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Self Care Exam 3- Atopic Dermatitis, Dry Skin and Scaly Dermatoses

STUDY
PLAY
Skin Function
~Protection from injury
~Barrier against microorganisms
~synthesis of melanin
~sensory input recipient
~vitamin D3 production
~prominent role in thermoregulation
Three layers of skin
~epidermis
~dermis
~hypodermis
Principles of drug absorption
~topical application
~passive diffusion
~percutaneous absorption
~general circulation
Drying agents
solutions, gels and occasionally creams
Lubricating agents
creams, lotions, ointments
crust
*secondary
*dried exudate containing proteinaceous and cellular debris from erosion or ulceration of primary lesion
erythema
*primary
*reddened skin
fissure
*secondary
*a split in the epidermis extending into the dermis
lichenification
*secondary
*thickening and hardening of the skin into irregular plaque due to excessive rubbing or scratching
macule
*primary
*flat, nonpalpable, discolored lesion less than 1cm in diameter; lesions larger than 1 cm are termed patches
necrosis
*secondary
*dead cells or groups of cells caused by severe trauma or an infectious process
papule
*primary
*a solid, circumscribed, elevatedlesion less than 1 cm in diameter
plaque
*primary
*a palpable, papular, relatively flat lesion more than 1 cm in diameter
pustule
*primary
*a circumscribed elevated lesion less than 1 cm in diameter containing pus; a larger lesion is termed an abcess or furnucle
scale
*secondary
*accumulation of loose, desquamated, hyperkeratitic epidermal cells
ulcer
*secondary
*an erosion of the epidermis exposing the dermis; deep ulcers may result in the destruction of the dermis
vesicle
*primary
*a sharply circumscribed, elevated lesion containing fluid; diameter may be up to 1 cm; if greater, then termed blister or bulla
other names of atopic dermatitis
eczema
atopic eczema
eczematous dermatitis
description of atopic dermatitis
chronic, relapsing skin disorder
exaggerated skin response to environmental stimuli
genetic basis, family history
Onset of atopic dermatitis
infancy or during early childhood
DIagnostic criteria of atopic dermatitis
Itchy skin, plus 3 or more of the following:
*Onset before 2 years of age
*History of skin crease involvement
*History of dry skin
*History of other atopic disease (or in 1st degree relative when <4 years old)
*Visible dermatitis on cheeks, forehead, and outer limbs
Exclusions for self treatment of atopic dermatitis
*severe condition with intense pruritus
*involvement of large body area
*<2 years of age
*signs/symptoms of bacterial or viral skin infection: pustules, vesicles, yellowish crusting
What are the goals of therapy of atopic dermatitis
*stop the itch-scratch cycle
*avoid/minimize aggravating factors
*hydrate skin
*prevent secondary infections
What are non-pharm measures for treating atopic dermatitis?
*wear irritant-free products
*loose clothing
*short fingernails
*moderate temperature
*bathing
*moisturizing
What is the patient education of atopic dermatitis?
*Avoid long, hot showers
*Use mild non-soap cleansers
*Moisturizer application
*Use liquid laundry detergent
*Keep fingernails short
*Avoid sudden and extreme temperature/humidity changes
Another name for dry skin
xerosis
Description of dry skin
abnormal loss of cells from the stratum corneum as a result of decreased water content in the skin
generally seen in older adults or people living in cooler climates during the winter
What is the etiology of dry skin
*disruption of keratinization and impairment of water-binding properties
*secondary to prolonged detergent use or physical damage to the stratum corneum
*sign of systemic disease
What is the clinical presentation of dry skin
*roughness
*scaling
*loss of flexibility
*fissures
*inflammation
*pruritus
What are the goals of therapy for dry skin
*restore skin hydration
*restore the skin's barrier function
*educate the patient about condition
Non-pharm therapy of dry skin
*oil or oatmeal bath
*use of oil-based emollients when skin is damp
*humidifier or vaporizer
*drink 8 ounce glasses of water daily
What is the patient education of dry skin
*avoid excessive bathing
*drink plenty of water
*apply moisturizers 3-4 times daily
*moisturizers should be applied within 3 minutes of bathing
*avoid caffeine, spices and alcohol
*keep the room humidity higher than normal
Types of moisturizers
*occlusives
*humectants
*emollients
Occlusives
coat the stratum corneum and decrease evaporation of water from skin
Humectants
glycerin, hyaluronic acid, propylene glycol
draw water into the stratum corneum from the dermis
Emollients
fill in the spaces between desquamating skin scales to create smooth surfaces
What is in a moisturizer
water (60-80%
lipids
emulsifiers
humectants
preservatives
fragrance
color
special additives
MOA of Urea (10-30%)
mildly keratolytic, increases water uptake in the stratum corneum
high water-binding
side effects: stinging, burning and irritation
MOA of lactic acid (2-5%)
increases skin hydration, may act as a modulator of epidermal keratinization
MOA of hydrocortisone (0.5-1%)
low-potency corticosteroid with mild anti-inflammatory effect
Side effects of hydrocortisone
epidermal atrophy, folliculitis
How long can you use hydrocortisone
up to 7 days
Application of cream/ointment (g) and lotion/solution/gel (mL) on various body parts
Face: 5-10g, 100-120mL
Both Hands: 25-50g, 200-240mL
Scalp: 50-100g, 200-240mL
Both arms or both legs:100-200g, 240-360mL
Trunk: 200g, 360-480mL
Groin & Genitalia: 15-25g, 120-180mL
3 types of scaly dermatoses
Dandruff
seborrheic dermatitis
psoriasis
Dandruff- cell turnover rate
13-15 days
dandruff- Signs and symptoms
large white or gray scales on scalp, pruritis
dandruff- goals of therapy
1. Reduce the epidermal turnover rate of the scalp skin
2. minimize cosmetic embarrassment
3. minimize itch
seborrheic dermatitis- Cell turnover rate
9-10 days
seborrheic dermititis- goals of therapy
1. reduce inflammation and the epidermal turnover rate of the scalp skin
2. minimize or eliminate visible erythema and scaling
Psoriasis- cell turnover rate
4 days
Psoriasis- signs and symptoms
Plaque, guttate, pustular or erythrodermic in nature, inflammation, minimal itching
Psoriasis- goals of therapy
1. control or eliminate the signs and symptoms
2. prevent or minimize the likelihood of flares
Exclusion criteria of scaly dermatoses
patients <2 yrs of age
no improvement after 2 weeks of self-care therapy
Psoriasis= BSA>10%
Goals of therapy for scaly dermatoses
*reduce epidermal turnover rate
*minimize the cosmetic embarrassment of visible erythema and/or scaling
*minimize itch
*prevent or minimize the likelihood of flares
Treatment options for scaly dermatoses
*cytostatic agents
*kerotolytic agents
*topical hydrocortison
*antifungals
MOA of cytostatic agents
decrease rate of epidermal cell replication
Adverse effects of cytostatic agents
skin irritation, staining (coal tar)
Active ingredients in cytostatic agents
pyrithione zinc
selenium sulfide
coal tar
MOA of keratolytic agents
loosen and lyse keratin aggregates, dissolving the bond that holds epidermal cells together
Adverse effects of keratolytic agents
skin irritation, alter hair appearance
Active ingredients of keratolytic agents
salicylic acid
sulfur
MOA of hydrocortisone
anti-inflammatory, antipuritic, vasoconstrictive and immunosuppressive on cellular activity
Adverse effects of hydrocortisone
atrophy, systemic sequelae
Active ingredients of hydrocortisone
hydrocortisone 0.5%-1%
MOA of ketoconazole
synthetic azole antifungal agent, active against pityrosporon yeast
Adverse events of ketoconazole
hair loss, skin irritation, abnormal hair texture, dry skin
Treatment options for dandruff
Pyrithione zinc
Selenium sulfide
Coal tar
Ketoconazole
Treatment options for seborrhea
Ketoconazole
Pyrithione zinc
Selenium sulfide
Treatment options for psoriasis
Hydrocortisone
Mild Cleansers
Emollients
Patient education of scaly dermatoses
Shampoo
*3 times/week initially
*leave on 3-5 minutes
*use minimum of 2 weeks
*weekly/bi-weekly for control
Cream
*apply thin layer
*2-3 times/day
Follow up
*consult PCP if no improvement after 1-2 weeks