Term
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Definition
| chronic, relapsing, inflammatory skin condition that has a genetic basis (Atopic Triad = asthma, allergic rhinitis, this disease); Prevalence Factors: male, caucasian, urban area, higher socioeconomic status; |
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Term
| Pathophysiology of Atopic Dermatitis |
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Definition
| complex interaction btw genetic & environmental factors: activation of T lymphocytes --> inflammation; decreased ability of keratinocytes to bind water --> dry skin; Exacerbating Factors: irritants, allergens, temperature/humidity changes, emotional stress |
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Term
| Clinical Presentation of Atopic Dermatitis |
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Definition
| pruritic papules or vesicles & dry, pale skin; Acute: intensely pruritic, erythematous papules or vesicles over erythematous skin; Subacute: erythematous, scaling, excoriated plaques; Chronic: thickened plaques & increased skin markings; Location of Lesions: infants & young children: face, neck, extensor surfaces of extremities; Older children & adults: flexor folds of extremities, hands |
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Term
| Diagnosis of Atopic Dermatitis |
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Definition
| pruritic skin condition plus 3 or more of following: history of flexural dermatitis of face in children <10 yrs old, history of asthma or allergic rhinitis in pt, history of generalized xerosis within past year, visible flexural dermatitis, onset of rash at <2 yrs old |
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Term
| Complications of Atopic Dermatitis |
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Definition
| Infections: bacterial (Staph. aureus), viral (herpes simplex), fungal; Ocular conditions: corneal scarring, atopic keratoconjunctivitis, vernal conjunctivitis, keratoconus |
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Term
| Goals of Treatment of Atopic Dermatitis |
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Definition
| 1) stop itch-scratch cycle; 2) maintain adequate skin hydration; 3) avoid/minimize factors that trigger or exacerbate condition; 4) prevent secondary infections |
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Term
| Nonpharmacological treatment of Atopic Dermatitis |
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Definition
| trigger identfication & avoidance (perfumed dyes, detergents, clothing, temp/humidity control, psychotherapy, stress reduction); bathing (use tepid water, wash quickly, use mild cleansers, apply moisturizers & emollients (provide & trap moisture in skin - ointments [petrolatum jelly, Aquaphor], creams/lotions [Eucerin, Cetaphil]); keep fingernails short, smooth, & clean; wet compresses; phototherapy |
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Term
| Pharmacological Treatment of Atopic Dermatitis |
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Definition
| topical corticosteroids (fluocinonide 0.05%, triamcinolone 0.1%, hydrocortisone 0.5-2.5%); topical calcineurin inhibitors (tacrolimus [Protopic], pimecrolimus [Elidel]); coal tar; oral antihistamines (H-1 antagonists - diphenhydramine, hydroxyzine); oral or topical antibiotics if infected (bacitracin/polymyxin B/neomycin [Neosporin]); systemic immunomodulators for severe, refractory pts (systemic glucocorticoids, cyclosporine, azathioporine, mycophenolate mofetil, methotrexate, interferon gamma) |
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Term
| Topical Corticosteroids in treatment of Atopic Dermatitis |
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Definition
| High-potency (fluocinonide 0.05%): use up to 3 wks for acute flares or lesions, do not apply to face, mucous membranes, or intertriginous areas; Intermediate-potency (triamcinolone 0.1%): used for chronic management on trunk & extremities; Low-potency (hydrocortisone 0.5-2.5%): used in children, applied to face or intertriginous areas; Apply to affected areas 1-4 times daily, rubbed in well; do not apply to infected skin; ADRs: local - skin atrophy, striae, hypopigmentation; systemic - HPA axis suppression, growth retardation |
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Term
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Definition
| more occlusive --> increased absorption, may be preferred for acute flares or lichenified lesions |
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Term
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Definition
| creams are stronger than lotions |
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Term
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Definition
| can irritate skin & promote drying; may be preferred for hairy areas (scalp, beard) |
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Term
| Topical calcineurin inhibitors (tacrolimus [Protopic], pimecrolimus [Elidel]) |
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Definition
| inhibits calcineurin & subsequent T cell activation --> decreased inflammation; used to treat atopic dermatitis; ADRs: transient itching/burning, BLACK BOX WARNING - rare cases of malignancy - long-term use not approved, limit sun exposure |
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Term
| tacrolimus (Protopic) 0.03%, 0.1% ointment |
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Definition
| topical ointment that inhibits calcineurin & subsequent T cell activation --> decreased inflammation; 2nd line therapy for short-term & non-continuous chronic treatment of moderate to severe atopic dermatitis; 0.03% ointment for children; 0.1% ointment for adults only; thin layer should be applied to affected area BID & rubbed in well |
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Term
| pimecrolimus (Elidel) 1% cream |
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Definition
| topical cream that inhibits calcineurin & subsequent T cell activation --> decreased inflammation; 2nd line therapy for short-term & non-continuous chronic treatment of moderate to severe atopic dermatitis; thin layer should be applied to affected area BID and rubbed in well |
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Term
| Coal tar - crude coal tar (1-3%), liquor carbonis detergens (5-20%) |
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Definition
| topical agent used to treat atopic dermatitis; antipruritic & anti-inflammatory activity; has strong odor & stains clothes (limits use); apply at bedtime & wash off in morning (do not apply to acutely inflamed or oozing lesions); ADRs: folliculitis, photosensitivity |
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Term
| Antihistamines (H-1 antagonists) |
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Definition
| hydroxyzine & diphenhydramine; helps control pruritus; use sedating formulas at bedtime since pruritus is worse at night; ADRs: sedation, dry mouth, blurred vision, urinary retention, constipation; Topical forms are NOT RECOMMENDED because they cause cutaneous sensitization |
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Term
| Antibiotics (bacitracin/polymyxin B/neomycin - Neosporin) |
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Definition
| use to treat infectious atopic dermatitis; routine use not recommended |
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Term
| Patient Education of Atopic Dermatitis Treatment |
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Definition
| discuss chronic nature, exacerbating factors, & treatment options: complete eradication may occur, but exacerbations are likely; wash hands before & after applying any meds; improvement should be noticed within a couple days |
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Term
| Seek medical attention for atopic dermatitis if: |
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Definition
| severe condition with intense pruritus; involvement of large area of body; less than 2 years of age; skin appears to be infected; condition worsens or does not improve after 2-3 days of self-treatment |
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Term
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Definition
| dry skin resulting from decreased water content & abnormal loss of cells from stratum corneum |
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Term
| Pathophysiology of Xerosis |
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Definition
| decreased water retention in stratum corneum: impaired keratinization & water-binding, prolonged detergent use, malnutrition, physical damage, hypothyroidism, dehydration; Factors: frequent or prolonged bathing with hot water, excessive use of soap, low humidity, high wind velocity, physical damage, advanced age |
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Term
| Clinical Presentation of Xerosis |
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Definition
| roughness, decreased flexibility, fissures, inflammation, pruritus, scaling: eczema craquele, ichthyosis |
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Term
| Goals of Treatment of Xerosis |
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Definition
| restore skin hydration; maintenance/restore barrier function |
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Term
| Nonpharmacologic Treatment of Xerosis |
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Definition
| bathing; humidifier/vaporizer; drink at least eight 8oz. glasses of water daily; avoid caffeine, spices & alcohol |
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Term
| Pharmacologic Treatment of Xerosis |
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Definition
| moisturizers & emollients (humectants, urea, alpha-hydroxy acid, allantoin, lanolin); topical corticosteroids (hydrocortisone); antipruritics: topical anesthetics (pramoxine, lidocaine, benzocaine), counterirritants (camphor, menthol), antihistamines (oral & topical H-1 antagonists: diphenhydramine (oral & cream), hydroxyzine (oral)) |
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Term
| Moisturizers & Emollients |
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Definition
| used to treat xerosis; provides & traps moisture in skin; apply 2-4 times daily; avoid contact with eyes or broken skin; contains humectants, urea, alpha-hydroxy acid, allantoin, or lanolin |
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Term
| Urea (10-30%) - urea 10% [Carmol 10 Lotion), urea 20% [Carmol 20 Cream] |
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Definition
| moisturizer & emmollient used in treatment of xerosis; mildly keratolytic & increases water uptake into stratum corneum; Lotions/creams: better at removing scales/crusts; Ointments: better at rehydrating skin; ADRs: stinging, burning, irritation |
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Term
| Alpha-hydroxy acid (Lactic acid) - ammonium lactate [AmLactin, Lac-Hydrin] |
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Definition
| moisturizer/emollient used to treat xerosis; increases hydration of skin & normalizes kertinization; ADRs: stinging, burning, irritation |
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Term
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Definition
| moisturizer/emollient used to treat xerosis; disrupts keratin structure --> softening; less effective than urea |
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Term
| Topical Corticosteroids in treatment of Xerosis - Hydrocortisone 0.5-1% |
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Definition
| used to treat xerosis; helps decrease inflammation & pruritus; apply 1-4 times daily and rubbed in well --> do not use for more than 7 days; |
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Term
| Topical Anesthetics (pramoxine, lidocaine, benzocaine) |
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Definition
| used to treat xerosis; antipruritic used to block conduction along axonal membranes to relieve pain & pruritus; apply 3-4 times daily; may cause sensitization in some pts |
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Term
| Counterirritants (camphor, menthol) |
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Definition
| used to treat xerosis; antipruritic used to produce a cooling sensation to help relieve pruritus; apply 3-4 times daily |
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Term
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Definition
| inflammatory skin condition resulting from dermal exposure to an exogenous agent |
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Term
| Irritant Contact Dermatitis |
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Definition
| caused by exposure to an irritant - many related to occupation; usually develops on exposed or unprotected skin surfaces (hands & face); Common irritants: strong acids, bases, detergents, solvents, oxidants; Factors affecting skin response: existing skin conditions, qty & conc. of irritant, occlusive clothing, wet work, increased temp. & humidity |
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Term
| Clinical Presentation of Irritant Contact Dermatitis |
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Definition
| initial presentation: erythema, swelling, and formation of small vesicles or papules (ooze when opened) - pruritus, stinging & burning, crusts may form after several days, may progress to ulcer formation & skin necrosis; usually resolves in several days if exposure to irritant is eliminated; with chronic exposure: inflammtion of skin continues, scaling, hyper- or hypopigmentation |
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Term
| Goals of Treatment of Irritant Contact Dermatitis |
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Definition
| relieve inflammation, tenderness, and irritation; prevent continued irritant exposure |
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Term
| Allergic Contact Dermatitis |
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Definition
| caused by allergen; type IV delayed hypersensitivity reaction: initial exposure leads to sensitization, re-exposure results in activation of sensitized T cells, dermatitis usually develops 2-48 hrs after re-exposure; Common causes: poison ivy/oak/sumac, metals - nickel salts, fragrances, cosmetics, skin care products, benzocaine, bacitracin, neomycin, thiomersal, latex |
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Term
| Clinical Presentation of Allergic Contact Dermatitis |
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Definition
| Initial presentation affected by allergen, site, duration of exposure, & host factors; General signs/symptoms: erythema, swelling, blisters, pruritus, burning, pain; usually resolves in 10-21 days |
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Term
| Goals of Treatment of Allergic Contact Dermatitis |
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Definition
| protect affected area during acute phase of rash; prevent itching & excessive scratching; prevent accumulation of debris |
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Term
| Nonpharmacological Treatment of Contact Dermatitis |
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Definition
| bathing; clean & trim fingernails; barrier products (Hydropel & Hollister Moisture Barrier Cream - prevent ICD if applied before contact with irritant) |
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Term
| Pharmacologic Treatment of Contact Dermatitis |
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Definition
| calamine lotion; sodium bicarbonate; astringents (witch hazel, aluminum acetate 5%, cool water, isotonic saline solution, diluted white vinegar); colloidal oatmeal; topical corticosteroids (hydrocortisone 0.5-1%); oral corticosteroids (prednisone); oral antihistamines; AVOID topical anesthetics, antihistamines, and antibiotics |
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Term
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Definition
| used to help relieve pruritus in contact dermatitis; apply to affected area every 4 hrs PRN; Shake well; Do not apply to open, oozing lesions; leaves light pink film on skin |
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Term
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Definition
| used to help relieve pruritus & irritation in contact dermatitis; can use as paste, cool compress, or warm bath; do not use near eyeas or in children <2 yrs old |
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Term
| Astringents (witch hazel, aluminum acetate 5%, cool water, isotonic saline solution, diluted white vinegar) |
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Definition
| treats contact dermatitis; used to retard oozing, discharge, or bleeding; Methods: soak affected area in it; soak washcloth, cheesecloth, or small towel in it & apply to affected area; ADRs: drying, tightening, contracting of skin |
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Term
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Definition
| cleanses skin & provides a soothing, antipruritic effect; used for contact dermatitis, also for atopic dermatitis |
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Term
| Patient Education on Contact Dermatitis |
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Definition
| Prevention: avoid exposure, use protective clothing; Seek medical attention if: <2 yrs old, involvement of >25% of BSA, extreme pruritus, irritation, or severe vesicle formation, swelling of body or extremities, impairment of daily activities, condition worsens |
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Term
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Definition
| transient inflammation of skin, occurring where sweat glands are present; due to obstruction of sweat glands --> dilation & rupture of sweat pores --> inflammation; Common causes: hot, humid weather; illness causing sweating; excessive, tight, or occlusive clothing; usually resolves rapidly if left alone or cause is removed |
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Term
| Clinical Presentation of Prickly Heat |
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Definition
| characterized by pinpoint-size, raised, red or maroon lesions; may be clustered together or spread out over occluded area, usually do not extend beyond occluded area, lesions may be accompanied by stinging, burning, pruritus; Common locations: axillae, chest, upper back, back of neck, abdomen, inguinal area |
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Term
| Goals of Treatment for Prickly Heat |
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Definition
| 1) remove causative agent; 2) alleviate symptoms; 3) promote healing of lesions; 4) prevent secondary infections |
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Term
| Nonpharmacological Treatment of Prickly Heat |
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Definition
| measures to decrease sweating (antipyretics if fever, wear loose, light-colored, lightweight clothing); bathing (mild soap); use chemical irritants & soap sparingly on affected area |
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Term
| Pharmacological Treatment of Prickly Heat |
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Definition
| emollients, skin protectants, antipruritics (avoid petrolatum or other oleaginous ointments, water-washable cream products preferred); topical corticosteroids (used to help relieve pruritus); AVOID topical anesthetics & antihistamines |
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Term
| Patient Education for Prickly Heat |
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Definition
| prevention strategies - avoid excessive sweating, wear loose, light-colored, lightweight clothing; powders; Seek medical attention if: presence of broken skin, oozing blood, vesicles, or pus at lesion sites, presence of constitutional symptoms, significant behavioral changes, comorbid conditions, or if condition worsens or does not improve after 7 days |
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