Intertrigo / Contact Derm / Poison Ivy / Lice & Scabies

Question 1

Common causes of Allergic Contact Dermatitis?

Answer 1

-Nickel
-Poison Ivy
-Latex
-Food
-Fragrances

Question 2

Common causes of Irritant Contact Dermatitis?

Answer 2

-Soaps
-Cleansers
-Water
-Detergents
-Oils
-Paints
-Hair Dyes

Question 3

How might we go about identifying allergens that may trigger Allergic Contact Dermatitis?

Answer 3

Patch Tests

Question 4

Most common medication agents that induce ACD?

Answer 4

Topical Antibiotics

Question 5

What type of Contact Dermatitis is most commonly seen with BP-induced flareups in Acne treatment?

Answer 5

Irritant Contact Dermatitis (ACD extremely small % of population)

Question 6

Chronic irritant exposure leads to what skin process?

Answer 6

Keratinization in & around affected area (protective measure put in place by the body).

Question 7

Treatment of Acute Contact Dermatitis?

Answer 7

-Cool Wet Dressings QID x 20mins (to alleviate some of the discomfort associated with blistering).

Question 8

Treatment of Sub-Acute Contact Dermatitis?

Answer 8

-Discontinuation of wet dressings
-Steroid Lotions / Creams

Question 9

Treatment of Chronic Contact Dermatitis?

Answer 9

-Warm water soaks (to soften up keratinized skin)
-Dry skin creams
-Steroid Creams / Ointments

Question 10

What is the difference between a “wet dressing” & a “water soak” as they pertain to CD treatment?

Answer 10

Dressing = Gauze or Facecloth + Cool Water.

Soak = Placement of AA in Warm Water… No Dressings.

Question 11

What needs to supplement warm water soaks in CCD treatments?

Answer 11

-Follow up with a steroid cream or ointment… Dry, unmedicated skin cream for sure.

Question 12

What does Intertrigo describe?

Answer 12

-Location!!! Problem itself can be a multitude of things (Psoriasis / Fungal / Bacterial Infection), but the basis of Intertrigo is contact between two skin folds.

Question 13

What non-medical measures can be undertaken to combat Intertrigo?

Answer 13

i) Keeping AA’s as clean & dry as possible.

ii) Very tight-fitting clothing (to prevent two areas around skin folds from contacting each other).

Question 14

What is the name of the resin that spreads an allergic rash in response to Poison Ivy exposure?

Answer 14

Urushiol (from broken / burned plants)

Question 15

What does Poison Ivy look like?

Answer 15

-Burning, red rash within 12-48hrs of exposure
-Often see streaking
-Blistering

Question 16

Can blisters spread Poison Ivy rash?

Answer 16

-No… Urushiol Oils do!

Question 17

What can be used to alleviate redness / itchiness from Poison Ivy rash?

Answer 17

-Cool Compresses
-Calamine
-Topical Steroid

Question 18

How long does it take mild rxn’s from Ivy exposure to subside?

Answer 18

7-10 days

Question 19

Can plant oils secreted from Poison Ivy persist on clothing for years on end?

Answer 19

Yeppers!

Question 20

If a Topical Steroid is chosen to treat Poison Ivy-Induced Rash, what product should we jump to?

Answer 20

-Spectro EczemaCare BID 2-3 days… HC 1% not strong enough of an agent (need something more potent).

Question 21

What length of time is required for a Lice Nymph to emerge from their eggs?

Answer 21

6-10 days

Question 22

How long do female lice survive for, & how many eggs / day do they usually lay?

Answer 22

1-3 months
5-10 eggs / day

Question 23

How do Lice spread?

Answer 23

Head Contact (between two people)
Bedding / Towels / Hats
Combs & Brushes

DO NOT JUMP TO NEW HOSTS!!!

Question 24

Do Lice discriminate who they target (ie. Clean vs. Dirty Hair)?

Answer 24

-Nope… Can survive showering & washing by closing their gills off.

Question 25

If Lice are found in bedding or on towels, how viable are they? In hats?

Answer 25

-Not very... Probably in the process of dying, as they prefer the warmth of a human head. -In hats, likely more viable b/c of the more frequented head contact.

Question 26

Other name for lice eggs?

Answer 26

Nits

Question 27

Do Nits wash out?

Answer 27

Nope

Question 28

Where do Nits / Lice generally present themselves on the scalp?

Answer 28

Back of the scalp & around ear lobes

Question 29

What lice product was taken off the market due to its seizural effects on kids taking it chronically for Scabies?

Answer 29

Kwellada

Question 30

Why is GBH / Lindane safe for treating kids with lice & not for treating Scabies?

Answer 30

-Contact duration... 8-12hrs in every bodily crevice for Scabies (vs. 8mins of exposure in shampoos for lice treatment).

Question 31

Name of the Pyrethrum compound in certain plants that acts as a natural insecticide?

Answer 31

Chrysanthemum

Question 32

What product did Chrysanthemum ultimately make its way into?

Answer 32

R & C Shampoo

Question 33

What additional agent is added to R & C Shampoos to enhance the potency of Pyrethrins (either via lasting longer or by increasing ability to enter lice bodies)?

Answer 33

Piperonyl Butoxide

Question 34

What unique instructions should be followed when taking a Pyrethrin Shampoo for one's lice?

Answer 34

-Application should be to dry (not wet) hair. -Contact time = 10mins.

Question 35

Is there a potential for lice resistance to Pyrethrin agents?

Answer 35

Potentially

Question 36

Location (in terms of depth in/on the hair & scalp) of Louse & Nits?

Answer 36

Nits: Tightly attached to hair strands. Lice: Crawl around on the scalp.

Question 37

What use would a Pyrethrin product containing Lead have?

Answer 37

-For use on lice-infested garments / bedding / mattresses / furniture... NOT for use on humans or pets. R & C II Spray

Question 38

Permethrin 1% is a _______ ________ derivative.

Answer 38

synthetic pyrethroid

Question 39

T or F: Permethrin has enhanced potency (relative to a classical Pyrethrin).

Answer 39

True.

Question 40

T or F: Permethrin is extremely safe to use with children.

Answer 40

True.

Question 41

Directions for Permethrin 1% usage?

Answer 41

1) Wash hair with shampoo 2) Creme rinse x 10mins 3) Rinse out

Question 42

T or F: Lice resistance can be demonstrated with Permethrin products.

Answer 42

True... Is a possibility.

Question 43

T or F: Permethrin & Pyrethrin products don't require nit removal.

Answer 43

False... Must remove nits after treatments!

Question 44

Brand name creme rinses containing Permethrin 1%?

Answer 44

Nix Kwellada-P

Question 45

"Physical Agents" that can be used for lice treatment?

Answer 45

Isopropyl Myristate Coconut / Anise Oil Dimethicone SH-206 Shampoo

Question 46

Isopropyl Myristate treatment regimen for lice?

Answer 46

10min contact time Nit Pick Repeat in 7d

Question 47

Coconut / Anise Oil treatment regimen for lice?

Answer 47

15min contact time Nit Pick Repeat in 9 days

Question 48

Dimethicone treatment regimen for lice?

Answer 48

30min Contact Time & Nit Combing with product in the hair Overnight treatment = 8hrs contact Nit Pick Re-Apply prn

Question 49

Why does persistent itch occur ~1wk after scalp infestation with lice?

Answer 49

-Lice secretes anticoagulant, which is the root cause of the itch.

Question 50

1st line lice product?

Answer 50

NYDA Dimethicone

Question 51

Utilization of heat (from hair straighteners or blow dryers) & bug-busting (combing with a lice comb w/o use of medicated shampoo) are two good lice treatment strategies.

Answer 51

-False... Both are not very effective.

Question 52

What lice product was forced to be withdrawn from a Calgary feed shop that saw customers buying it for SARS-CoV2 treatment?

Answer 52

Ivermectin

Question 53

What other products have been used as lice treatment strategies?

Answer 53

Dry-On Suffocation (Cetaphil Lotion) Lice Electrocution Tea Tree Oil (insecticidal, but to what capacity?) Ulesfia Natroba

Question 54

Lice treatment expectations... When will itch go away, how fast do they work, when can my kids go back to school?

Answer 54

i) Few days & itch will go away ii) ~10mins to work iii) Next day

Question 55

Why is nit comb dipping in vinegar discouraged when one is on a Permethrin product such as Nix?

Answer 55

-Vinegar reduces the residual effects of Permethrin! -Secondarily; not enough contact time for Nit glue dissolving with simple dipping.

Question 56

Is there a treatment for body lice?

Answer 56

-Nope... Only option is to treat clothing.

Question 57

What product is officially indicated on its packaging for the treatment of pubic lice?

Answer 57

Pyrethrins (R & C Shampoo)

Question 58

How do we treat pubic lice?

Answer 58

-Treat once with Pyrethrin product & shave the area. -Note that other Physical Agents discussed priorly can (probably) be used for treating pubic lice, but Pyrethrins are officially indicated on their packaging.

Question 59

Main transmission route of Scabies?

Answer 59

Person-to-Person contact

Question 60

Secondary transmission route of Scabies?

Answer 60

Bedding & Clothing

Question 61

Where are Scabies mites predominantly located?

Answer 61

Between fingers & on the wrists

Question 62

What diagnostic sign indicates the potential location of Scabies mites?

Answer 62

-Blue dots where burrowing has taken place.

Question 63

What makes Scabies treatment frustrating for patients?

Answer 63

-Must treat head-to-toe. -Itch persists for a few weeks. -Requires blind treatment of close contacts.

Question 64

Product for Scabies treatment?

Answer 64

Permethrin 5% dermal cream / lotion

Question 65

How do blind treatments for Scabies differ from Lice?

Answer 65

Scabies: 12hrs full body contact once, then follow-up treatment 7 days later. Lice: Treat blindly every 7-9 days with safer current agents.