and serum sickness-like reactions. Blistering reactions include fixed drug eruptions, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Pustular eruptions include acneiform drug reactions and acute generalized exanthematous pustulosis. There are other drug-induced skin reactions including hyperpigmentation and photosensitivity.
- Not all skin reactions are drug-induced.
- Contact dermatitis is a common skin disorder caused either by an irritant or an allergic sensitizer.
- The first goal of therapy in the management of contact dermatitis involves identification, withdrawal, and avoidance of the offending agent. A thorough history, including work history, must be carefully reviewed for potential contactants.
- Other goals of therapy for contact dermatitis include providing symptomatic relief, implementing preventative measures, and providing coping strategies and other information for patients and caregivers.
- Diaper dermatitis is most often seen in infants although the condition may also be seen in older adults who wear diapers for incontinence. Management includes frequent diaper changes, air drying, gentle cleansing, and the use of barriers.
- Skin cancers include squamous cell carcinoma, basal cell carcinoma, and malignant melanoma.
After reviewing this chapter the reader should be able to:
- 1. Discuss the normal structure and functions of the human skin.
- 2. Describe the common types of drug-induced skin reactions, including urticaria, maculopapular skin rashes, fixed drug eruptions, hyperpigmentation, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug hypersensitivity syndrome, phototoxic and photosensitivity reactions and acneiform drug reactions.
- 3. Discuss common skin conditions, including contact dermatitis and diaper dermatitis; and briefly describe common types of skin cancers
- 4. Distinguish between various common skin conditions that may be self-treatable and those requiring professional assessment and treatment.
- 5. Recommend an appropriate course of action for a patient presenting with a skin condition described in this chapter, including general care plans for various drug-induced skin reactions.
Skin is an essential part of our body. Although it is not commonly thought of as such, skin is an organ. In ...