Dermatitis Flashcards
Two types of contact dermatitis:
- irritant
- allergic
Irritant contact dermatitis (ICD) is the…
inflammatory reaction of the skin caused by exposure
Allergic contact dermatitis is the…
immunologic reaction of skin caused by exposure
Majority of cases of irritant contact dermatitis are related to…
occupation
- water exposure
- chemical exposure
- cleaning substances
Clinical presentation of ICD:
- inflammation
- swelling
- redness
- itching
- stinging
- rash
Severity of ICD is determined by…
- quantity
- concentration
ICD treatment:
- avoid irritants
- immediately wash exposed areas w/ warm water and mild soap
- use emollients, moisturizers, and barrier creams for prevention
Which OTC treatments should be avoided for ICD?
- topical caine-type anesthetics
- topical corticosteroids
T/F: allergic contact dermatitis (ACD) appears on first contact
F, initial exposure sensitizes immune system and the second contact induces immune response
Examples of ACD antigens:
- toxicodendron genus (poison ivy, urushiol)
- metal allergy
- latex
- neomycin
Clinical presentation of ACD:
- rash anywhere on body that contacts the antigen
- can be transferred
- papules
- small vesicles
- larger bullae
- inflamed and swollen skin
- prominent itching
Exclusions of self-treatment of ACD:
- < 2 YO
- dermatitis present > 2 weeks
- failure of self-management after 7 days
- involves > 20% of body surface area
- signs of infection
- swelling of body
- discomfort in genitalia
- involves mucous membranes
Non-pharmacologic treatment of ACD:
- wear long pants and sleeves
- use barrier products
- immediately wash exposed area
- trim fingernails to help reduce scratch injuries
Bentoquatam (Ivy block) lotion is the only…
FDA approved product to provide protection against exposure to poison ivy/oak/sumac
- non-pharmacologic
Counseling points for bentoquatam (Ivy block) lotion:
- apply at least 15 minutes before exposure
- apply generously to clean, dry skin
- reapply every 4 hours
- remove with soap and water
- do not use < 6 YO
Pharmacologic treatments of ACD:
- oral antihistamines
- topical hydrocortisone creams
- calamine lotion
- colloidal oatmeal baths
Examples of oral antihistamines:
- for itching
- cetirizine (Zyrtec)
- diphenhydramine (benadryl)
What types of topical ointments and creams should not be used for ACD?
- anesthetics
- antihistamines
- antibiotics
Calamine lotion should only be used on ____ for ACD
non-weeping lesions
Topical hydrocortisone counseling points:
- for inflammation
- apply QD or BID
- don’t use dressings or bandages
- don’t use < 2 YO
- max of 7 days
- if affected area is larger than 20%, topicals would not be recommended
Astringents should be used for ACDs with…
weeping wounds
Astringents:
- slow oozing, discharge, or bleeding
- cools and dries skin through evaporation
- causes vasoconstriction, which reduces blood flow in inflamed tissue
- can cleanse skin of crust and debris
Activity of astringents are limited to…
cell surface
Examples of FDA category 1 astringents:
- aluminum acetate (burrow’s solution)
- witch hazel (hamamelis water)
Alternatives to astringents:
- isotonic saline solutions (1 tsp salt and 2 cups of water)
- white vinegar with tap water (1/4 cup to 1 pint of water)
When should you follow up with ACD treatment?
w/in 5-7 days of treatment
When should you refer to MD after ACD treatment?
if rash increased significantly in size, affects eyes, genitals, or even covers extensive areas of face
When would complete remission of ACD occur?
up to 3 weeks
- should see reduction in itching, weeping, inflammation after 5-7 days of therapy
Majority of diaper rash cases appear in…
infants < 2 YO
Causes of diaper rashes:
- occlusion: tight fitting diapers
- moisture: held in diapers
- microbes
- mechanical chafing and friction
- high sugar foods and dairy -> diarrhea
- breast-fed have less incidents
Presentation of diaper rashes:
- red to bright red rash
- can be shiny or wet looking
- severe: papule formation with oozing
- occurs in area covered by diaper
Exclusions for self-treatment of diaper rashes:
- lesions present > 7 days
- fever, diarrhea, nausea, vomiting
- secondary infections
- rash outside diaper region
- comorbid conditions
- broken skin
- behavioral changes
Examples of non-pharmacologic treatment for diaper rashes:
- increase frequency of diaper changes
- try to change immediately after infant urinates
- use plain water or sensitive baby wipes
- allow for drying before re-diapering
Pharmacologic treatment of diaper rashes:
skin protectants, which serve as a physical barrier between skin and irritants
Skin protectants for diaper rashes:
- absorbs or prevent moisture
- used in treatment and prevention
- should monitor because some have non-FDA approved ingredients
Examples of skin protectants:
- zinc oxide: most commonly used
- calamine: mix of zinc and ferrous oxides
- mineral oil
- petrolatum
- lanolin-bacterostatic product
- dimethicone: repels water and soothes inflammation
- topical cornstarch and talc: not on broken skin
What agents are excluded from self-care use for diaper rashes?
- topical nonrx antibiotics or antifungal
- topical analgesics
- hydrocortisone cream
Why are topical analgesics not recommended for diaper rashes?
it can alter sensory perception in infants who can’t communicate the changes
Why are hydrocortisone creams excluded from self-care use for diaper rashes?
- not for < 2 YO
- should be used under medical supervision
- can increase risk of infections
How long should treatment of diaper rashes be?
7 days
What should one do if diaper rash has improved but not healed by 7 days?
continue therapy for 3 more days or until resolution
What should one do if diaper rash isn’t improved or worsened after 7 days of treatment?
see MD
What could you use for a diaper rash that recurs often?
prophylactic use of skin protectants
What causes heat rashes?
- blocked or clogged sweat glands
- inability to sweat causes dilation and rupture of epidermal sweat pores
Heat rash causes…
acute inflammation, which results in stinging, burning, or itching
Presentation of heat rash:
pinpoint lesions that are raised or red
- self limiting
Common sites of heat rash:
- axillae
- chest
- upper back
- back of neck
- abdomen
Non-pharmacologic therapy for heat rash:
- decrease sweating
- increase air flow to area
Pharmacologic therapy for heat rash:
- want to use water-washable, cream based products
- self-limiting so don’t need to use anything
- hydrocortisone cream
- moisturizing lotions
- colloidal oatmeal baths
- above three alleviate symptoms of itching
