Dermatitis, Burns, Cellulitis Flashcards
Atopic Dermatitis: What is it?
- most common form of dermatitis
- AKA eczema
- affects between 10-15% of children in U.S.
- 90% of patients experience remission by puberty
- common in those with other atopic illnesses (asthma, allergic rhinitis)
- usually begins before age 5 in children
Atopic Dermatitis: Risk Factors
- family history of atopy
- repeated skin infections
Atopic Dermatitis: Assessment Findings
Pruritic, ill-defined, red scaly plaques often seen on the face, neck, and upper trunk, and flexural surfaces of knees and elbows
** In patients with dark skin, the pigmentation may be lost in areas of lichenification when severe disease is present
Atopic Dermatitis: Diagnostic Tests
- clinical exam
- may also see increased IgE levels and eosinophils
- may need a culture to rule out staph
** New diagnoses should not be made in those 30 and older without consultation with a dermatologist.
Atopic Dermatitis: Non-Pharmacologic Management
- gentle skin cleansing
- avoid low-humidity environments (flares common in winter)
- only bathe once daily and confine soap to armpits, groin, scalp, and feet in adults
- pat skin dry; do not rub
- immediately apply a thin film of emollient after bath/shower
- avoid wools and acrylics, sweating, and heat
Atopic Dermatitis: Pharmacological Therapy for Mild Disease
** Antihistamines and topical steroids are mainstay
1. Low-potency topical corticosteroids (TCS) [triamcinolone] once daily for 2-4 weeks.
- If improvement is seen, use emollients and intermittent use of TCS.
- If there is no improvement, assess triggers, adherence to treatment, check for infection, or switch to a topical calcineurin inhibitor (TCI) such as tacrolimus (if the child is> 2 years old).
- If still no better after 2-4 weeks, switch to a medium-to-high-potency TCS twice daily for 2-4 weeks (in consultation with and probable referral to a dermatologist).
Atopic Dermatitis: Tapering Steroids
- In general, for treatment of lesions on the body (excluding genitalia, axillary or crural folds), one should begin withtriamcinolone0.1% or a stronger corticosteroid
- then taper tohydrocortisoneor another slightly stronger mild corticosteroid (alclometasone,desonide).
- It is vital that patients taper off corticosteroids and substituteemollientsas the dermatitis clears to avoid side effects of corticosteroids.
- Tapering is also important to avoid dermatitis flares that may follow abrupt cessation
Atopic Dermatitis: Pharmacologic Management in Moderate to Severe Disease
- Medium to high potency topical corticosteroids to affected areas BID for 2-4 weeks
- Use low to medium potency topical corticosteroids or topical calcineurin inhibitor (TCI) for areas at increased risk of skin atrophy (face, neck, skin folds)
THEN… - Reassess after 2-4 weeks
IF NO IMPROVEMENT… - Refer
Non-Steroidal Pharmacological Treatment for Atopic Dermatitis
- tacrolimusointment (Protopic 0.03% or 0.1%)
- pimecrolimuscream (Elidel 1%)
- crisaborole(Eucrisa 2%)
- ruxolitinib(Opzelura 1.5%)
** may be effective in managing atopic dermatitis when applied twice daily
** burning with application occurs in about 50% of patients using Protopic and 10–25% using Elidel but may resolve with continued treatment.
Seborrheic Dermatitis: What is it?
- AKA cradle cap
- a chronic, superficial, papulosquamous disorder affecting the hairy areas of the body, such as the scalp, eyebrows, and face
- possible causes include genetics and environment
Seborrheic Dermatitis: Risk Factors
- common throughout the lifespan
- affects men more often
- emotional stress
- family history
- Parkinson’s
- HIV
- cold/dry weather
Seborrheic Dermatitis: Assessment Findings
- the mildest and most common form of seborrheic dermatitis is dandruff
- blepharitis with redness of the free margin of the eyelids and yellow crusting between the eyelashes may be the sole manifestation of seborrheic dermatitis or may accompany its more classic distribution.
- well demarcated erythematous plaques with greasy-looking, yellowish scales most commonly on oily areas of the skin such as:
- scalp
- external ear
- center of the face
- upper part of the trunk
- interiginous areas
Seborrheic Dermatitis: Diagnostic Studies
Usually clinical exam
Seborrheic Dermatitis: Scalp Treatment Mild Disease
- ketoconazole shampoo 2% 2-3 times per week
THEN… - Reassess after 4 weeks
IF NO IMPROVEMENT… - Add a high-potency topical corticosteroid once daily until symptoms subside or up until 4 weeks
IF STILL NO IMPROVEMENT… - Systemic antifungal (itraconazole 200 mg PO QD x 7 days)
** If still no improvement, reconsider diagnosis
** If improvement is seen at any point, use the shampoo once or twice a week to prevent relapse
Seborrheic Dermatitis: Scalp Treatment Moderate to Severe Disease
- Ketoconazole shampoo 2-3 times per week
AND - High-potency topical corticosteroid QD until symptoms improve or up to 4 weeks
** If improvement is seen at any point, use the shampoo once or twice a week to prevent relapse
Seborrheic Dermatitis: Non-Scalp Treatment Mild Disease
- Topical antifungal once or twice daily
THEN… - Reassess at 4 weeks
IF NO IMPROVEMENT… - Add a low potency TCS cream/gel once or twice daily until symptoms subside or up to 2 weeks
IF STILL NO IMPROVEMENT… - Switch to a TCI (tacrolimus) and reassess after 4 weeks
** If no improvement after all this, reconsider diagnosis