Dermatitis

Question 1

Describe the therapeutic approach for atopic dermatitis for mild, moderate-severe, and severe disease?

Question 1

Dermatitis red flags? (3-4)

Answer 1

concomittant skin infection, large BSA affected, open wounds oozing or blsitering, systemic sx (fever, malaise, pain), psychological distress, if pts needs a Rx drug product, treatment failure, ambiguity on dx (always refer if unsure).

Question 2

What is the therapeutic approach for irritant contact and allergic contact dermatitits?

Answer 2

AVOIDANCE of trigger and occasional use of barrier creams, and topical steroids for acute flares.

Question 3

what are the ABCDEs of Diaper Dermatitis?

Answer 3

A- AVOID aggravating factors
A- air, absorptives, antifungals, anti inflammatories ->
air: allow diaper area to dry btwn changes.
absorptives: use diapers that absorb moisture and wick it away from skin, do nOT recommend powders (candida growth), antifungals (miconazole, clotrimazoel, nystatin),
anit inflamatories: 0.5-1% hydrocortisone.

B- Barrier creams -> zinc oxide paste, vaseline (minimizes irritant contact with skin)

C- clean and compress.
-> cleans with warm water and mild soap on clean cloth or cotton pad.
-> if oozing and crusting, can use wet compress.

D- Diaper -> change diaper frequently.

E- education -> educate pt on prevention and trx.

Question 4

Monitoring parameters for dermatitis?
- efficacy: By when should they start to notice some improvement?
- what are 3 common a/es of topical steroids?

Answer 4

Efficacy:
- monitor improvment in itching, area affected, redness, swelling, a/es to pharm treatments. should expect some improvmenet iwthin 7 days.

safety:
- Topical steroid a/es:
stinging
skin thinning/lightening, stretch marks, easy bruising.

A potent steroid applied for wks to months can lead to:
Perioral dermatitis
Steroid rosacea
dvlpment of tolerance and Topical steroid withdrawal

• pt to monitor for development of red flags.

Question 5

Follow up duration for dermatitis?

Answer 5

have pt follow up in 7-10 days.
- if condition worsens or no response, refer to physician for assessment and change in therapy.

Question 6

is it reasonable to recomend a 2nd gen anithistamine for itch?

Answer 6

itch is not histamine related, so it’s not shown to have good benefit, but pt can try if wants to.

Question 7

When would bleach baths be reasonable for a patient ?

Answer 7

for a pt WITH ATOPIC DERM ONLY who has frequent bacterial infections, but ONLY on recommendation of a dermatologist (tell them to talk to a derm).

Question 8

What are 3-4 non-pharm education points for dermatitis (assuming it’s not diaper dermatitis)?

Answer 8

• USE A nonscented MOISTURIZER 3-4 TIMES DAILY.
• switch to non scented soaps and detergents.
• avoiding irritants/trigger.
• reduce stress
• use tepid water (not hot) to wash hands or shower
• **avoid SCRATCHING (use cotton gloves)

Question 9

How often should moisturizers be appleid?

Answer 9

3-4 days

Question 10

What is theodsing and duration of treatment of topical corticosteroid for mild-moderate dermatitis (any type)?

Answer 10

Dosing: once or twice daily application of low or med potency steroid for 1-2 wks to control initial flare up.
–> AVOID USING for more than 2 wks due to incr risk A/es and tachyphylaxis. if using chronically, use 2 wks on and 1 wk off.

notes:
Mainstay trx of atopic derm.
Reduce inflam and pruritis - useful for both acute and chronic phases.

Medium to high potency steroids may require a taper to a lower potency steroid (i.e. step down to hydrocortisone 0.5% for a few days before d/cing)

Question 11

Steroid dosing:
- what is a ftu?
- how much does 1 FTU cover?
- how many grams is 1 ftu?

Answer 11

1 FTU = ribbon from first joint to fingertip.
1 FTY = covers area of two adult hand prints.
1 FTU = 0.5 g

Application:
Steroid and Moisturizer: There are no standard rules as to which agent should be applied first. Must make sure they wait 10 mins between application tho to prevent steroid dilution.