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47.1 Three layers of skin, epidermis, dermis, and the subcutaneous layer provide effective barrier defenses for the body. The most superficial layer of skin is the epidermis. Here, skin cells are replenished every three weeks. New cells arise from the bottom layer (germinativum) and are pushed to the outermost layer. 47.2 Skin disorders that may benefit from pharmacotherapy are acne, sunburns, infections, dermatitis, and psoriasis. Many symptoms are associated with skin stress and injury. Others are associated with a patient's changing age or health. Skin disorders fit into three main categories: infectious, inflammatory, and cancerous disorders. 47.3 When the skin integrity is compromised, bacteria, viruses and fungi can gain entrance and cause infections. Anti-infective therapy may be indicated. Normal flora of the skin is comprised of fungi, viruses, and bacteria. This includes streptococcus and staphylococcus. Various topical anti-infectives are used in the pharmacotherapy of skin infections. In some fungal and viral infections, systemic medications are indicated. 47.4 Scabicides and pediculicides are used to treat parasitic mite and lice infestations, respectively. Mites affect the skin and hair, while lice remain localized in hairy regions of the body. Both conditions are treatable with medications. Scabicides kill mites; pediculicides kill lice. Some medications are effective for both mites and lice. 47.5 The pharmacotherapy of sunburn includes the symptomatic relief of pain using soothing lotions, topical anesthetics, and analgesics. Local anesthetics are the primary medication used to treat mild sunburn and irritation. Often, drugs are used for the temporary relief of minor discomfort, and in some cases, drugs may not be needed at all. 47.6 The pharmacotherapy of acne includes treatment with benzoyl peroxide, retinoids, and antibiotics. Therapies for rosacea include retinoids and metronidazole. Topical drugs for acne and rosacea are those that inhibit bacterial growth or promote the shedding of old skin. Vitamin A-like compounds (retinoids) provide an improved resistance to bacterial infections by reducing oil production and the occurrence of clogged pores. Rosacea can be treated by many of the same medications used to treat acne and, in addition, may be treated by metronidazole cream. 47.7 The most effective treatment for dermatitis is topical glucocorticoids. Agents that reduce the symptoms of inflammation, itchiness, flaking, cracking, bleeding, and lesions are used in the treatment of dermatitis. Topical corticosteroids are the primary drug treatment for dermatitis. 47.8 Both topical and systemic medications including glucocorticoids, immunomodulators, and methotrexate are used to treat psoriasis. Psoriasis is a chronic disorder characterized by discomfort and flaky areas called plaques. The treatments for psoriasis include topical glucocorticoids, retinoid-like compounds, drugs that arrest skin cell growth, and immunosuppressants. Skin therapy techniques are also used including keratolytic agents, coal tar, anthralin, psoralens, and phototherapy.
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