atopic dermatitis, dry skin, contact dermatitis Flashcards
atopic dermatitis definition
chronic, relapsing, skin disorder characterized by redness and inflammation caused by an exaggerated reactivity from environmental stimuli +/- genetic component
atopic triad
atopic dermatitis, asthma, allergic rhinitis
epidemiology of AD
- most common dermatologic condition in children
- more common in males, Caucasians, in urban areas, and occurs in higher socioeconomic classes
signs and symptoms of AD
intense itching, vesicles and papules, chapping, redness, crusting and dry skin
2 months
location and signs of AD
location: chest and face
signs: red, raised vesicles, dry skin, oozing
2 years
location and signs of AD
location: scalp, neck, and extensor surface of extremities
signs: less acute lesions, edema, erythema
2-4 years
location and signs of AD
location: neck, wrist, elbow, knee
signs: dry and thickened plaques, hyperpigmentation
12-20 years
location and signs of AD
location: flexors, hands
signs: dry and thickened plaques, hyperpigmentation
xerosis common in
elderly population
xerosis is result
of decreased water content of the skin
exclusions for self treatment of atopic dermatitis and xerosis
- moderate - severe conditions with intense pruritus
- involvement of large area of body
- <1 year of age
- possible skin infection
- involvement of face or intertriginous areas
goals of therapy for atopic dermatitis and xerosis
- stop the itch/scratch cycle
- maintain skin hydration
- avoid or minimize aggravating factors
- prevent secondary infections
how to maintain skin hydration
drink plenty of water, avoid dehydration with improper bathing
soaps for AD and xerosis
- use glycerin bars, non soap cleansers, bath oils
- bath oil in bathwater is very good for xerosis
use of emollients in AD and xerosis
applied within three minutes of bathing and reapplied 3-4x daily prn
emollient examples
- petroleum emollients
- lubricating ointments
non pharm treatment for AD and xerosis
- drink plenty of water
- use humidifiers to maintain room hydration
- use cold compresses for wet oozing or crusty vehicles
cold compress examples
isotonic saline solution or wet cold compresses using tap water for 15-20 minutes at a time 4-6 times daily
avoid or minimize aggravating factors of AD or xerosis
- avoid irritating or tight clothing; cotton is recommended
- follow proper bathing techniques
- use of hypoallergenic cleansers
- use detergents and cosmetics without perfumes or fragrances
- avoid fabric softeners
AD pharm treatment
no cure, controlling symptoms
- hydrocortisone cream or ointment
- topical anesthetics
- antihistamines
- astringent compresses
- topical antibiotics
hydrocortisone application
apply sparingly 1-2 times daily with intermittent courses of therapy
do not use hydrocortisone longer than
7 days
hydrocortisone can be used on
neck, face, axillae, and groin (do not apply to > 20% BSA)
avoid hydrocortisone if
- oozing / weeping lesion or open / cracked skin
- not for children < 2 y/o
topical anesthetics moa
block conduction along the axonal membranes that carry sensation of itching and pain to the CNS
applying topical anesthetics
apply sparingly, 3-4x a day for up to 7 days
avoid topical anesthetics if
skin is raw, blistered, or on large surface areas
do not take topical antihistamines longer than
7 days, they are sensitizers and can make AD worse
astringent compress examples
- aluminum acetate (burrow’s solution) diluted 1:40 with water
- witch hazel
topical antibiotic examples
polysporin or Neosporin
xerosis pharm treatment
- moisturizers w urea or lactic acid
- aluminum lactate 12% lotion
- hydrocortisone
irritant contact dermatitis
direct tissue damage by irritant; usually results from occupational exposure to chemicals or solvents
first and second likely cause of ICD
- occupation exposure
2. diaper rash
ICD generally appears
after single exposure
ICD usually seen on
hands, face, forearms
signs/symptoms of ICD
red, inflamed, swollen skin; dry, macerated, or cracked skin; +/- vesicles or papule formation and/or peeling or sloughing of skin; painful, burning or stinging
goals of treatment for ICD
remove offending agent, prevent future exposure, relieve inflammation/irritation, and patient education
non pharm treatment of ICD
- avoid irritant and use protective clothing (if irritant cant be avoided use barrier creams)
- immediately wash exposed area
- apply emollients liberally or cold compresses
pharm treatment of ICD
- liberal application of emollients
- colloidal oatmeal baths
avoid use of ____ in ICD
topical -caine anesthetics
allergic contact dermatitis (ACD)
immunologic reaction of the skin caused by exposure to an antigen
ACD is a _____ reaction
delayed; typically does not appear on first contact
induction phase of ACD
usually no rash forms after initial exposure; immune system is sensitized to the antigen
second exposure in ACD
patient has type IV hypersensitivity reaction and release t-cells to fight antigen –> rash
ACD most commonly caused by
urushiol (poison ivy/oak), nickel, and latex
signs and symptoms of ACD
rash develops only in area where skin was exposed; intense pruritus, erythema, vesical formation; rash typically clears in 10-21 days
only FDA approved barrier product for prevention of ACD
ivyblock lotion
- needs to be applied 15 minutes prior to exposure and every 4 hours
- avoid in children < 6 years
prevention of ACD
- wear protective clothing
- wash all previously exposed clothing with detergent and hot water
goals of treatment in ACD
remove offending agent, treat inflammation / irritation, relieve itching/scratching
non pharm treatment of ACD
- wash exposed area (within 10 min of exposure)
- use approved soap/wash
approved washes for non pharm treatment of ACD
tecnu and zanfel
tecnu
- contains mineral spirits, water, soap, surface active ingredient
- no more effective than soap
- rub into affected area ASAP for at least two minutes
zanfel
- polyethylene granules, surfactant, etc.
- marked to bind and remove urushiol from new or old rashes
- expensive
pharm treatment of ACD
- hydrocortisone cream (2-4 times daily for up to 7 days)
- oral antihistamines
avoid ____ use in ACD
topical products containing anesthetics, antihistamines, and antibiotics (can cause drug induced ACD)
if ACD has nonweeping/oozing lesions
calamine lotions
if ACD has weeping/oozing lesions
consider astringent solutions to dry, soothe pruritus, or loosen exudate
exclusions for self treatment of ICD and ACD
- patients < 2y/o
- dermatitis present > 2 weeks
- involvement of > 20% BSA
- presence of numerous large blisters
- extreme itching, irritation, or severe vesicle and blister formation
- swelling of the body or extremities
- swollen eyes or eyelids swollen shut
- discomfort in genitalia from itching, redness, swelling, or irritation
- involvement and/or itching of mucous membranes of the mouth, eyes, nose, or anus
- signs of infection
- symptoms worsen
- low tolerance for pain, itching, or symptom discomfort
- impairment of daily activities
