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Pharmacy Skills > Dry Skin > Flashcards

Dry Skin Flashcards

0
Q

Name the three layers of the skin from superficial to deep

A

Epidermis
Dermis
Hypodermis

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1
Q

What are the many purposes of the skin?

A 
Acts as a barrier to the elements/physical agents
Protects against injury
Protects from infections
Acts as a thermo-regulator protecting the body from excessive heat loss or overheating
Reduces penetration of UV radiation
Provides our physical appearance
Prevents dehydration
Synthesizes Vitamin D
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2
Q

Describe the epidermis

A

Physical barrier/protects the skin from the environment
Approximately 0.1 mm thick
It is thickest on the palms of the hands and soles of the feet
It is thinnest on the eyelids
Stratum corneum is the upper layer

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3
Q

Describe the dermis

A

Tough supportive connective tissue located just below the epidermis
It is important for sensation, protection and thermoregulation
It is thinnest on the eyelids and thickest on the back, palms and soles of the feet
It includes blood vessels, lymph vessels, hair follicles and sweat glands

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4
Q

How does topical absorption occur?

A

It occurs through passive diffusion through the stratum corneum. The stratum corneum is a rate limiting barrier (semi-permeable membrane)

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5
Q

What are three ways to increase topical absorption?

A

Increasing the temperature of the skin
Vigorous rubbing/massaging a product into the skin
Occluding the skin (ointment base/airtight dressings)

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6
Q

What is a fissure?

A

A thin linear crack in the skin which is deeper than it is wide - furrow or slit on the skin

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7
Q

What is a plaque?

A

A well-defined raised flat-topped lesion

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8
Q

What is a pustule?

A

A circumscribed raised area which contains pus

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9
Q

What are scales?

A

Flat plates or flakes found on the stratum corneum (a buildup of dead epidermal cells)

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10
Q

What is the clinical name for dry skin?

A

Xeroderma or xerosis

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11
Q

What are possible reasons for dry skin?

A

Inadequate water or oil on the skins surface
Deficiencies in moisture binding substances found naturally in the skin (amino acids, lactate, urea, inorganic salts)
Decreased skin barrier lipids and ceramides
Changes in the skins moisture network

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12
Q

What are signs and symptoms of dry skin?

A

Feeling of skin tightness (after showering, bathing or swimming)
Mild scaling or visible peeling of outer skin layer/increased flaking of the skin
Mild to moderate itching (when left untreated)
Cracks, fine lines in skin, fissures
Skin that looks rough and is rough to touch

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13
Q

What areas of the body are most affected by dry skin?

A

Legs, hand and forearms (1st to be affected)

Trunk and face also affected

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14
Q

Describe the signs and symptoms of mild dry skin?

A 
Mild roughness or scaling
Mild or not itching
No pain
Mild or no redness
No fissures
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15
Q

Describe the signs and symptoms of moderate dry skin

A 
Rough and moderate scaling
Mild or moderate itching
Some pain (mild)
Mild redness
Fissures possible
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16
Q

Describe the signs and symptoms of severe dry skin?

A 
Rough and severe scaling
Severe itching
Severe pain
Moderate redness
Likely to have fissures
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17
Q

What are different environmental causes/aggravating factors of dry skin?

A

Electric heat, air conditioning, wood burning stoves, space heaters, fireplaces - reduces humidity in the air and creates dry air conditions
Dry, cold or low-humidity climates (can be hot climates)
Chronic exposure to sunlight and photoagin

18
Q

What are lifestyle causes/aggravating factors of dry skin

A

Bathing or showering often/use of hot/swimming in chlorinated pools
Use of harsh soaps and detergents (deodorant and antibacterial soaps are the most damaging)
Long term sun exposure damages the skin and leads to dry skin
Poor hydrating/dehydration/high intake of caffeinated beverages

19
Q

What are medical conditions that cause/aggravating factors of dry skin?

A

Skin conditions (atopic dermatitis, psoriasis)
HIV, chronic renal failure, hypothyroidism, diabetes, some cancers, radiation therapy, liver disease
Malnutrition

20
Q

What are medications that cause/aggravating factors of dry skin?

A

Accutane, retinoids, benzoyl peroxide (acne medications), chemotherapy agents, alcohol containing products (gels), diuretics (in high doses)

21
Q

How does age affect dry skin?

A

Older adults often have dry skin (arms, legs)
Ageing of the skin causes a thinning of the epidermis and decreased ability to retain moisture
Activity of sebaceous gland and sweat glands is decreased

22
Q

When assessing dry skin, what are factors that should be taken into account?

A 
Location (Where on the body? How large is the area?)
Symptoms (Mild, moderate or severe? What symptoms are currently experienced? When are the symptoms better or worse? When did the symptoms start? Any recent changes to lifestyle/medications?)
Past history (Any past history of dry skin/other skin conditions? Any family history of dry skin/eczema?)
23
Q

When assessing dry skin, what types of lifestyle factors should be taken into account?

A 
Personal habits (Baths or showers/length of time? Water temperature? Use of harsh or perfumed soaps? Environment?)
Previous treatments (Tried OTC products, prescription products, no products? Length of treatment if product previously used?)
25
Q

What are red flags/when should you refer someone?

A

Large areas (>30% of the body)
Under 2 years old or over 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)
Quality of life affected (sleep affected)
Severe itching and/or inflammation present
Involvement of flexural areas, neck or bottom of the feet (particularly in diabetics)

26
Q

What are the goals of treatment of dry skin?

A

Decrease or alleviate the rough, scaly skin
Improve or restore skin hydration
Repair the barrier function and maintain the integrity of the stratum corneum (repair the skin barrier)
Relieve itching related to dry skin
Educate the patient on self care management in order to prevent further skin damage

27
Q

Name different types of treatment options

A 
Occlusives
Humectants
Emollients
Corticosteroids
Bath Oils
Soaps
Soapless cleansers
28
Q

What is the mechanism of action of occlusives? How are they applied?

A

Physically block transdermal water loss/prevents evaporation
Minimize water loss to the external environment by providing an oil layer on the skins surface
Apply a small amount as required

29
Q

What are the advantages and disadvantages of occlusives?

A

Advantages: Provides long lasting protection from external irritants (physically blocks). Protects skin that is scaling or cracking
Disadvantages: Messy, cosmetically unacceptable, greasy feeling

30
Q

Name some examples of occlusives

A

Elta cream (often recommended for diabetic or renal patients - Petrolatum/Mineral oil/paraffin - fragrance free)

31
Q

How do occlusives work?

A

Forms a barrier on the skin that physically blocks water loss from the skins surface
Very effective moisturizer (can relieve surface water loss by almost 99%)
Restores the stratum corneum layer and moisturizes thes kin
Recommended for dry skin on hands and feet
Apply as often as required

32
Q

How do humectants work?

A

Increases water content of the skin by drawing water from the dermis to the epidermis (attract and hold water)
May also enhance water absorption from the environment
Urea and lactic acid containing products are often used for dry skin with fissures or when moisturizers have not worked well
Recommended when moderate scaling is present or other products have failed
Generally applied 2-3 times daily

33
Q

How do emollients work?

A

Fills the cracks/fissures produced by dry skin by filling the spaces around the cracks
Restores skin barrier function
Hydrates (decreases dryness) by sealing the moistures into the skin, softens skin, decreases itching and gives the skin a smooth feeling
Effects last 2 to 3 hours then reapply
Apply as often as needed

34
Q

Describe ointments

A

Usually 80% oil/20% water
Useful for chronic, very dry skin and areas that have fissures (hands and feet)
Require less frequent application than creams or lotions
Greasy and may be difficult to spread and remove (preferred at night)
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

35
Q

Describe creams

A

Creams are half oil and half water
Can be applied to areas that are moist, weeping, oozing or very dry
Well absorbed, easy to spread and can be used during the day
Cosmetically more acceptable than ointments
Useful for the face as well as all over the body

36
Q

Describe lotions

A

Contain more water than oil
Useful for hairy areas and if immediate absorption is necessary
Not effective for very dry skin
Easier to spread than ointments
Short acting and must be applied more often than creams or ointments

37
Q

Describe gels

A

Can be drying when used for long periods of time
May contain alcohol or propylene glycol which can be drying or irritating to open areas
Liquefy on contact with skin and leave a thin layer of active medication
Useful for hairy areas
Cosmetically acceptable

38
Q

Describe bath products

A

May make surfaces slippery (increase risk of falls) if applied directly into the bath
Apply small amounts after a bath directly onto damp skin (pat dry)
Products containing oatmeal are used to relieve itching
Occasional use only and only for those where risk of fall is not a factor

39
Q

Describe cleansers/soap substitutes

A

Use non-foaming cleansers in place of soaps (soaps, shower gels, bubble baths can remove the skin natural layer of oils and dry out the skin)
Use a small amount mixed with warm water and apply to damp skin (rinse and pat dry)

40
Q

What should be kept in mind when 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 product, type of lesion (dry/moist), type of site (hairy area, face, feet)

41
Q

How can patient preference affect choosing a product?

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 are OTC product options available/recommended?

A

Fragrance free
CDA recognized
Cleansers: CeraVe Hydrating Cleanser
OTC products: CeraVe Cream/Lotion/Facial, Eucrerin Complete Repair Lotions, Marcelle Products

43
Q

What are non-pharmacological treatment options?

A

Re-hydrate with moisturizers/bath oils (after bath)
Short baths or showers (less than 10 minutes)
Warm water not hot water (washes away oils and releases histamine)
Pat body dry, don’t rub
Mild cleansers/shower gels (non-perfumed and mild products)
Keep humidity of the environment higher during winter months/extreme dry heat
Cover face and hands to protect them from cold, dry air
Avoid products that contain perfumes or fragrances (detergents, fabric softeners)
Trim nails

44
Q

What should be monitored (monitoring parameters)?

A

Rough scaly skin (daily for signs of improvement)
Signs of infection (daily)
Itching (daily for 7-10 days after starting treatment)
Dry, flaky skin (daily)

Pharmacy Skills (4 decks)

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