Term
|
Definition
Topical staph skin infection
most common in children
direct spread
refer to PCP
treat with topical or oral antibiotics |
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|
Term
| Topical Candida Infection |
|
Definition
common in moist, humid areas
treat with topical anti-fungals and dry the affected area |
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Term
| Tinea pedis (Athlete's foot) |
|
Definition
often spread in pools/showers
moist environments promote growth
dermatophyte infection
treat with topical anti-fungals |
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|
Term
| Tinea corporis (body ring worm) |
|
Definition
commonly transmitted in day care
hot/humid environments promote growth
small, circular, red, scaly areas
treat with topical antifungals |
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Term
|
Definition
children 3 - 12 years old
scalp redness and scaling
pruritis
refer to PCP
treat with:
-Permethrin 1%
-Malathion (Ovide)
-oral Ivermectin (Stromectol) |
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|
Term
|
Definition
Sarcopes scabiei infection
primarily in children and adolescents (LTCF)
raised lines caused by mite burrowing into the skin
extreme pruritus
refer to PCP
treat with:
-Permethrin 5%
-Crotamiton (Eurax cream)
-oral Ivermectin (Stromectol) |
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|
Term
|
Definition
adults > 40 years old
triggered by stress, old age, immunosuppression
extreme pain along the dermatome
tender, red papules - progress to scabs
refer to PCP
treat with:
-oral valcyclovir or famciclovir
-manage acute pain and postherpatic arthralgia |
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|
Term
|
Definition
basal cell carcinoma (most common)
squamous cell carcinoma (sun exposure)
melanoma (most deadly)
Caucasians with light eye and skin color
refer to PCP
treat with:
-removal of the lesion
-chemotherapy
-radiation |
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|
Term
| Dry skin (xerosis) Common Features |
|
Definition
fall and winter
feet, lower legs
hands, elbows, face
rough, dry scales, cracks
itching is a common symptom |
|
|
Term
| Dry skin (xerosis) Who is at risk? |
|
Definition
The elderly
Frequent bathers |
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Term
| Dry skin (xerosis) Treatment options |
|
Definition
Emollients
-first line for itching
-restores barrier and skin function
agents for itching
after bathing habits |
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|
Term
| Dr. Martin's Rule of 3's for dry skin (xerosis) |
|
Definition
Tub bath or shower no more than 3 times per week
tepid water 3 - 5 degrees above body temperature
bathe for 3 - 5 minutes
apply copious amounts of emollients within 3 minutes of showering
apply emollients 3 times daily |
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|
Term
| Emollients for dry skin (xerosis) |
|
Definition
Vaseline
Nivea
Keri
Eucerin
Lubriderm
AmLactin |
|
|
Term
| Agents to reduce itching in dry skin (xerosis) |
|
Definition
Menthol and camphor
-1/2 - 1%
-create a sensation of cooling
Pramoxine
-1%
-local anesthetic
Hydrocortisone
-1/2 - 1%
-anti-inflammatory |
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Term
|
Definition
| inflammation process of the upper two layers of the skin |
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Term
|
Definition
1. acute
2. sub-acute
3. chronic |
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Term
|
Definition
red patches or plaques
pebbly surface or blister (vesicles)
itching is common |
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|
Term
|
Definition
dry
less red
crusting, oozing
mild thickening |
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|
Term
|
Definition
epidermal thickening
exaggerated skin marking
lichenification
scaling
less itching |
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|
Term
|
Definition
look at pattern
look at part of body involved
main symptom is itching
two types:
-allergic
-irritant |
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|
Term
|
Definition
Acute contact dermatitis
direct exposure
-broken plant
-resin - 2 weeks
indirect exposure
-smoke, dog, clothes
-does not spread from lesions
prevention is key:
-Ivy-Block is a protectant/barrier that should be applied every four hours |
|
|
Term
|
Definition
dermatitis occurs 24 - 48 hours after exposure
pruritis is intense
-secondary infections
-cool water
wash skin and nails within 10 minutes - wash clothing as well
topical therapy is ok if less than 10% BSA is involved |
|
|
Term
| Poison Ivy Treatment Options |
|
Definition
Remove source
Soaks
Calamine lotion
Topical antihistamines
Oral antihistamines
Topical corticosteroids
Oral corticosteroids |
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|
Term
| Irritant Acute Contact Dermatitis |
|
Definition
non-immunologic reaction to frequent contact with everyday substances
reaction within a few hours
common irritants??
more common than allergic
treatment is the same as with poison ivy |
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|
Term
| General treatment principles for dermatitis |
|
Definition
stop the itch-scratch cycle
must understand the patient's personality, social, and domestic conditions
ability to carry out treatment
no one therapy is best for every patient |
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|
Term
| Use of soaks to treat acute dermatitis |
|
Definition
use for oozing, weeping lesions
wet dressings are useful for drying acutely inflamed, wet areas |
|
|
Term
| Treatment of acute contact dermatitis |
|
Definition
Domeboro (5% aluminum acetate)
-packets in cool water
Acetic acid: 60 mL of vinegar per 1 qt of warm water
Water
Saline: 1 tsp of salt in 2 cups water
Apply linen or cheesecloth for 30 minutes twice to four times daily; remove when dry |
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|
Term
| Mechanism of action of topical corticosteroids for acute dermatitis |
|
Definition
anti-inflammatory
anti-pruritic
suppress immune response |
|
|
Term
| Topical corticosteroids for acute dermatitis |
|
Definition
apply twice to four times daily for 3 - 14 days
choice of vehicle depends on type of dermatitis |
|
|
Term
| Choice of topical corticosteroid agent for acute dermatitis |
|
Definition
Choice is based upon:
-location of lesions
-types of lesions
-severity of lesion/degree of inflammation
-degree of skin penetration desired |
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|
Term
| Classification of Topical Corticosteroids |
|
Definition
Classified according to the anti-inflammatory and vasoconstricive potency
High - Mid - Low (Grades I to VII) |
|
|
Term
| Side effects of topical corticosteroids |
|
Definition
thinning of skin
dilated blood vessels
bruising
skin color changes
risk of HPA suppression with long term use of high-potency agents
development of tolerance (tachyphylaxis) |
|
|
Term
| Low Potency Topical Corticosteroids |
|
Definition
Grades V - VII
Hydrocortisone
Hytone
Cortaid
Desonide
Aclovate
use on:
-face
-groin
-genital
-axilla
mild anti-inflammatory effect
safest for long term use |
|
|
Term
| Mid-potency Topical Corticosteroids |
|
Definition
Grades II - V
Vasilone
Diprosone
Kenalog
Cordran
used on most skin surfaces
moderate anti-inflammatory effect
safer for longer use than high potency |
|
|
Term
| High/Very-high Potency Topical Corticosteroids |
|
Definition
Grades I - II
Lidex
Ultravate
Psorcon
Temovate
use for very severe lesions and on thickened skin when maximum penetration is needed
do NOT use on the face
avoid using super-potent for more than 2 weeks
Limit to 50 g per week |
|
|
Term
| Topical Calcineurin Inhibitors |
|
Definition
MOA: blocks pro-inflammatory cytokines
can be used on any area
equivalent to mid-potency corts
no risk of atrophy
few side effects
very expensive
Elidel cream 1% |
|
|
Term
| Concerns with topical calcineurin inhibitors |
|
Definition
now considered 2nd line therapy
intermittent use only
recent concern regarding long term use
-risk of malignancies
-risk of respiratory infection in children less than 2 years old |
|
|
Term
| Systemic corticosteroids for acute dermatitis |
|
Definition
Avoid dose-packs - do not provide long enough period of time
start at prednisone 40 - 60 mg per day, taper every 3 days
minimum of 10 - 14 days of treatment |
|
|
Term
| Systemic Non-sedating antihistamines for acute dermatitis |
|
Definition
Allegra (fexofenadine)
Claritin (loratadine)
Clarinex (desloratadine)
Sedating (Benadryl) are useful at night |
|
|
Term
|
Definition
red scaling, fissured patches or plaques
slight to moderate pruritis, pain, stinging or burning |
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|
Term
| Sub acute Atopic Dermatitis |
|
Definition
most common form of eczema
usually presents in infancy
-1 in 5 children
-1 in 12 adults
strong genetic link
-2/3 will also develop asthma or allergic rhinitis
prone to infections due to scratching
usually staph aureus
treat with antibiotics |
|
|
Term
| Sub acute Atopic Dermatitis Clinical Presentation |
|
Definition
Pruritis
Red patches or plaques
scaling exoriations
overall dryness of the skin
redness and inflammation
common locations:
-folds of elbows/knees
-face commonly involved in children
-adult is more widespread |
|
|
Term
| Triggers of Sub acute Atopic Dermatitis |
|
Definition
Allergens
Chemicals
Detergents
Bathing
Smoke
Dust
Infections |
|
|
Term
| Treatment of Sub Acute Atopic Dermatitis |
|
Definition
Emollients and Education
Topical corticosteroid
Topical calcineurin inhibitor
Antihistamines at night
Systemic treatment:
-only when topical fails
Avoid chronic treatment if possible |
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