Atopic Dermatitis & Dry Skin and Scaly Dermatoses Flashcards
1
Q
Skin Role
A
- Protect the body
- Flora is a defense mechanism
- Hydroregulation
- Sensory
- Temperature control
- Pigment development
- Synthesis of vitamins
- Variability in thickness
- Affect absorption in addition to specific vehicle properties
2
Q
Atopic Dermatitis (AD)
A
Skin reaction to environmental stimuli
- Characterized by episodic flares and periods of remission.
- Atopic Triad : asthma, allergic rhinitis, AD simultaneously
- AD beginning in infancy/childhood
- Typically lasts through adulthood
- Commonly affects
- Face, inside of knees & elbows, collar area of neck
- Intense, pruritic papules and vesicles that is associated with pruritus
- 70% of cases are genetic
- Pruritus, the hallmark symptom of AD
3
Q
Classification of AD
A
- Acute AD Intense itching, red papules/vesicle with exudates
- Subacute AD Red, excoriated, scaling papules
- Chronic AD Thickened plaques, lichenification
4
Q
Topical Hydrocortisone
A
- COC most likely suppress cytokines associated with the development of inflammation and itching, symptoms that are associated with various dermatoses.
- Topical hydrocortisone rarely produces systemic complications, because its systemic absorption in adults is relatively minimal (approximately 1%).
- skin atrophy rarely occur with nonprescription concentrations; they are more common with the more-potent prescription products.
- Intermittent courses of therapy are advised when possible, because response to topical hydrocortisone may decrease with continued use owing to tachyphylaxis.
- These intermittent courses can include daily use of hydrocortisone only during periods of flareups and once weekly dosing, or no hydrocortisone at all,
5
Q
Antipruritics
A
Although topical antihistamines may provide some short-term relief from itching, their use is not recommended and, furthermore, may be associated with sensitization.
- Oral antihistamines are not recommended for the routine treatment for pruritus in AD because of the lack of demonstrated efficacy and the hypothesis that the pruritus in AD often is not histamine related.
- However, an oral antihistamine may help with sleep in the patient who has been staying up all night scratching
6
Q
Xerosis (Dry Skin)
A
- Decreased water content in stratum corneum
- Major factor is bathing (frequent, hot water, excessive use of soap)
- Environmental conditions (decrease in humidity)
- Physical damage to skin (leg ulcer)
- Advancing Age(changes in skin cells, dehydration, decrease in hormones)
- Clinical presentation
- Roughness, scaling, pruritis, inflammation, fissures
- Eczema craquele (cracked appearance)
- Ichthyosis (fish scaling)
7
Q
Psoriasis
A
- Chronic inflammatory disease
- Can lead to deformities or arthritis
- Cause unknown
- Epidermal cell turnover is 4 days
- Normal turnover is 25-30 days
- Clinical Presentation
- Occur in multiple areas of body
- Plaques are symmetrical and are not characterized by itching
- Multiple forms (inverse, guttate, plaque, pustular, erythrodermic)
8
Q
Treatment for psoriasis
A
- Mild cases only treatment with
- Emollients (apply 4-6 times a day)
- Hydrocortisone cream (2-3 times a week for 2 weeks)
- Coal tars (CT), salicylic acid, UV
- radiation
- CT: Apply at bedtime, staining
- Refer if therapy does not resolve in 7 days
- Referral to dermatologist for moderate-severe cases
9
Q
Pyrithione Zinc
A
- reduces yeast count; binds to hair and external skin;
- absorption of product dependent on several factors – contact time, temp, concentration of product, freq of application.
10
Q
Selenium Sulfide
A
- efficacy dependent on contact time; discoloration possible; frequent use may cause odor or oily scalp
- 1% OTC and 2.5% Rx
11
Q
Ketoconazole- synthetic azole antifungal (NizoralAD 1%)
A
use biw for 4 weeks with 3 days between treatment.; skin irritation, hair loss and abnormal hair texture may occur
12
Q
Coal Tar:
A
has the ability to cross link with DNA
- Odor, color and staining
- Applied at bedtime
- Avoid sun exposure for 24 hours after application
- SE: folliculitits, staining, photosensitivity, ICD
13
Q
Keratolytic Agents
A
“dissolve the cement” that holds epidermal cells together
- Effectiveness : Vehicle composition, contact time, concentration dependent
- Salicylic acid- decreases skin pH, increases hydration allowing for loosening and removal of skin
- Monitor salicylism (tinnitus)
- Sulfur- increase sloughing of cells and reduce corneocyte counts
14
Q
Topical hydrocortisone (0.5% and 1%)
A
- Ointment more potent
- SE: Local atrophy, risk of masking infections
15
Q
Treatment Options – Seborrheic Dermatitis
A
- Pyrithione zinc*, selenium sulfide*, sulfur, ketoconazole**, salicylic acid, or coal tar (2nd line)
- Left on hair for 3-5 minutes and used 2x/week for 4 weeks then weekly (Contact time is essential to get BEST results)
- Anti-Malassezia products preferred initially(*)
- **has antifunal and anti-yeast activity
- Hydrocortisone 2-3 times a day for 7 days
