Final 2- Alternative Medicine, Weightloss, Dandruff, Poison Ivy, Diaper Rash Flashcards
acupuncture
stimulate specific points on body through inserting thin needs through skin
homeopathy
-use cause to treat; dilute it to make it more potent (10C=100x dilution- diluted 10x), non toxic and no SEs because nothing, BS. Can be harmful if putting off other things
alternative medicine good on own
only if not putting off something serious, but can be great adjunct to therapy, pre surgery, with cancer, etc
how to potentially lose 1 lb
500 calories/day for 7 days; eventually will plateau and become harder to lose weight
must add if viscous dieting
multivitamin
phenylpropanolamine
- used to be standard decongestant, amphetamine like (raise heart rate, stay awake)
- removed due to heart effects
- never indicated for appetite suppressent OTC
methylcellulose in weight loss product thought to
-bind and absorb water, swell, make feel more full. didn’t work
ephedra/ephedrine for weight loss
- not significant
- 8mg as decongestant
- decrease half a kg per month only if in high doses (100-150 mg/day)
- with caffeine can be 1kg/month, again only in high doses
- ephedra is not as good as parent compound (ephedrine) and will get even slimmer chance of losing weight
bitter orange
- in caffeine naive people, will get initial water loss from duresis, but coffee drinkers will see no effect
- little value
caffeine
- CNS stimulant, early diuresis
- cocoa bean, yerba mate, green tea, guarana, kola nut are sources
green tea
-has natural phenols in unroasted beans , some link to antioxidants maybe cancer/heart benefit, not good for weight loss
chlorogenic acid
a phenolic compound in coffee
chlorogenic acid
a phenolic compound in coffee
hoodia
no value in weight loss
desperate for weight loss product
-give one a day weightsmart vitamin with green tea, at least its a multivitamin with some minerals too
raspberry ketones
can be linked to decongestion, but unlikely to increase metabolism
- flavoring agent that may or may not be from raspberries
- chemically similar to synephrine, that’s why thought to increase lipid metabolism
slim fast
less bad than just taking chemicals, at least still get carbs, etc
-may even lose weight with it;take less calories in (meal replacement)
gluten free products: calories
may have increased amounts
PGX
-bulking tool; but it is just as important as exercise ie it doesn’t work
acai and weight loss
doesn’t work
orlistat (xenical, Alli)
inhibits intestinal lipase so fat you had in meal is less digested (1/3 less fat absorption); ALL IT DOES IS MAKE YOU WANT TO CHANGE YOUR DIET
- TID during or within 1 hr after meals
- officially used for BMI over 30
- Alli is USA OTC- has half dose of rx
- GI SEs are significant and unpleasnt: if don’t lower fat intake on own, will get fatty, gross, smelly stool, flatulance, oily spotting in underwear, frequency and urgency
spirulina
seen in weight loss products as kelp and algae
- contain iodine, link to thyroid activity,
- rare that obesity results from hypothyroidism and no evidence this will help weight loss
sibutramine (Meridia)
- increases NA and seratonin blockade to emhance satiety
- SE= dry mouth, constipation, insomnia, CV
- 10 mg OD
diethylpropion
amphetamine like, central appetite suppression
-potential for dependence and CV SEs
malassezia
yeast like, fungal organisms that causes dandruff and seborrhea
increased incidence of dandruff and seborrhea
-malessezia, puberty (androgens), male, stress, genetics, HIV patients, psoriasis patients
dandruff
dry, large, thin, white powdery scales, minimal inflammation
-even distribution over scalp
seborrhea
yellow, oily, greasy scales, with inflammation
- can be in other areas of body too
- tends to be more patchy
- can be on eyelids (blepharitis), ear cannal, cradle cap (seen at 3-4 weeks old)
- can be on face/chest
dandruff treatment products
- triclosan= not strong enough
- salicylic acid (2-4%)- keratolytic and helps get top layers off (rarely given on own, good to combine with coal tar)
- coal tar- cytostatic (either as percent 0.5% or solution 10% )
- cytostatic antifungals like selenium sulfide, zinc pyrithione, or even stronger ketoconazole, ciclopirox
dandruff treatment factors
- treat scalp not hair
- use 2x per week
- if see tachyphylaxis to standard agent, switch
coal tar 0.5% equivalent solution
10%
treating sebhorreic dermatitis
- by Rx, apply to body region
- tar shampoos
- anti fungal products (ketoconazole cream 2% OD-BID for 4 weeks) (ciclopirox shampoo)
- topical steroids
chronic case of seb derm
nimecrolimus cream
treating sebhorreic dermatitis
- by Rx, apply to body region
- if ask, can use non rx agents as well
- tar shampoos
- *anti fungal products (ketoconazole cream 2% OD-BID for 4 weeks) (ciclopirox shampoo)
- *topical steroids
chronic case of seb derm
nimecrolimus cream
relapses with seb derm?
expect them
cradle cap occurance
3-4 weeks of birth
- scales on scalp with no oozing or weeping
- disappears after 8 months
- unknown etiology
cradle cap treatment
-baby oil, vaseline to soften scales prn over night for 5-6 days
contact dermatitis: allergic vs irritant exposure time
-allergic: amount of exposure not important
-irritant: amount of exposure is important
BUT get almost exact same result on skin for both
what to do for acute contact dermatitis
cool, wet compress/dressing QID for 20 minutes
what to do for subacute contact dermatitis
- discontinue the wet dressings from acute
- use steroid lotion or cream
what to do for chronic contact dermatitis
warm water soaks (to soften)
- dry skin creams
- steroid or fungal creams
- maybe spectro eczema cream
for infected ears use/ don’t use
- USE: soap and water, maybe polysporin
- DON’T: burrows solution, calamine
don’t use burrows solution for
dermatitis
resin from poison ivy
urushiol
resin from poison ivy
urushiol
wash off contacted areas with poison ivy within
15 minutes
symptoms of poison ivy contact
-burning, red rash in 12-48 hours in streaks from contact
how to spread poison ivy
- NOT from you blister fluid
- oil/resin left on clothes, hands, etc
treat poison ivy rash
- burrow’s
- cool compress*
- calamine: a few times a day only for a day or 2 because it pulls out fluids (don’t want for too long) *do not put on dry lesions it will make itchier and drier
- DO NOT SCRATCH
- short, lukewarm baths with colloidal ointmeal or baking soda to soothe itch (also short, cool showers, lotion, etc)
- can use antihistamine pills
mild reactions to poison ivy subside in
7-10 days
dandruff treatment products
- try non medicated shampoo first
- triclosan= not strong enough
- salicylic acid (2-4%)- keratolytic and helps get top layers off (rarely given on own, good to combine with coal tar)
- coal tar- cytostatic (either as percent 0.5% or solution 10% ), antipruritic, unpleasant odor, stains
- cytostatic antifungals like selenium sulfide, zinc pyrithione, or even stronger ketoconazole (cream 2% or shampoo), ciclopirox
contact dermatitis: allergic vs irritant exposure time
-allergic: amount of exposure and concentration not important (cosmetic, metal, plant, latex, topical meds)
-allergic is usually delayed reaction, 12 to 48 hours
-irritant: amount of exposure and concentration are important (soap, detergent, solvent, fiberglass)
BUT get almost exact same result on skin for both (reddened, itchy skin with some weeping and inflam, can progress to thickened, scaling, patchy lesions)
resin from poison ivy, oak or sumac
urushiol
wash off contacted areas with poison ivy within
15 minutes, use normal saline or water (best), or waterless cleanser if really have to to get rid of some oils and don’t have anything else
-skin can react within 2-3 days (minimum 12 hours)
mild reactions to poison ivy subside in
7-10 days
prevention of poison ivy
- covering clothes=good
- prevention/blockers=make no sense
coal tar on hairy or broken skin areas
can cause folliculitis
clinical presentation of acute dermatitis
PEEV
- pruritis
- erythema
- edema
- vesicles
clinical presentation of sub acute dermatitis
PELM
- pruritis
- erythema
- lesions drying
- minimal scaling
clinical presentation of chronic dermatitis
PLTS
- pruritis
- lichenification
- thickened skin
- scaling
what to do for subacute contact dermatitis
- discontinue the wet dressings from acute
- use steroid lotion or cream (rehydrate skin)
what to do for chronic contact dermatitis
warm water soaks (to soften)
- dry skin creams/ointments prn
- steroid (sparingly tid-qid) or fungal creams
- maybe spectro eczema cream
treat poison ivy rash
- burrow’s dressing 3-4x dat
- cool compress*
- calamine: a few times a day only for a day or 2 because it pulls out fluids (don’t want for too long) *do not put on dry lesions it will make itchier and drier
- DO NOT SCRATCH
- short, lukewarm baths with colloidal ointmeal (Aveeno) or baking soda to soothe itch (also short, cool showers, lotion, etc)
- can use antihistamine pills
clinical presentation of chronic dermatitis
PLTS
- pruritis
- lichenification
- thickened skin
- scaling
clinical presentation of chronic dermatitis
PLTS
- pruritis
- lichenification
- thickened skin
- scaling
diaper rash is a type of ____ contact dermatitis
irritant, where skin fold are typically spared, last 2-3 days
cause of diaper rash
- fecal (esp viral gastroenteritis ie stomach flu with GI enzymes coming out in diarrhea which is hard on baby’s bum- enzymes degrade skin)/urine contact
- chemical residue- very, very small risk (esp from wipes- prop glycol has been removed therefore very safe unless extremely sensitive skin/eczema)
- chafing
- antibiotic use- post use can increase diarrhea
- formula more risky than breast milk
treatment of diaper rash
same approach as prevention:
- keep clean
- use barrier products- can be after every change or not, no difference baby can handle both (but if use barrier, can help decrease chance of diaper rash)
- allow air time
- bigger diaper
time to treat diaper rash
less than 3 days: if more, and not getting any better, likely fungal
diaper rash is a type of ____ contact dermatitis
irritant, where skin fold are typically spared, lasts 2-3 days, is not an infection, contained in diaper area and to wherever contact was
time to treat diaper rash
less than 3 days: if more, and not getting any better, likely fungal
if child has diaper rash as well as oral thrush
assume diaper area is infected with yeast
yeast infection of diaper area
in skin folds, lesions beyond diaper often, fiery red and spotty, vesicles/satellites, need antifungals
eczema or diaper rash/yeast?
eczema spares under diaper because moist
seb derm or diaper rash/yeast?
seb derm usually seen in other areas (cradle cap) and is yellowy scales usually only in skin folds
impetigo or diaper rash/yeast?
impetigo is honeycolored, crusted erosions, common cause of rash on infant bottom, 1-2 mm fragile pustules
scabies or diaper rash/yeast?
widespread, pruritic rash
psoriasis or diaper rash/yeast?
sharply demarcated scaly papules and plaques
treating yeast diaper infection
antifungals BID for 2 weeks (or until baby is “clear”) then 1 week after clearing. IF not better in 3 weeks, could be bacterial. Should visibly improve in a few days.
- miconazole or clotrimazole 1%
- ketoconazole is most common rx, we can prescribe
- steroid can be used to control faster, but do not use in a combo product (1% BID for 3-7 days) use one one day, one next if really want both- but steroids can get rid of very important clinical monitor
canesten vaginal cream for diaper yeast infections
- the 1% (ie 6 day) is best
- do not use 1 day (10%)
- if really stuck, 2% 3 day would be okay
treatment of diaper rash
same approach as prevention:
- keep clean
- use barrier products- can be after every change or not, no difference baby can handle both (but if use barrier, can help decrease chance of diaper rash)
- allow air time
- bigger diaper
- can use HC 1% (3-7 days), then wait 5 minutes and apply barrier
treating yeast diaper infection
antifungals BID for 2 weeks (or until baby is “clear”) then 1 week after clearing. IF not better in 3 weeks, could be bacterial. Should visibly improve in a few days.
- miconazole or clotrimazole 1%
- ketoconazole 2% cream BID for up to 2 weeks is most common rx, we can prescribe
- steroid can be used to control faster, but do not use in a combo product (1% BID for 3-7 days) use one one day, one next if really want both (or steroid first then a few minutes later antifungal)- but steroids can get rid of very important clinical monitor
canesten vaginal cream for diaper yeast infections
- the 1% (ie 6 day) is best
- do not use 1 day (10%)
- if really stuck, 2% 3 day would be okay
talc powder on babies
not loved by pediatricians because can get in to lungs, but as long as child doesn’t inhale it’s okay
diaper rash; ointment vs cream
ointment
when to refer diaper rash/ yeast
if no improvement/ resolvement in 7 days
zinc vs vaseline
more protective (zn)
diaper rash is a type of ____ contact dermatitis
irritant, where skin fold are typically spared, lasts 2-3 days, is not an infection, contained in diaper area and to wherever contact was, mild redness and swelling that can have pimples, blisters and sores
cause of diaper rash
- fecal (esp viral gastroenteritis ie stomach flu with GI enzymes coming out in diarrhea which is hard on baby’s bum- enzymes degrade skin)/urine contact
- chemical residue- very, very small risk (esp from wipes- prop glycol has been removed therefore very safe unless extremely sensitive skin/eczema)
- chafing
- antibiotic use- post use can increase diarrhea
- formula more risky than breast milk
- intro of new foods
yeast infection of diaper area
in skin folds, lesions beyond diaper often, fiery red and spotty, probably swollen, vesicles/satellites, need antifungals
