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PHAR 153 > Childhood Derm / Eczema / Itch / Dry Skin > Flashcards

Childhood Derm / Eczema / Itch / Dry Skin Flashcards

1
Q

What length of sun exposure (in mins) provides Vitamin D stores for a couple day’s time?

A

20mins

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2
Q

Overview of some of the conditions associated with Melanocytes?

A

Vitiligo
Melanoma

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3
Q

Overview of some of the conditions associated with Epidermis?

A

Dry Skin
Aging

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4
Q

Overview of some of the conditions associated with Sebaceous Glands? Sweat Glands?

A

Sebaceous Gland:
Acne
Seborrhea

Sweat Gland:
Heat-Related Illness

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5
Q

Describe “Apocrine Sweat Glands”.

A

-Attached to hair follicles (generally)
-Activate during puberty
-Under arms & anogenital area
-Odorless secretions (until bacterial interactions)

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6
Q

Describe “Eccrine Sweat Glands”.

A

-Independent of hair follicles
-Over most of the body… NOT genital area / legs
-In great number on palms & soles
-Heat Ctrl

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7
Q

List some skin factors affecting drug absorption.

A

-Skin hydration
-Drug / Vehicle pH
-Application thickness
-Temp of skin
-Damage to skin

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8
Q

Which skin layer provides the largest barrier to drug delivery processes?

A

Stratum Corneum

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9
Q

T or F: Enhancing skin hydration will increase drug absorption.

A

True.

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10
Q

Acute vs. Chronic Skin Conditions… Which products are appropriate for use?

A

Acute - Lotions & Creams
Chronic - Ointments

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11
Q

Describe the administration of an FTU (Fingertip Unit)… What would be the length of an FTU on an adult finger?

A

End of the finger to the 1st finger crease.

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12
Q

1) 1 FTU is large enough to treat an area of skin ___x the size of the flat of an adult hand.

2) 2 FTU’s are about the same as ___g of topical steroid.

A

1) 2x
2) 1g

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13
Q

If I hypothetically came to the Pharmacy in need of topical steroid treatment for an area the size of 14 adult hands (treatment is BID), how many FTU’s / grams of topical steroid should be taken in a day?

A

1 FTU = 0.5g… Treats area 2x size of hand.
14 / 2 = 7 FTU’s (or 3.5g)
7 x 2 (b/c of BID dosing) = 14 FTU’s (or 7g)

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14
Q

Vesicles & Bullae are both blistering conditions… How do they differ in terms of classification?

A

Vesicle: Individual Blisters < 0.5cm in diameter… Clear liquid.

Bullae: Clustered Blistering… > 0.5cm in diameter & clear liquid.

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15
Q

Describe Erythema… What does it look like & what might cause it?

A

-General redness with no blistering.
-New deodorants / shaving / start of infectious processes / mechanical irritation from clothing etc.

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16
Q

Describe Wheals.

A

-Aka Hives… Pimple-like lesions arising out of Edema & almost always lead to Pruritus (itching).
-Utilized in pediatric allergy screening.

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17
Q

Papule vs. Pustule vs. Nodule vs. Cyst…

A

Papule: Solid, elevated lesion < 0.5cm diameter (small).
Pustule: Vesicle filled with purulent liquid (pus).
Nodule: Lesion > 0.5cm in width & depth (large).
Cyst: Form of Nodule containing liquid or semisolid.

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18
Q

Description of an Abscess…

A

-Centralized pimple with surrounding Erythema.
-Prime territory for Folliculitis (as late-staged Abscesses become Folliculitis).

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19
Q

Describe the process of Lichenification.

A

-Skin thickening over time to protect from various traumas such as shoe blistering, scratching, etc.

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20
Q

Describe Plaque Psoriasis.

A

-New skin cells pushing old ones to the top of the Epidermis & cause plaque-y formations.

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21
Q

Describe a Crust (Scab).

A

-Exudate from lesions that have dried on the skin.

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22
Q

Describe an Ulcer.

A

-Epidermal destruction leading to Dermis exposure.

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23
Q

Describe Macules.

A

-Flat lesions that are flush with the skin & differ in color from surrounding tissue.

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24
Q

Medical term for dry skin???

A

Xerosis

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25
Factors that may induce dry skin?
-Excessive bathing / hand washing / mechanical rubbing -Medical conditions (ie. Diabetes, Hypothyroid) -Soap products -Low humidity / atmospheric dryness -Aging -Sun damage
26
Why does our skin dry as we age?
-Decreased vascularity & oil production (due to reductions in Sebaceous Gland activity).
27
Defacto "Eczema-Grade" product for dry skin?
Spectro
28
What qualifies a product to be "Eczema-Grade"?
-Unscented -Non-Allergenic -Gentle & Soapless -No colors added
29
1) How do scented male bathing products such as Irish Spring Soap & Axe Body Wash dry out the skin? 2) Better cleansing products to switch to?
1) Scented perfumes leech out natural lipids from the skin. 2) Pears / Neutrogena / Dove Soaps, Cetaphil Facial Cleanser.
30
Name of Bath Oil product suggested in class for dry skin treatment?
Alpha Keri (contains a mineral oil & surfactant)
31
Historical product used for its anti-pruritic & slight anti-inflammatory properties?
Colloidal Oatmeal
32
Brand name lotion / cream product that contains oatmeal derivatives?
Aveeno
33
The addition of what ingredient to traditional emollients / moisturizers make the product "oil-free"?
Dimethicone
34
Rank the following emollient / moisturizer products in order of increasing occlusion / effectiveness (least to greatest): Creams Lotions Ointments Bath Oils Petrolatum
1) Bath Oils 2) Lotions 3) Creams 4) Ointments 5) Petrolatum
35
List some solid base level products for treatment of dry skin.
GlaxalBase Moisturizing Lotion / Cream Moisturel Lotions / Creams CeraVe & Curel Lotions / Creams LC Hydrous Emulsifying Ointment (HEO)
36
Name of the oil-free dry skin product targeted towards the "blue collar working male" demographic?
O'Keeffe's Working Hands Cream... Contains Dimethicone.
37
What historical ingredient was added to humectant products because of its ability to complex up to 15 water molecules (thus aiding in skin hydration)?
Phospholipids... Complex 15 lotions (now just another ingredient added to lotions & isn't as groundbreaking as originally proposed).
38
T or F: Keratin Softening agents such as AHA, Urea, & Lactic Acid are suitable to treat typical dry skin.
False... More for the targeting of elbows.
39
Products discussed in class that contain Keratin Softening Agents?
LactiCare Lotion & Uremol 10% Lotion / 20% Cream.
40
At what percentage is AHA considered to be therapeutically effective?
10%
41
The addition of what ingredient to CeraVe products make it more "clinical-grade" in nature?
3% Salicylic Acid
42
Treatment strategies for treating dry & cracked heels?
-Cleaning AA -Sanding down excess Keratin -Utilization of lotions / creams / ointments
43
Prescription / OTC drugs used to bleach out pigmented age spots?
Tretinoin (Rx) Monobenzone (Rx) Hydroquinone (OTC @ 2%, Rx @ 5%)
44
In which situations would administration of Calamine Lotion to a patient be appropriate? Inappropriate?
A: First Aid treatment of insect bites or poison ivy exposure & chicken pox. I: Itch of typical dry skin.
45
Calamine is what type of an agent?
Astringent... Acts upon skin proteins & dries them out (so really bad for those with itch).
46
At what strength does Menthol act as an anti-pruritic agent? As a counter-irritant?
< 1% = Anti-Pruritic > 1% = Counter-Irritant
47
Pramoxine & Benzocaine are ______ _________ agents that are suitable for first aid situations such as bug bites.
local anaesthetizing
48
Taylor says 3-in-1 Lanacane products containing Benzocaine & Resorcinol are shitty for itch & dry skin... How come?
-Resorcinol shown to act as an exfoliating agent (which is bad for someone with dry skin & itch). Benzo addition not great either. -Go with unmedicated products (creams or ointments more often than not) whenever possible.
49
What OTC product utilized for its potential anti-pruritic effects in kids with chicken pox went behind the counter for a brief stint of time?
-Topical Diphenhydramine (Benadryl) due to adverse rxn's in these kids.
50
Ronnie comes into your Pharmacy looking for a cure to his itchy mosquito bites. He tells you that he's thinking about going for Topical Benadryl, as he saw on the internet that it works for bites. What cheaper product would you recommend for him?
Calamine... Waaaaaaay cheaper than Topical DPH.
51
What topical steroid product is safe to use on babies who have either itch-associated diaper rash or facial rash?
Hydrocortisone 0.5% crm
52
What topical steroid product is safe to use on babies who have either itch-associated diaper rash or facial rash?
Hydrocortisone 0.5% crm -Adults jump to 1% (more effective).
53
Behind-the-counter, eczema-grade product that contains Clobetasone?
Spectro EczemaCare
54
Length of a typical Eczema flare-up?
1 week (so long as the allergen moves away).
55
How does Eczema present differently in infants & toddlers compared to adolescents & adults?
Greater prevalence of it on the face... Hands / Elbows / Wrists / Back of Knees with age.
56
Up to what percentage of adults suffer with persistent Atopic Dermatitis (ie. Continuation into adulthood)? How many are first diagnosed as adults?
30% - Chronic 50% - 1st diagnosed as adults
57
Wool or Cotton or Synthetic: Which material is best for Eczema patients?
Cotton... Wool is EXTREMELY irritating. Synthetic is the WORST!
58
Hot commodity ingredient seen in products for dry skin?
Ceramide
59
Bleach baths (may) have some utility in moderate to severe Eczema... Why?
Proposed to help with Staph Aureus infections attributed to opened lesions (from scratching away AD-associated itch).
60
Bathing regime to treat weeping lesions associated with acute Eczema flare-ups?
Plain Water 20min QID x 2-3d
61
What corticosteroid formulation type should be used with patients who present chronic Eczema (ie. Dryness & Scaliness)? For Acute staged Eczema?
Chronic: Ointments Acute: Lotions & Creams
62
Prescribed agent for severe, acute contact dermatitis?
Ultravate (contains Halobetasol Propionate 0.05%)
63
Prescribed agent for chronic contact dermatitis?
Halog (contains Halcinonide 0.1%)
64
Prescribed agent for mild-moderate contact dermatitis?
Westcort (contains HC 0.2%)
65
T or F: Low strength topical steroids can only be used for up to 3 weeks in treatment of AD.
False... Treat for as long as flare-up lasts. Can use low potency agents such as HC 1% for up to 3 months at a time with little to no risk of adverse s/e's (mod-high potency agents shouldn't be used past 3 weeks, however).
66
S/E's of Topical Steroid usage?
Note: Taking a week off between treatments during 3mth usage of a low potency CS greatly reduces s/e risks... -Acne -Skin Atrophy -Striae (stretch marks) -Telangiectasia (spider veins due to skin thinning)
67
Criterion for determining what strength of a topical steroid to use?
i) Location... Lower potency agents on face, groin, armpits. ii) Is use acute or chronic in nature? iii) Patient age.
68
Best time to apply a topical steroid in Eczema treatment?
Right after baths or showers (on hydrated skin), as absorption is greatly enhanced with hydration.
69
Potential Eczema treatment regimes?
-Combo therapy... One higher strength CS for 3-7 days, taper off after a week with lower strength CS. -Steroid with dry skin cream. -Starting lower strength & being prepared to shift to higher strength.
70
T or F: You switch to an infant's finger when determining FTU's in a topical steroid dosing regimen.
False... Still use your adult-sized finger.
71
Kimmy comes in with her 3yr old son Jamieson; he has Facial Eczema. She's afraid of using steroidal products on his skin, as she believes that the steroid might "stunt his growth". What 2nd line product might you recommend instead?
Pimecrolimus -Tacrolimus is used in typically mod-severe cases of Eczema. However, given Jamieson's age, Pimecrolimus is a more suitable agent (better safety profile).
72
Provide additional examples of non-steroidal products for Eczema treatment.
i) PDE4 Inhibitor --- Crisaborole 2% ointment... Works by degrading cAMP & prevents production of inflammatory cytokines. ii) Opzelura --- JAK Inhibitor (Ruxolitinib 1.5% crm)... Prevents inflammatory signaling via JAK1 / JAK2.
73
Do probiotics help Eczema at all?
Treatment: Not really. Prevention: Mom taking them throughout pregnancy / during breastfeeding timeframes led to less Eczema prevalence & reduced allergies in their children.
74
Coal Tar remedies... Any good for Eczema?
More so for treatment of Psoriasis, as it reduces cell turnover of scalp skin cells (good for dandruff & reasonably good for anti-pruritic care, but irritating for Eczema).
75
How does Roseola (6) differ from Parvovirus (5) in terms of presentation on the skin?
Parvo: "Slapped Cheek"... Redness, NOT maculopapular in nature. Roseola: Maculopapular in nature.
76
Johnny is an 8yr old boy who comes in with suspected HFM Disease... Is this possible?
NO!!! HFM disease presents in kids < 5yrs of age.
77
How does Hand / Foot / Mouth disease present in young children?
Rule of 2... 2 days fever, 2 days mouth sores, 2 days rash.
78
Suzie is a 4yr old who comes in with wart-like lesions on her body. Her mom tells you that a few other kids at Suzie's daycare have experienced similar lesion presentations over the last week. What might you suspect Suzie has, & how is it treated?
Molluscum... Viral & clears on its own.
79
Childhood Derm condition that presents within the first few days of life & clears up by 7-14 days?
Erythema Toxicum
80
Name of the "pediatric acne" condition that presents itself as white, pimple-like lesions along the nose line?
Milia
81
Childhood Derm condition that presents honey-colored, crusty lesions on the face?
Impetigo... Only bacterial one seen.
82
Two bacteria responsible for causing Impetigo?
Strep pyogenes & Staph aureus
83
Two other Impetigo variants seen in class?
i) Bullous Impetigo... Large blisters occurring on the trunks of infants & younger children. ii) Ecthyma... More serious Impetigo form that penetrates deep into the skin & causes painful fluid or pus-filed sores to form.
84
Differential symptom that distinguishes Herpes from Impetigo???
-Tingling... Seen with cold sores, NOT with Impetigo. Cold Sores also hurt & the exudate is clear. -Impetigo spreads faster & red blisters quickly break & turn brown in color (Cold Sores form red blisters most of the time).
85
Two Gram Positive Agents commonly seen in Polysporin products? Gram Negative Agent?
GP: Bacitracin, Gramicidin GN: Polymyxin B
86
1st line prescribed agents we can use to treat Impetigo?
Mupirocin 2% crm or ointment Fusidic Acid 2% crm or Na+ Fusidate 2% ointment TID x 7d desirable for both!
87
Different forms of Folliculitis?
1) Bacterial Folliculitis... Infection of hair follicle via bacteria (usually Staph aureus). 2) Hot Tub Folliculitis... Pseudomonas-caused. 3) Razor Bumps... Ingrown hairs. 4) Furuncles & Carbuncles... Deep infection with Staph & sudden appearance of painful pink or red boils.
88
What prescribed agents can be used to treat Folliculitis?
Exact same as Impetigo agents... Only thing that differs is length of time. Impetigo = TID x 5-7d; Folliculitis = TID x 7-10d (longer).
89
How can we speed up the treatment of Furuncles?
-Warm compresses (speed up rupturing) -Antibiotic treatment (to clear infection) -Manual draining with sterilized Dr. tools
90
T or F: OTC antibiotics are capable of penetrating Furuncle-type boils.
False... Won't penetrate infected skin.
91
How do German Measels & standard Measels differ in terms of rash presentation in kids & sickness intensity / onset / duration / demonstrated symptoms?
Measels: Hits harder... Kids present higher fever & quite sick for 3-5 days. Itchy rash lasts about 5 days & total illness duration 7-14d. German Measels: 1-2 days mild fever, itchy rash for up to 3d. Less severe illness intensity than standard Measels.
92
Treating child Chicken Pox... What can we use?
-Tylenol (for pain associated with sores)... NO ADVIL!!! -Oatmeal Bath (for anti-pruritic effects). -Dabbing Calamine lotion on itchy spots. -Cool, damp washcloths on itchy spots.

PHAR 153 (10 decks)

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