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OTC > Exam 5 - Contact Dermatitis > Flashcards

Exam 5 - Contact Dermatitis Flashcards

1
Q

Define contact dermatitis

A

Condition characterized by the following on dermal areas exposed to irritant or antigenic agents:
- inflammation
- redness
- itching
- burning
- stinging
- vesicle/pustule formation

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2
Q

What is irritant contact dermatitis (ICD)?

A

Inflammatory reaction of the skin caused by exposure to an irritant

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3
Q

Causes of irritant contact dermatitis (ICD)

A

Frequent handwashing
Oils
Strong acids/bases
Fiberglass
Wood dust
Urine
Fecec

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4
Q

Causes of allergic contact dermatitis (ACD)

A

Nickel
Cobalt
Cosmetics
Latex
Poison ivy/oak/sumac

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4
Q

What is allergic contact dermatitis? (ACD)

A

Immunologic reaction of the skin caused by exposure to antigen

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5
Q

Clinical presentation of ICD

A

Skin is:
- inflamed
- swollen
- erythematous
- painful
- itchy
- stinging/burning

Skin may be dry or macerated

Most commonly seen on hands, forearms, face

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5
Q

What irritants require multiple exposures to cause ICD?

A

Mild irritants:
- soaps
- solvents
- detergents

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5
Q

What affects response severity of irritant contact dermatitis (ICD)?

A

Quantity and concentration of substance exposure

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6
Q

What irritants are likely to cause immediate/severe response of ICD?

A

Chemical irritants like acids/bases

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7
Q

When should a patient with ICD be referred?

A

Younger than 2

> 10% of skin surface

Rash has not decreased in 7 days

Chronic dermatitis symptoms present

Involvement of:
- eyes
- eyelids
- mouth
- face
- neck
- genitals

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7
Q

Where is ICD most commonly seen?

A

Hands
Forearms
Face

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8
Q

Treatment goals of ICD

A
  1. Remove irritant & prevent further exposure
  2. Relieve inflammation & irritation
  3. Educate patient on self-treatment & prevention
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9
Q

OTC pharmacologic treatment for ICD

A

Burow’s solution (aluminum acetate 5%)
Emollients & moisturizers
Barrier creams/ointments

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10
Q

What is the gold standard emollient/moisturizer for ICD

A

Petrolatum

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11
Q

Non-pharmacological treatment for ICD

A

Avoid the irritant

Wash w/ tepid water and mil/hypoallergenic soap or saline soak

Change clothes, diapers, and gloves more frequently

Wear protective clothing/gloves

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12
Q

Burow’s solution preparation and use

A

1:40 aluminum acetate - tap water solution

Soak affected area for 15-30 min 3-4x daily

OR use compress for 20-30 min 4-6x daily

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13
Q

OTC pharmacologic treatments for itching

A

Topical corticosteroids
Colloidal oatmeal bath

13
Q

What causes allergic contact dermatitis?

A

3000 chemicals

Common:
- poison ivy/oak/sumac
- nickel
- latex
- fragrances
- cosmetics

14
Q

What products should be AVOIDED for itching?

A

Topical “-caine” anesthetics

15
Q

Patient education for ICD

A

Rash should resolve once irritant is removed

Emphasize prevention and protection

Nonpharmacologic factors are key

Counsel on proper use of pharmacologic options

Refer if rash/itching worsens or does not heal in 7 days

16
Q

Clinical presentation of allergic contact dermatitis (ACD) (acute vs late)

A

Acute:
- papules
- small vesicles
- large bullae
- inflamed
- swollen

Late:
- oozing
- drying crust lasting 14-21 days

17
Q

What should NOT be done with urushiol containing plants

A

DO NOT burn them

Smoke can affect lungs and other unprotected areas

18
Q

What is urushiol

A

Oily allergen in toxicodendron plants (poison plants)

Oil remains active for 5 years and can seem to “spread”

19
Q

What do the symptoms of urushiol ACD depend on?

A

Amount of urushiol exposure
Area/length of exposure
Age
Genetics/sensitivity
Immune tolerance

20
Q

Treatment goals for ACD

A
  1. Remove irritant, prevent future exposure
  2. Treat inflammation/irritation
  3. Relieve itching & excessive scratching
  4. Relieve debris from oozing, crusting, scaling
  5. Prevent secondary infections
21
Q

Exclusions for self-treatment of ACD

A

Younger than 2 years

Involvement of the eyes, eyelids, mouth, or genitals

If urushiol: BSA >20%
If anything else: BSA >10%

22
Q

Prevention of ACD

A

ID and avoid plant
Never burn the plant
Avoid the antigen
Clip/clean nails
Wear protective clothes (launder separately)
Mechanically remove or apply herbicide

(I Need A Cig With Mia)

23
Q

OTC prevention options for ACD

A

Barrier products: IvyBlock, Hydropel

Removal of antigen at time of exposure: wash with mild soap and water ASAP

24
Q

Symptomatic relief of ACD

A

Weeping: astringents
Non-weeping: calamine
Itching: colloidal oatmeal, oral antihistamines
Inflammation & itching: hydrocortisone 0.25-1%

25
Q

ACD treatment for pregnant patients

A

Topicals generally safe if limited use

25
Q

ACD treatment for elderly patients

A

Increased absorption risk
Fall hazard w/ ointments

26
Q

What is xerosis

A

Dry skin

Barrier dysfunction due to decreased lipid components, NOT a lack of natural oils

26
Q

Clinical presentation of xerosis

A

Roughness
Fissures
Loss of flexibility
Inflammation
Pruritus
Scaling

(R-FLIPS)

27
Q

Treatment goals for xerosis

A
  1. Hydrate the skin
  2. Restore skin barrier function
  3. Educate about prevention/treatment
28
Q

Key aspects of xerosis care

A
  1. Proper moisturization w/ emollients
  2. Modification of bathing practices
29
Q

How do emollients work?

A

Filling cracks and forming occlusive barrierr

30
Q

Examples of emollients

A

Petrolatum
Oils
Dimethicone
Silicone

(PODS)

30
Q

What else may moisturizers contain?

A

Fragrances
Colors
Plant oils
Emulsifiers (polysorbates)
Humectants (glycerin, urea)
Preservatives

(Fucking Crazy People Eat Hot Pasta)

31
Q

Xerosis: neonates

A

Higher drug absorption

32
Q

Xerosis: pregnancy

A

Topicals generally safe w/ limited use

33
Q

Xerosis: elderly

A

Increased absorption risk
Fall hazard w/ ointments

OTC (31 decks)

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