| Term 
 
        | What can be used to treat Tinea infections? |  | Definition 
 
        | gentian violet (used before modern topical antifungals) hygeine
 topical antifungals (clotrimazole, miconazole, terbenafine, tolnaftate)
 |  | 
        |  | 
        
        | Term 
 
        | Brand: Lotrimin AF 
 generic/indication
 |  | Definition 
 
        | clotrimazole tinea infection
 |  | 
        |  | 
        
        | Term 
 
        | brand: micatin 
 generic/indication
 |  | Definition 
 
        | miconazole tinea infection
 |  | 
        |  | 
        
        | Term 
 
        | brand: lamisil 
 generic/indication
 |  | Definition 
 
        | terbenafine tinea infections
 |  | 
        |  | 
        
        | Term 
 
        | brand: tinactin 
 generic/indication
 |  | Definition 
 
        | tolnaftate tinea infections
 |  | 
        |  | 
        
        | Term 
 
        | how long/frequnecy should topical antifungals be used? |  | Definition 
 
        | apply at least BID for 2-4 weeks |  | 
        |  | 
        
        | Term 
 
        | What are tinea infections? |  | Definition 
 
        | foot fungi/jock itch (associated with moist footwear)
 |  | 
        |  | 
        
        | Term 
 
        | What is seborrhic dermatitis? |  | Definition 
 
        | -fungal like condition -around the hairline, scalp, nose, neck, ears, back
 -itching involved
 -erythema with greasy yellow scaling
 -scaly areas
 -increased sebaceous gland activity
 |  | 
        |  | 
        
        | Term 
 
        | How can babies get seborrhic dermatitis? |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | How do you treat seborrhic dermatitis in infants from cradle cap? |  | Definition 
 
        | Baby oil to soften baby shampoo
 no drug treatment usually required
 can use a comb to get rid of the scales
 |  | 
        |  | 
        
        | Term 
 
        | What are treatment options with seborrhic dermatitis? |  | Definition 
 
        | medication shampoo topical corticosteroids
 |  | 
        |  | 
        
        | Term 
 
        | examples of medicated shampoos used for seborrhic dermatitis |  | Definition 
 
        | coal tar, pyrithione zinc, sulfur, selenium, salicylic acid, ketoconazole (keratolytics and cytostatic agents)
 |  | 
        |  | 
        
        | Term 
 
        | Can you use medicated shampoos for seborrhic dermatitis on the face? |  | Definition 
 
        | yes, but these will sting the eyes more than regular shampoos. |  | 
        |  | 
        
        | Term 
 
        | How often/where should medicated shampoos for seborrhic dermatitis be used? |  | Definition 
 
        | 2-3 times per week on scalp and hair line (also face if needed)
 
 use OTC first then Rx if needed (Rx is 2xs stronger than OTC for ketoconzole/selenium)
 |  | 
        |  | 
        
        | Term 
 
        | What is the purpose of the medicated shampoo for seborrhic dermatitis? |  | Definition 
 
        | removes scales reduces cell turnover
 |  | 
        |  | 
        
        | Term 
 
        | What strength of topical corticosteroids should be used for seborrhic dermatitis and what is the purpose? How often should they be used? |  | Definition 
 
        | low strength. it will reduce inflammation and itching
 ideal for lesions on face and ears
 Use BID then PRN
 not used for a chronic basis on the face
 |  | 
        |  | 
        
        | Term 
 
        | Who is at risk for topical fungal infections? |  | Definition 
 
        | infants elderly
 immunosuppressed
 incontinent; increase frequency of BM
 obese
 warm and humid climates
 |  | 
        |  | 
        
        | Term 
 
        | What are the treatment options for diaper rashes? |  | Definition 
 
        | remove irritant (aka freq diaper changes) air dry
 keep clean (mild soap and water)
 antifungal agents
 apply protectants
 |  | 
        |  | 
        
        | Term 
 
        | Examples of protectants for diaper rashes |  | Definition 
 
        | zinc oxide destin
 aveeno
 A&D ointment
 butt paste (can be applied over anti-fungal if needed)
 |  | 
        |  | 
        
        | Term 
 
        | How long should be the treatment for fungi? |  | Definition 
 
        | treatment often 4 weeks or longer (slow to grow, slow to go)
 |  | 
        |  | 
        
        | Term 
 
        | What do pharmacist have to know when managing dermatologic patients? |  | Definition 
 
        | knowledge of ... vechiles and bases, commonly used terminology, drug-induced skin conditions
 
 Be able to ID common dermatologic lesions and rashes
 
 know advantages and disadvantages of dermatologic products
 
 advise pts on the the proper use of dermatolgoic products
 |  | 
        |  | 
        
        | Term 
 
        | When should refer to a MD? |  | Definition 
 
        | multiple or extensive burns human or animal bites
 multiple or extensive cuts, bruises, or abrasions
 rahs that is extensive, weeping, or infected
 tumors or growths
 yellow skin
 deep infection (cellulitis)
 large blisters of unknown origin
 |  | 
        |  | 
        
        | Term 
 
        | What are the basic vehicles for derm products? |  | Definition 
 
        | ointment cream
 lotion
 gel
 solution/spray
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | semisolid preparations intended for external application to skin and mucous membranes 
 there are four classes
 |  | 
        |  | 
        
        | Term 
 
        | Which vehicle is best for delivering a drug? |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | What are the four classes of ointments? |  | Definition 
 
        | hydrocarbon absorption
 water-removable
 water-soluble
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | ointment bases of the water-removable class 
 consisting of oil-in-water emulsions or aqueous microcrystalline dispersion of long fatty acids or alcohols
 |  | 
        |  | 
        
        | Term 
 
        | Why is a cream better than an ointment? |  | Definition 
 
        | water washable and more cosmetically and aesthetically acceptable than ointments |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | A watered-down cream they feel less greasy and easier to apply.
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | Used if want to dry out the area. semisolid systems consisting of either suspensions made up of small inorganic particles or large organic molecules interpenetrated by a liquid.
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | softens the skin soothes irriation in skin or mucous membranes
 |  | 
        |  | 
        
        | Term 
 
        | What is a protective? (give an example) |  | Definition 
 
        | protects injured or exposed skin surfaces from harmful or annoying stimuli (zinc oxide, sunscreen, diaper ointment, A&D ointment) |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | promotes retention of water in the skin and forms a hydrophobic barrier that prevents moisture in the skin from evaporating |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | causes water to be retained bc of its hygroscopic properties. (when added to ointment it helps the water to be maintain) |  | 
        |  | 
        
        | Term 
 
        | What are the properties of ointment? |  | Definition 
 
        | emollient protective
 occulsive
 humectant
 |  | 
        |  | 
        
        | Term 
 
        | What are the uses of ointments? |  | Definition 
 
        | protect skin or mucous membrane permit rejuvenation of the tissue
 provide hydration of the skin
 provide a vehicle for applying medication
 |  | 
        |  | 
        
        | Term 
 
        | examples of drugs for ointments |  | Definition 
 
        | antibiotics antifungals
 corticosteroids
 retinoids
 nitroglycerin
 analgesicsa
 |  | 
        |  | 
        
        | Term 
 
        | The nature of the incorporated medication must have... |  | Definition 
 
        | bioavialiabity stability
 compatibility
 |  | 
        |  | 
        
        | Term 
 
        | What is the advantage of an ointment? |  | Definition 
 
        | hydrates removes scales
 greatest bioavailibity
 |  | 
        |  | 
        
        | Term 
 
        | what is the disadvantage of an ointment? |  | Definition 
 
        | greasy (hard to have compliance when used with hair) |  | 
        |  | 
        
        | Term 
 
        | What is the preferred area of use for an ointment? |  | Definition 
 
        | smooth skin with short or sparse hair |  | 
        |  | 
        
        | Term 
 
        | What is the advantage of using a cream? |  | Definition 
 
        | good cosmetic appearance high patient acceptance
 |  | 
        |  | 
        
        | Term 
 
        | what is the disadvantage of using a cream? |  | Definition 
 
        | not as hydrating as ointments |  | 
        |  | 
        
        | Term 
 
        | What is the preferred area of use for creams? |  | Definition 
 
        | smooth or hair-bearing skin intertriginous areas (ie. groin, armpit)
 |  | 
        |  | 
        
        | Term 
 
        | What is the advantage of using a gel? |  | Definition 
 
        | non-greasy easy to apply to hairy areas
 high patient acceptance
 |  | 
        |  | 
        
        | Term 
 
        | What is the disadvantages of using a gel? |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | What is the preferred area of use for a gel/lotion/solution/foam? |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | How often should a lotion by applied? |  | Definition 
 
        | 3-4 hours (has a lower bioavailibility) |  | 
        |  | 
        
        | Term 
 
        | What is the advantage of using a lotion/solution/spray? |  | Definition 
 
        | easy to apply to hairy areas, scalp, high patient acceptance
 |  | 
        |  | 
        
        | Term 
 
        | What is the disadvantage of using a lotion/solution/spray? |  | Definition 
 
        | drying lower bioavailability (therapeutic event is compromised)
 |  | 
        |  | 
        
        | Term 
 
        | What is the preferred area of use for lotion/solution/spray? |  | Definition 
 
        | intertriginois and hair-bearing skin, face |  | 
        |  | 
        
        | Term 
 
        | examples of oleaginous base |  | Definition 
 
        | white petrolatum vaseline
 plastibase
 |  | 
        |  | 
        
        | Term 
 
        | examples of absorption bases |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Characteristics of an oleaginous base |  | Definition 
 
        | absorbs no water not water washable (soap is required)
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of an absorption base |  | Definition 
 
        | can absorb several times its weight of water not water washable
 |  | 
        |  | 
        
        | Term 
 
        | examples of water-in-oil emulsion bases |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | characteristics of water-in-oil emulsion bases |  | Definition 
 
        | absorbs less water than absorption bases not water washable
 |  | 
        |  | 
        
        | Term 
 
        | examples of oil-in-water emulsion bases |  | Definition 
 
        | hydrophilic ointment dermabase
 hydrocerin
 unibase
 cetaphil lotion
 vanicream
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of oil-in-water emulsion bases |  | Definition 
 
        | water washable add water = lotion
 |  | 
        |  | 
        
        | Term 
 
        | examples of water soluble base |  | Definition 
 
        | polyethylene glycol ointment |  | 
        |  | 
        
        | Term 
 
        | characteristics of water soluble base |  | Definition 
 
        | water washable minimal therapeutic effect
 used primary to deliver drugs
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | methylcellulose gel liqua-gel
 carbomer gel
 polxamer gel
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | water washable accepts water
 has a polymer associated with it
 |  | 
        |  | 
        
        | Term 
 
        | what are the two major types of skin lesions? |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | What are the primary lesions? |  | Definition 
 
        | flat, nonpalpable changes in skin color elevation formed from a fluid in a cavity
 elevated, palpable solid masses
 |  | 
        |  | 
        
        | Term 
 
        | What type of primary lesions are flat,nonpalpable changes in skin color |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | what types of skin lesions are elevation formed by a fluid in a cavity |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | what type of skin lesions are elevated, palpable solid masses |  | Definition 
 
        | papule plaque
 nodule
 tumor
 wheal
 |  | 
        |  | 
        
        | Term 
 
        | What is the difference with a papule, vesicle, and pustule |  | Definition 
 
        | papule is raised vesicle is raised with fluid
 pustule is raised with pus
 |  | 
        |  | 
        
        | Term 
 
        | What are the types of secondary lesions? |  | Definition 
 
        | material on skin surface loss of skin surface
 vascular lesions
 |  | 
        |  | 
        
        | Term 
 
        | examples of drug induced disease |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | how do you treat drug rxns? |  | Definition 
 
        | 1) stop the drug (until have been evaluated) 2) systemic antihistames
 3) systemic or topical corticosteroids
 4) soothing baths or soaks (helps locally)
 |  | 
        |  | 
        
        | Term 
 
        | types of drug-induced skin disorders |  | Definition 
 
        | 1) hypersensitivity/allergic rxn 2) photosensitivity (increase chance of development of a sunburn
 3) toxic rxns
 4) drug-induced disease
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | erythema multiforme stevens johnson syndrome (SJS)
 toxic epidermal necrolysis
 |  | 
        |  | 
        
        | Term 
 
        | how do you treat photosensitivity? |  | Definition 
 
        | 1) prevention with suncreens/clothing 2) systemic analgesics (for pain - best used is NSAIDS or aspirin)
 3) systemic antihistamines for itching
 4) prevent infection
 5) moisturizers
 6) cooling creams and gels (initially bc after 1st day probably will not help)
 |  | 
        |  | 
        
        | Term 
 
        | what is toxic epidermal necrolysis? |  | Definition 
 
        | drug rxns and attacks mucous membrane areas, this leads to infections (they die of the infection not TEN) |  | 
        |  | 
        
        | Term 
 
        | What is the basic characteristics of Stevens Johnson syndrome? |  | Definition 
 
        | severe breakdown of the skin typically start with red large areas
 |  | 
        |  | 
        
        | Term 
 
        | drugs that are associated with SJS/TEN |  | Definition 
 
        | antibiotics: penicillins, fluoroquinolones, sulfonamides, cephalosporins 
 anticonvulsants
 allopurinal
 NSAIDS
 can occur with any drug
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | usually occurs within the first 1-4 weeks of treatment prodromal NVD, myalgias, sore throat, arthralgias (flu-like symptoms plus rash)
 involement of mucous membranes
 widespread blisters and lesions
 full thickness epidermal detachment (risk of infection occurs bc of this)
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | IV fluids/nutrition pain control
 eye care
 nasal saline
 oral hygiene and anesthetics
 topical antiseptics
 wound care
 STOP OFFENDING AGENT
 |  | 
        |  | 
        
        | Term 
 
        | common race associated with drug-induced lupus |  | Definition 
 
        | butterfly rash (on the face) |  | 
        |  | 
        
        | Term 
 
        | what drugs are associated with drug-induced lupus? |  | Definition 
 
        | phenytoin hydralazine
 isoniazid
 procainamide
 |  | 
        |  | 
        
        | Term 
 
        | true or false: lupus will generally go away when remove drug |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | what are some of the drugs associated with drug induced acne? |  | Definition 
 
        | BC, testosterone, corticosteroids, (increased androgen in the system) |  | 
        |  | 
        
        | Term 
 
        | example questions to ask a patient to evaluate them |  | Definition 
 
        | anything new? ie food, soap painful?
 where is it?
 how long?
 have you had it before?
 where do you work?
 when did it start?
 is it getting worse?
 is it local/systemic?
 |  | 
        |  | 
        
        | Term 
 
        | what can you treat acne with? |  | Definition 
 
        | topical and systemic antibiotics topical and systemic comedolytics
 |  | 
        |  | 
        
        | Term 
 
        | true or false: pharmacist should recommend a dermatologist for all forms of acne |  | Definition 
 
        | false: refer all but those with mild forms |  | 
        |  | 
        
        | Term 
 | Definition 
 | 
        |  | 
        
        | Term 
 
        | what do you treat for tinea pedis |  | Definition 
 
        | topical antifungals and use for a while (slow to grow, slow to go) |  | 
        |  | 
        
        | Term 
 
        | how is tinea pedis spread? |  | Definition 
 
        | pools/showers moist environments that promote growth
 dermatophyte infections
 |  | 
        |  | 
        
        | Term 
 | Definition 
 | 
        |  | 
        
        | Term 
 
        | how can you get tinea corporis |  | Definition 
 
        | commonly transmitted in day care hot/humid environments promote growth
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of tinea corporis |  | Definition 
 
        | located on body in areas where air flow is limited worms are not involved
 no itching
 small, circular, red scaly areas
 its a fungi
 |  | 
        |  | 
        
        | Term 
 
        | true or false: can use the same treatment for tinea corporis, tinea pedis, and candida infections |  | Definition 
 
        | true bc they are all fungal infections |  | 
        |  | 
        
        | Term 
 
        | what can you use to treat tinea corporis |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | what is topical candida infection? |  | Definition 
 
        | its fungal. common in moist areas in humid conditions. (where no air flow) |  | 
        |  | 
        
        | Term 
 
        | what can you treat candida with? |  | Definition 
 
        | topical antifungal dry the affected area
 |  | 
        |  | 
        
        | Term 
 
        | What is contact dermatitis? |  | Definition 
 
        | delayed hypersentivity rxn localized eruption in area exposed to irritant or allergen
 pruritis (aka itch)
 |  | 
        |  | 
        
        | Term 
 
        | How can you treat contact dermatitis? |  | Definition 
 
        | remove allergen topical corticosteroids
 oral antihistamines
 -use OTC if localized, Rx needed if systemic
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | its immune related disorder with red and silver plaque lesions |  | 
        |  | 
        
        | Term 
 
        | what can you use to treat psoriasis |  | Definition 
 
        | emollients topical corticosteroids and immunosupressants
 systemic immunosuppressants
 phototherapy
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | redness of the skin; adult acne |  | 
        |  | 
        
        | Term 
 
        | what can you use to treat rocacea |  | Definition 
 
        | avoid triggers (sun is usually one) topical and oral antibiotics
 topical retinoids
 laser treatment
 |  | 
        |  | 
        
        | Term 
 
        | what is atopic dermatitis |  | Definition 
 
        | eczema: common in pts with other allergies dry skins with raised patches/lesions
 |  | 
        |  | 
        
        | Term 
 
        | what can you use to treat atopic dermatitis? |  | Definition 
 
        | topical emollients topical corticosteroids
 oral antihistamines for itching
 
 -if very localized can use OTC
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | infection in the skin (located near break in skin) red, warm, swollen
 |  | 
        |  | 
        
        | Term 
 
        | How do you treat cellulitis? |  | Definition 
 
        | oral antibiotics IV antibiotics in severe cases
 must see PCP
 |  | 
        |  | 
        
        | Term 
 
        | Which people are more likely to get cellulitis? |  | Definition 
 
        | obese diabetes
 compromised circulation
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | topical STAPH skin infection most common in children
 direct spread (from touching)
 |  | 
        |  | 
        
        | Term 
 
        | How do you treat impetigo? |  | Definition 
 
        | topical or oral antibiotics refer to PCP
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | permethrin 1% malathion (ovide)
 oral invermectin (strmectol)
 see PCP
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of head lice |  | Definition 
 
        | chidlren 3-12 yo scalp redness and scaling
 pruritus (itch)
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | sarcoptes scabiei infestation raised lines caused by mites burrowing under skin
 exterme pruritus (itch)
 can be spread easily
 primarily in children and adolescents (LTCF) (not good hygiene)
 they have little lesions with itching
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | permethrin 5% crotamiton (Eurax Cream)
 oral ivermectin (stromectol)
 -treatment like head lice
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | shingles!!! viral infection among the nerve tract |  | 
        |  | 
        
        | Term 
 
        | characteristics of herpes zoster |  | Definition 
 
        | adults > 40 yo triggered by stress, old age, immunosuprresion
 extreme pain along dermatome
 tender red papules - progress to scabs- usually one side of body
 can spread to small infants or pts with immunosuppressant therapy
 even after lesions the pain still among nerve tract
 |  | 
        |  | 
        
        | Term 
 
        | treatment of herpes zoster |  | Definition 
 
        | antivirals - oral valacyclovir and famciclovir manage acute pain and posterpetic neuralgia
 today there is a vaccine
 can use lidoderm patches to protect and numb
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | basal cell carcinoma (most common) squamous cell carcinoma (sun-exposed)
 melanoma (most deadly)- dark lesion
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | removal of lesion chemotherapy
 radiation
 |  | 
        |  | 
        
        | Term 
 
        | what is activic carontosis |  | Definition 
 | 
        |  | 
        
        | Term 
 | Definition 
 
        | dry skin - fissures, itching, cracking |  | 
        |  | 
        
        | Term 
 
        | characteristics of xerosis |  | Definition 
 
        | -fall and winter - dryer climates, tanning, bath excessively, older -feet, lower legs
 -hands, elbows, face
 -rough, dry, scales, cracks
 -itching is common
 -wont bother until it starts flaking
 |  | 
        |  | 
        
        | Term 
 
        | who is at risk for xerosis |  | Definition 
 
        | elderly frequent bathing
 very warm, dry enviroments
 -because of decreased sweat and sebaceous glands
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | -emollients - first line for itching and restores barrier and skin function -agents for itching
 -alter bathing habits
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | -tub bath or shower no more than 3 times per week -tepid water (3-5 degrees above body temperature bc hot water water promotes dry skin)
 -bathe for 3-5 minutes
 -apply copious amounts of emollients within 3 minutes
 -apply emollients at least 3 times a week
 
 -pat dry because irritate if rub
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | vaseline nivea
 keri
 lubriderm
 AmLactin
 eucerin
 |  | 
        |  | 
        
        | Term 
 | Definition 
 | 
        |  | 
        
        | Term 
 
        | characteristics of acute dermatitis |  | Definition 
 
        | red patches or plaques pebbly surface or blisters (vesicles)
 itching is common
 |  | 
        |  | 
        
        | Term 
 
        | how do can tell if its acute contact dermatitis |  | Definition 
 
        | look at pattern look at part of body involved
 main symptom is itching
 irritant- non-immunological response to frequent contact with everyday substances
 rxn in a few hrs
 more common than allergic
 -there are two types: allergic and irritant
 -if systematic then its NOT acute contact dermatitis
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of subacute dermatitis |  | Definition 
 
        | dry, less red, crusting, oozing, mild thickening. dry lesions |  | 
        |  | 
        
        | Term 
 
        | characteristics of chronic dermatitis |  | Definition 
 
        | -epidermal thickening -exaggeration skin markings aka lichenification
 -scaling
 -less itching (some itching occurs)
 -looks like leather bc of very prominent lines
 |  | 
        |  | 
        
        | Term 
 
        | two ways to get poison ivy |  | Definition 
 
        | -direct- broken exposure; resin 2 weeks active -indirect - clothing, dog, smoke; does not spread from lesions
 -most common Acute Contact Dermatitis
 |  | 
        |  | 
        
        | Term 
 
        | how to prevent poison ivy |  | Definition 
 
        | ivy-block: it will be a barrier (protectant) and must reapply every 4 hrs -petrolatum can work as ivy-block
 -eliminate all sources of exposure
 -wash skin and nails within 10 mins (and clothing)
 -topical therapy is fine if <10% of BSA
 -1st want to dry the skin
 -remove source, soaks, calamine lotion (dries), topical and oral antihistamines and corticosteroids
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of poison ivy |  | Definition 
 
        | -dermatitis occurs 24 to 48 hrs after exposure -pruritis is intense: as a result can get 2ndary infections. use cool water to help
 |  | 
        |  | 
        
        | Term 
 
        | general treatment principles |  | Definition 
 
        | if its wet, dry it if its dry, wet it
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | inflammatory/excitation of C-nerve fibers leads to scratching leads to itching and repeat |  | 
        |  | 
        
        | Term 
 
        | how to stop scratch itch cycle |  | Definition 
 
        | -keep finger nails short or wear gloves -keep in mind the patients lifestyle, so each pt is diff
 |  | 
        |  | 
        
        | Term 
 
        | treatment of acute dermatitis |  | Definition 
 
        | soaks topical corticosteroids
 water
 |  | 
        |  | 
        
        | Term 
 
        | types of soaks and how to use |  | Definition 
 
        | domeboro (5% aluminum acetate) - packets in cool water acetic acid: 60 mL vinegar in 1 qt warm water
 saline: 1 tsp salt in 2 cups of water
 
 apply linen or cheesecloth for 30 mins bid-qid remove when dry
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | for oozing, weeping, crusting lesions wet dressings useful for drying acutely inflammed, wet areas
 |  | 
        |  | 
        
        | Term 
 
        | choice of agent based upon... |  | Definition 
 
        | location of lesion type of lesion
 severity of lesion/degree of inflammation
 degree of skin penetration desired
 |  | 
        |  | 
        
        | Term 
 
        | side effects of topical corticosteroids |  | Definition 
 
        | -thinning of skin -dilated blood vessels
 -bruising
 -skin color changes
 -risk of HPA (hypo potency agents) suppression with long-term use of high-potency agents
 =development of tolerance (tachyphylaxis) aka effects wear off
 |  | 
        |  | 
        
        | Term 
 
        | how are topical corticosteroids classified |  | Definition 
 
        | high mid low now days using grades I (most potent) to VII (least potent)
 
 potency relates to anti-inflammatory activity and vasocontrictive potency
 |  | 
        |  | 
        
        | Term 
 
        | absorption of topical corticosteroids how to improve
 |  | Definition 
 
        | -only 1% is absorbed when applied to NORMAL INTACT skin -if skin is BROKEN down then more is absorbed
 -to improve use: plastic wrap + t-shirt/bandage because increases penetration
 -leave on for 6 hrs (8 at most)
 |  | 
        |  | 
        
        | Term 
 
        | freq and duration of topical corticosteroids |  | Definition 
 
        | bid to qid for 3 to 14 days 
 choice of vehicle depends on type of dermatitis
 |  | 
        |  | 
        
        | Term 
 
        | purpose of corticosteroids |  | Definition 
 
        | anti-inflammatory anti-pruitic
 suppress immune response
 |  | 
        |  | 
        
        | Term 
 
        | low potency topical corticosteroids examples, uses
 |  | Definition 
 
        | -grade 5-7 -examples: hydrocortisone; hytone; cortaid; desonide; actovate
 -use on face, groin, genitals, axilla
 -mild anti-inflammatory effect
 -safest for long-term use
 -may not be strong enough to get rid of condition
 |  | 
        |  | 
        
        | Term 
 
        | mid-potency topical corticosteroids examples and uses
 |  | Definition 
 
        | -grades 3-5 -examples: valisone, diprosone, kenalog, cordran
 -used on most skin surfaces
 -moderate anti-inflammatory effect
 -safer for longer usage than high potency
 |  | 
        |  | 
        
        | Term 
 
        | high/very high topical corticosteroids examples and uses
 |  | Definition 
 
        | -grades 1-2 -examples: lidex, ultravate, topicort, psorcon, temovate
 -NEVER use on face or intratrigenous areas
 -used for very severe lesions and on thicken skin when maximum penetration is needed (aka psoriasis)
 avoid using super-potent agents for >2 weeks
 -limit to no more than 50 grams a week
 |  | 
        |  | 
        
        | Term 
 
        | What are topical calcineurin inhibitors? |  | Definition 
 
        | MOA: blocks pro-inflammatory cytokine genes can be used in any area
 like a mid-potency
 no risk of atrophy
 few side effect
 very costly
 now considered a 2nd line treatment
 intermittent use only
 risk of problems when used for a long time
 risk of resp infect in <2 yo
 |  | 
        |  | 
        
        | Term 
 
        | True or False: dose pack should be avoided when administrating systemic corticosteroids |  | Definition 
 
        | TRUE because the treatment is not long enough |  | 
        |  | 
        
        | Term 
 
        | What is the dose/frequency/duration used for system corticosteroids |  | Definition 
 
        | start at predinisone 40-60 mg per day; taper every 3 days. use for 10-14 days |  | 
        |  | 
        
        | Term 
 
        | What can be used to treat systemically for acute dermatitis? |  | Definition 
 
        | corticosteroids non-sedating antihistamines
 sedating antihistamines
 |  | 
        |  | 
        
        | Term 
 
        | examples of non-sedating antihistamines |  | Definition 
 
        | loratadine (Clartin) desioratadine (clarinex)
 fexofenadine (allergra)
 
 *these will not help with severe itching*
 |  | 
        |  | 
        
        | Term 
 
        | examples of sedating antihistamines |  | Definition 
 
        | diphenydramine (benadryl) certizine (zrytec)
 hydroxyzine (atarax)
 doxepin
 
 *especially useful at night*
 |  | 
        |  | 
        
        | Term 
 
        | what is the allergic traid |  | Definition 
 
        | asthma, allergic rhinitis, eczema 
 people with eczema will 2/3 will have asthma or allergic rhinitis.
 |  | 
        |  | 
        
        | Term 
 
        | examples of triggers of atopic dermatitis |  | Definition 
 
        | allergens chemicals
 bathing
 detergents
 smoke
 dust
 infections
 |  | 
        |  | 
        
        | Term 
 
        | common locations of atopic dermatitis (subacute) |  | Definition 
 
        | folds of elbows and knees face commonly involved in children
 adults have more widespread involvement
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of subacute dermatitis |  | Definition 
 
        | -red scaling, fissured, patches, or plaques -slight to moderate pruritis, pain, stinging, or burning
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of atopic dermatitis |  | Definition 
 
        | pruritis red papules or plaques
 scaling excoriations (when get worse)
 overall dryness of skin
 redness and inflammation
 located on face and folds
 |  | 
        |  | 
        
        | Term 
 
        | another name for atopic dermatitis |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | how to treat atopic dermatitis |  | Definition 
 
        | -emollients + education -topical corticosteroid
 -topical calcineruin inhibitor
 -antihistamines at bedtime
 -use systemic when topical fails
 -avoid chronic treatment if possbile
 -cont. to use emollients even after corticosteroid is gone
 |  | 
        |  | 
        
        | Term 
 
        | want to avoid scratching with atopic dermatitis because... |  | Definition 
 
        | -prone to infections -usually staph aureus
 -treatment with antibiotics
 |  | 
        |  | 
        
        | Term 
 
        | treatment of stasis dermatitis |  | Definition 
 
        | topical corticosteroids: for itching emollients: for all pts
 oral antihistamines
 oral antibiotics for local infections
 -use cephalexin 250 mg - 500 mg TID
 -bandage any weeping lesions until healed
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | elevate feet and legs support stockings
 compression bandages
 |  | 
        |  | 
        
        | Term 
 
        | treatment of chronic dermatitis |  | Definition 
 
        | same as subacute use emollients daily or more
 avoid long-term corticosteroids
 UV light
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of chronic dermatitis |  | Definition 
 
        | well demarcated, lichenified, thickened plaques excoriations, fissures, scaling
 itching predominates (minor irritations or trauma worsens itching)
 |  | 
        |  | 
        
        | Term 
 
        | characteristics of stasis dermatitis |  | Definition 
 
        | patients > 50 yo poor circulation
 most common around ankles and uplegs
 aching, swelling, discomfort
 discoloration can occur
 red, scaly, crusted plaques
 swelling edema
 2ndary infection and ulcers common
 hyperpigmentation - retention of Fe++ in skin because circulation is compromised and capillaries leaks releasing iron deposit
 |  | 
        |  | 
        
        | Term 
 
        | Types of 2ndary lesions that have a loss of skin surface |  | Definition 
 
        | excoriation, fissure, ulcer, erosion |  | 
        |  | 
        
        | Term 
 
        | type of 2ndary skin lesion that have material on skin surface |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | type of 2ndary skin lesion that are vascular |  | Definition 
 
        | petechias, ecctymiosis, cherry angioma, telangiectasia |  | 
        |  |