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
Contact Derm tx for weeping lesions
- Astringents (drying agents): aluminum acetate, zinc oxide, calamine, witch hazel
- protective covering
Contact Derm OTC tx ingredients
- aveeno: colloidal oatmeal
- burrow’s solution: aluminum acetate
- calamine lotion: calamine
Cortaid: hydrocortisone
Contact Derm general tx plan
- hydrocortisone 1% cream to affected areas 3-4x/day
- domeboro soaks as needed to decrease itching
- repeat as long as blisters do not get larger
- call physician if sx worsen or no improvement within 2 weeks
Diaper dermatitis
red to bright red, sometimes shiny, wet-looking patches and lesions
Diaper dermatitis affects who?
babies and adults who wear diapers
Diaper dermatitis causes
- occlusion (urine and stool)
- moisture
- bacteria
- pH changes
- chafing and friction
Diaper derm referral
- lesions present >7 days with no improvement despite tx
- secondary infection
- rash outside of diaper area
- broken skin
- oozing or blood or pus
- fever, diarrhea, n/v, ect
- behavior changes
- blisters
- co-morbid conditions (HIV, immunosuppression)
Diaper derm tx
- keep skin clean and dry
- frequent diaper changes
- diaper free time
- avoid alcohol based wipes or fragrances
- use topical agent right before putting on diaper to create barrier
Diaper derm topical agents
allatonin, calamine, cocoa butter, cod liver oil, colloidal oatmeal, dimethicone, kaolin, lanolin, mineral oil, zinc, etc
- DO NOT USE: antimicrobials, antifungals, external analgesics, boric acid, baking soda (bicarb)
OTC tx
Popular brands: A&D: petrolatum, lanolin A&D + zinc: zinc oxide 10%, dimethicone Desitin: zinc oxide 40% Bourdreaux's Butt Paste: zinc oxide 16% (SEE CHART for more)
Diaper derm prevention
- keep clean and dry
- frequent changes
- don’t over-tighten diapers
- use hot water to wash hands and dirty clothes
- skin protectant: A&D for preventative; Desitin to dy out rash
- yeast suspected: clotrimazole
- hydrocortisone: BID, less than 7 days
- combo tx
