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PCC Lectures > Dermatology II > Flashcards

Dermatology II Flashcards

1
Q

What is the epidermis?

A

The outer layer, stratum corneum at the surface

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2
Q

What is the dermis?

A

Contains nerve endings, vasculature, and hair follicles

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3
Q

What is the hypodermis?

A

Provides nouishment and cushioning for the upper two layers

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4
Q

What is pruritus?

A

Sensation to scratch

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5
Q

How does drug absorption with topical work?

A
  • Most of the drug that gets absorbed in the skin is from passive diffusion (when applied topically)
  • Drug absorption can vary depending on the thickness of the skin, thinner = more permeable, allowing more substance to get through
  • Thick part of the skin is in the hands and sole
  • thin parts are like the eye lids
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6
Q

What are creams and lotions?

A
  • Oil in water emulsion
  • Less greasy
  • Cooling effect
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7
Q

What are ointments?

A
  • Water in oil emulsions
  • Greasy feeling
  • Long lasting
  • Occulusive effect
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8
Q

Describe irritant contact dermatitis (ICD).

A
  • Inflammatory skin, direct damage to the epidermal layer
  • Mostly on hands and forearms
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9
Q

Describe allergic contact dermatitis (ACD).

A
  • Immunologic skin reaction, contact with allergenic substance.
  • Can affect any part of the body.
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10
Q

Describe contact dermitis.

A
  • 3 steps: irritation and disruption of the skin barrier, stimulations of epidermal cells, release of proinflammatory cytokines
  • Substance commonly associated with irritant contact dermatitis
  • Acids, alkalis, detergents, disinfectants/antiseptics, foods, oils, radiation, sunscreen, urine/feces, water, and wood dust.
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11
Q

What are the ICD goals of contact dermatitis?

A
  • Prevent contact with irritant
  • Prevent reoccurence and secondary infection
  • Relieve inflammation and irritation
  • Educate the patient on self-management
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12
Q

What are signs of infection for contact dermatitis?

A
  • Fever
  • Increase redness
  • Swelling
  • Increase pain or tenderness
  • Pus or discharge
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13
Q

What are preventative measures for contact dermatitis?

A
  • Frequent changes in coverings, avoiding the irritant
  • Applying a barrier to the skin can be helpful as well
  • Ointments are better to use if the irritant is aqueous solution
  • Lotion and creams are better for lipophilic materials
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14
Q

What are non-pharm treatments for contact dermatitis?

A
  • Remove contact with irritant
  • Washing with hypoallergenic soap
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15
Q

What are pharmacological treatments for contact dermatitis?

A
  • Burow’s solution (aluminum acetate 5% solution)
  • Cooling, anti-inflammatory, and antibacterial effects
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16
Q

What is the role of petrolatum jelly (Gold Standard)?

A
  • Prevents water loss due to its ointment properties
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17
Q

What is contact dermatitis- ACD?

A
  • Delayed hypersensitivity reaction form exposure to a foreign substance–Type IV
  • Delayed hypersenesitivity reaction, occurs between 1-21 days
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18
Q

What are common substances that cause ACD?

A
  • Poison ivy, poison oak, poison sumac, kewelry, clothing, and electronics
  • Nickel, fragrances, rubber, neomycin
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19
Q

What are ACD allergens?

A
  • Toxicodendron, poison ivy, oak and sumac (Urushiol)
  • General appearance is three leaves growing from a central stem.
  • Poison Ivy – grown in central and northeastern part of the states
  • Poison Oak – located along the west coast and southern areas of the states
  • Poison Sumac – mid west and some parts of the east in the states
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20
Q

What are key presentation characteristics of allergic dermatitis?

A
  • Ballae
  • Vesicles
  • Oozing/Weeping
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21
Q

What are the goals of contact dermatitis ACD?

A
  • Remove and avoid contact from offending agent
  • Treat inflammation and relieve itching/scratching
  • Relieve accumulation of debris from oozing, crusting, and scaling
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22
Q

What are non-pharm treatments for ACD?

A

Prevent contact with urushiol
* Eradication of Toxicodendron plants

Prevent spread of urushiol
* Inanimate objects can carry
* Handwashing to prevent transfer
* Wash exposed area with water and a mild soap

Relief of itching
* Cold or lukewarm soap-less showers

Products that remove urushiol
* Zanfel and Tecnu
* Both are not FDA approved
* Zanfel – removes Toxicodendron induced ACD
* Tecnu – chemical deactivator removes the urushiol oil on the skin
* Applied to skin ASAP and repeated as needed

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23
Q

What are pharmacological treatments of ACD?

A

Pruritus (itching)
* Topical anesthetics, antihistamine (diphenhydramine), or antibiotics should NOT be used
* Known to cause drug-induced ACD which could mask existing symptoms
* First generation oral antihistamine may be used for sedation at bedtime

Weeping
* Aluminum acetate solution (Burrow’s solution)

Inflammation
* OTC Hydrocortisone cream (0.5% and 1%)
* RX Hydrocortisone cream (2% and 2.5%)
* Low potency steroid to reduce inflammation and pruritus
* For mild to moderated symptoms of ACD

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24
Q

What are exclusions to self-care for contact dermatitis?

A
  • <2 years of age
  • Dermatitis present >1 week (with self-care)
  • Chronic dermatitis symptoms
  • Body Surface Area (BSA) Greater than: 10% (ICD) or 20% (ACD)
  • Extreme itching, irritation, or severe vesicle formation
  • Swelling of the body, extremities or eyelids/area around the eye
  • Discomfort in mouth, nose, eyes, anus or genital area from itching, redness, swelling, or irritation
  • Signs of infection
  • Involvement of face scalp or neck
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25
Q

What is the background for scaly dermatitis?

A
  • Includes dandruff, seborrheic dermatitis, and psoriasis
  • Increasing amount of inflammation and scaliness: Dandruff, seborrheic, and then psoriasis
  • Really only effect the top layer of the skin (epidermis)
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26
Q

What is scaly dermatitis caused by?

A
  • Malassezia yeast
27
Q

How does scaly dermatitis present?

A

Presentation: mild inflammation, flaking, and pruritus.
* Small white or gray loosely bound flakes
* Typically, the least likely to be inflamed

28
Q

What is the seborrheic background?

A
  • More severe form of dandruff Malassezia species
  • More common in areas with dense distribution of sabaceous glands (head, face, chest, eyebrows, eye lids)
29
Q

What is the pathophysiology of psoriasis?

A
  • Immunologic mechanism: T-cell induction, keratinocyte and epidermal proliferation
  • Genetic predisposition
30
Q

How does psoriasis present?

A
  • Starts as small papules which grows and unites to form plaque
  • Commonly on elbows, knees, lumbar region, scalp, and trunk
31
Q

What are psoriasis triggers?

A
  • Environmental factors, physical, ultraviolet, and chemical injury
  • Various infections
  • Rx drug use and withdrawal of systemic corticosteroids
  • Emotional and psychological stress
  • Use of alcohol and tobacco
32
Q

What are the goals of treatment for scaly dermatitis?

A
  1. Redice the epidermal turnover rate, decrease Malassezia fungi
  2. Minimize the cosmetic embarrassment of visible scaling
  3. Minimize itch
33
Q

What is the first line of treatment for scaly dermatitis?

A
  • Pyrithione zinc (0.1% - 0.25%)
  • Selenium sulfide (1%)
  • Important to have long enough contact time of 3-5 mins
34
Q

How long do you use dandruff medication?

A
  • Use daily for 1 week
  • Used for maintenance after initial treatment (2-3 times a week)
35
Q

How long do you use medication for seborrheic dermatitis?

A
  • Used daily for 1-2 weeks
  • Slowly decrease frequency
36
Q

What are psoriasis treatment options?

A

Topical steroids or emollients
Removal of scales
* Continues to cause further growth of plaque
* Less penetration with topical agents
* Daily lubrication of the skin after bath to remove scales

Cytostatic agent
* Coal tar (Creams, ointments, pastes, lotions, bath oils, shampoos)
* Applied to selected area
* Discoloration

Antifungal agents
* Ketoconazole 1% (OTC) for Malassezia
* AW- hair loss, skin irritation

Keratolytic agents
* Salicylic acid
* 1.8-3% for self-care for all three conditions
* MOA: decreases the skin pH, making it easier to remove the keratin

Sulfur (dandruff only)
* 2-5% concentration

Topical hydrocortisone
* Inflammation treatment only (SB and Psoriasis)

37
Q

What is Cradle Cap?

A
  • Scaly Dermatitis
  • Usually occurs in the first three months of life
  • Yellow-brown greasy scales on the scalp
  • Can go to the face, neck, and trunk
  • Treatment: Gently massaging baby oil into the affected area followed by a non-medicated shampoo
  • Refer to pediatrician if therapy fails (after 7 days)
38
Q

What are exlusions to self-care for scaly dermatitis?

A

Dandruff, seborrheic, and psoriasis:
* <2 years old
* Worsening symptoms or no improvement after 2 weeks of proper OTC treatment

Psoriasis Only:
* >5% BSA (Lesions larger than a size of a quarter)
* Involvement of the face
* Presence of joint pain
* More than a few lesions

39
Q

What is the pathophysiology for acne?

A

Overview
* Sebum production by the sebaceous gland
* Follicular colonization (cutibacterium acnes)

Etiology:
* Condition, genetics, diet, gender

Different types of presentation:
* Close comedo (whiteheads) or open comedo (blackheads)
* Papule and Nodule

40
Q

What are exacerbating factors?

A
  • Acne cosmetica
  • Acne excoriee (excoriated)
  • Acne mechanica
  • Drug-induced acne
  • Hormone-induced acne
  • Hydration-induced acne
  • Occupational acne
  • Stress/Extreme-emotion induced acne
41
Q

What are the goals of acne care?

A
  1. Eliminate visible lesions
  2. Maintaining treatments ro prevent relapse
  3. Treat scarring or other complications
42
Q

What are non-pharmacological treatments for acne?

A
  • Identifying the type of acne
  • Eliminating exacerbating factors
  • Cleanse with a mild soap and water
  • Hydration
  • Dietary changes (fruits and vegetables)
43
Q

Whan are Non-Rx Pharm Treatment for Acne?

A

Different formulations:
* Cleansers – removes dirt, makeup, or oil from the area
* Creams – Mostly water based, allows easier absorption
* Gels – water based, lighter compared to ointments
* Astringents – causes tissues to contract/shrink

44
Q

What are pharmacological treatments for acne?

A
  • Adapalene 1% (OTC) – higher strength requires Rx
  • MOA: modulate cellular differentiation, keratinization, and inflammatory process
  • AE: Redness, drying, scaling, and burning
  • Typically, in front month of therapy
  • Acne may worsen if the first few weeks
  • Therapeutic effects occurs with 8-12 weeks of therapy
  • Avoid excessive sun exposure
  • Benzoyl Peroxide 2.5%-10% (OTC)
  • MOA: keratolytic and inhibits C. Acnes
  • AE: Burning, skin peeling, scaling
  • Apply 1-2 small amounts onto affect area once daily x 3 days
  • May increase to 2-3 a day if able to tolerate symptoms
  • Decrease frequency if unable to tolerate
  • Avoid excessive sun exposure
  • Salicylic acid (beta hydroxyl acid)
  • MOA: lowers skin pH to break up the epidermis layer (unclog pores)
  • AE: burning sensation, redness
  • May take up to 8 weeks to see efficacy
  • Applied 1-3 times a day
  • Cleanser or topical gel
  • Gel formulation, only on affected areas
  • Avoid excessive sun exposure
  • Azelaic Acid
  • MOA: Inhibits C. acnes growth
  • Used twice daily (gels, creams, or lotion)
  • Less irritation than salicylic acid
    Sulfur
  • MOA: Inhibits C. acnes growth
  • Used 1-3 times daily
  • Unpleasant odor/chalky consistency
  • Do not use in sulfa allergy patients
45
Q

What are exclusions to self-care for acne?

A
  • Moderate to severe acne
  • Exacerbating factors
  • Possible rosacea

Severe Acne: extensive pustules, multiple nodules with inflamed skin

46
Q

What is the background for diaper dermatitis?

A
  • Most known as diaper rash
  • Most occurs from the first few years of life from build up of urine and feces with occlusion

Prevention:
* Frequent changes in diaper for infants (every 2 hours)
* Keeping area clean and dry

Clinical presentation – bright red and moist area

47
Q

What are the goals of diaper dermatitis?

A
  1. Relieve symptoms
  2. Prevent reoccurrence
  3. Prevent secondary infection
48
Q

What are the treatments for diaper dermatitis?

A
  1. Air
  2. Barrier
  3. Cleansing
  4. Diaper Change
  5. Education
49
Q

What are treatment options for diaper dermatitis?

A

Non-pharmacological
* Frequent diaper changes, keeping area dry and clean, contact with air

Pharmacological – apply a skin protectant
* Allows a barrier between skin and diaper to treat or prevent further irritation
* Calamine
* Cocoa butter
* Petrolatum

50
Q

What are treatments for diaper dermatitis?

A

Contraindications
* Anti-fungal agents
* Anti-bacterial agents
* Hydrocortisone

If fungal or bacterial infection – refer to PCP

Patient unable to communicate any changes

51
Q

What are the exclusions to self care for diaper dermatitis?

A
  • Lesions present >7 days
  • Lack of improvement despite appropriate care (7 days)
  • Secondary infection
  • Lesions cause by another disease state
  • Presences of diaper dermatitis outside of diaper region
  • Oozing, blood, vesicles, or pus at legion site
  • Significant behavioral change
  • Comorbid conditions (HIV, organ transplant)
52
Q

What is the background for prickly heat?

A

Pathophysiology- caused by partially clogged sweat glands.

Hallmark presentation- pinpoint sized lesions that are raised and red or maroon.

53
Q

What are goals of prickly heat treatment?

A
  1. Eliminate occlusions of the skin
  2. Protect the skin from further irritation
  3. Promote healing of the skin
54
Q

What are non-pharm treatments for prickly heat rash?

A
  • Cooling down area
  • Remove occlusions to the skin
  • Washing and drying skin
55
Q

What are pharm treatments for prickly heat treatment?

A
  • Emollients, Skin Protectants, and Antipruritic
  • Hydrocortisone (adults only)
56
Q

What are exclusions for self-care for prickly heat rash?

A
  • High fever without sweating
  • Heat Exhaustion–> Heat Stroke
  • Slow or weak pulse
  • Lethargy
  • Cold and pale clammy skin
  • Absence of fever
  • If patient is experiencing heat stroke, move to cool area and call 911.
57
Q

Describe the pathophysiology of atopic dermatitis.

A
  • Barrier dysfunction: can be caused by environmental triggers or altered immunity
  • Abudance of CD4 T-helper cells and mass production of cytokines
  • Inability to retain moisture
  • More susceptible to allergens
58
Q

List the steps of atopic dermatitis.

A
  1. Inflammation
  2. Itching
  3. Scratching
  4. Damages skin barrier
  5. Irritant/Allergen penetrates skin
59
Q

What are triggers of atopic dermatitis?

A
  • Aeroallergens (pollen, dusts, grass, etc.)
  • Clothes that are tight fitting
  • Dyes and preservatives
  • Excessive hand washing or bathing
  • Food allergen
  • Psychological stress
  • Electric blankets
  • Irritating soaps and detergents/scrubs
    Weather
60
Q

What are the treatment goals of atopic dermatitis?

A
  1. Sop the itch-scratch cycle
  2. Maintain skin hydration and barrier function
  3. Avoid aggravating factors
  4. Prevent secondary infection
61
Q

What are non-pharm treatments of atopic dermatitis?

A
  • Moisturizers are the first line treatment
  • Cleansers – removes many substance from the skin, also hydrates the skin
  • Bath soaps – removes skin, oil, and debris
  • Emulsifiers – helps lipids and water maintain a continuous phase
  • Humectants – helps the skin retain water
  • Avoid triggers
  • Short bath/showers (lukewarm water)
  • Moisturizers applied 3 mins after a shower
  • Increase humidity to prevent evaporation in the skin
62
Q

How do we apply hydrocortisone for atopic dermatitis?

A
  • Topical hydrocortisone 0.5% or 1% (OTC)
  • Apply to affected area 1-2 times daily
  • Limit to 7 days for use
  • Possible rebound or withdrawal symptoms
  • Itch/redness returns
63
Q

What are exclusions for self-care for atopic dermatitis?

A
  • Moderate-severe condition with intense pruritis
  • Involvement of large area of the body
  • Less than ONE years of age
  • Skin appears to be infected
  • Involvement of fave or intertriginous areas

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