Atopic Dermatitis/ Dry- Skin/ Scaly Dermatoses Flashcards
Bath Oils
mineral or vegetable oils plus surfactant. Some are combined with colloidal oatmeal for relief of itching.Bath oils minimally effective in dry skin disorder bc greatly diluted in water. When applied as wet compresses(1 tsp of ¼ cup warm H20), bath oils lubricate dry skin and decrease frequency of full body bathing
Cleansers
Special soaps including glycerin (extra oils minimize drying effect of washing).
Lotion
his water content can have drying, useful in hairy areas
Emollients
soften skin by reestablishing integrity of stratum corneum.
Moisturizers
consist of 60-80% water. Impart moisture increasing skin flexibility. Contains emulsifiers, humectants, alpha hydroxy acids and urea, fragrance, color (dyes), additives like vitamins which have no clinical effect, natural moisturizing factors.
~.Petroleum-Simple & economical hand ointment. Greasy. Effective when applied bedtime and covered with wraps or clothing
Ointments
Contain petrolatum (greasy). effective penetration but greasy ✖For oozing/weeping avoid bc do not allow lesions to dry and heal.
Lotions
high water content can have drying effecting, useful in hairy areas
gels, foams, moussses
“cooling” effect from alcohol
drying effect may cause hyper sensitivity
atopic dermatitis exclusions
- severe conditions with intense pruritus
- involvement of large are of body
- <2 years of age
- skin appears to be infected
scaly dermatosis exclusions
- dandruff, seborrhea, and psoriasis
- < 2 years of age
- worsening or no improvements of disorder after 2 weeks of OTC meds
- psoriasis only
- > 10% involvement of BSA
Atopic dermatitis
Erythema (redding of the kin), inflammation, and scaling of cheeks
Secondary infections: present as yellowish crusting, pustules, vesicles
PRURITUS
Simultaneous occurrence with asthma and allergic rhinitis
Hyperreactivity to irritants or environmental stimuli
The primary sign of avoid is intense pruritic papules (solid, circumscribed, elevated lesions less than 1 cm in diameter) and vesicles (sharply circumscribed, elevated lesions containing fluid).
- onset at <2 years
- history of skin cease
- dry skin
- personal history of atopic disease
Atopic dermatitis
tx
Skin hydration through the use of emollients and moisturizers.
Atopic dermatitis
non-pharm
- Avoid triggers (soaps, smoking, pollen, etc.)
- Laundering and thoroughly rinsing new clothing
- Wearing non irritating fabrics
- Avoid sunburn
- Keep fingernails short (pruritis)
- Tx of oozing/weeping lesions with wet compresses using tap water or aluminum acetate soaks
- For itching use bacitracin/polymyxin B ointment (Polysporin)
- Avoid occlusive, tight clothing
- Remain in moderate temperature and moderate humidity
- Using oil-in-water preparations (creams and lotions)
Atopic dermatitis
pharm
- HYDROCORTISONE is used to tx AD (avoid in open or cracked wounds)
- Bathe in tepid water containing colloidal oatmeal
Secondary infection: identify exclusion for self-care and avoid hydrocortisone
Dry Skin (Xerosis)
Roughness, scaling, loss of flexibility, fissures, inflammation, and pruritus.
Particularly on the arms and legs that may appear “cracked” or fish scaling
Dry Skin (Xerosis) non pharm
- Using oil based emollients (lotion) and modification to bathing practice
- Room humidity should be increased with a humidifier or vaporizer
- Use bath oils in tepid water
- Use corticosteroid ointments rather than creams
Avoid bath oil in elderly due to risk of slip/fall; pat dry after bathing
Ointment increased ability to retain moisture (>lotion alone)
Dry Skin (Xerosis) pharm
- More severe cases may require a product containing urea or lactic acid to enhance hydration
- Hydrocortisone ointment
- Short term use of topical corticosteroids (see PCP after 1-2 weeks of use)
- Moisturizers containing ammonium lactate
- Alpha-hydroxy acids
Seborrheic dermatitis
Scalp, face, chest
Significant inflammation
Dull, yellow-ish, oily, scaly areas on red skin.
Itchy rash with two age peaks of occurrence: One within the first 3 months of life. Second peak around 40-70 years of age
Common in infants
Severe in winter and commonly found in pt with parkinsonism, zinc deficiency, endocrine states associated with obesity, and human immunodeficiency virus (HIV).
Cannot be cured
Seborrheic dermatitis tx
Use medicated shampoo infant adults EAR: - Use medicated shampoo followed by application of an emollient and hydrocortisone cream.
Lotions are preferred for hairy areas
Consult PCP after 7 days of hydrocortisone use
Seborrheic dermatitis tx children
IN INFANTS:
- use baby oil, followed by the use of a non medicated shampoo to remove scales. For more severe cases, crust can be removed by salicylic acid in olive oil or a water soluble base and warm olive oil compresses, followed by gently shampooing with a mild shampoo or a shampoo containing salicylic acid.
- A low potency nonprescription glucocorticoid (e.g. HYDROCORTISONE) in a cream or lotion may be tried for a few days in children > 2 years.
- For face use mild soap and gently washing. DO NOT use corticosteroid on infants face.
Seborrheic dermatitis tx
adults
ADULTS:
- Shampooing is the foundation of Tx
- Shampoo should contain pyrithione zinc, selenium sulfide, sulfur, KETOCONAZOLE, salicylic acid, or coal tar
- A regular non medicated shampoo or liquid dishwashing soap (e.g. Dawn) can be used to soften and remove crust or scales
- AVOID greasy ointments, pre/after shave lotions containing alcohol, and reduce the use of soaps.
dandruff
Diffuse rather than patchy confined to scalp
Scaling with large white or gray scales
dandruff tx
Washing hair and scalp with a general-purpose non medicated shampoo every other day or daily
Use medicated shampoo with a scalp scrubber and leave for 5 minutes
A cytostatic agent
- Pyrithione zinc
- Selenium sulfide (may discolor hair/clothes)
- Coal tar (may discolor light hair as well as clothing and jewelry)
Keratolytic shampoo, containing salicylic acid or sulfur
KETOCONAZOLE shampoo as alternative tx
Refer after 4-8 weeks of use
Psoriasis
In mild cases: lesions are localized, few lesions smaller than quarter
Usually symmetrical with minimal itching
Type I: typically present at an early age, have a strong family history of the disorder
Type II: develops in the later decades of life and does not show a high incidence of family history.
Lesions start small that grow and unite to form plaques (they are light pink to bright red plaques, opaque, thick, adherent, white scale that can pulled of in layers)
Small bleeding points when scale removed (Auspitz sign)
Common areas are elbows and knees
Cannot be cured
