Topical medicine application

Definition

A topical medicine is a form of medication meant to be administered externally onto the body rather than ingested or injected into the body. Medicines administered to the eye, ear, and nose are considered topical medicines, will be discussed in separate articles. Topical medicine in this article refers to medicines applied externally onto the skin. Topical medicines available for external application include lotions, creams, ointments, powders (talc), and solutions (liquids). A specific dose of medication is prepared and suspended into a transport media such as a lotion. Topical lotions are water based and thin. They are absorbed quickly into the skin and are often invisible after application. Topical creams are thicker and are visible on the skin after application. They require more time for the medication to be absorbed into the skin. Ointments or unguents are the thickest form of topical medication. The medicine is suspended in a greasy substance that adheres to the skin until the medicine is absorbed.

Purpose

The purpose of using topical medicine is to deliver medication directly onto areas of the skin that are irritated, inflamed, itching, or infected. Topical medicines are often applied directly onto a rash or a irritated area on the skin for rapid relief of symptoms.

Precautions

Topical skin medicines should not be applied near the eyes or the mouth. They can cause stinging and irritation in the eyes and are not meant to be taken orally.

Description

To apply topical medicine, the health care provider places a small amount on gloved finger tips or a sterile gauze pad and spreads a thin layer of lotion, cream, or ointment across the affected area. Cover the affected area and overlap slightly onto the unaffected skin. A thin layer is usually sufficient. A thick coating may prevent air that is necessary for healing from reaching the wound.

Preparation

The health care provider should wash his or her hands and put on a glove before applying topical medicine. The medication label should be checked each time to avoid medication errors. Be sure it is the right medicine, the right dose (strength), the right time, the right person and the right method. Look at the expiration on the label. Do not use outdated medicine. Cleanse the affected area on the skin with warm water or a gentle soap and water. This will remove drainage and the residue of old medication. Rinse and allow the skin to air dry.

Aftercare

After applying topical medicine, the health care provider should place the glove and/or gauze used to apply the medicine in a trash bag that can be closed and discarded. The hands should be washed. If topical medicines are applied to skin on the hands, the hands may need to be wrapped in gauze to prevent the patient from accidentally rubbing the medicine into their eyes or mouth. Wounds or rashes with a lot of drainage may require special dressings after the topical medicine is applied. Wrapping the area with a sealed dressing such as saran wrap will increase the absorption of the medicine. Follow the physician's or advanced practice nurse's directions in these matters.

Complications

Applying excessive amounts of topical medicine can cause adverse skin reactions such as redness, itching, and inflammation.

Results

Most topical medicines, when applied properly, will produce the desired results within a few days. Contact the leader of the health care team if the skin condition deteriorates or the original condition does not improve.

Health care team roles

Administering any medicine is generally the responsibility of a licensed nurse (R.N. or L.P.N.). Unlicensed staff can be trained to administer topical medicine under the direction of a registered nurse in some health care settings. A licensed nurse, however, must observe the affected area routinely to evaluate the outcome of medication application. The patient or a patient family member can be instructed on how to apply topical medicine in the home setting.

Resources

OTHER

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"Corticosteroids-Medium to Very High Potency (Topical)." Drug Information: Mayo Clinic Online. August 2000. <http://www.mayohealth.org/>.

"Getting the Most Out of Your Medicines." Drug Information: Mayo Clinic Online. November 2000. <http://www.mayohealth.org/>.

Lesar, Timothy Pharm.D. "Following Medication Instructions." Albany Medical Center Health Update Online. 2000. <http://www.amc.edu/gethealthupdates.cfm?healthupdatesid=72>.

"Skin, Hair and Nails. First Aid and Self-Help." Mayo Clinic Online. April 2000. <http://www.mayohealth.org/>.

"Topical Skin Medications." The Merck Manual Home Edition Online. 2001. <http://www.merck.no/pubs/mmanual_home/>.

Mary Elizabeth Martelli, R.N., B.S.