Therapeutics Iii Exam 3- Skin Care: Atopic Dermatitis

Front 1

atopic dermatitis- aka?

primary affected population

Back 1

Also known as eczema

Primarily seen in infants, children, and young adults

Front 2

presentation of eczema in infants vs. childrens vs adults

Back 2

Infants: rosy cheeks, forehead, scalp (head)
Children: folds of elbows and knees, legs (joint folds)
Adults: dorsa of hands, face, folds and legs (back of hands, face , legs)

Front 3

Atopic Dermatitis presentation (6) (s/sx)

Back 3

Symptoms include intermittent and intense itching

“Itch-scratch” cycle

May begin like clusters of tiny blisters

Inflammation, dryness, and scaling often present

Lichenification (thickening) of skin possible with chronic scratching

As older child and adult can have dry, thickened plaques with hyperpigmentation

Front 4

atopic dermatitis etiology

linked diseases (3)

Back 4

unknown. just that it is not contagious..
Atopic triad: things that are linked to it

asthma, allergic rhinitis, atopic dermatitis

Front 5

exacerbators of eczema (6)

Back 5

Irritants - Allergens (foods)
- Dry skin - Humidity
- Stress - Temperature extremes

Front 6

atopic dermatitis treatment goals (4)

Back 6

NOT to cure (there is no cure)
Control symptoms
Prevent secondary infection
Heal affected skin

Front 7

Assessment considerations
for eczema before deciding treatment (4)

Back 7

Clarify onset and duration of symptoms
Identify any predisposing factors or triggers
Location
Age (if <2 go to doc)

Front 8

how to tell acute vs chronic eczema

Back 8

Acute flares – may be weeping, red, inflamed
Chronic concerns – may be dry, scaling, thickening

Front 9

Atopic Dermatitis - Treatment
Non-medication measures (5)

Back 9

Avoid excessive bathing
Apply moisturizers immediately after bathing

Use humidifier in dry seasons or low-humidity environments

Avoid known irritants

Minimize scratching

Front 10

Treatment of acute, weeping lesions
(4)

Back 10

KEY: Dry affected area(s)
tap water compress
Tepid baths with colloidal oatmeal may soothe

Hydrocortisone 0.5-1% in (o:w) base may be useful (no ointment if oozing)

Front 11

Treatment of chronic, dry lesions
(3)

Back 11

Maintain hydration and decrease itching
bathing with oatmeal or oil
Oral antihistamines- may be useful at bedtime (hydroxyzine if extreme case)

Front 12

eczema- when to talk to doc (4)

Back 12

Large areas
Facial, eye involvement
Secondary infection
OTC treatment insufficient

Front 13

things the doc can give for eczema (3)

Back 13

Prescription corticosteroids
Immunomodulator
Immunosuppressants, light therapy for severe cases

Front 14

children and hydrocortisone- give or not?

Back 14

Because AP is a child it is important to have a definitive diagnosis before recommending a pharmacologic agent, such as hydrocortisone.

Front 15

Contact dermatitis definition

Back 15

Rash resulting from allergen or irritant

Front 16

acutve vs chronic contact dermatitis (3 properties each)

Back 16

Acute phase: red, vesicular, and weeping
Chronic phase: dry, thickened, with fissures

Front 17

characteristic of contact derm lesions

Back 17

Lesions are asymmetric and sharply demarcated as they reflect where contact occurred

Front 18

2 types of contact derm

Back 18

Irritant (nonallergenic, nonimmunologic) or allergic

Front 19

3 types of irritants- describe when they will cause a response

Back 19

Primary (strong) irritants may cause response after one exposure; may range from erythema to ulceration
Mild irritants may require several exposures
Secondary irritants may require combination w/others

Front 20

2nd most common cause of contact derm

Back 20

Nickel is 2nd most common cause

Front 21

allergic contact dermatitis- describe the 2 phases

common allergy (2)

Back 21

First contact: initial sensitizing exposure
Elicitation: subsequent contact w/allergen results in eczematous symptoms

nickel allergies
Toxicodendron (Rhus) genus plants (poison ivy, etc.)

Front 22

KEY to treating allergic CD (2)

Back 22

Identify and eliminate offending substance
May require skin patch testing by physician

Front 23

contact dermatitis- treatment- depends on what?

what will the treatment be/look like? (3

Back 23

if nonallergic- you want to cleanse the area
wet = dry it, dry = wet it (same with atopic derm)
hydrocortisone if not a young child and not oozing

otherwise can use systemic abx if allergic

oatmeal
preventive measures
topical corticosteroids

Front 24

poison ivy/oak/etc- rhus dermatitis- what causes it?

other ways of contact that are not direct (2)

Back 24

A phenolic, oily resin (toxicodendrol) that contains URUSHIOL- offending agent

oil can stay on objects or be in smoke

Front 25

5 ways of preventing Rhus derm

Back 25

Avoid allergen

Remove known plants or use herbicide

Protective clothing

Proper care of affected clothing and objects
barrier craems may help

Front 26

barrier creams- is there an age limit?

Back 26

<6 do not use (organoclays)

Front 27

washing stuff (3 things) after touching poison ivy- and how to best clean them

Back 27

Clothes: detergent and hot water
Tools: wash with alcohol
Skin: wash within 10-15 minutes (soap, technu??, zanfel- all efficacious))

Front 28

4 categories of OTC stuff for poison ivy

Back 28

Antipruritics
-Low potency steroids, antihistamines, counterirritants
Astringents
Antiseptics
Local anesthetics

Front 29

other "stronger" meds for pioson ivy (2)

Back 29

Topical antibiotics only if secondary infection

Higher-strength corticosteroids available by prescription

Front 30

Antipruritics for poison ivy (2)

Back 30

Low Potency Steroids- Topical hydrocortisone 1%

antihistamines- topical or oral (if wide spread)- but consider age of pt due to Ach effects

Front 31

downside to topical antihistamines

Back 31

May act as a sensitizer and cause secondary inflammation

Front 32

Counterirritants (3)

Back 32

menthol
camphor, and phenol

Front 33

counterirritants- what do they do

low vs high conc activity

Back 33

Produce cooling sensation and reduce irritation
Low concentrations relieve irritation by depressing cutaneous receptors

Higher strengths produce local hyperemia, irritation
want to keep low conc

Front 34

Astringents usage

Back 34

Used to stop oozing, reduce inflammation, and promote healing

Front 35

4 roles that astringets play

Back 35

Reduce exudates, crusts, and debris
Protein coagulation
Vasoconstriction
Evaporation

Front 36

3 astringents

Back 36

Aluminum acetate (Burrow’s solution)
Witch hazel (Hamamelis water)
Zinc oxide (15-25%) (or calamine- which is zinc + ferrous oxide- inactive, makes it pink)

Front 37

4 directions for using astringents for pt

Back 37

Following preparation, may soak affected area for 15-30 minutes two to four times daily

Compresses - apply for 20-30 minutes four to six times daily

Extending use beyond 5-7 days may be irritating- so make sure to remove buildup/cleanse/hydrate

Avoid use around eyes

can use for other shit

Front 38

local anesthetics- duration
usage

Back 38

Short duration of action: 15-30 minutes

NOT a preferred treatment option

Front 39

local anesthetic ADR (3)
what to do if you get these

Back 39

dermatitis, urticaria, allergic reactions

if occurs, wash area with soap and water

Front 40

mild rhus dermatitis characteristics

Back 40

characterized by linear streaks of papules, vesicles

Front 41

treating mild poison ivy (3)

what to avoid (3)

Back 41

Antipruritic lotions (calamine, ZnO +/- menthol)
Wet dressings with astringents and apply for 30 minutes three to four times daily
Topical hydrocortisone cream safe and effective
Best to avoid local anesthetics and topical antihistamines
avoid ointments if rash is weeping

Front 42

moderate poison ivy - describe

Back 42

bullae and swelling in addition to vesicles

Front 43

3 eextra things you can do if moderate poison ivy

Back 43

can drain bullae if large (professionally done)
Facial lesions may be treated with cold water compresses
Soothing no fragrance cream (Aveeno®, Curel® Therapeutic) may be added to minimize crusting, thickening
Consider pH of cream

follow with mild poison ivy treatment

Front 44

Severe rhus dermatitis (3)

Back 44

widespread reaction, major swelling, pulmonary, eye or genital involvement

Front 45

treatment of severe poison ivy (first step, then rx steps (4)

Back 45

Refer to physician
Rx therapy: oral or topical corticosteroids- will have to taper over 12-21 days
Oral antihistamines may decrease itching and aid sleep
2-6 tepid baths/day may be soothing
Colloidal oatmeal is a good option

Front 46

5 causes for diaper rash

Back 46

Moisture
Occlusion
Contact with urine or feces
Chafing
Mechanical or chemical irritation

Front 47

main complication of diaper rash

Back 47

Fungal and bacterial infections

Front 48

common fungi responsible for diaper rash complication

Back 48

C. albicans likely responsible

Front 49

where does c.albicans come from?
what might induce it to spread?

Back 49

May be part of normal flora or present in stool
Secondary to use of broad spectrum antibiotics

Front 50

characteristics of a c albicans compmlication (4)

Back 50

Produces bright red, patchy rash with satellite pustules and erosions

Front 51

bacteria often involved with diaper rash

describe the lesions

Back 51

S. aureus most common cause
Classic lesions are micropustules that coalesce

Front 52

infections in diaper rash can lead to... (3)

Back 52

Infections could progress to skin ulcerations, infection of penis/vulva, or UTI

Front 53

4 steps that can keep your baby rash free

Back 53

keep area dry and clean by:

changing diaper a lot (>6 x a day)

Use appropriately sized diapers that are non-plastic and absorbent

Clean area with each diaper change
(hypoallergenic wipes or mild soap and water- better to not use tub- can reinfect)

Allow skin to dry before replacing diaper
Bland ointment may be helpful in keeping skin dry (powders not helpful)

Front 54

Diaper Rash - Treatment- first line

Back 54

Protectants- ONLY approved OTC product

Front 55

how does a diaper rash protectant work

Back 55

Act as physical barrier by sealing out or absorbing moisture

Front 56

ingredients in most diaper rash products (2)

Back 56

include zinc oxide and petrolatum

Front 57

Points of caution with powders: (why they not as good) (3)

Back 57

causes caking if rash is oozing (DO NOT USE FOR THOSE)
inhalation by infant!
Cornstarch may promote bacterial growth

Front 58

powder protectants (4)

Back 58

Talcum, cornstarch, kaolin, magnesium stearate

Front 59

additional protectants

compare vs. zinc oxide and petrolatum

Back 59

Cod liver oil, vitamins A and D, lanolin, silicone, etc.

no significant benefit

Front 60

OTC products not recommended for routine treatment (4) and briefly, why

Back 60

External analgesics

Antifungal creams and powders (only use with doc approval)

Antimicrobials -can sensitize and want to make sure it is bacteria first (refer)

Hydrocortisone
Inflamed, abraded skin will increase absorption
Chronic use may impair healing

Front 61

diaper rash duration of treatment- when to refer to MD

Back 61

Treat for 1 week up to 10 days if improving. If no improvement after 7 days, see MD.

Front 62

5 things that a pharmacist should do with diaper rash

Back 62

Keep skin clean and dry

Assess each rash carefully
Consider irritants; watch for secondary infections

Remove any suspected irritants (change diapers)

Provide proper education for selected products
Avoid indiscriminate use

Refer to physician if condition persists, symptoms spread or worsen (blisters, fever)