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Clinical 1 (Part A) > Dermatitis > Flashcards

Dermatitis Flashcards

1
Q

Two types of dermatitis discussed in this lecture

A

1) contact dermatitis

2) atopic dermatitis

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2
Q

Atopic dermatitis = ?

A

eczema

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3
Q

Pharmacological treatment for dermatitis?

A

topical corticosteroids

*this is the first line medication for dermatitis

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4
Q

What are topical corticosteroids effective for treating?

A

skin conditions of: hyperproliferation
inflammation
immunologic involvement

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5
Q

Topical corticosteroids provide symptomatic relief of ?

A

itching and burning

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6
Q

topical corticosteroids are classified into __ categories

A

7

  • classified into 7 categories based on potency, ranging from low to very high potency.
  • relates to the amount of vasoconstriction the formula induces
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7
Q

List the 4 components of the mechanism of action for topical corticosteroids

A

1) anti-inflammatory
2) vasoconstrictive
3) immunosuppression
4) anti proliferative

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8
Q

Explain the MOA for topical corticosteroids:

-anti-inflammatory

A

decreases formation, release and activity of inflammatory mediators

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9
Q

Explain the MOA for topical corticosteroids:

-vasoconstrictive

A

prevents cell migration and decreased access to affected area thereby reducing swelling

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10
Q

Explain the MOA for topical corticosteroids:

-immunosuppression

A

inhibits action of cells involved in the immune response

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11
Q

Explain the MOA for topical corticosteroids:

-antiproliferative

A

able to interfere with DNA synthesis and mitosis and obstruct fibroblast activity and the development of collagen

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12
Q

Topical corticosteroids:

low potency used where?

A

on skin areas such as face and folds

*b/c these areas of thin skin have increased absorption

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13
Q

Topical corticosteroids:

medium potency used where?

A

on medium thickness skin such as body and scalp

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14
Q

Topical corticosteroids:

high potency used where?

A

used on thick skinned areas such as palms and soles

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15
Q

When do you stop using a topical corticosteroid product?

A

as soon as the skin is clear!

-do not continue use as it will continue to thin your skin and make it more prone to infections, cuts, or damage

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16
Q 
Topical corticosteroids that Mb Pharmacists can prescribe:
What class and schedule is clobetasone 17-butyrate in?
A

class IV (considered moderate potency)

schedule 2 (behind the counter, but do not need an Rx)

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17
Q

Topical corticosteroids that Mb Pharmacists can prescribe:
What class and schedule is
triamcinolone actonide in?

A

class IV (considered moderate potency)

schedule = ?

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18
Q

Topical corticosteroids that Mb Pharmacists can prescribe:
What class and schedule is
desonide in?

A

class VI (low potency)

schedule = ?

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19
Q

Topical corticosteroids that Mb Pharmacists can prescribe:
What class and schedule is
hydrocortisone in?

A

class VII (low potency)

schedule 1 or 3

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20
Q

Topical corticosteroids that Mb Pharmacists can prescribe:
What class and schedule is
hydrocortisone acetate in?

A

class VII (low potency)

schedule 1 or 3

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21
Q

As the classes increase (1-7) does potency increase or decrease?

A

decrease

Class 1 = ultra high potency
Class 2 = high potency
Class 3, 4, 5 = moderate potency
Class 6, 7 = low potency

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22
Q

Describe the effect of vehicle on potency

A

optimized vehicle > ointment or gels > creams or lotions

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23
Q

Describe ointments

A
  • occlusive and provide lubrication
  • good for dry, scaly lesions
  • greasy, which may tend to decrease patient compliance
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24
Q

Describe creams

A
  • generally less potent than ointments
  • good lubrication
  • can contain preservatives
  • cosmetically appealing
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25
Q

Describe lotions or gels

A

-helpful in hairy areas

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26
Q

Why do ointments have the highest potency?

A
  • they seal skin and create an occluded area which:
  • increases temp
  • increases absorption
  • increases potency
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27
Q

What are the adverse effects of topical corticosteroids?

A
  • dryness
  • itching
  • burning
  • local irritation
  • infections
  • ocular changes (ocular hypertension, glaucoma, cataracts)
  • suppression of the hypothalamic-pituitary-adrenal (HPA) axis
  • steroid rebound
  • steroid addiction
  • tachyphylaxis
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28
Q

What are the adverse effects usually a rxn to?

A

most likely due to the vehicle that the corticosteroid is in

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29
Q

List some atrophic changes that may occur as an adverse effect from a topical corticosteroid

A 
steroid atrophy (thinning of skin/redness)
telangiectasia (spider veins)
striae (stretch marks)
purpura
ulceration
easy bruising
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30
Q

Frequency of application for topical corticosteroids?

A

apply once or twice daily

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31
Q

Does a more frequent application of a topical corticosteroid provide better results?

A

no man

  • applying it more often is just as effective as not as often
  • less frequent application reduces risk of side effects
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32
Q

OTC treatments for atopic dermatitis

A

Corticosteroids!

-hydrocortisone 0.5% (schedule 1 or 3)
-hydrocortisone 1.0% (schedule 1 or 3)
(these are not recommended in children <2 years old)
7-14 day therapy

-clobetasone butyrate 0.05% (Schedule 2)
(not recommended in children <12 years old)
7 day therapy

33
Q

Describe contact dermatitis

A

inflammatory skin condition with two subcategories:

  • irritant contact dermatitis
  • allergic contact dermatitis
34
Q

Describe irritant contact dermatitis

A

occurs when skin undergoes mechanical or chemical trauma on exposure to an irritating substance

35
Q

How much % of cases does irritant contact dermatitis make up?

A

it makes up 80% of contact dermatitis cases

36
Q

Describe allergic contact dermatitis

A

occurs when skin is exposed to an allergen

37
Q

What is contact dermatitis characterized by?

A 
inflammation
redness
itching
burning
*all of these can be relieved by use of a topical corticosteroid

stinging
vesicle and pustule formation on skin areas that are exposed

38
Q

What is the difference between irritant and allergic contact dermatitis?

A

irritant
-will be inflamed on very 1st exposure

allergic
-needs to have a prior interaction with the allergen

39
Q

There can be acute rxns and chronic rxns:

Describe acute

A

red, oedematous papules in early phase, which become vesicles and bull that ooze if the rxn is severe enough

40
Q

There can be acute rxns and chronic rxns:

Describe chronic

A

primary lesions are minimal, and secondary changes such as dryness, lichenification, pigment changes, hyperkeratosis or thickening, excoriation and fissuring predominate

41
Q

What is the primary symptom in both acute and chronic?

A

itching

42
Q

Signs and symptoms of ICD (irritant contact dermatitis)

A

mild irritants produce erythema, gesticulation and oozing while strong irritants produce blistering, erosions and ulcers

43
Q

Signs and symptoms of ACD (allergic contact dermatitis)

A

mild form similar to the irritant exposure. A typical allergic rxn consists of grouped or linear tense vesicles and blisters. Severe = edema, especially in the face and periorbital and genital areas

44
Q

Types of Irritants

A 
plants (poison ivy)
foods (peanuts)
chemicals
cosmetics
latex
metals
45
Q

Describe poison ivy

A
  • perennial
  • 3 leaves
  • edges may be smooth or toothed
  • leaves vary in size (8-55 mm long)
  • reddish in spring
  • green in summer
  • orange/red in autumn
  • allergen = urushiol
46
Q

What is the allergen for poison ivy?

A

urushiol

47
Q

Risks/aggravating factors include ?

A
  • gender (women wear jewellery and cosmetics)
  • area on the body susceptible to different types of irritants (ex. jewellery)
  • seasonal (poison ivy)
  • occupational (irritation through contact with chemicals)
  • UV light (phytotoxic rxns when taking medications)
48
Q

When do you refer contact dermatitis?

A
  • if dermatitis spreads to distant sites or becomes generalized to more than 30% of BSA
  • acute and non responsive with a few days
  • edema persists or increases within a few days/swelling of body
  • discomfort in genitalia from itching, redness, swelling or irritation
  • involvement and/or itching of mucous membranes of the mouth, eyes, nose, anus
  • chronic and or non responsive within 7-10 days
  • interferes with quality of life
  • < 2 yrs of age
  • presence of numerous vullae
  • extreme or low tolerance to itching, irritation, or severe vesicle and bullae formation
49
Q

Describe atopic dermatitis

A
  • genetic based
  • chronic relapsing skin disorder
  • usually begins in infants or early childhood and may last into adulthood

**most common dermatological condition in children

**exact cause is unknown

50
Q

atopic dermatitis causes a __% incidence people with 2 parents that have eczema

A

70

51
Q

atopic dermatitis causes a __% incidence in the general population

A

17

52
Q

Describe the pathophysiology of atopic dermatitis

A

chronic inflammatory skin disease associated with cutaneous and mucous membranes hyper-reactivity toward environmental triggers that are innocuous to normal, non-atopic individuals

53
Q

80-85% of people with atopic dermatitis have high levels of ____

A

IgE

54
Q

Signs and symptoms of atopic dermatitis (eczema)

A
  • pruritus (itching)
  • no primary skin lesion
  • skin dry and lesions are scaly (although they may be vesicular, weeping and oozing in the acute stage)
55
Q

If Pts have reacted to wool before, don’t recommend creams with ______

A

lanolin

56
Q

Can we diagnose eczema?

A

no

-but we can recommend treatment for already diagnosed eczema

57
Q

What is the diagnostic criteria for atopic dermatitis (eczema)

A
  • onset before 2 years old
  • history of skin crease involvement
  • history of generally dry skin
  • personal history of other atopic disease (or history of any atopic disease in 1st degree relative in children <4 yrs)
  • visual flexural dermatitis
58
Q

What is a 1st degree relative?

A

parent or sibling

59
Q

What are some risk factors for atopic dermatitis?

A
  • genetics
  • environmental allergens
  • climate (cold, dry weather)
  • sweating
  • physiologic stress
  • dietary influences
  • irritants
  • infections
  • itch-scratch cycle
60
Q

When do you refer atopic dermatitis? (eczema)

A
  • if dermatitis is acute and vesicular
  • if it is a severe condition with intense pruritus
  • if moderate to severe defined as:
  • large area of the body
  • remains unresponsive
  • skin appears to be infected
  • <2 years of age
  • interferes with activities of daily life or sleep patterns
61
Q

Explain atopic triad

A

If you have one atopic condition, you are at risk of developing other atopic conditions

*so you want to be sure to document in their file somewhere that they have this atopic condition so other HCPs are aware of it

62
Q

Goals of treatment for dermatitis

A
  • eliminate trigger factors or contact exposure to irritants and allergens
  • provide symptomatic relief
  • decrease skin lesions
  • implement preventative measures
  • develop coping strategies
63
Q

non-pharmacological treatment for contact dermatitis?

A

-immediatley wash with soap and water
-avoid or remove the allergen
(tips on reducing exposure)
-take cold or tepid soapless showers
-avoid scrubbing affected area
-remove and wash all clothing exposed to irritant/allergen
-use wet compresses for acute keeping or oozing lesions

64
Q

Treatment for contact dermatitis

A
  • identify and avoid irritant
  • wet compresses for 20 minutes 4-6 times per day
  • topical steroid may be used to treat symptoms on a short term basis
  • acute symptoms should resolve within 7-10 days
  • in addition, an oral antihistamine may be added to therapy
65
Q

Treatment of poison ivy

A
  • shower after exposure
  • wash all items exposed to plant using oil free soap
  • application of topical corticosteroid
  • oral antihistamines PRN (For itching)
66
Q

When can initial rash of poison ivy appear?

A

can appear up to 9 days after exposure

but with previous exposure (like you’ve had the rash before) the rash may appear within 1-2 days after contact

67
Q

What 4 things do a corticosteroid do?

A
  • suppresses immune system
  • decreases IS response
  • decrease inflammation
  • relieve itch
68
Q

How do you prevent poison ivy?

A
  • total avoidance of plant
  • wear protective clothing that can be removed
  • wash objects that have come into contact with the plant
69
Q

should you burn poison ivy?

A

NO! - can cause rash/rxn in respiratory tract if the smoke is inhaled

70
Q

SEE MONITORING ON PAGE 698 OF TEXT BOOK

table 7

A

okay man no need to yell

71
Q

Non-pharmacological treatment for atopic dermatitis?

A
  • bathing in lukewarm water for 5 mins, every other day with tepid water - use mild non-soap cleansers
  • pat skin dry, don’t rub
  • trim nails short and smooth
  • avoid occlusive, tight clothing
  • wash new clothing before wearing
  • limit exposure to sudden temperature changes, maintain moderate humidity
  • avoid triggers
  • use wet compresses for acute weeping or oozing lesions
  • keep skin hydrated
72
Q

Treatment for atopic dermatitis

A

when skin is dry with mild itch or irritation:
-emollient or barrier repair treatment recommended twice daily and after bathing

in an acute flare:

  • topical corticosteroid or barrier repair therapy applied to the affected area
  • skin lesion should resolve in two weeks
  • if effective - reinforce emollient use for prevention
  • if not effective - refer to physician
73
Q

Topical calcineurin inhibitors are another Rx product - they are used for long-term therapy for atopic: Describe tacrolimus (protopic)

A
  • can be used on face and neck
  • only used in children older than 2
  • reduces itching and inflammation
74
Q

Topical calcineurin inhibitors are another Rx product - they are used for long-term therapy for atopic: Describe pimecrolimus (Elidel)

A
  • causes less burning and itching than Protopic
  • lower cost
  • only used in children older than 2
75
Q 
OTC treatments for atopic dermatitis include:
-skin protectants
-oral antihistamines
-moisturizers
-skin cleansers
-astringents:
List some skin protectants
A

calamine lotion
zinc oxide
colloidal oatmeal
sodium bicarbonate

76
Q

How do oral antihistamines work?

A

by blocking H1 receptors therefore decreasing itch caused by histamine

  • cause drowsiness
    eg. diphenhydramine 25-50 mg (Benadryl)

Histamine is not really involved so oral antihistamines aren’t really effective but they can make you drowsy and allow you to sleep & heal

77
Q

List the 4 R’s of management of atopic dermatitis

A

Recognize - diagnose condition and seek treatment early

Remove - triggers

Restore - moisturizers/ointments

Regulate - treatment (OTC & RX)
-follow up

78
Q

See monitor therapy for atopic, contact or stasis dermatitis on pg 698 of text

A

OOOOOO TAY

Clinical 1 (Part A) (15 decks)

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