Eczema Flashcards
What is one of the most common skin conditions in children?
Eczema
Describe the difference between skin in eczema and healthy
Describe how eczema occurs regarding the skin
Defective Skin Barrier
–> Microbes and allergens can get deeper into the skin and cause you to react
–> Allergens are a false start of the immune system
Protein Deficiency in Skin Component
Describe the hygiene hypothesis
A medical theory that suggests early exposure to germs and microorganisms helps develop a healthy immune system and protects against allergies, asthma, and eczema
Describe the concept of the “allergic march”
The allergic march is characterized by antibody responses to immunoglobulin E and clinical symptoms that can change with age and continue for years or decades.
Eczema
V
Asthma
V
Allergic Rhinitis
Describe the presence of eczema regarding prevalence and its corresponding age
80% of eczema is seen before the age of 5
What is the common progression of symptoms in eczema?
Blistering
V
Dry Skin
V
Scaling
What is a common issue in eczema that pertains to the main bothersome symptom of eczema?
Pruritis: Scratch-itch-scratch
–> Leads to disturbed sleep
Where does eczema commonly occur regarding body parts?
Face especially infants
With age:
—> Hands, elbows, wrists, back of knees
When is a diagnosis of eczema common? Exception? Course of disease?
Usually diagnosed early on in life
Can still occur in older age; but more rare
Often occurs in cycles with flare up occurring with triggers
Describe the areas on the body that eczema commonly occur in different aged individuals?
What is a key distiinguishing feature here to another condition?
No truncal aspect here
If located on the trunk, more likely to be hives
A major location for hives to occur is on the trunk area
Describe the severity of most cases of eczema?
Most cases of eczema are mild
Moderate and severe can have drastic impacts on quality of life
What are some implications of severe eczema on an individuals quality of life?
Waking up with bloody lesions
Wearing clothes can become uncomfortable
Loss of 14 nights of sleep per month
Describe the differential for eczema
Psoriasis
Contact Dermatitis
Impetigo
Fifth Disease
Prickly heat
Seborrhea Dermatitis
Psoriasis Differential Eczema
Usually diagnosed later in adolescence and then between the ages of 30 and 40
Contact Derm Differntial Eczema
- Quite similar of a presentation to eczema
- Identifiable cause is more likely and helps to clue us in to the diagnosis
- Hopeful parent knows a diagnostic cause
Impetigo Eczema Differntial
Yellow crusting commonly present
- Often occurs around the area of the mouth
- However, atypical presentations can make diagnosis hard
Fifth Disease Differential Eczema
Rash is not itchy
- If child is old enough and scratching, less likely to be fifth disease
- If infant, child may just be fussy making diagnosis difficult
- Occurs in response to an URTi
Prickly Heat Differential Eczema
- Heat related
- Parents can likely timeline when it occurs
- Will resolve in a few days
Seborhhea Derm Eczema Differntial
- Cradle Cap - Scaly things on the scalp
- Low level condition
- Seborhhea Dermatitis - Does not often occur on infants
How can a parent be confident in knowing that a child may have eczema?
Eczema is a condition that comes and goes
Intensely itchy and can be very uncomfortable
Scratching can cause thickened, darkened or scarred skin over time
What are the difference between the stages of eczema?
Inflammation: Allergen and irritant causing a flare up
–> Tends to last 7 days
Can last weeks after that as the body begins to deal with the remnants of that allergen
When is chronic eczema regarding seasons?
Since winter tends to be more dry, tend to see more chronic eczema
What course of eczema may be seen in children?
Some children will have flare ups of eczema
Some will have chronic eczema as the allergen is always present
Describe the process for eczema
Flare Up
- When a trigger causes chemical changes in the body producing burning, tingling, or minor itching sensations that you scratch
- The more you scratch the worse it gets
Outbreak
- Constant scratching damages the skin resulting in significant inflammation
- This often produces redness, swelling, fluid filled vesicles, weeping and crusting
- The outbreak stage doesn’t subside until the root cause trigger is removed
Healing
- Healing begins once the root cause are identified and treated
- During this stage, the skin can become thickened, cracked, dry, scaly, and have red to brownish-gray patches
- This slowly subsides and the skin improves over time
Clear Skin
- Clear skin is revealed once healing is complete
- However if someone doesn’t find and treat the root they could have a flare up as soon as they have another trigger
How commonly do flare ups last? Chronic Eczema?
With proper treatment, flare ups can last for one to three weeks
Chronic eczema can go into remission with the help of a good preventative plan
Remission means that the disease is not active and you remain free of symptoms
Describe how the severity and its corresponding presentation of eczema?
What is the most common severity of eczema in children? What level of care can these individuals be seen at?
Two-thirds of children have mild disease and can be managed at the primary care level
Describe eczema as a condition and it’s course through an individual’s life
Eczema is a non-contagious inflammatory chronically relapsing and intensely pruritic skin disease often occurring in families with atopic disease (eczema, asthma, and allergic rhinitis)
The onset of eczema is typically between the age of 2-6 months however can occur at any age
The majority of affected individuals have resolution of the disease by adulthood
–> Only 10% will go to have a longer course occuring in adulthood
What can worsen eczema?
Eczema can be worsened by:
1) Low humidity
2) Stress
3) Irritants:
–> Wool»_space;> Cotton
–> Fabrics are important for eczema
–> Cotton is ideal; wool and synthetics are bad
–> Sweating
–> Hundreds of others
4) Allergens
–> Dust mites (not common in Canada)
–> Foods (early exposure can be beneficial and avoidance is not the best move; not a pharmacist recommendation)
What are some strategies to manage dry skin?
1) Baths/Showers
- Cut back the temperature of the water
- Shower once a day instead of twice a day
2) Weather Exposure
3) Winter Humidifier
- Help the nose tissues (nose bleeds)
- Questionable of helpful for skin
- Worth a try
4) Cream
- Lotions are too light for eczema
-If you can pump it, too light
- Require thickness to CONTROL EPIDERMAL WATER LOSS
- Eczema grade is the way to go
Describe the benefit of the sue of dry skin creams in eczema
Dry skin cream use can help to reduce overall steroid use
Describe the types of dry skin moisturizers to be used in eczema
Any skin product that you can pump out (like a lotion) is likely too weak for eczema
Need a cream or an even thicker agent
What is the goal of therapy in eczema? What encompasses daily care?
Repair and maintain a functional skin barrier
The two key components of care include moisturizer and bathing recommendations
Patients should be instructed to develop these habits and perform them daily
What is the benefit of moisturizers in the care of eczema?
Daily skin mositurizers:
Helps to decrease itch
Prevents and reduces flares
Decreasing the need/potency for prescription medications
Reduce transepidermal water loss
What is critical for the care of the varying severities of eczema?
Mid eczema - Frequent and consistent use of moisturizers may sufficiently manage the disease
In moderate to severe disease, mositurizing regimens remain a fundamental part of treatment
Mosisturizers are an important compinent of maintenance therapy and prevention of flares
What part of the skin do mositurizers protect?
Mositurizers help protect the outermost layer of skin known as the straum corneum or skin barrier
Describe the effects of a dmaged skin barrier in eczema?
People living with eczema have a damaged skin barrier which makes skin more sensitive to irritants, allergens, bacteria and other invaders
A damaged skin barrier also make it harder for the skin to retain water leading to chronic, dry, itchy skin which can cause eczema to flare or get worse
What are some triggers for eczema?
Wind, low humdiity, cold temperatures, harsh soaps and prolonged exposure to water all lead to dry skin
How are moisturizers classified? Which moisturizers should be sued for eczema?
Mositurizers care classified based on the amount of oil and water they contain
The more oil in. amaoisturizer the better it usually is at treating eczema
The best mositurizers are the ones that feel “greasy” such as ointments and creams because they contain more oil
Very effective a keeping moisture in and irritants out
How should mositurizers be applied to the skin?
All moisturizers should be applied to your hands immediately after washing and gently blotting them dry
Good idea to keep mositurizer near every sink in your home and carry a small tube with you at all times so you can reapply it throughput the day
What is commonly recommended mositurizer in eczema? Why? Examples?
Ointmnets are usually the first choice for eczema treatment
They have the highest oil content of all the products followed by creams and then lotions
They generally do not burn when they are applied to sensitive skin and are very good at sealing in mositure
Products high in oil content such as petrolateum jelly and mineral oil are particularily good at treating ecczema
What is a name brand of products that can be particularily useful in eczema care?
Spectro Eczema
- Huge line of products
- Eczema grade products - No added perfumes or colours, etc. –> Additional irritants
Why are lotions not recommended for the treatment of eczema?
Lotions contain a higher proportion of water to lipid than creams
Frequent reapplication of lotions is needed to maintain skin hydration
Lotions are not as effective in eczema
High water content leads to evaporative skin drying, irritants, such as fragances and preservatives, may irritate or inflame non-intact skin
What types of ointments are best for eczema? Why? Example?
Hydrophilic ointments and creams without added fragrances or preservatives are recommended over lipophilic ointments, as lipophilic ointments may cause irritation and should be applied to wet skin after bathing
EMulsyfying Ointmnet - 250 g weekly for adults
The best mositurizers are fragrance free and have the least amount of preservatives
Describe the role of ceramide in eczema products
Ceramide is low in eczematous skin. It helps to make the skin more porous
Many sub-types
Maybe not much better than simpler products p becoming just another lipid in the cream
Describe the recommendations for bathing and showering in eczema
Clincians can recommend that patients bathe or shower (5-10 mins) in warm, plain water once daily or every other day
Moisturizing should immediately follow bathing or showering, since exposure to water can exacerbate eczema if the skin is not mositurized soon after exiting the water
Gentle cleansers may be sued only on areas that need cleaning and shgould be used at the end of the bath or shower
A mild synthetic detergents without fragrance should be sued to cleanse soiled areas without fear of exacerbating the skin disease
Describe the microbial colonization of the skin of an individual with eczema
Up to 90% of patients with moderate to severe eczema have a high rate of cutaneous colonizqation of S. Aereus whereas only seen in 5% of the population without dermatitis
The routine use of topical anti-staphylococcal antibiotic treatment in the abscence of clinical signs of infection is not recommended
Bleach baths may have limited therapeutic effect, andd research does not support bleach bathes –> Leap of faith aspect
What is another non-pharamcologic treatment option that may be used? What severity is it common in?
Weeping Lesions
Plain Water - Cool Compress - 20 min QID for 2-3 days
–> cool comp 1 min on/off cycle over 20 mins
Or Longer Contact
Wet-Dressings
–> Wraps are common as well
–> Sveere variant o may be told to have some wet dressings
–> Can be useful to help getmore steroid absorbed into the skin
What is the mainstay of eczema therapy? What stage of eczema can it be used in?
Topical RX Steroids
- Cream or ointment (may need both for different stages)
- Can be used even during the weeping stage
Is there a concern with steroid absorption in the weeping stage of eczema? Explain?
Weeping Stage - Not going to lead to more absorption of the steroid
Can be used in the weeping stage to help the skin return to normal faster
Topical steroids are good at healing dried and cracked skin
What conditions require more aggressive approach to care?
Acne –> USe of Adapalene earlier on in in therapy
Pain - Do not wanna play ctahc up with pain
Weeping Stage of Eczema –> If you have a flare, use a steroid
Describe the strength of steroid use in intial tx of eczema?
Can start a steroid in the weeping stage
Rather start a steroid at a lower grade strength than do nothing at all
Start with a category 5 topical steroid and hope that it does not get worse
- Not using Hydrocortisone 0.5-1%
Rather recommend spectro-eczema behind the counter (mid-potency)
Describe the use of topical steroids on cracked or broken skin? What else can be used”?
Topical steroids are effective in helping to heal cracked and broken eczematous skin
Effective and safe to use on eczematous skin
Can still use cold compresses alongisde steroid for relief
Describe the difference in steroid usage between the stage of eczema and duration
Cream and an ointment topical steroid may be required
Acute Stage lasts 7 days on average
–> Use cream formulation at this stage
Sub-acute - Cream
Chronic Stage: Dryness/Sca;les
–> Use ointment formulations
- Continue to use dry skin creams for prevention
- If skin is dry, use ointments
Describe goal of acute stage of eczema treatment
Local treatments are effective on flare ups
The onjective is to reduce inflammation and pruritis
Corticosteroids applied once per day are crucial to reduce inflammation (generally between four to eifhts days) and rapidly diminish the red weeping lesions
USed according to the doctors prescription, side effects are very rare
Describe the chronic stage of eczema treatment
Over time, frequency of flare ups will diminish and let way to a more favourable period: the “remission” during which the patient can recover
However, the skin remains excessively dry and and emoillments should be applied to a number of times every day over the entire body
Should certain leasions remain inflammed, steroids must be applied exclusively to these areas on an intermittent basis
–> Use oitnment formulations with dryness/scales
Describe the potency scale of topical corticosteroids
Classified on a 7 point scale –> Logarithmic Scale
1,2 - Ultra-potent
3 - High Potency
4,5 - Medium Potency
6,7 - Low potency
Are potentiates of topical corticosteroids equivalent when changing formulation?
Potency moves from a 3 (if a cream) to a 2 (if ointment)
This is not just a “jump” of 1 number of potency
–> Exponential curve –> A large jump in potency
–> Ointment holds the water in more and us more slowly absorbed
–> If want potency, go for ointment
HOWEVER NOTE - Some do not change in potency –> Example: Dermovate, Ultravate
What are the available OTC topical steroids available?
Category 7 - Hydrocortisone 0.5-1.0% Cream and Ointment
Category 4 - Clobetasol Butyrate - Spectro Eczema
–> Mid Category
What topical steroid can be used in diaper rash?
We can go beyond HC 0.5-1% for infants on their butt
A day of spectro eczema, usual diaper stuff and then the next day
RAther than HC BID for a few days, hit the diaper rash harder
What is an oddity in the topical steroid world? Explain?
Spectro Eczema (Category 4 - Mid potency) is behind the counter –> only kind of product
Steroid for at home use
Other OTC steroids (HC) are in the low category 7
Good choice to go with here
What is an error pharmacists commonly make when explaining topical corticosteroids?
- 3 weeks of usage max and apply thinly
- Both of these recommendations are not useful and can have negative consequences such as the under-treatment of eczema
Describe what can occur once a topical steroid is discontinued?
Steroid Rebound
Using a potent steroid, use for 2 weeks and stop immediately
Condition will come back, someone will likely go back on the steroid
Usually occurs with high and ultra-high potency
Will not see rebound eczema and psoriasis with spectro eczema and higher –> Category 1 and 2
Often not the drug’s fault here
What are the common side effects of topical steroids?
Acne
Skin Atrophy
Straie
Telangiectasia (spider Veins)
What is the most common side effect of topical corticosteroids?
Skin Atrophy is the most common side effect
Regarding topical steroid usage, what side effects are not a concern?
No systemic side effects
No cushingoid symptoms here
What is the duration of usage for high potency corticosteroids? Is this applicable to other potencies of steroids? Explain the overall concept of duration of usage?
Super-high potency steroids should be used for no more than three weeks at a time
–> Category 1 and 2
High and medium potencies should bee used for no more than 12 weeks at a time
–> As long as used as prescribed by MD, things will be fine
–> Medium Potency –> 4 and 5, high potency 3
LESS IS STILL A GOOD GUIDE, BUT NOT IF IT LEADS TO UNDER-TREATMENT
How can one select a steroid for eczema?
Match the potency of the steroid to the severity of the condition
Describe the initial usual approach of an MD’s decision for topical steroids in eczema.
Common practice to use the lowest-strength topical steroid which clears the flare-up
Hydrocortisone 1% is often used, especially in children
This may work well for some, if no improvement after 3-7 days, a stronger topical steroid is usually prescribed
For severe flare ups, a stronger topical steroid may be prescribed from the onset
An MD may try HC first, but will be prepared to go stronger
Why may someone with eczema have two different topical steroids? Example?
Sometimes two or more preparations of different strengths are used at the same time
Example:
For example, a mild steroid for the face and a moderatley strong steroid for patches of eczema on the thicker skin of the arms and legs
A very strong steroid is often needed on the palms and soles of the feet in adults beacuse of these areas of thick skin
Ointment and cream for the different stages of eczema is also a reasonable approach
What can be used as a guide for the duration of use of a topical steroid?
You should use topical steroids until the flare up has completly gone and then stop it
In most cases, a course treatment for 7-14 days is enough for a flare up of eczema although in some cases a longer duration may be required
When using a topical steroid, what other aspect of therapy is critical?
After you finish a course of topical steroid, continue to use mositurizers (emoillments) every dya to help a further flare up
What is another approach to therapy that may be used in an eczema flare up that contradicts a slower approach?
For adults, a short course (usually three days) of a strong topical steroid may be an option to treat mild to moderate flare up of eczema
A strong topical steroid cream often works quicker than a mild one
This is in contrast to the traditional method for using the lowest strength wherever possible
Describe 3 critical points regarding duration/use of topical steroids in regards to reducing steroid phobia
1) Depending on the body area, use different strengths
2) The ‘3 week’ rule applies to highest strengths; lower potency (but still can be the high group) can be sued for up to 12 weks
3) A week off between treatments (or during the 3 months of use) really reduces the risk of side effects
Describe the balance of risk of side effects and undertreatment of eczema
The negative effects of undertreatment outweigh the risk of adverse effects of corticosteroids
Treatment should continue until rash and itch are resolved
MAy be a few days or up to several weeks for each flare, depending in the patient
Describe when certain potencies of corticosteroids should be used based on body area and skin properties
What is steroid phobia? What is the risk of steroid phobia and the pharmacists role in the spread?
Steroid phobia refers to negative feelings and beliefs of patients and caregivers regarding topical corticosteroids
This phenonemem can manifest as under dosing and early treatment discontinuation, leading to uncontrolled eczema
Clinicians can inadvertently contribute to topical corticosteroid phobia by advising patients to arbiturarily limit the amount of duration
Describe the burden of eczema on quality of life
The self-reported burden of eczema has been found to be compatible with that of diabetes and cystic fibrosis
Describe the use of topical corticosteroids in eczema overall (summary)
Depending on where the red patches on your body, and whether they are red or oozing, doctor will prescribe an ointment or a cream
Start applying as soon as the redness appears, and continue until it has completly cleared (the average use of time will be 1-2 weeks)
Mild Eczema –> Potency 5 or 6 –> 1-2 weeks should take care of most cases
Stop application once redness has totally cleared
If even the slightest bit of redness occurs, begin re-applying immediately
–> Not a rebound (just continuation of the acute phase)
2/3 cases on the mild front
What are the mainstay of therapy for eczema?
Topical corticosteroids
Describe the absorption of topical corticosteroids. When is the best time for application?
The absoprtion of topical steroids is much better through hydrated skin; thus, the ideal time for application is in the first 3 minutes after a bath or shower
Describe how to manage eczema in infants?
For eczema in infants, class 6 or 7 topical steroids should be effective
If the infant has more severe eczema, a moderate-potency steroid can be prescribed for long as 1 week and then tapered down to a lower potency medication for maintenance therapy
What is a rule that can be sued for dtermining duration of topical steroid usage?
The Touch Rule
Rough and Red –> Apply steroid
Smooth and skin tone –> Time to stop the therapy
Describe the a critical take-home point for patients with eczema?
Daily emollients and moisturizers and topical steroids are standard treatments for managing eczema im adults and children
Describe the cochrane evidence for topical steroid usage in eczema?
There is cocharnae evidence that:
1) Stronger topical steroids are probably more effective than weaker ones
2) Stronger steroid cream applied once daily is probably as good as twice daily
3) Using steroid cream for two consecutive days weekly probably prevents eczema dlare ups
4) Skin thinning (unwanted side effect) may be uncommon and most likely associated with using stronger steroid creams but more research is needed
Describe the role of prophylatic therapy in eczema. Example?
Long Term Use
- Every 2 days for a week in the last 2 years with a potency category 4 can be used for moderate to svere eczema cases for prophylatic therapy
- No need to care what the days are but rather a break between therapeutic hits reduces the potential for side effects drastically if not super high or super potent corticosteroids
- Only if needed, prophylatoc therapy could be therapeutic
- Drug holidays between 2 weeks pulses of eczema
2 weeks, 3 days off, 2 weeks, 3 days off, etc.
Describe the evidence and study for the use of moistiurizers in eczema?
There is evidence that using emoillments and mositurizers is better than not using them
No one option is best, and preferences are key
The best mositurizers are the ones that the patient will use
What are some guidelines that can be used for the application of topical steroids?
1) Apply thinly
2) 1 FTU treats both sides of one hand
Describe the area of FTU’s and what is required for different areas of the body?
Need 7 FTU’s for the entire chest and abdomen
= area of 14 hand (one side)
= area of 7 hands (both sides)
What is an FTU measured on? How can a parent sue this for a child with eczema?
An FTU of cream or ointment is measured on an adult index finger before being rubbed on to a child
One FTU is used to treat an area of skin on a child, equivalent to twice the size of the flat of an qadults hand with the fingers together
Can gauge amount of topical steroid to use by using your (adult) hand to measure the amount of skin affected on the child
Describe the use of FTU’s in a child with eczema
An FTU corresponds to the amount of cream dispensed when squeezed out continously along the entire lengtyh of an adults index finger
This amount is enough to treat a surface area equivalent to two adult sized hands (or approximately 250-300 cm2)
A finger tip unit is equal to 0.5 g of product
A single 30 g tube contains 60 FTU
Describe the warnings listed on the label for SPectro Eczema? Legal or clinical?
Do not use cream on:
1) Face or scalp (can use on the neck and ears)
2) On the groin, genital area or armpits
3) Between your toes
Do not use for more than 7 days and do not use more than 1/2 the tube (15g) in 7 days, except on advice of physician
Do not get the cream in the eyes
- Legal for 7 days to get on the market; can go well beyond 7 days and up to 12 weeks as 12 weeks is safe
Describe the application instructions of Spectro Eczema?
Use the cream twice a day for up to 7 days
Wash your hands and dry them
Squeeze out the cream along the top of your index finger
A single streak of cream from the top crease in the finger to the fingertip is one FTU
–> This is the amount enough to treat a patch area equal to the front and back of one hand
–> 1/2 FTU –> Area of one hand plam
Only need a thin layer
What are some problematic pharases for a pharamcist regarding sue of a topical stsroid?
Use this for 3 weeks maximum at a time
Use this for qa maximum of 3 months at a rime
How can a pharamcist educate on duration of topical steroid in a refill. counsel?
How do tou use this?
–> Patient indicates how they use it
Okay if that is working, keep doing it
How can a pharamcist educate on duration of topical steroid in a new rx counsel?
Were you told how to use this?
Eczema flare ups typically get better in 7-14 days with this
You may have heardnot t use for more than 3 weeks at a time; we have flexibility there
We do have to worry about continous use tho
How long dpoes a flare up tend to last for you?
What is a common issue in New RX counsels of a topical corticosteroid?Re-wording: What is an issue in the treatment of eczema regarding steroid application?
Under therapeutic applictaion is more of an issue than over use here
–> Although problems with over use still can exists
We still want patients to be juducious with use, but our current approach likely leads to udnertreatment
Period sof no use helps reduce potential problems between flare ups
Describ ethe selection of TCS regarding phsyician decisons?
Most eczema patients treated in primary care can be effectively managed with low to moderate steroids
With wide number of TCS chouices, clinicans are advised to rely on 2-3 medications from the low (CLass 6 and 7) and moderate potency groups (Class 3, 4, and 5) as “go-to” medications for everyday practice
MD’s will have 1 or 2 favourites
Describe the MedSask Tx algorithm for eczema?
What is an issue with the MEdSask algorithm for tx of eczema?
Conservative approach - Worried about side effects
–> Only 14 days of therapy
Why are lowe rpotency TCS used on the face?
More absorption due to thickness of skin on the face
- Dial back the agents
What are some causes of itch?
What is the most bothersome symptom associated with eczema?
Itchiness is the worst and most uncomfortable symptom of eczema and can be the most difficult symptom to treat
In what stages of eczema is an itch a common symptom?
Itch can occur in the acute, sub-acute and in the chronic stage of eczema
- More so towards the chronic stage of eczema however can occur at any stage
What are some options for the treatment of itch in eczema? Are these all useful agents? Describe there efficacy in eczema?
Topical Steroids
Dry Skin Creams
Bathing Habits
- Dry skin creams and CS’s are anti-itch themselves especially the steroid
- Steroid can reduce itch within a day
Menthol
Coal Tar Remedies
Antihistamines
- Often do not need to get into anti-itch medications here
- Coal tar is not a good idea; can be irritating in eczema –> More so for use in psoriasis
- Menthol –> Skip as just another chemical
Describe the used of menthol for the treatment of itch in eczema?
Cooling sensation may overpower the itch sensattion
Gold Bond -> 0.15% and 0.5% menthol
Useful in first aid for bug bites; just TLC
Describe the use of coal tar remedies for the treatment of itch in eczema?
NOOOOOOO
Scalp shampoos (scalp) vs skin products
More useful in psoriasis than in eczema
What arse some coal tar products individuals may use for the treatment of itch in eczema? Use in eczema? Mechanism?
T/Gel –> Tar 0.5%
Denorex –> Tar SOlution 10%, Menthol 1.5%
Elta TAr - Tar 2%
Not for use in eczema
Anti-mitotic for psoriasis (fast skin turnover)
Low level care; products should not say eczema relief
Psoriasis is more common on the scalp than eczema is
Describe the role of anti-histamines for the treatment of itch in eczema?
Role of histamine in eczema is controversial
Pure He-induced itch is rare (except perhaps hives)
None very helpful for itch of eczema
Why are anti-histamines not useful in eczema?
Eczema used to be called atopic dermatitis: may have allergens there but anti-histamine not helpful as not alot of histamine release
Benadryl for itch in eczema
- Overused agent
- Mainly used as a sleep aid now
- Bug Bites - Go for 2nd generation anti-histamines
- Does not work any faster than 2nd generation agents
- A second gen can be slotted any time on the spectrum
What are the main differeces between benadryl and second generation anti-histamines?
Benadryl does not work faster than 2nd generation anti-histamines
benadryl Onset: 1 hour
Benadryl is dosed every 4-6 hours
All 2nd generatiosn are dosed OD except allegra (fexofenadine - Q12 hours)
Benadryl is on the BEER’s list
Second genrations do not have an injectable formulation –> IV type/injectable agent is benadryl
