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Pharmacy Practice II > Dermatitis > Flashcards

Dermatitis Flashcards

1
Q

ATOPIC DERMATITIS (AD): AKA ECZEMA

A

Complications

  • Secondary cutaneous infections (scratching, “itch that rashes”) (bacterial: staph. aureus: yellow crusting lesions/eczematous lesions)
  • Poor sleep/insomnia: waking up to itch

REFER if bacterial infection

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2
Q

ATOPIC DERMATITIS: WHEN TO REFER

A

1 Moderate to severe condition with intense pruritis
2 Involvement of large area of body (> 20%)
3 < 1 year of age
4 Secondary Infection
5 Involvement of face / intertriginous areas (armpits/groin)
6 If Sx worsen during treatment

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3
Q

ATOPIC DERMATITIS: PREVENTION

A

Identify/avoid triggers:

  • allergens, chemicals, cosmetics, etc
  • use cotton sheets
  • launder new clothes before wearing

Skin hydration
- moisturize with emollients BID

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4
Q

ATOPIC DERMATITIS: NON-PHARMACOLOGIC TREATMENT

A

Limit bath/shower time

  • first 5 min hydrates the skin, > 5 min dehydrates the skin when water is hot
  • lukewarm water
  • daily or every other day (QOD) baths
  • avoid soap (use non-soap cleansers)
  • pat skin dry (do not rub)
  • apply moisturizer to skin immediately after bathing

Keep fingernails short, smooth and clean
- wear cotton gloves/socks on hands to bed at night if itching at night

Keep room humidity high
- humidifier in bedroom at night

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5
Q

TREATMENT: PHARMACOLOGIC-ACUTE AD + refer

A

If its wet, dry it” : For weeping

  • Astringents: Al acetate 5%, USP: dilute
  • Witch hazel (hamamelis water)
  • Less expensive: Isotonic saline solution, Tap water, Diluted white vinegar

REFER:
- If lesions continue to weep after TWO days of treatment

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6
Q

Pharm Tx of Acute AD: CS dosing/admin, poor sleep, what to avoid

A

OTC hydrocortisone 0.5-1% cream

  • Apply BID-QID prn to affected area for up to 7 days
  • Avoid use over large surface areas, prolonged use (> 7 days)
  • Avoid use on infected site or eyes/face, avoid ointment

Itching/Poor Sleep
- Oral, sedating antihistamine

AVOID

  • Topical anesthetics (benzocaine), topical antihistamines (diphenhydramine) , topical antibiotics (containing neomycin)
  • May cause sensitization leading to drug-induced ACD
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7
Q

TREATMENT: PHARMACOLOGIC: CHRONIC AD

A

“ If it’s dry, wet it”: Chronic AD
Moisturization:

Bath Oils: mineral/veg oil w. a surfactant

  • May also contain colloidal oatmeal
  • Can add to bath water at end of bath or applied as a wet compress (1 tsp in 1⁄4 cup warm water)
  • Can make tub slippery; safety hazard for children and elderly patients

Cleansers

  • Avoid typical soaps that contain long chain fatty acids (oleic, palmitic, stearic acid) and alkali metals (Na, K): remove natural lipids that keep skin soft and pliable + increase skin pH
  • Glycerin soaps: Transparent, higher oil content because addition of castor oil
  • Mild cleansers (Cetaphil Restoraderm): Contain shea butter, glycerin + maintains skin pH
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8
Q

Moisturization: Chronic AD

A

Emollients and Moisturizers

  • Petrolatum 100% USP: effective/inexpensive when applied at bedtime and covered with wet wraps/clothes
  • Greasy; less cosmetically appealing
  • Do not apply over puncture wounds or laceration
  • Mineral Oil
  • Dimethicone
  • Lanolin (rxn from wool fraction)

Humectants: help skin retain water (glycerin, hyaluronic acid, etc)

Ceramides

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9
Q

DRY SKIN (XEROSIS): Signs and Sx

A

DUE TO: winter, low humidity, windy/cold/dry climates, hot showers/excessive soap, prolonged detergent use, malnutrition, dehydration, hypothyroidism, advanced age

1 Roughness
2 Scaling
3 Loss of flexibility
4 Fissures
5 Inflammation
6 Pruritis
7 “Cracked” appearance, esp on arms and legs
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10
Q

DRY SKIN (XEROSIS): TREATMENT

A

Treatment similar to Chronic Dermatitis

Bathing

  • Limits baths/showers to 3-5 minutes 2-3x/week
  • Can add bath oil to baths. Tepid water baths, not hot
  • Bath products: avoid soap-use non-soap cleansers
  • Pat body dry, and apply body moisturizer within 3 minutes of leaving bath

Moisturization: Apply at least TID

If itching

  • Apply a more lubricating moisturizer, and/or
  • Topical hydrocortisone 0.5-1% ointment BID-QID for up to 7 days if needed
  • See PCP if no resolution within 1-2 weeks

Stay well hydrated
Increase room humidity with a humidifier

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11
Q

IRRITANT CONTACT DERMATITIS (ICD): Sx

A

Acute
1 Inflammation, redness, swelling
2 Itching, burning, stinging
3 Crusting may occur within days
*If remove irritant, resolution in several days
*If chronically exposed to irritant, inflammation can persist and lead to fissures, scales, hyper-and hypo-pigmentation

Chronic
- Lichenification

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12
Q

IRRITANT CONTACT DERMATITIS: Tx (prev, non-pharm, pharm, avoid)

A

Prevention

  • Using protective clothing, gloves or other equipment
  • Frequent changes in coverings

Non-pharmacologic Treatment
- Immediate washing of area if exposed to an irritant

Pharmacologic Treatment

  • Liberal application of emollients
  • Assist in restoring moisture and protect stratum corneum from further damage

If itching: Colloidal oatmeal baths or Topical Hydrocortisone

AVOID: caine-type anesthetics, salicylic acid, lactic acid, urea, propylene glycol

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13
Q

ALLERGIC CONTACT DERMATITIS (ACD): Sx

A

Distribution and presentation of rash

Acute

  • Rash presents as papules, small vesicles, sometimes large bullae over inflammed , swollen skin
  • Significant itching

Chronic
- Lichenification

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14
Q

ALLERGIC CONTACT DERMATITIS (ACD): REFER

A

1 < 2 years of age
2 Dermatitis present for > 2 weeks
3 Involvement of > 20% of body surface area
4 Presence of numerous bullae
5 Extreme itching, irritation, or severe vesicle/bulla
6 Swelling of body/extremities/eyes
7 Involvement / discomfort of genitalia or mucus membranes
8 Signs of infection
9 Failure of self-management after 7 days
10 Low tolerance for pain, itching, or sx discomfort
11 Impairment of daily activities

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15
Q

ALLERGIC CONTACT DERMATITIS (ACD): Non-pharm

A

Removal of antigen
- Wash exposed area with soap and water

  • Can use an urushiol cleanser: contains mineral spirits, water, soap, and a surface active agent
  • Rub into area as soon as possible after exposure
  • Aims to limit exposure to other areas of the body
  • Cleanse area for a minimum of 2 minutes

Avoid cleaning with alcohol

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16
Q

ALLERGIC CONTACT DERMATITIS (ACD): PHARM

A
  • Aluminum acetate 5% (Burow’ solution)
  • Aluminum sulfate 1347mg (Domeboro astringent solution)
  • Calcium acetate 952mg (astringent powder packets)
  • Isotonic saline solution, or diluted white vinegar, or tap water

Itch relief

  • Calamine Lotion: skin protectant that provides relief from itch, pain, discomfort and dries weeping and oozing
  • Caladryl Lotion: shake well, leaves a pink/white residue on skin
  • Hydrocortisone 0.5-1% cream TID-QID prn: Don’t use ointment if weeping, oozing lesions. Cream is preferred
  • Colloidal oatmeal baths
17
Q

ALLERGIC CONTACT DERMATITIS (ACD): AVOID

A
  • Caine-type anesthetics
  • Topical diphenhydramine and other topical antihistamines
  • Topical antibiotics containing neomycin
  • All are known sensitizers and can cause drug-induced ACD and worsen the problem
18
Q

WOUND INFECTIONS: Sign and Sx

A

LOCAL

  • Erythema
  • Edema
  • Pain
  • Crepitation
  • Purulent / odorous exudate in affected area
SYSTEMIC
- Fever
- Flu-like sx
- Leukocytosis
> REFER
19
Q

CLASSIFICATION OF WOUNDS: STAGES

A

SELF CARE

  • Stage 1: no loss of skin, warmth, redness
  • Stage 2: superficial lesion, epidermis/dermis damage

REFER

  • Stage 3: full-thickness skin loss, damage to entire epidermis
  • Stage 4: deep full thickness skin loss, tissue necrosis
20
Q

PHARMACOLOGIC TREATMENT OF WOUNDS

A

Antiseptics:
• Chemical substances used to disinfect
• Designed for application to INTACT skin up to the
EDGES of a wound
• In open wounds antiseptics can cause harm by:
- leukocytotoxic action
- increasing intensity and duration of inflammation; causes tissue necrosis

• Normal saline or water is sufficient for irrigation to remove dirt and debris with a wound

21
Q

FIRST AID TOPICAL ANTIBIOTICS

A

Act to prevent infection in minor cuts, wounds, scrapes, and burns, especially useful if wound contains debris or foreign matter

If healing has not occurred within 7 days, refer patient to PCP

Products:

  • Some contain a triple antibiotic formulation:
  • Bacitracin
  • Neomycin (sensitizing. Avoid using alone)
  • Polymyxin B

Pharmacy Practice II (25 decks)

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