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Flashcards in 6 - Atopic & Contact Dermatitis (AD + ICD/ACD) Deck (47)
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1

Dermatitis

non-specific term

Generally characterized by erythema & inflammation
Skin may blister / ooze / crust / flake

 Known causes:
Allergens / Irritants / Infections

Usually SELF TREATED

2

Atopic Dermatitis

AD

Primarily driven by GENETIC FACTORS

Usually develops in infantry, all over the body
especially in skin folds

Physical Contact with irritant / allergen may exacerbate

3

Contact Dermatitis

Driven mainly by EXTERNAL FACTORS

Develips @ site of physical contact w/ irritant or allergen

4

What is the "Atopid Triad"

or Atopic March

AD + Asthma + Allergic Rhinitis

 

Atopy = exaggerated skin & mucosal reactivity
in response to environmental stimuli
genetically predipsosed

 

5

Pathophysiology of AD

Skin is inflammed with and expression of CYTOKINES
IL-4IL13TNF

 

FLG = Fliggrin Mutation, INCREASES risk of AD

6

Diagnostic Criteria for AD

Essential Features:
Pruritis / Eczema

Important Features:
Early Age of Onset
Atopy / Xerosis / FMH

 

Possible Lab Findings:
Elevated IgE levels & peripheral blood eosinophilia

7

Characteristics of Atopic Dermatitis by AGE

8

3 Stages of AD

ACUTE AD
INTENSELY Pruritic + Papules/vesicles over erythematous skin
often associated with an exudate, pus/leak

SUB-ACUTE AD
Red / scaling papules / plaques

Chronic AD
Thickened plaques of skin
accentuated skin markings

9

Complications of AD

S/Sx = Pustules / Vesicles / Yellow Crusting

Secondary BACTERIAL infections
>90% of skin lesions harbor staph

Secondary VIRAL infections
Herpes simples or molluscum

10

Exacerbating Factors of AD

Allergens

Irritants

Temperature Changes

Airborn Irritants
Pollution / Cigarette Smoke / Traffic Exhaust

11

Goals of Therapy for AD

*CAN NOT be curedsymptom control is key

Stop Itch-scratch cycle
Topical steroids

Maintain skin hydration + barrier function
Emollients + Moisturizers

Avoid or Minimize exacerbating factors

prevent 2ndary infections

12

Bathing Procedures for AD

Bathe in lukewarm water for limited duration

Fragrance-Free bath oils (Aveeno)

Use hypoallergenic cleanser (Cetaphil)

Skin should be patted dry or air-dried

Application of moisturizer within 3 minutes of bathing

Use lubricating ointment for excessively dry areas

13

What type of moisturizers for LESS severe cases?

Atopic Dermatitis treatments

EMOLLIENTS

Aquaphor / Nivea

14

What type of moisturizers are used for MORE SEVERE cases?

Atopic Dermatitis treatments

HUMECTANTS
Eucerin + Urea

UREA increases water uptake in the stratum corneum
giving it high-water binding

 

RX Strength Urea acts as a KERATOLYTIC agent

15

Creams

Atopic Dermatitis treatments

Usually Oil-in-Water emulsions (O/W)

LESS occlusive than ointments

common mistake = using too much and/or not rubbing in fully

Cetaphil / Nivea

16

Ointments

Atopic Dermatitis treatments

W/O emulsions

Act primarily by leavan an oily film on the skin surface
that moisture can NOT readily escape

MOST OCCLUSIVE vehicle
relives dryness / brittleness / protects fissures

AVOID ON:
Inflammed skin / interinous areas / hairy areas

WEEPING LESIONS

17

Topical Steroids

Dose / MoA ADR

Atopic Dermatitis treatments

STANDARD OF CARE
Hydrocortisone 0.5% & 1%
low potency

MOA: Supresses cytokines​ associated with the development of inflammation and itching
minimal systemic absorption (~1%)

During flare ups: AAA BID 
prior to application of moisturizers

AVOID use if skin is infected / open / cracked

18

Wet Wraps

AD Treaments

INCREASES Skin Hydration
decreases scratching

Apply steroid or emollient to affected area
then wrap MOIST dressing to AA
then wrap a DRY dressing OVER the wet one
put over nighttime clothing -> LEAVE WRAP OVER NIGHT

19

Astringents

Atopic Dermatitis treatments

Aluminum Acetate & Witch Hazel
(Burrows solution / Domeboro)

Cause vasoCONSTRICTIOn & reduce Bloodflow to inflammed tissue
slow oozing / discharge / bleeding

Wet Dressing
Cool & dry skin through EVAPORATION

20

Burow's Solution

Directions / Duration

Type of Atopic Dermatitis treatments

Category 1 ASTRINGENT
Dissolve 1-3 packets in a PINT (16oz) of cool/warm water -> dissolve

for use as SOAK:
soak AA for 15-30 min Q8H PRN, or AD by a doctor

for use as COMPRESS or WET DRESSING:
soak a clean/soft cloth in the solution
apply cloth loosely to the AA for 15-30 minreapply PRN

21

How to PREVENT / MANAGE Infections

Atopic Dermatitis treatments

Topical Antibiotics NOT routinely recommended

Bleach Bath & IntraNASAL MUPIROCIN
BID used to decrease disease severity

Bleach bath for ECZEMA:
1/2 cup for a FULL TUB or 1/4  cup for HALF tub
soak for 10 minutes -> Dry -> Lotion -> WRAP w/ eczema clothing

22

EX-ST

for ATOPIC DERMATITIS

SEVERE condition with INTENSE PRURITIS

Involvement of LARGE AREA of the body

< 2 years old

Skin appears to be INFECTED

No improvement after 2-3 days of self care

23

Important notes on AD

Most AD cases are MILD and can be treated with NON-RX products
for patients >2 y/o

Need to be counseled on potential exacerbating factors

Errors in BATHING / Moisturizing procedures are THE MOST COMMON FACTORS in persistant AD

Treatment should involve focus on skin care / moisturization in order to enhance/restore barrier properties

OTC therapies can be recommended for symptomatic treatment of dermatosies to reduce inflammation / pruritis

24

What Characterizes CONTACT DERMATITIS?

Inflammation / Redness / Itching / Burning / Stinging

VESICLE + PUSTULE formation on dermal areas that are 
Exposed to irritant / antigenic agents

 

2 Main types:
Irritant & Allergic

25

What are the 3 possible mechanisms that cause
Irritant Contact Dermatitis?

ICD

Caused by exposure to an irritant:

DISRUPTION of skin barrier

Irritant may DIRECTLY DAMAGE the epidermis

Release of CYTOKINES as a result of chemical exposure

26

Common IRRITANTS associated with ICD

Acids / Alkalis

Detergents / soaps / hand sanitizers

Oxidants / Solvents

Urine / Feces

Epoxy Resins / Ethylene Oxide / Oils

Wood dust / products

27

Symptoms / Clinical Presentation

of ICD

Skin becomes inflammed / swollen / red on exposure to IRRITANTS
symptoms may be DELAYED, often limited to hands & forearms

Presents as DRY / MACERATED / PAINFUL / CRACKED skin
that often induces:
Itching / stinging / burning

Generally resolves within a few days, if AVOIDING irritant

CHRONIC EXPOSURE 
-> develop FISSURES / SCALES / Pigmentation

28

3 Treatment goals of ICD

REMOVE / PREVENT 
exposure to the irritant

RELIEVE
inflammation
 / tenderness / irritation

EDUCATE 
patient on self-management to PREVENT recurrence

29

What to AVOID in treating ICD

AVOID:

topical CAINE-type anesthetics

Salicylic / Lactic ACID

UREA

PROPYLENE GLYCOL

30

TREATMENTS for ICD

Cleansing 
area of exposure with tepid water & hypoAllergenic soap (Cetaphil)

Protective clothing / equipment
 
to avoid further exposure

Emollients / Moisturizers
to assist in REPAIRING epidermal barrier

Corticosteroids
to reduce inflammation & relieve itching

Colloidal OATMEAL Bath
also to relieve ITCHING