Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PDAT1 > 6 - Atopic & Contact Dermatitis (AD + ICD/ACD) > Flashcards

6 - Atopic & Contact Dermatitis (AD + ICD/ACD) Flashcards

1
Q

Dermatitis

A

non-specific term

Generally characterized by erythema & inflammation
Skin may blister / ooze / crust / flake

Known causes:
Allergens / Irritants / Infections

Usually SELF TREATED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Atopic Dermatitis

AD

A

Primarily driven by GENETIC FACTORS

Usually develops in infantry, all over the body
especially in skin folds

Physical Contact with irritant / allergen may exacerbate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Contact Dermatitis

A

Driven mainly by EXTERNAL FACTORS

Develips @ site of physical contact w/ irritant or allergen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the “Atopid Triad”

or Atopic March

A

AD + Asthma + Allergic Rhinitis

Atopy = exaggerated skin & mucosal reactivity
in response to environmental stimuli
genetically predipsosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophysiology of AD

A

Skin is inflammed with and expression of CYTOKINES
IL-4, IL13, TNF

FLG = Fliggrin Mutation, INCREASES risk of AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnostic Criteria for AD

A

Essential Features:
Pruritis / Eczema

Important Features:
Early Age of Onset
Atopy / Xerosis / FMH

Possible Lab Findings:
Elevated IgE levels & peripheral blood eosinophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Characteristics of Atopic Dermatitis by AGE

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 Stages of AD

A

ACUTE AD
INTENSELY Pruritic + Papules/vesicles over erythematous skin
often associated with an exudate, pus/leak

  • *SUB-ACUTE AD**
  • *Red** / scaling papules / plaques

Chronic AD
Thickened plaques of skin
accentuated skin markings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Complications of AD

A

S/Sx = Pustules / Vesicles / Yellow Crusting

Secondary BACTERIAL infections
>90% of skin lesions harbor staph

Secondary VIRAL infections
Herpes simples or molluscum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Exacerbating Factors of AD

A

Allergens

Irritants

Temperature Changes

Airborn Irritants
Pollution / Cigarette Smoke / Traffic Exhaust

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Goals of Therapy for AD

A

*CAN NOT be cured; symptom control is key

Stop Itch-scratch cycle
Topical steroids

Maintain skin hydration + barrier function
Emollients + Moisturizers

Avoid or Minimize exacerbating factors

prevent 2ndary infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bathing Procedures for AD

A

Bathe in lukewarm water for limited duration

Fragrance-Free bath oils (Aveeno)

Use hypoallergenic cleanser (Cetaphil)

Skin should be patted dry or air-dried

Application of moisturizer within 3 minutes of bathing

Use lubricating ointment for excessively dry areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of moisturizers for LESS severe cases?

Atopic Dermatitis treatments

A

EMOLLIENTS

Aquaphor / Nivea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of moisturizers are used for MORE SEVERE cases?

Atopic Dermatitis treatments

A
  • *HUMECTANTS**
  • *Eucerin + Urea**

UREA increases water uptake in the stratum corneum
giving it high-water binding

RX Strength Urea acts as a KERATOLYTIC agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Creams

Atopic Dermatitis treatments

A

Usually Oil-in-Water emulsions (O/W)

LESS occlusive than ointments

common mistake = using too much and/or not rubbing in fully

Cetaphil / Nivea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ointments

Atopic Dermatitis treatments

A

W/O emulsions

Act primarily by leavan an oily film on the skin surface
that moisture can NOT readily escape

MOST OCCLUSIVE vehicle
relives dryness / brittleness / protects fissures

  • AVOID ON*:
  • Inflammed skin / interinous areas / hairy areas*

WEEPING LESIONS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Topical Steroids

Dose / MoA / ADR

Atopic Dermatitis treatments

A
  • *STANDARD OF CARE**
  • *Hydrocortisone** 0.5% & 1%
  • low potency*

MOA: Supresses cytokines​ associated with the development of inflammation and itching
minimal systemic absorption (~1%)

During flare ups: AAA BID
prior to application of moisturizers

AVOID use if skin is infected / open / cracked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Wet Wraps

AD Treaments

A

INCREASES Skin Hydration
decreases _scratching_

Apply steroid or emollient to affected area
then wrap MOIST dressing to AA
then wrap a DRY dressing OVER the wet one
put over nighttime clothing -> LEAVE WRAP OVER NIGHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Astringents

Atopic Dermatitis treatments

A

Aluminum Acetate & Witch Hazel

Cause vasoCONSTRICTIOn & reduce Bloodflow to inflammed tissue
slow oozing / discharge / bleeding

  • *Wet Dressing**
  • *Cool & dry** skin through EVAPORATION

(Burrows solution / Domeboro)

20
Q

Burow’s Solution

Directions / Duration

Type of Atopic Dermatitis treatments

A

Category 1 ASTRINGENT
Dissolve 1-3 packets in a PINT (16oz) of cool/warm water -> dissolve

for use as SOAK:
soak AA for 15-30 min Q8H PRN, or AD by a doctor

for use as COMPRESS or WET DRESSING:
soak a clean/soft cloth in the solution
apply cloth looselyto the AA for15-30 min, reapply PRN

21
Q

How to PREVENT / MANAGE Infections

Atopic Dermatitis treatments

A

Topical Antibiotics NOT routinely recommended

  • *Bleach Bath_ & _IntraNASAL MUPIROCIN**
  • BID** used to *_decrease disease severity_

Bleach bath for ECZEMA:
1/2 cup for a FULL TUB or 1/4 cup for HALF tub
soak for 10 minutes -> Dry -> Lotion -> WRAP w/ eczema clothing

22
Q

EX-ST

for ATOPIC DERMATITIS

A

SEVERE condition with INTENSE PRURITIS

Involvement of LARGE AREA of the body

< 2 years old

Skin appears to be INFECTED

No improvement after 2-3 days of self care

23
Q

Important notes on AD

A

Most AD cases are MILD and can be treated with NON-RX products
for patients >2 y/o

Need to be counseled on potential exacerbating factors

Errors in BATHING / Moisturizing procedures are THE MOST COMMON FACTORS in persistant AD

Treatment should involve focus on skin care / moisturization in order to enhance/restore barrier properties

OTC therapies can be recommended for symptomatic treatment of dermatosies to reduce inflammation / pruritis

24
Q

What Characterizes CONTACT DERMATITIS?

A

Inflammation / Redness / Itching / Burning / Stinging

  • *VESICLE + PUSTULE** formation on dermal areas that are
  • *Exposed to irritant / antigenic agents**

2 Main types:
Irritant & Allergic

25
Q

What are the 3 possible mechanisms that cause
Irritant Contact Dermatitis?

ICD

A

Caused by exposure to an irritant:

DISRUPTION of skin barrier

Irritant may DIRECTLY DAMAGE the epidermis

Release of CYTOKINES as a result of chemical exposure

26
Q

Common IRRITANTS associated with ICD

A

Acids / Alkalis

Detergents / soaps / hand sanitizers

Oxidants / Solvents

Urine / Feces

Epoxy Resins / Ethylene Oxide / Oils

Wood dust / products

27
Q

Symptoms / Clinical Presentation

of ICD

A

Skin becomes inflammed / swollen / red on exposure to IRRITANTS
symptoms may be DELAYED, often limited to hands & forearms

Presents as DRY / MACERATED / PAINFUL / CRACKED skin
that often induces:
Itching / stinging / burning

Generally resolves within a few days, if AVOIDING irritant

CHRONIC EXPOSURE
-> develop FISSURES / SCALES / Pigmentation

28
Q

3 Treatment goals of ICD

A
  • *REMOVE / PREVENT**
  • *exposure** to the irritant

RELIEVE
inflammation / tenderness / irritation

EDUCATE
patient on self-management to PREVENT recurrence

29
Q

What to AVOID in treating ICD

A

AVOID:

topical CAINE-type anesthetics

Salicylic / Lactic ACID

UREA

PROPYLENE GLYCOL

30
Q

TREATMENTS for ICD

A

Cleansing
area of exposure with tepid water & hypoAllergenic soap (Cetaphil)

Protective** **clothing / equipment
to avoid further exposure

Emollients / Moisturizers
to assist in REPAIRING epidermal barrier

Corticosteroids
to reduce _inflammation_ & relieve itching

  • *Colloidal OATMEAL Bath**
  • also to relieve ITCHING*
31
Q

What is Allergic Contact Dermatitis = ACD?
and what are common allergens?

A

Inflammatory dermal RXN related to exposure to allergen
Activites sensitized T-Cells
Usually does NOT appear on first contact

Poison ivy/oak/sumac = MOST COMMON CAUSE

Metal Allergy (NICKEL)

LATEX

32
Q

STEPS to developing ACD

A
  • *Induction phase**
  • *INITIAL exposure** to antigen –> sensitizes the immune system

Next Contact
induces type 4 IV delayed hypersensitivity reaction
cell mediated IMMUNE rxn –> 24hours - 21 days to develop

Dermatitis
along with associated symptoms
if _previously sensistized_,
may appear between 24-48hours after exposure

33
Q

Urushiol-Induced ACD

A

Caused by Toxicodendron species = Poison IVY
can occur in a BROADER AREA
80% of people are sensitive to it & it INCREASES into adulthood

declining sensitivity with _advanced age_
but with prolonged duration & severity of symptoms

34
Q

Symptoms / CLinical Presentation of ACD

A

Can ocur ANYWHERE on the body after contact with antigen

  • *Rash is limited** to the area of antigen contact
  • Urushiol-induced ACD* can occur on BROADER area

Presents w/:
Papules / Small vesicles / Large Bullae
over inflammed / swollen skin

SIGNIFICANT ITCHING
Heals in 10-21 days as a result of our own immune system

35
Q

Treatment Goals of ACD

A

REMOVE offending agent

TREAT inflammation

RELIEVE itching & excessive scratching

Relieve accumulation of debris

PREVENT secondary skin infection

36
Q

What to AVOID when treating ACD

A

use of TOPICAL:

Anesthetics

Antihistamines

Antibiotics

known SENSITIZERS
–> can cause drug-induced ACD
superimposed on the existing AC

37
Q

Treatments for ACD

A

REMOVE the known antigen
w/ mild soap & tepid water + Zanfel / Tecnu for Urushiol

Rash w/ pruritis & erythema
treat with Hydrocortisone 1% , CREAM>ointment for WEEPING lesions

Oozing Vesicles
use Astringents or cool water compress to DRY

  • *Non-Weeping_ _Lesions**
  • *Calamine Lotion** -> Drying / Colloidal Oatmeal –> Itching
38
Q

TECNU

ACD Treatments

A

Skin cleanser used to REMOVE KNOWN ANTIGEN
for URUSHIOL-induced ACD

use ASAP up to <8 hours after exposure

  • *Cleanse** the contaminated area for >2minutes
  • *Wipe away** with cloth or rinse with water

EQUAL efficacy between
Tecnu / dish soap / GOOP grease remover

39
Q

Zanfel

ACD Treatments

A

Skin cleanser used to REMOVE KNOWN ANTIGEN
for URUSHIOL-induced ACD

Can be used at any time following exposure, even after rash develops
because it provides RELIEF from PAIN & ITCHING

MoA:
bonds with urushiol within the dermal layer to create an aggregate that can be washed away w/ water

40
Q

Ivy Block

ACD Treatment

A

Lotion that is the only FDA approved
BARRIER PRODUCT
provides protection against exposure to:
poison ivy / oak / sumac

BENTOQUATAM
active ingredient believed to physically block urushiol from being absorbed into the skin when applied
<15 minutes PRIOR to exposure

REAPPLY once Q4HOURS

41
Q

EX-ST / Refer to MD

for ACD

A

Children <2 years old

Involvement of Eyes / eyelids / mouth / genitals

or >20% of skin surface

Rash does not improve in 1-2 weeks
or failure of Self management _>7 days_

S/Sx of INFECTION

Presence of numerous LARGE Bullae
SWELLING of body / impairment of daily activities

42
Q

Important Patient counseling for ACD

A

Bathing Procedure

AVOID triggers/allergens

Humidifyer + adequate HYDRATIOn

Minimize SCRATCHING
fingernail hygiene

Correct use of moisturizers + OTC products

43
Q

Important notes on CONTACT DERMATITIS

ICD / ACD

A

should resolve within 10-21 days W or W/O therapy

knowing the surrounding circumstances for the occurance helps

leading cause of ICD = frequent / unprotected exposure
to WET environments that may contain irritant

ACD is produced through sensitization to antigen

Discuss preventative therapies

Washing (remove) > Hydrocortisone (itching) > Astringents (weeping/oozing lesions) > Emollients (restore barrier)

44
Q

Zanfel INSTRUCTIONS for use

A
  1. Wet affected area
  2. Measure 1 ½ inches of the product into one palm
  3. Wet both hands and rub the product into a paste
  4. Rub both hands on the affected area until there is no sign of itching (up to 3 minutes)
  5. Rinse the affected area thoroughly
  6. If itching returns after several hours, the product may be used again
45
Q

Inflammation

How to treat this SYMPTOM in ACD?

A

HYDROCORTISONE
Most effective NON-RX therapy
for mild-moderate ACD, that does NOT involve edema/extensive areas

Urushiol ACD may require RX-strength corticosteroid

AAA TID-> QID
_DO NOT USE DRESSINGS / BANDAGES_
when self-care

46
Q

ITCHING

How to treat this SYMPTOM in ACD?

A

Cold or tepid soapless SHOWERS
or use hypoallergenic soap (cetaphil)

you can use oral antihistamines, not topical

Topical hydrocortisone
will help the itching through vasoconstriction

47
Q

Oozing Lesions

How to treat this SYMPTOM in ACD?

A
  • *ASTRINGENTS**
  • *Aluminum Acetate = Burow’s Solution**

used as a wet dressing or compress

applied to unhealthy skin to
decrease:
weeping / oozing / discharge / bleeding

PDAT1 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions