Dermatitis Flashcards
Atopic Dermatitis (eczema) triggers
foods, soaps, detergents, fragrances, chemicals, temp changes, dusts, some bacteria, stress/emotional changes
Atopic Dermatitis referral
- Intense pruritis
- large areas of the body
- < 2 y/o
- skin appears infected: yellowish crusting, pustules, or vesicles
- intertriginous involvement
- after 2 weeks of tx, sx getting worse
Atopic Dermatitis Pharmacological
- hydrocortisone 1% cream/ointment applied sparingly, 3-4 times daily, for 7 days max
- add antihistamine for itch
- AVOID antihistamine in elderly, and avoid gel (contains alcohol)
Atopic Dermatitis non-pharmacological
- minimize length and number of hot showers
- use hypoallergenic soap such as Cetaphil
- pat dry and apply cream moisturizer within 3 min of washing
- apply moisturizer liberally as needed
- Keep cook and humidity > 50%
- reduce stress
What is Dermatitis
- inflammatory erythematous rash
- atopic dermatitis (exzema)
- seborrheic dermatitis
- contact dermatitis
- diaper dermatitis
Atopic Dermatitis risk factors
- Genetic, chronic relapsing disorder
- most common derm condition in children
- affects male/female equally
- more common in urban areas
Atopic Dermatitis diagnostic criteria
- Itching PLUS >/= 3 of the following:
- onset at < 2
- history of skin crease involvement
- hx of dry skin
- hx of asthma or allergic rhinitis
- 1st degree relative with atopic disease
- visible flexural dermatitis
Common characteristics
- 2 months - chest/face - red, raised vesicles, dry skin, oozing
- 2 years - scalp/neck/extremities - less acute lesions, edema, erythema
- 2-4 years - neck/wrist/elbow/knee - dry, thickened plaques, hyperpigmentation
- 12-20 years - flexors/hands - dry, thick plaques, hyperpigmentation
Hydrocortisone patient education
- relief of inflammation and itch
- apply 2-4x daily
- small amount of cream
- avoid face unless directed by physician, avoid eyes, do not use for longer than 7 days
Atopic Dermatitis alternative tx
- monoclonal abx
- phototherapy
- coal tar
- chinese herbal tx
- probiotics
Seborrheic dermatitis
- red, scaly, itchy rash
- sebaceous glands location (scalp, face, trunk)
- more severe in winter
- common in: infants, parkinson’s, Zinc deficiency, HIV
Dandruff (compare to seborrheic derm)
- location: scalp
- Exacerbating factors: dry climate, but usually stable
- Appearance: think, white flakes, even distribution
- Inflammation: absent
- Epidermal hyperplasia: absent
- Cell turnover: 2x normal
- Incompletely keratinized cells: rarely > 5%
Seborrheic dermatitis (compare to dandruff)
- location: head and trunk; children only - back, intertriginous areas
- exacerbating factors: mainly external factors, stress
- Appearance: macules, patches, thin plaques of yellow color, oily scales on red skin
- Inflammation: present
- Epidermal hyperplasia: present
- Cell turnover: 3x norma
- incompletely keratinized cells: 15-25%
Seborrheic Derm referral
- < 2 y/o
- worsening or NO improvement after 2 weeks of proper OTC product use
Seborrheic Derm tx infants
- typically self-limiting
- mild to moderate cases: massage scalp with baby oil and non-medicated shampoo
- severe cases: warm olive oil compress with salicylic acid (3-5%) followed by gentle shampoo
- severe cases: hydrocortisone 1% can be applied
Seborrheic Derm tx adults
- shampoo several times/week
- pyrithione zine, selenium sulfide, sulfur, ketoconazole, salicylic acid, or coal tar
- if erythema present: hydrocortisone 0.5-1%, 2-3x daily until sx subside, apply directly on scalp, use for < 7 days
OTC tx ingredients
include: ketoconazole, pyrithione zinc, salicylic acid, selenium sulfide, sulfur, hydrocortisone
Contact Dermatitis symptoms
inflammation, redness, itching, burning, stinging, and vesicle/pustule formation of skin exposed to allergens
Contact Derm causes
strong acids/bases, detergents, epoxy resins, oils/fragrance, solvents, oxidizing/reducing agents, plants
Contact Derm from plants
Poison oak
Poison ivy
Poison sumac
Sap (contains uroshiol toxin); can remain under fingernails
Irritant contact derm (compare to allergic)
- Itching: yes (later)
- Stinging/burning: early
- Erythema: yes
- Vesicles/papules: rare or none
- Dermal edema: yes
- Delayed rxn to exposure: minutes-hours
- Causative agents: acids/bases, solvents, oxidizers
- MOA: direct tissue damage
- Presentation: no clear margins
Allergic contact derm (compare to irritant)
- Itching: yes (early)
- Stinging/burning: Late or none
- Erythema: yes
- Vesicles/papules: yes
- Dermal edema: yes
- delayed rxn to exposure: Days (slower rxn)
- Causative agents: fragrances, metals, plants
- MOA: immunologic rxn
- Presentation: clear margins based on contact
Contact Derm Referral
- < 2 y/o
- present for > 2 weeks
- more than 20% surface area
- numerous bullae
- extreme itching, severe vesicle formation
- swelling
- swollen eyes/eyelids
- discomfort in genitalia from itching/swelling
- involvement of mucous membranes
- signs of infection
- no improvement with self-tx after 7 days
Contact Derm tx for itching
- Hydrocortisone
- oral antihistamines: Benadry/diphenhydramine (drowsy), Claritin/Loratadine (non-drowsy), Allergra/Fexofenadine (non-drowsy)
- calamine lotion
- colloidal oatmeal