Derm Conditions Flashcards
Local Anesthetics - Can be
Can be applied topically to relieve pain and itching associated with skin disorders
Benzocaine
Lidocaine
Pramoxine
Urticaria - 20%
20% prevalence in general population
Urticaria - intensly
Intensely pruritic, erythematous plaque
Urticaria - sometimes with
Sometimes with angioedema (swelling deeper in skin)
Urticaria - trigger
Acute (<6 weeks); chronic (>6 weeks)
Urticaria - acute
Acute (<6 weeks); chronic (>6 weeks)
Urticaria - Prefered
H1 anithistimines Second-generation (preferred*) First-line Minimally sedating Some patients requiring higher than standard doses
First gen can also be used
Urticaria - Glucocorticoids
Glucocorticoids – do not appear to be necessary in isolated urticaria Brief course (one week or less) of systemic glucocorticoids could be added to anti-histamine therapy – patients with prominent angioedema or if symptoms persist past a few days Suppress a variety of inflammatory mechanisms
Drug-induced exanthems
most common cutaneous reactions to drugs (90% of all drug rashes)a
Exanthems, morbilliform, and macular and popular eruptions
Pruritis - Can be due to
Can be due to a distinct dermatological condition or an occult underlying systemic disease.
Pruritis - Can contribute to
Can contribute to a high burden, decreased quality of life
Pruritis - Acute - Less than
less than 6 weeks
Pruritis - Chronic
6 weeks or greater
Identify underlying
dermatologic or systemic cause
Non-pharmacological interventions
Stop medications that cause pruritis
Cool environment
Avoidance of skin irritants
Stress reduction
Puritis managment
Topical and intralesional corticosteroids
Treatment inflammatory skin disease with outcome of relief of associated pruritis.
NOT indicated if no evidence of skin inflammation.
Systemic therapy – H1 antagonists (1st and 2nd)
TCA – doxepin (Sinequan) 25mg at night up to 150mg daily (divided doses)
Gabapentin (Neurotonin) 200 to 300mg nightly – dialysis patient, neurogenic pruritis.
Irritant contact dermatitis (ICD) (80%
occupational) – direct cytotoxic action of an agent on the cells of the epidermis and dermatitis.
Allergic contact dermatitis (ACD)
type 4 delayed hypersensitivity reaction (exposure to nickel, neomycin, fragrances).
Atopic dermatitis (AD) –
pruritic inflammatory skin disorder, exacerbations and remissions of dry, itchy, red skin.
Common at 3 to 6 months of age
Associated with other atopic disorders (asthma, AR, urticaria, food allergy)
Contact Dermatitis Management -
Avoidance of the offending agents Handwashing to a minimum Emollients Medium-high potency corticosteroids (choice based on thickness, surface involved). Ointments often preferred Topical calcineurin inhibitors
ACD involving >20% of the body, involving face, hands, feet or genitalia
Prednisone
Poison iv dermatitis severe
(involving face or genitlia) – 1m/kg/day tapered over 2 to 3 weeks
Antihistamines – use in
ACD, unsure beneficial in contact dermatitis
Atopic Dermatitis Management
Patient education Eliminate exacerbating factors Moisturization, control of inflammation, prevention of scratching. Antihistamines Emollient moisturizer Bathing practices Controlling pruritis Topical corticosteroid ointment Calcineurin inhibitors Prevent secondary skin infections Systemic corticosteroids – extreme cases
Herpes Zoster - unilateral
Unilateral within one dermatome (20%, adjacent dermatome)
Herpes Zoster - prodrome
Prodrome – pain (stabbing, burning, aching, or excruciating), dysesthesia, or pruritis
Herpes Zoster erythematous
Erythematous and maculopapular, becomes cluster of clear vesicles
Herpes Zoster low
Low-grade fever, lymphadenopathy
Herpes Zoster zoster
sine herpete
Herpes Zoster - Uncomplicated – symptomatic treatment
prevention secondary infection
Herpes Zoster Antiviral
Antiviral therapy
< 72 hours after onset
Greatest benefit in patients older than 50 years of age
> 72 hours after onset
New lesions are appearing
Choice based on cost, dosing
Acyclovir – 800mg five times daily x 7 days
Valacyclovir – 1000mg three times day x 7 days
Famciclovir – 500mg three times day x 7 days
Analgesics – narcotics
Topical cool moist compresses, Lidoderm patches
Adjunct therapies – gabapentin, TCA, oral steroids
Pediculosis Capitis - Common condition
Common condition caused by infestation of the hair and scalp by Pediculus humanus capitis (the head louse)
Pediculosis Capitis - Treatment
Multiple topical pediculicides
Wet combing – very young infants/want to avoid pediculides
