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69 Cards in this Set
- Front
- Back
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4 characteristics that can be found in xerosis
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Roughness, scaling
Loss of flexibility Inflammation and/or fissures Pruritis |
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most common affected areas of xerosis (4)
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lower legs, forearms, dorsa of hands, and the back
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Dry Skin - Etiology (5)
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lack of water in stratum corneum (causes abnormal loss of cells in stratum corneum.)
winter itch Low humidity environments Excessive use of detergent, soap, and hot water (soap removes natural oils increasing dryness) Physical damage to stratum corneum (shaving, scrubbing) |
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chapping occurs if water in skin is at what lvls
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<10%
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increased incidence of dry skin in what pop
why? (2) |
elderly
due to Epidermal thinning resulting from abnormal maturation of keratinocytes Hormonal changes reduce sebum production |
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systemic disorders causing dry skin (2)
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Dehydration
Hypothyroidism |
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key to treatment approach for dry skin
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Improve and maintain skin hydration
` |
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3 ways to treat dry skin (non pharm)
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Reduce exposure to aggravating factors
Maintain barrier (skin hydration via moisturizers) Avoid products containing alcohol or keratolytics |
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4 aggravating factors of dry skin
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Hot water
Cold air/wind Low humidity in winter (makes skin less flexible = bracks) Sun Soaps and detergents |
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3 skin product types
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Bath products
skin cleansers moisturizers |
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Bath oils- properties
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lubricating but NON occlusive
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Colloidal oatmeal products properties (2)
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soothing
anti itch |
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Bath soaps (2 types)
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Oilated soaps
Glycerin soaps |
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Available bath oils include (4)
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Lubriderm
neutrogena nivea generics |
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bath oil contents (2)
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mineral or vegetable oil with a surfactant
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bath oil conc and temperature correlate with what?
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Adsorption onto and absorption into the skin increase with oil concentration and temperature
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benefit of bath oils
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provide lubrication to the skin
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main limitation of bath oil
how to get around it (2) |
often diluted in bath water
Add in at end of bath, “pat” skin dry Wet compresses may be used, body oils also available |
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4 pt edu points with bath oils
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Use with caution: oils may make tub slippery
May increase difficulty with cleansing skin All bath oils appear equally useful Patients with additional dermatological conditions should avoid fragrances |
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Colloidal Oatmeal Products- contain what 3 things
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Contain starch, protein, and oil
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efficacy/evidence for colloidal oatmeals (2)
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Appear to be less effective for dry skin than bath oils
Evidence-based efficacy is minimal |
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oatmeal beneficial effects (3)
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Lubricating effect
-Colloidal oatmeals combine effect of oatmeal and bath oils. (soothing, anti itch) |
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what is in a bath soap (3)
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salts of long chain fatty acids and alkali metal (Na+, K+)
fats/oils too |
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bath soaps + water- what does it do
downside to this |
With water, they act as surfactants to remove unwanted substances from skin
Necessary lipids also removed |
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what about extra oil soaps, to offset the stripping effect of natural body oils? and prevent drying?
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usually lather and clean poorly.
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Dry skin- what soap to choose
sensitive skin? |
Mild soaps with added fats or oils
Balance oils, avoid deodorant and antibacterial soaps |
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favorable bar soaps to use (3)
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Unscented Dove®, Basis®, Oil of Olay® Sensitive Skin, Glycerin soaps
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Glycerin soaps- evidence?
properties (3) |
Water-soluble, higher oil content, neutral pH
no evidence really |
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what to rec if soaps should be avoided?
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Soap-free Skin Cleansers
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contents of soap free skin cleansures (2)
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contain a surfactant and oil
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how soap free cleansers work (2)
evidence? |
Foam upon application and leave a thin lipid layer on skin when removed gently
Assists in retaining water in stratum corneum Low potential for irritation, but clear evidence of superiority is lacking |
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soap free skin cleansers (5)
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Aveeno® Cleansing - Cetaphil®
- pHisoDerm® - Neutrogena® - Free & Clear® |
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cleanser good for infants
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soap free skin cleansers
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best way to use soap free cleansers (2)
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Apply to skin and rub gently
rinse and pat skin dry Apply, rub gently, and remove excess with soft cloth to leave thin film on skin |
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most moisturizers and dry skin products contain a combination of what 3 things?
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Emollients/moisturizers
Humectants Keratin-softening agents |
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agents that enhance stability and appearance in moistureizers (4)
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Emulsifiers (span, tween)
Emulsion stabilizers aka thickening agents (methylcellulose) preservative Fragrance or color can also be added |
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Moisturizers/Emollients definition
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Occlusive agents used to prevent or relieve signs and symptoms of dry skin
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primary actions of moisturizers/emoolients (4)
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leave oily film on skin surface so that moisture cannot escape
Re-establishes integrity of stratum corneum Lipid components reduce flaking Improve skin tone, texture |
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how does moisturizers decrease flaking
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Reduces flaking by flattening scales against skin
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application of lotions after handwashing
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May need to apply 3-4 times/day and on hands after each washing for max benefit
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4 examples of emollients
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petrolatum, lanolin, mineral oil, and butyl stearate
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emollients- what are they doing
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Fill spaces between skin cells and replace lipids
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petrolatum- when to avoid
use |
avoided on puncture wounds and infections as can cause more inflammation
effective occlusive agent and skin protectant (better than others) |
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Lanolin- may cause what AE
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allergic rxn (from sheep)
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ointments are hard to apply- counseling tips (2)
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Recommend warming product, applying thin layer and massage gently
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Humectants- used to do what
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Used to draw water into the stratum corneum from dermis or high humidity atmosphere (>80%)
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Common hydrating agents (humectants) (4)
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Glycerin
Propylene glycol Phospholipids (often contain lecithin) Alpha-hydroxy and lactic acids also considered |
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glycerin- humectant- mechanism
what conc. of glycerin solutions do we use. why? |
Speeds diffusion of moisture from dermis to epidermis
Use low concentrations (5%) to decrease water loss |
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propylene glycol downside
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May cause irritation with increasing concentrations
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phospholipid humectant mechanism
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Contain lecithin; may form a complex with water and form fatty acids (via hydrolysis) to help retain moisture
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Keratin-Softening Agents do what 2 things
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Promotion of hydration & break down of scales or crusts by binding to skin proteins
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Keratin-Softening Agents (2)
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Urea (carbamide)
Lactic Acid Allantoin |
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Urea- properties (3)
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Mildly keratolytic, may remove scales and crusts
Promotes hydration by increasing water uptake in the stratum corneum Affects elasticity of stratum corneum |
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avail % formulations of urea- and when to use (like, the severity of dry skin) (3)
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Mild conditions: 10%
Resistant skin: 20-30% Carmol® 40: RX strength (40% urea) |
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Alpha-hydroxy acids properties- it is used as what? )2_
mechanism it's an acid so what about the pH? |
keratin softening and Increase skin hydration (humectant properties)
May act as modulator of keratinization rather than as a keratolytic May be neutralized in formulation? to achieve favorable pH |
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allantoin products (2)
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Sofenol 5®, Cutemol
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allantoin efficacy and mechanism
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Thought to soften keratin by disrupting its structure
Less effective as softening agent than urea |
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allantoin- safe conc.
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safe and effective protectant at concentrations 0.5-2.0%
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um...dry vs wet skin- choosing moisturizing products
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If It’s Wet, Dry It= solutions, gels, some creams
If It’s Dry, Wet It= creams, lotions, ointments |
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normal skin- moisturizer choice (2)
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Water-based, non-greasy feel
Cetyl alcohol, silicone derived ingredients |
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oily skin- moisturizer properties (4)
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Water-based, oil-free, light in nature
Non-comedogenic |
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sensitive skin and mature skin- moiturizer properties to choose
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Sensitive skin
Consider skin-type, avoid potential allergens Mature skin (uhh like old people?) Consider skin-type, likely need oil based |
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Treatment Approach to Dry Skin (4 steps)
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Improve and maintain skin hydration
(humidifiers, keep room temp lower to prevent sweating DRINK) Proper bathing- 1x a day, no hot water, short Eliminate exposure to harsh agents and cold weather Protect- emollient 3-6x daily, keratolytic, maaaybe mild corticosteroid |
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when to refer to PCP (4)
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large areas, severe damage to skin integrity (splitting, cracking), or infection
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appropriate use of moisturizers- when to apply/ how often...etc (3) which most effective
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Apply at least two to three times daily
Apply immediately after bathing, showering “Three-minute rule”?? wtf. apply within 3 min of finishing bath Oil based products most effective |
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4 things to warn pt about moisturizers
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Can be greasy and stain clothing
Avoid puncture wounds, infections or lacerations Avoid eyes, mucous membranes, acne prone areas Over application can lead to tissue maceration |
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hydrocortisone indications (3)
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dry skin...maybe
Atopic or contact dermatitis |
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applying HTC (3)
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Apply sparingly up to three to four times daily
Intermittent use recommended as response may decrease over time |
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cautions with HTC (3)
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Avoid use in areas which may be infected
Caution on face if face or large area involved- talk to PCP may need oral |
