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Dermatological Disorders Therapeutics Exam
Dermatological Disorders Therapeutics Exam 8
flat lesions of any shape or size that differ from surrounding skin because of their color (e.g. birthmark or freckle)
small, solid, elevated lesions that are less than 1 cm in diameter (not fluid-filled)
a mesa-like elevation that occupies a relatively large surface area in comparison with its height above the skin
palpable, solid, round or ellipsoidal lesions with varying depth of involvement into the skin
(papules that extend under the skin)
rounded or flat-topped papules or plaques that are characteristically evanescent, disappearing within hours and usually itch (usually from allergic rxn)
Define vesicle and bullae
blisters; vesicles are < 0.5 cm in diameter and bullae are > 0.5 cm in diameter
Characteristics of xerosis
: dry skin, winter itch
decreased water content in stratum corneum
: roughness, scaling, loss of flexibility, fissures, cracks, inflammation and/or pruritis
What is the most common dermatologic problem in children?
S/S and other names for atopic dermatitis
: eczema, "the itch that rashes"
Chronic, relapsing (relapsing and remitting)
oozing vesicles with or without excoriations
what is the atopic triad?
What areas are most common for atopic dermatitis at which ages?
: face and scalp
2 years - puberty
: wrists, ankles, neck
: upper arms, back, wrists
How is atopic dermatitis diagnosed?
If pt has itchy skin + 3 of the following:
onset < 2 years
hx of skin crease involvement
hx of generally dry skin
personal or 1st degree relative hx of other atopic disease
visible flexural dermatitis
Non pharmacologic treatment of atopic dermatitis
decrease exposure to triggers
bathing (soak & seal - apply moisturizer within 3 min)
keep nails short
wear loose fitting cotton clothing
avoid all triggers
What is the teaspoon rule?
tells the amount of moisturizer to use
one teaspoon per arm, chest, abdomen, upper back, lower back, each thigh, each shin
Compare emollients vs. moisturizers
Emollients smooth the skin
Moisturizers hydrate the skin
What do humectants and keratolytics do?
humectants attract water
keratolytics soften scales
Exclusion for self treatment of atopic dermatitis
1. severe condition with intense pruritis and crusting (severe flare)
2. involvement of large area of the body
3. less than 2 years of age
4. infected lesions
5. treatment for 7 days with no resolution
Treatment algorithm for atopic dermatitis
cool tap water compress, astringents
topical antibiotics if infx present (honey-colored crusting)
moisturizers and emollients throughout the day plus:
topical glucocorticoids (up to 7 days)
topical calcineurin inhibitors
cyclosporine A, azathioprine, interferon gamma, mycophenolate mofetil, phototherapy
Should topical antihistamines and anesthetics be used in atopic dermatitis and contact dermatitis? Why or why not?
No because they are skin sensitizers
What are the 2 types of contact dermatitis and common causes?
Irritant contact dermatitis - caused by exposure to irritant (e.g. strong acids/bases, detergents, fiberglass, leather, solvents, etc.)
Allergic contact dermatitis - caused by exposure to allergen (poison ivy/oak/sumac, metal)
What is the chemical that causes the allergic reaction to poison ivy?
s/s of contact dermatitis
inflamed, swollen, red skin
vesicles and bullae
intense itching - may lead to skin breakdown and open lesions
Nonpharmacologic treatment of contact dermatitis
wash self and objects with soap and water
men should shave
Treatment algorithm for contact dermatitis
tap water compress
shake lotion, sodium bicarb compress/paste
counterirritants, oral antihistamines
oral steroids (1mg/kg/day tapered over 2-3 weeks)
can topical corticosteroids/glucocorticoids be applied to broken skin? can counterirritants?
Exclusions for self-treatment of contact dermatitis
Less than 2 years old
greater than 2 weeks duration
greater than 25% of body surface area
extreme itching, irritation, or severe vesicle and bullae formation
swelling of the body and/or extremities
involvement of mucous membranes
impairment of daily activities (e.g. it's on the bottoms of feet, hands, etc.)
Signs/symptoms of first degree and second degree sunburns
: superficial burn, mild erythema, tenderness, pain, edema, pruritis, macular
: visicles, bullae, fever, shills, weakness, shock
What is the max SPF there is?
How is the UVA protection with sunscreen rated?
4 star rating (low, medium, high, highest)
How much sunscreen is needed per body part for proper protection?
Define "water resistant" and "very water resistant" in terms of sunscreens
water resistant retains SPF for at least 40 minutes when sweating or swimming
very water resistant retains SPF for at least 80 minutes when sweating or swimming
What is the difference between organic and inorganic sunscreens?
Organic - the active ingredient absorbs at least 85% of UV rays
Inorganic - the active ingredient reflects or scatters all light (physical barrier)
What are the major categories of sunscreen ingredients?
PABA and derivatives
What agents fall under which categories of sunscreens?
PABA and derivatives - Aminobenzoic Acid (PABA), Padimate O
Anthranilates - Menthyl anthranilate
Benzophenones - Dioxybenzone, Oxybenzone, Sulisobenzone
Cinnamates - Cinoxate, Octyl methoxycinnamate, Octocrylene
Dibenzoylmethane Derivatives - Avobenzone
Salicylates - Octyl salicylate, homosalate, Trolamin salicylate
Misc. - Terephthalyidene dicamphor sulphonic acid, Phenyl benzimidazole, Titanium dioxide, Zinc dioxide
Which sunscreens are sensitizers?
PABA (aminobenzoic acid)
Benzophenones (dioxybenzone, oxybenzone, sulisobenzone)
Which sunscreens are weak and do not adhere well?
the salicylates (octyl salicylate, homosalate, trolamin salicylate)
Which sunscreen provides protection for the entire UVA range, and what is its problem?
Avobenzone - it is not photostable
Nonpharmacologic treatment of sunburn
cool with tap water for 10-30 min
do not pull loose skin
Treatment algorithm for sunburn
skin protectant, emollient/moisturizer
Weeping Burn (2nd degree):
cool tap water compress/soak
topical antibiotics if infx present
local anesthetics (3-4x/day)
Should astringents or counterirritants be used to treat sunburns?
Exclusions for self-treatment of sunburn
more than 2% of body surface area (for regular burns, not sunburn)
treatment for 7 days with no resolution
Which type of insects bite pattern is a linear formation?
Characteristics of Lyme disease
Spirochete found in deer ticks
Initial rash is papule that enlarges to a bulls-eye rash that disappears in 3-4 weeks
Infection spreads and pt experiences flulike sx and muscle aches
Years later - neurologic and cardiac sx
Finally, arthritis and red discoloration on hands, wrists, feet, or ankles
Are insect repellants effective for stinging or biting insects?
biting, not stinging
How does DEET work, and how should it be used?
It discourages insect approach
Apply max of q6hours (nmt qd in kids)
it decreases the efficacy of SPF
Alternative insect repellants
tea tree oil
Nonpharmacologic treatment for insect bites/stings
RICE therapy (rest, ice, compression, elevation)
: Vacuum daily, petroleum jelly on bed legs
Treatment algorithm for insect bites/stings
topical antihistamines, topical hydrocortisone
counterirritants, shake lotion
local anesthetics, oral NSAIDS
Exclusions for self treatment of insect bite/stings
Hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing
Hx of significant allergic response to any sting
Allergic response away from sting
Less than 2 y.o.
spider bite requiring medical attention (brown recluse, black widow)
s/s of infx
Treatment for scabies
Cover entire body, wash in 8-12 h, retreat if necessary
Lots of counseling necessary
Nonpharmacologic treatment of pediculosis
Nit comb over a 10 day period (as monotx, or following pediculocides)
Petrolatum for eyebrows or eyelashes
Wash bedding and clothes in washer and dry in dryer
Seal unwashable items in plastic bag for 2 weeks
Pharmacologic treatment for pediculosis
Pediculicides - neurotoxins that cause paralysis - pyrethrin, permethrin (ovicidal)
Benzyl alcohol lotion - suffocates the lice (not ovicidal)
Counseling re: pediculicides
May cause scalp irritation
ONLY for actual infestation (don't use as prevention)
Must use nit comb
Only repeat if necessary
Do not use on eyebrows or eyelashes
Exclusions for self-treatment of pediculosis
Hypersensitivity to chrysanthemums or ragweed
Evidence of secondary infx
Less than 2 y.o.
Infestation of eyebrows or eyelashes (sign of sexual abuse)
Pregnancy or lactation
Important points regarding product selection for dermatologic conditions
If it's wet, dry it
If it's dry, wet it
Water in oil is more effective (e.g. ointment)
Oil in water is more esthetic (e.g. lotion) and may evaporate, causing a drying effect
Do not use ointments, shake lotions, or counterirritants on weeping lesions
Topical antihistamines and anesthetics are known sensitizers
Aerosol products may be drying or irritating and are not protective
Avoid camphor in children
Ointments > Creams > Lotions
Atopic dermatitis is a _______ disease state that requires both _________ and ____________ treatment to maintain the integrity of the stratum corneum. How do we prevent flares?
Preventive and active
use emollients and moisturizers to prevent flares
When treating urushiol induced contact dermatitis what is the #1 thing to do?
Eliminate the urushiol
Must use nonpharmacologic measures to prevent recontamination
What type of product is best for preventing sunburn?
A product with good UVA and UVB protection. Be sure to apply it correctly.
What is the difference in treatment of insect bites vs. insect stings?
What is extremely important to consider with the use of pediculocides?
Only treat with them when necessary
Do not use for prevention
Patients must take non-pharm measures to control the infestation
Why should topical corticosteroids not be applied to eye area or eyelids?
They can thin the skin (epidermal atrophy)
When should sunscreen be applied and how often?
15-30 minutes prior to sun exposure and reapplied q 2-3 hours