Atopic Dermatitis and Dry Skin Flashcards
What is Atopy?
- Genetic tendency to develop allergic diseases
2. Heightened immune response to common allergens
What is dermatitis?
Dermatologic condition characterized by erthema and inflammation
What is dermatitis interchangeable with?
Eczema
What is Atopic dermatitis?
Inflammatory condition of the dermis + epidermis; episodic flares and remissions are common
Which layer of the skin controls drug transport?
Epidermis
Which layer of the skin contains nerve endings, vasculature, and hair follicles?
Dermis
Which layer of the skin provides nourishment, cushions the other two layers?
Hypodermis
Which layer of the skin regulates H20 content?
Epidermis
What is the most important function of the skin?
Protects body from external agents and pathogens/chemicals
What is the issue with aging skin?
More fragile and take slonger to heal after injury
Ointments are _____-based
petrolatum
Lotions are _____-based
water
Powders are (hydrophobic/hydrophilic)
Hydrophilic
What is the major mechanism for drug absorption?
Passive diffusion
What is the rate-limiting barrier in drug absorption?
Stratum Corneum (epidermis)
Increase of hydration of Stratum Corneum will ______ drug absorption
increase
Which situation will allow the greatest drug absorption?
When wounds, infections, burns, etc are present. Alter Stratum Corneum and acts like a shunt
Who should you automatically refer to PCP with major skin problems? Why?
<1 yrs old
BSA for neonates are 2-3 times compared to adults which allows for more drug absorption
What are the most common disorders in children due to atopy?
- Asthma
- Allergic rhinitis
- Atopic dermatitis
What makes up 80% of atopic disorders symptoms?
Asthma + allergic rhinitis
How would you diagnose atopic disorder?
a pruritic skin disorder + 3 or more of the following:
Onset <2 yrs old History of skin crease involvment History of dry skin Personal history of other AD Visible flexural dermatitis
What are the three forms of AD?
Acute, subacute, chronic
What bacteria is common in AD patients?
90% Staph. Aureaus and possibly Strep
What visual cue is common in AD patients?
Yellowish crusting
When should you seek medical attention in AD patients?
Pustules, vesicles, and crusting forms
What is the hallmark symptom in AD?
Pruritus
How does AD present in infants?
Red scaling of cheeks, progresses to face, neck and trunk
What are the 4 goals in treating AD?
- Stop the itch - scratch cycle
- Hydrate skin
- Avoid/minimize triggers
- Prevent 2nd infections
What can you stress to patients about AD?
AD cannot be cured, but rather managed
Exclusion to AD: (T/F)
<2 years old
False; <1 years old
Exclusion to AD: (T/F)
Infection
True
Exclusion to AD: (T/F)
Intense itching + affects large area
True
Exclusion to AD: (T/F)
Involvement of intertriginous areas
True
Nonpharmacolgic treatments for AD: (T/F)
Bath with cold water
False; luke-warm water
Nonpharmacolgic treatments for AD: (T/F)
Apply moisturizer one hour after bath
False; immediately after
What are the nonpharmacolgic treatments for AD
Bathe in luke-warm water and apply mosturizer immediately after bath
What is better for AD, wool or cotton?
Cotton
What kind of clothes should you wear if you have AD?
Anything is fine except if it is tight-fitting
What is the treatment of choice for dry, scaly, or fissured lesions?
Ointments
What kind of moisturizer is used for lubrication?
Cream
What kind of moisturizer is non-greasy?
Lotions / Gels
What kind of moisturizer dries quickly?
Lotions / Gels
What kind of moisturizer spreads more easily?
Lotions / Gels
What kind of moisturizer should be avoided on intertriginous areas?
Ointments
What kind of moisturizer should be avoided on weeping or oozing lesions?
Ointments
What kind of moisturizer used in hairy areas?
Lotions / Gels
Creams vs Ointment; which is more greasy / potent?
Ointment
What is the typical ingredient in butter?
Shea butter
What kind of moisturizer is occlusive in warm weather?
Ointments
What is the MOA for emollients?
Deposits oily film on skin to prevent moisture escape
How do emollients and humectants differ?
Emollients retain the water already present
What is the MOA for humectants?
Draws water into the straum corneum to hydrate skin
Emollinet vs humectant; which is the standard of care?
Emollients
What is the MOA for topical corticosteroids?
Relieves pruritic and reduce inflammation
When should you apply topical corticosteroids?
1-2 times daily BEFORE moisturizers
How long can you use topical corticosteroids before consulting w/ physician?
7 days or less
Who should not use topical corticosteroids?
< 2 yrs old
If lesions are oozing, what kind of moisturizer should be used?
Creams
What are some complementary therapies?
Coal tar, bleach bath (1/2 cup to 40 gallons), and wet wraps
What are some things to avoid for the skin? Recommended?
Topical anesthetics + topical antihistamines
Oral antihistamines
How do oral antihistamines help?
Help sleep and reduce scratching at night
What is another name for dry skin?
Xerosis
How many ppl are affected by dry skin?
> 50% older adults
What is the common cause of pruritus?
Dry skin
Dry skin is the common cause of _______
pruritus
What causes dry skin?
Disruption of keratinization and desquamation; loses water in skin and loss of cells from stratum corneum
Which layer gets thinner as you get older?
Epidermis; produces roughened skin surface
What are some nonpharmacolgic treatments for dry skin?
Keeping humidity higher than normal, moisturize w/ humectant or keratolytic agents, stay hydrated, take bath oils
What should you avoid if you have dry skin?
Caffeine, spices, and alcohol
What are some pharmacologic treatments for dry skin?
Severe case: urea / lactic acid
Topical hydrocortisone
What is a short-term pharmacologic treatment for dry skin?
Topical hydrocortisone (ointment)
When should you report to PCP when using hydrocortisone?
Thinning of skin
When should you consult PCP in treating AD / dry skin?
2-3 days for AD
7 days for dry skin
As you age, sebum levels will ______
decrease
How effective are bath oils?
Minimally effective, more effective if used as a wet compress
Which kinds of soaps are close to neutral pH?
Glycerin
Which moisturizer promotes occlusive?
Ointments
Increase in occlusive (increase/decrease) lipids
increase
What binds to skin protein and is useful for crusted, necrotic tissue?
Urea (also a humectant)
What is the only OTC drug approved for dermatitis?
Hydrocortisone
Hydrocortisone vs Ointment; which is the better option for chronic, non-oozing dermatoses?
Ointments
When should you not use antihistamines?
Person w/ BPH (benign prostate hyperplasia) or glaucoma