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Clinical Pharmacy 1 - Term 1 > 2 - Atopic & Contact Dermatitis > Flashcards

2 - Atopic & Contact Dermatitis Flashcards

1
Q

What are topical corticosteroids effective at treating?

A

Skin conditions with hyperproliferation, inflammation, and immunologic involvement

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2
Q

What do topical corticosteroids provide symptom relief for?

A

Itching and burning

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3
Q

How many categories of topical corticosteroids are there?

A

7, ranging from low to very high potency

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4
Q

How do topical corticosteroids get rid of inflammation?

A

By decreasing formation, release, and activity of inflammatory mediators

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5
Q

How do topical corticosteroids cause vasoconstriction?

A

Prevent cell migration and decrease access to affected area, thereby reducing swelling

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6
Q

How can topical corticosteroids be immunosuppressive?

A

Inhibit action of cells involved in the immune response

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7
Q

How are topical corticosteroids anti-proliferative?

A

They interfere with DNA synthesis and mitosis and obstruct fibroblast activity and the development of collagen

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8
Q

What does hyperproliferation mean?

A

Rapid cell turnover

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9
Q

What is the main guideline for topical corticosteroids?

A

The least potent effective dosage should be used for the shortest duration to reduce the likelihood of adverse effects

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10
Q

Which areas of the body is low potency topical corticosteroids used?

A

Thin skin areas such as face and folds

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11
Q

Which areas of the body is medium potency topical corticosteroids used?

A

Medium thickness skin such as body and scalp

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12
Q

Which areas of the body is high potency topical corticosteroids used?

A

Thick skinned areas such as palms and soles

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13
Q

Response to topical corticosteroids depends on _____

A

Condition being treated

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14
Q

What is the difference between clobetasol and clobetasone?

A
  • Clobetasol is an ultra-high potency topical corticosteroid

- Clobetasone is a moderate potency topical corticosteroid

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15
Q

____ affects potency of topical corticosteroids

A

Formulation

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16
Q

Can the same concentration of a steroid have different potencies?

A

Yes, depending on vehicle

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17
Q

What is significant about propylene glycol in topical corticosteroids?

A

Propylene glycol enhances absorption creating an ultra-high potency

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18
Q

What are advantages to topical corticosteroid ointments?

A
  • Occlusive
  • Provide lubrication
  • Good for dry, scaly lesions
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19
Q

What is a disadvantage of topical corticosteroid ointments?

A

Greasy, which tend to decrease patient compliance

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20
Q

What are advantages to topical corticosteroid creams?

A
  • Good lubrication

- Cosmetically appealing

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21
Q

What are disadvantages to topical corticosteroid creams?

A
  • Generally less potent than ointments

- Often contain preservatives

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22
Q

Which type of topical corticosteroids are helpful in hairy areas?

A

Lotions or gels

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23
Q

What are common adverse effects of topical corticosteroids?

A

Dryness, itching, burning, and local irritation

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24
Q

How often should you apply a topical corticosteroid?

A

1-2 times daily

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25
Q

Does applying a topical corticosteroid more often improve the results?

A

No

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26
Q

What is an advantage to less frequent application of topical corticosteroids?

A

Reduced risk of side effects

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27
Q

____ may be helpful to prevent rebound flares where potent or prolonged treatment is needed

A

Tapering (decrease potency and/or decrease frequency)

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28
Q

What are the 3 OTC treatments for atopic or contact dermatitis?

A

1) Hydrocortisone 0.5%
2) Hydrocortisone 1.0%
3) Clobetasone butyrate 0.05%

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29
Q

What is the age group for OTC hydrocortisone?

A

Anyone over 2 years

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30
Q

What is the duration of treatment for hydrocortisone?

A

7-14 days

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31
Q

What schedule is hydrocortisone 0.5%

A

1 or 3

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32
Q

What schedule is hydrocortisone 1.0%

A

1 or 3

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33
Q

What schedule is clobetasone butyrate 0.05%?

A

2

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34
Q

What is the age group for OTC clobetasone butyrate?

A

Anyone over 12 years

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35
Q

What is the duration of treatment for clobetasone butyrate?

A

7 days

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36
Q

What are the 2 subcategories of contact dermatitis?

A

1) Irritant contact dermatitis

2) Allergic contact dermatitis

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37
Q

What causes irritant contact dermatitis?

A

When the skin undergoes mechanical or chemical trauma on exposure to an irritating substance

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38
Q

What causes allergic contact dermatitis?

A

Exposure to an allergen

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39
Q

What are symptoms of contact dermatitis?

A
  • Inflammation, redness, itching
  • Burning, stinging
  • Vesicle and pustule formations
40
Q

What is one significant difference between irritant and allergic contact dermatitis with respect to the cause?

A
  • Everyone who is exposed to the irritant will experience a reaction
  • Not everyone exposed to the allergen will have a reaction b/c not everyone has a sensitization to the antigen
41
Q

What are symptoms of acute contact dermatitis?

A

Red, edematous papules which become vesicles that ooze if reaction is severe enough

42
Q

What are symptoms of chronic contact dermatitis?

A

Secondary changes such as dryness, lichenification (formation of thick, leathery patches), pigment changes, and thickening

43
Q

What is the primary symptom in acute and chronic contact dermatitis?

A

Itching

44
Q

What are signs and symptoms of irritant contact dermatitis?

A
  • Erythema
  • Vesiculation and oozing
  • Blistering
  • Linear fashion
45
Q

What are signs and symptoms of allergic contact dermatitis?

A
  • Mild form similar to irritant

- Severe - edema in face, periorbital, and genital areas

46
Q

When a patient presents with a red, inflamed area, what do you first want to do?

A

Rule out infection

47
Q

What are common irritants for contact dermatitis?

A
  • Poison ivy (aka rhus)
  • Kiwi, bananas, peanuts
  • Fertilizers and weed killers
  • Cosmetics
  • Latex
  • Metals (nickel and copper)
  • Lanolin
48
Q

Poison ivy consists of __ leaflets

A

3

49
Q

What is the allergen found in poison ivy?

A

Urushiol

50
Q

Are men or women more frequently exposed to contact dermatitis?

A

Women because of cosmetic use

51
Q

When do you want to refer for contact dermatitis?

A
  • More than 30% of body
  • Edema persists or increases within a few days
  • Discomfort in genitalia
  • Involvement of mucous membranes of mouth, eyes, nose, or anus
  • Younger than 2
52
Q

When do you want to refer for an acute case of contact dermatitis?

A

If it has been nonresponsive for a few days

53
Q

When do you want to refer for a chronic case of contact dermatitis?

A

If it has been nonresponsive for 7-10 days

54
Q

What is atopic dermatitis?

A

A genetic based, chronic relapsing skin disorder

55
Q

When does atopic dermatitis usually begin?

A

In infants or early childhood

56
Q

Who does atopic dermatitis affect the most?

A

Children

57
Q

What is the cause of atopic dermatitis?

A

Unknown

58
Q

What is the pathophysiology of atopic dermatitis?

A
  • Chronic inflammatory skin disease associated with cutaneous and mucous membrane hyper-reactivity
  • Most people have high levels of IgE
59
Q

What is significant about atopic dermatitis presenting in infants?

A

It may be a prelude to the development of other atopic disorders later in life

60
Q

What is the expected cause of atopic dermatitis?

A

Genetic impairment of epidermal barrier

61
Q

What are signs and symptoms of atopic dermatitis?

A
  • *Itching is always first symptom, which then leads to a rash
  • Skin is dry and lesions are scaly; may be vesicular, weeping, or oozing
62
Q

What is the typical location of atopic dermatitis in infants under 6 months?

A

Chest, face, and scalp

63
Q

What is the typical location of atopic dermatitis in children under 2 years?

A

Scalp, neck, and extensor surface of extremities

64
Q

What is the typical location of atopic dermatitis in children aged 2-6 years?

A

Neck, wrist, elbow, knee, hands, feet, and back of thigh

65
Q

What is the typical location of atopic dermatitis in people over 12 years?

A

Flexors, hands and upper body

66
Q

What is the diagnostic criteria for atopic dermatitis?

A

Itching and at least 3 of the following:

  • onset before 2 years old
  • history of skin crease involvement
  • history of generally dry skin
  • personal history of atopic disease
  • visible flexural dermatitis
67
Q

Is a pharmacist expected to diagnosis atopic dermatitis?

A

No, but we can suspect it and refer

68
Q

What are the top 5 risk factors for atopic dermatitis?

A

1) Genetics
2) Environmental allergens
3) Climate
4) Sweating
5) Physiologic stress

69
Q

When should you refer for atopic dermatitis?

A
  • if the child is younger than 2 and hasn’t been diagnosed
  • If dermatitis is acute and vesicular
  • Appearance of infection
  • Large area of body
  • Severe condition with intense itching
70
Q

How should you asses a patient for dermatitis?

A
  • Ask questions regarding signs and symptoms, onset, progression, timeframe, location, and previous occurrence
  • Determine urgency
  • Medication history
71
Q

What are the goals of treatment for atopic and contact dermatitis?

A
  • Eliminate trigger factors or contact exposure to irritants and allergens
  • Provide symptomatic relief wile decreasing skin lesions
  • Implement preventative measures
  • Develop coping strategies
72
Q

What are some non-pharms for contact dermatitis?

A
  • Immediately wash with soap and water
  • Avoid or remove allergen
  • Take cold soapless showers
  • Avoid scrubbing affected area
  • Remove and wash all clothing exposed to irritant/allergen
73
Q

What is the recommended treatment of contact dermatitis?

A
  • Identify and avoid irritant
  • Wet compresses for 20 minutes 4-6 times/day
  • Topical steroids (on a short term basis)
  • May want to add an oral antihistamine
74
Q

Why should topical anesthetics and topical antihistamines be avoided for contact dermatitis?

A

Can sometimes cause or aggravate the contact dermatitis

75
Q

What is the recommended treatment of poison ivy?

A
  • Shower after exposure
  • Wash all items that have been exposed
  • To treat the itch and rash apply topical corticosteroid and oral antihistamine (if needed)
76
Q

Why are baths not recommended for treatment of poison ivy?

A

Uroshiol will spread in the water and may infect other areas of the body

77
Q

How long can it take a poison ivy rash to appear?

A

Up to 9 days after exposure

78
Q

How can poison ivy be prevented?

A
  • Total avoidance of plant
  • Protective clothing
  • Wash objects that have come into contact w/ plant
  • Wash skin w/in 10 minutes of exposure
  • Do not burn the plant
79
Q

Which type of corticosteroids can pharmacists prescribe?

A

Topical, not oral

80
Q

Which topical corticosteroids are available for sale in Canada?

A
  • Hydrocortisone
  • Clobetasone
  • Desonide
  • Triamcinolone
81
Q

What are some non-phrms for atopic dermatitis?

A
  • Bathe in lukewarm water for 5 minutes using non-soap cleansers
  • Pat skin dry
  • Trim nails short and smooth
  • Avoid occlusive, tight clothing
  • Avoid triggers, allergens, and irritants
  • Keep skin hydrated
82
Q

____ is a common trigger to an atopic dermatitis flare

A

Dry skin

83
Q

What is the recommended treatment for atopic dermatitis when the skin is dry with mild itch and no patches of dermatitis?

A

Emollient or barrier repair treatment twice daily and after bathing

84
Q

What is the recommended treatment for atopic dermatitis during an acute flare?

A
  • Topical corticosteroid or barrier repair therapy

- Reinforce emollient use for prevention

85
Q

What are the 2 goals of treatment for atopic dermatitis?

A
  • Treat the current condition

- Increase the time between flares

86
Q

How is atopic dermatitis prevented?

A

Prevent dry skin

87
Q

What is a prescription product that is used for the long term therapy of atopic dermatitis?

A
  • Topical calcineurin inhibitors (tacrolimus or pimecrolimus)
88
Q

What does tacrolimus (protopic) do and where can it be used?

A
  • Reduces itching and inflammation

- Can be used on children older than 2 on the face and neck

89
Q

Is tacrolimus (protopic) or pimecrolimus (elidel) better?

A

Pimecrolimus has a lower cost and causes less burning and itching than protopic

90
Q

What are some OTC skin protectants that can help atopic dermatitis?

A
  • Calamine lotion
  • Zinc oxide
  • Colloidal oatmeal
  • Sodium bicarbonate
91
Q

Why are oral antihistamines recommended for atopic dermatitis?

A

They act by blocking H1 receptors, therefore decreasing itch caused by histamine

92
Q

What is the recommended oral antihistamine for atopic dermatitis?

A

25-50mg diphenhydramine (benadryl)

93
Q

What are the most useful moisturizers for people with atopic dermatitis?

A

Emollients with humectants added

94
Q

Are astringents more effective than saline when used as a wet dressing for atopic dermatitis?

A

No, saline or tap water is preferred

95
Q

What are 7 OTC products that you can recommend to a patient with atopic dermatitis?

A

1) Hydrocortisone cream
2) Calamine lotion
3) Zinc oxide
4) Colloidal oatmeal (aveeno baths)
5) Sodium bicarbonate (baking soda)
6) Aluminum acetate
7) Diphenhydramine (benadryl)

96
Q

What are the 4 R’s of management of atopic dermatitis?

A

1) Recognize condition and seek treatment early
2) Remove triggers
3) Restore moisture to skin
4) Regulate

Clinical Pharmacy 1 - Term 1 (18 decks)

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