Xerosis and Atopic Dermatitis Flashcards
What is xerosis
dry skin
What are the external or environmental factors that can cause xerosis
dry air and wind
long and hot showers
prolonged use of detergents and soaps
What are some internal factors that can cause xerosis
dehydration
malnutrition
health conditions like hypothyroidism
What are the presenting symptoms of xerosis
roughness
scaling
cracking
fissuring
erythema
pruritis
When should you refer someone experiencing xerosis
severe dry skin (bleeding or infection)
large body surface area
intense itching
infection skin
What is the general treatment approach when it comes to treating xerosis
modify environmental factors and bathing habits
bath oils and moisturizers
topical hydro cortisone
When should topical hydrocortisone be used
ONLY IF there is pruritis and erythema
When should moisturizers be applied
while skin is still damp after bath/shower
*within 3 minutes
**frequent re-application during the daytime
What other complementary and non-pharmacologic options are available for xerosis
humidify air
drink water
What OTC treatment options are available for xerosis
moisturizers
cleansers
hydrocortisone ointment/cream
Why should soap not be used with xerosis
pulls lipids and oils out of the skin and can worsen the dryness
What is the follow-up recommendation for xerosis
follow-up with prescriber in 1 week if not resolved
What is atopic dermatitis
an inflammatory condition of the epidermis and dermis characterized by episodic flares and periods of remission
also known as eczema
What can cause eczema
genes/mutations
environmental triggers such as diet, pollution, tobacco smoke, clothing, climate, stress, and more
What are the presenting symptoms of eczema
redness and scaling
crusts and pustules caused by itching
remissions and flares
lichenification of the skin
secondary infections can occur
When should you not self-treat eczema
*same as xerosis
age less than 1 year old
face or intertriginous areas
*skin or skin folds are touching or rubbing
What are the goals of therapy of eczema
stop the itch-scratch cycle
maintain skin hydration and barrier function
avoid or minimize triggers
prevent secondary infections
What is the general treatment approach for eczema
manage symptoms because there is no cure
nonpharmacologic first
hydration
skin barrier support and moisture
topical hydrocortisone for itch and inflammation
What are complementary and non-pharmacologic options for eczema
trigger avoidance
oral hydration
skin hydration
trim fingernails short and keep clean
wear cotton gloves at night
wear wet wrap compresses
moisturizers
moderate to severe AD can use dilutes bleach baths
What is the process for preparing and wearing the wet wrap compress
apply an emollient and/or topical hydrocortisone, cooked and cooled oatmeal
wrap in wet layer and then wrap in a dry layer
keep in place overnight
What kind of moisturizers should be used when someone is experiencing eczema
emollients used at least 2 times a day
patient product/ingredient preference
use creams and ointments
coconut oil
*AVOID lotions because they are pretty watery and will evaporate off skin and worsen condition
What is the purpose of diluted bleach baths
control bacteria growth
What are the directions for preparing and using the diluted bleach bath
use 2 times daily 3 times per week
add 1/ cup of 5% household bleach in 40 gallons/full tub and soak for 10 minutes
Rinse with fresh water and pat dry
Apply moisturizer within 3 minutes
What OTC treatment options are available for eczema
bath oils
cleansers
moisturizers
hydrocortisone ointment/cream
*use fragrance free products
**avoid products that say they are unscented
When should you recommend a patient seek follow up for their eczema
symptoms worsen or do not improve after one week
itching is not improves after 1 week of topical hydrocortisone
What is the mechanism of action behind bath oils
lubricate dry skin
what is the mechanism of action behind cleansers
reduce skin drying
What is the MOA of an emollient
fill the space between flaking dead skin cells with oil droplets
What are some examples of an emollient
glycol
glyceryl stearate
What is the MOA of occlusives
prevent evaporation of water from the skin
What are some examples of occlusives
petrolatum
mineral oil
dimethicone
What is the MOA of humectants
Attract and hold water in the skin
what are some examples of humectants
glycerol
lactic acid
urea
How do you use moisturizers
apply liberally and frequently
apply within 3 minutes of toweling off
*at least twice a day and up to 4 times a day
What is the MOA of hydrocortisone
suppresses cytokines involved in inflammation and itching
What is the onset and duration of hydrocortsone
onset within 10 minutes and lasts 10-12 hours
What are the side effects of hydrocortisone
skin atrophy/thinning
When should you avoid using hydrocortisone
weeping lesions present on the skin
cracked, open or infected skin
What is the dosing and usage guidelines for hydrocosrtisone
apply before any moisturizers
apply twice daily during flares ONLY
use as much as the tip of your index finger
use sparingly
use for a MAX of 7 days
