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Clinical Therapeutics 1 > Dry Skin > Flashcards

Dry Skin Flashcards

1
Q

What is dry skin?

A
  • Most often caused by a lack of water in the stratum corneum/water loss from the skins surface
  • May be a decrease of skin barrier lipids and ceramides
  • May be genetic (deficiency in filaggrin)
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2
Q

What are the contributing factors for dry skin?

A

can be environmental, lifestyle, medical conditions, medications or ageing of the skin

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3
Q

What are the symptoms of dry skin?

A
  • Mild scaling or visible peeling of outer skin layer/increased flaking of the skin
  • Mild to moderate itching
  • Cracks, fine lines in skin, fissures
  • Skin that feels and looks rough & uneven
  • Skin feels tight after showering or swimming
  • May have some redness
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4
Q

What is the location of dry skin?

A
  • Most likely to appear on the trunk and limbs (thighs, lower legs, abdomen & arms) but can occur anywhere on the body
  • Fingertips & knuckles can be dry due to lack of flexibility and continuous pressure or stress
  • Face because of exposure to the environment
  • Areas that normally have high levels of moisture are not generally affected (groin & underarm)
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5
Q

What are the symptoms/appearance of MILD dry skin?

A

▪ Mild scaling & some roughness
▪ Itching may/may not be present
▪ No or minimal redness
▪ No fissures present

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6
Q

What are the symptoms/appearance of MODERATE dry skin?

A

▪ Moderate scaling & roughness
▪ Mild to moderate itching & some pain
▪ Mild redness
▪ Fissures may be present

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7
Q

What are the symptoms/appearance of SEVERE dry skin?

A
  • Severe scaling & skin is very rough
  • Severe itching
  • Severe pain
  • Fissures may be present & severe
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8
Q

What are the causes/aggravating ENVIRONMENTAL factors?

A

*Electric heat , air conditioning, wood burning stoves, space heaters, fireplaces
- Reduces humidity in the air and creates dry air conditions

*Cold, windy or very hot & dry climates
- Low humidity environment (cold/winter or desert like climates)

*Chronic exposure to sunlight & sun damaged skin
ex: sunburn

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9
Q

What are the causes/aggravating LIFESTYLE factors?

A

*Bathing or showering often/use of hot water/swimming in chlorinated pools
- Breaks down lipid barriers in the skin

*Use of harsh soaps & detergents (deodorant and antibacterial soaps are the most damaging)

*Skin sensitizers (lanolin, propylene glycol, aloe vera)
*caution when recommending emollients b/c would have these in them

*Poor hydration/dehydration/high intake of caffeinated beverages

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10
Q

What are the causes/aggravating MEDICAL CONDITIONS factors?

A

*Skin conditions (atopic dermatitis, psoriasis, acne)

*Chronic renal failure (changes in sweat glands & high phosphorous levels)

*Hypothyroidism (decreased sweat & oil gland activity)

*Uncontrolled diabetes (high blood sugar)

*HIV (low CD4 count, medications)

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11
Q

What are the causes/aggravating MEDICATIONS factors?

A

*Acne medications (remove oils or sebum from the skin)
- Isotretinoin, retinoids, benzoyl peroxide

*Some chemotherapy agents (may affect growing skin cells)

*Alcohol containing products such as gels (remove lipids from the skins surface)

*Diuretics (decreases the bodies water content)

*Statins (decrease lipids in the skin)

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12
Q

What are the causes/aggravating AGE factors?

A
  • Dry skin is more common in the 65 year and older group
  • Ageing of the skin causes a thinning of the epidermis and decreased ability to retain moisture
  • Filaggrin is lower in aged skin
  • Decreased activity & size of the sebaceous gland and sweat glands occurs as we age
  • Women in their 60’s and men in their 80’s
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13
Q

What is included in the assessment of dry skin?

A
  • *Location
  • Where on the body?
  • How large is the area?
  • Symptoms
  • What symptoms currently experienced?Severity?
  • *Onset? Duration?
  • *Any recent changes to lifestyle/medications?

*Past history
- Any *past history of dry skin/other skin
conditions?
- Any family history of dry skin/eczema?

*Red Flags?

  • Personal habits
  • Baths or showers/length of time?
  • Water temperature?
  • Use of harsh or perfumed soaps?
  • Environment?
  • Exposure to chlorine? Sun? low humidity?
  • Previous treatments
  • *Tried OTC products, prescription products, no products?
  • Length of treatment if product previously used
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14
Q

When to refer?

A
  • Large areas (>30% of the body)
  • Under 2 years old or > 60 years old
  • < 50% improvement after 7-10 days
  • Monitor for changes daily
  • Signs of infection (discharge, redness, pain)
  • Medical conditions that impair wound healing (HIV)
  • Severe itching and/or inflammation present
  • Involvement of flexural areas, neck or bottom of the feet (particularly in diabetics)
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15
Q

What is the differential DIAGNOSIS?

A
  • Atopic Dermatitis
  • Red, ITCHY areas (usually flexural areas in adults & first seen in
    childhood)
  • Contact Dermatitis
  • EXPOSURE to allergen (can be on the hands, trunk if exposed)
  • Psoriasis
  • Red PLAQUES WITH SILVER SCALES (usually knees & elbows)
  • Photoallergic/photosensitive reaction
  • Red, itchy areas (anywhere on the BODY EXPOSED TO SUN)
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16
Q

What are the Goals of Therapy?

A
  • Restore smoothness and softness to the skin
  • Improve or restore skin hydration
  • Repair the skin barrier
  • Relieve itching related to dry skin
  • Prevention of further skin damage
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17
Q

What are moisturizers?

A
  • Moisturizers or emollients moisten the skin
  • Used to decrease “cracks” in the skin as well as smooths and hydrates the skin
  • Reduces the dry feeling
  • Decreases skin tightness, pain, itching and stinging
  • Combinations of emollients, humectants and occlusives
18
Q

What is the Occlusive Tx?

A
  • Forms a barrier on the skin that physically blocks water loss from the skins surface - blocks water loss
  • Restores the stratum corneum layer and moisturizes the skin
  • Recommended for dry skin *on hands and feet
  • Apply as often as required
19
Q

What are examples of Occlusive Tx?

A
  • Plant oils: hemp oil, soybean oil, coconut oil, jojoba oil
  • Beeswax, lanolin
  • Hydrocarbons: petrolatum, mineral oil
  • Silicones based: dimethicone
20
Q

What are some ex’s of Occlusive products?

A
  • Vaseline
  • Vaseline Problem Skin Therapy
  • Eucerin Original Cream/Lotion
  • Eucerin Aquaphor Ointment
21
Q

What are Humectants tx?

A
  • Increases water content of the skin by drawing water from the dermis to the epidermis (attracts and holds water) or drawing from the environment
  • Recommended when moderate scaling is present or other products failed
  • Generally applied 2 to 3 times daily
22
Q

What are examples of Humectants Tx?

A
  • Glycerin, honey, colloidal oatmeal, alpha-hydroxy acid (AHA)
  • Urea & lactic acid
23
Q

What are some ex’s of Humectant products?

A
  • Uremol 10 Cream/Lotion
  • Uremol 20 Cream/Lotion
  • Eucerin Complete Cream/Lotion
  • Dermal Therapy Lotion
  • Aveeno Cracked Skin
24
Q

What are Emollients Tx?

A
  • Fills the cracks/fissures produced by dry skin by filling the spaces around the cracks – lubricates & softens skin
  • Hydrates (decreases dryness) by sealing the moistures into the skin, softens skin, decreases itching and gives the skin a smooth feeling
  • Apply as often as needed (at least 3 to 4 times per day as needed)

(most common)

25
Q

What are ex’s of Emollient Tx?

A
  • Ceramides, lanolin, mineral oil, castor oil, cocoa butter, fatty acids, lipids
26
Q

What are ex’s of Emollient products?

A
  • CeraVe Cream Lotion
  • Glaxal Base Cream/Lotion
  • Cetaphil Creams/Lotions
  • Aveeno Lotions/Creams
27
Q

What is the recommended order of Moisturizers?

A

recom. an emollient mosterizer 1st & then occulusive or humectants

28
Q

What is the application of moisturizers?

A
  • Apply to moistened skin (3 to 5 minutes after a shower and towel drying)
  • Lightly applied along the hair follicle direction (rub gently)
  • Dependent on skin dryness & product, can be applied 1 to 3 times daily

Cautions:
* Irritation (lactic acid, urea, propylene glycols)
* Allergic contact dermatitis (Lanolin, propylene glycols, fragrances, aloe, olive oil, tea tree oil)

29
Q

What are Ointments?

A

*Usually 80% oil & 20% water
*Useful for chronic, VERY dry skin and areas that have fissures (hands & feet)
*Requires less frequent application than creams or lotions
*Greasy and may be difficult to spread & remove (preferred at night)
**CAN BE APPLIED TO HANDS & FEET
* NOT to be used on the face or skin folds
* NOT to be used on areas that are moist, weeping, oozing, infected or acne prone areas

30
Q

What are Creams?

A
  • Creams are half oil and half water
  • Can be applied to areas that are moist, weeping,
    oozing or very dry
  • Absorbed well, easy to spread and can be used multiple times per day/night
  • Cosmetically more acceptable than ointments (less greasy than ointments)
  • Can be applied to the face, body, hands, feet (all areas)
31
Q

What are Lotions?

A
  • Contains more water than oil
  • Not effective for very dry skin (unless used many times per day)
  • Easier to spread than ointments or thick creams
  • Short acting and must be applied more often than
    creams or ointments
  • Can be applied to the face and entire body
  • Useful for hairy areas (scalp)
32
Q

What are Gels?

A
  • May contain alcohol or water-based (hydrogel)
  • Can be drying or irritating to open areas
  • Liquefies on contact with skin and leaves a thin layer
    of active medication
  • Can be used on the face and on hairy areas (scalp)
  • Acne, scalp, psoriasis and seborrheic treatments
  • Cosmetically acceptable but easily removed by sweating
33
Q

What are the Bath Products?

A
  • Oils
  • Provide a layer of oil on skin that prevents moisture from evaporating
  • Can make surfaces slippery (may increase risk of falls) if applied directly into the bath
  • Colloidal oatmeal products
  • Used to relieve itching
34
Q

What are ex’s of Bath Products?

A
  • Colloidal oatmeal

Aveeno Bath
(Colloidal Oatmeal)

Aveeno Bath Oil
(Mineral Oil, Colloidal Oatmeal)

35
Q

What are Cleansers/Soap Substitutes?

A
  • Ideal cleanser should be:
  • Soap free
  • Fragrance free (decrease sensitivity)
  • Rich in emollients
  • Does not disrupt the pH
  • Synthetic cleansers (less irritation)
  • Use a small amount mixed with warm water and apply to damp skin (rinse and pat dry)
36
Q

What are non-pharmacological treatments?

A
  • Re-hydrate with moisturizers
  • Within 3 to 5 minutes of bathing while skin is still damp
  • Short baths or showers
  • Less than 10 minutes to decrease the drying of the skin
  • Warm water NOT HOT
  • Hot water washes off the natural oils
  • Pat body dry (do not rub)
  • Less irritation to the skin
  • Mild cleansers/shower gels
  • Non-perfumed & mild products for dry skin are best - Some research states to avoid all soaps
  • Loose fitting cotton/linen clothing
  • Allows moisture wicking
  • Keep humidity of the environment higher during winter months/extreme dry heat (humidifiers)
  • 50% in winter and 30% in summer months
  • Prevents drying of skin
  • Cover face and hands to protect them from the cold, dry air
  • Avoid products that contain perfumes or fragrances
    (detergents, fabric softener)
  • May cause allergic dermatitis or worsen the itching
  • Trim nails
  • Prevents scratching the area leading to an increased risk of infection
37
Q

What is the monitoring of rough scaly skin? What are the goals?

A

DAILY for signs of improvement for 7-10 days after starting treatment (with moisturizers or non- pharms)

Skin to feel smoother
Skin to be less irritated/red/rough

38
Q

What is the monitoring of itching skin? What are the goals?

A

DAILY for signs of improvement for 7-10 days after starting treatment

Itching is less (no scratching)

39
Q

What is the monitoring of itching skin? What are the goals?

A

DAILY for signs of improvement

Soft, hydrated skin

40
Q

Choosing a Product?

A
  • *Patient preference
  • Patient’s age
  • Package size (small, large, pump, tube)
  • Cost of product
  • Ingredients (allergies to
    additives/preservatives, fragrance
  • Effect of the product
  • Type of lesion (dry/moist)
  • Type of site (hairy area, face, feet)
41
Q

Patient preference?

A
  • How easy is the product to apply?
  • How long does it take to rub in?
  • Does it absorb into the skin easily?
  • How does it feel when applied (greasy, irritating, stinging)
  • What does the skin feel like after application? (smooth, less itchy)
  • Does the product smell/have fragrance?

*If a patient does not like a product, they will not use it

42
Q

What is the summary?

A
  • Assess your patient and determine what may be the main cause of the dry skin (environmental, medical)
  • Determine if patient should be referred or if the condition is self treatable
  • Choose a product that will be most effective & suitable/preferable for your patient
  • Provide the patient with SPECIFIC non-pharm/non-drug advice that will prevent worsening of the condition
  • Provide a monitoring plan for your patient

Clinical Therapeutics 1 (12 decks)

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