Lecture 16: Dermatology I Flashcards

Question

Examples of emollients

Answer 1

* Shea butter * Cocoa butter * Mineral oil * Lanolin * Beeswax * Olive oil

Answer 2

Passive diffusion through stratum corneum

Answer 3

* Relationship between the drug and the vehicle * Drug solubility in the vehicle * Diffusion coefficient from vehicle * Skin factors

Answer 4

Hydration • Wounds/burns • Inflammation/dermatitis • Age – pediatric patients absorb greater proportion of drug than adults → Ratio of surface area to body weight is 2-3x

Answer 5

``` OTC options are 1% or 0.5% = low potency steroid - Low risk of local and systemic effects • Safe short term • Skin atrophy is possible but rare • Caution face, eyelids, genitals Apply before moisturizers Avoid in children < 2 years of age DO NOT apply if skin in open or cracked ```

Answer 6

Ointment-Preferred on thick skin | Cream-less greasy, patients often prefer

Answer 7

* Macules * Papules * Nodules * Vesicles and bullae * Plaques

Answer 8

* Circumscribed, flat lesions * Any shape or size * Differ from surrounding skin in color

Answer 9

* Small, solid, elevated lesions * Usually <1 cm in diameter * The major portion of a papule projects above the plane of the surrounding skin

Answer 10

* Palpable, solid, round, or ellipsoidal lesions | * Not a papule – deeper or more palpable

Answer 11

* Technical terms for blisters * Vesicles are circumscribed lesions that contain fluids * Bullae are vesicles larger than 0.5 cm in diameter

Answer 12

* Mesa-like elevation | * Occupy a relatively large surface area compared with height above the skin surface

Answer 13

- Inflammation of the skin

Answer 14

Skin disorder or disease

Answer 15

Skins normally contains 10% to 20% water by weight • If skin hydration drops below 10% the stratum corneum becomes brittle and may crack more easily • Affects >50 % of older adults

Answer 16

* Environmental (i.e. hot showers) * Dehydration * Physical damage to skin * Malnutrition * Hypothyroidism * Advanced age - epidermis thins over time

Answer 17

* Loss of moisture from skin à loss of elasticity à skin cracking * Roughness * Scaling * Loss of flexibility * Fissures * Inflammation * Pruritus

Answer 18

Moisturization = adding moisture + trapping moisture • Baths are better than showers for moisturizing • Moisturizers should be fragrance free • There are no specific recommendations for quantity or frequency of moisturization

Answer 19

the skin is still moist or slightly damp (within 3 minutes of towel drying)

Answer 20

* Emollients * Moisturizers * Glycerin containing cleansers * Bath oils * Increased room humidity * Hydration (oral)

Answer 21

Topical hydrocortisone (OTC) • Short-term use (< 7 days) • Often does not respond well • May reduce erythema and pruritus

Answer 22

* Lotions may be used on the scalp and other hairy areas and for mild dryness on the face, trunk and limbs * Creams are more occlusive than lotions * Ointments are the most occlusive and can be used for drier, thicker, or more scaly areas

Answer 23

they capture trans-epidermal water loss by providing a layer of oil on the skin surface, increasing the moisture content of the stratum corneum

Answer 24

(cleanser + bath oil + emollient)

Answer 25

Common inflammatory condition of the epidermis and dermis • Affects children and adults • Also known as atopic eczema • 70% of AD cases have an atopic family history • Characterized by episodic flares and periods of remission

Answer 26

* Inflammation with expression of cytokines and chemokines | * Decreased ability to retain moisture

Answer 27

* Often presents within first year of life * Erythema, scaling on cheeks and folds * Transitions to dry skin by age 2

Answer 28

* Often less severe plaque formation * Erythema, scaly, exudative, lichenified * Antecubital and popliteal fossae, hands, neck, forehead * Pruritus * Scratching and lichenification → excoriation

Answer 29

* Food allergens (egg, milk, peanut, soy, wheat, nuts) * Aeroallergens (dust mites, cat dander, mold, grass, ragweed, pollen) * Stress * Airborne irritants (tobacco smoke, air pollution) * Cosmetics, fragrances * Temperature extremes * Electric blankets * Excessive hand washing * Soaps, detergents, scrubs * Dyes or preservatives

Answer 30

* Moderate-severe condition with intense pruritus * Large area of body involvement * <1 year of age * Cutaneous infection * Face or intertriginous areas

Answer 31

* Stop itch-scratch cycle * Maintain skin hydration * Avoid triggers * Prevent infections

Answer 32

* Identify and eliminate triggers * Skin hydration/barrier protection * Topical therapy (+/- systemic in refractory cases) * Refer if symptoms worsen or do not resolve within 7 days

Answer 33

* Avoid triggers * Regular bathing * Short time, lukewarm water, mild cleansers (ex. Cetaphil), moisturize after * Avoid scratching * Keep nails short and clean * Cotton gloves at night * Topical emollients/ointments * Standard of care * Maintain skin hydration * Improves skin response rate in AD * Apply at least twice daily

Answer 34

Hydrocortisone (HCT) • Apply 1-2 times per day during flare-ups • Refractory conditions should be referred for prescription agents

Answer 35

* Essential features = pruritus + eczema | * May have elevated IgE or eosinophils

Answer 36

* Erythema * Edema * Papulation * Excoriations * Dryness * Scaling and crusting

Answer 37

* Asthma * Allergic rhinitis * Atopic dermatitis

Answer 38

Acute inflammation of skin in perineum, buttocks, inner thighs, and abdomen • Can occur in any population with incontinence • Most common in infancy (thinner skin than adults)

Answer 39

* Skin compromise due to occlusion, moisture, microbes or friction * Urine and feces break down skin * Ammonia in urine raises skin pH which makes it more prone to breakdown

Answer 40

• Bight red, wet-looking patches and lesions

Answer 41

* Lesions present >/= 7 days or have not improved in 7 days despite treatment * Secondary skin infection or symptoms of UTI * Diaper dermatitis outside diaper region * Presence of broken skin, including oozing, blood, or pus * Chronic or frequently recurring lesions * Systemic infection symptoms * Behavioral changes * Immunocompromised condition

Answer 42

* Relieve symptoms * Rid the patient of rash * Discourage infection * Prevent recurrences

Answer 43

* Determine whether self-care is appropriate * Recommend OTC protectants for up to 7 days * Refer if symptoms worsen or do not resolve within 7 days

Answer 44

* Increase diaper changes * Gentle wiping with baby wipes * Use of disposable diapers * Prevention is key! * Change diapers immediately * Keep diaper area clean and dry

Answer 45

* Skin protectants - serve as a lubricant and physical barrier * Topical talc and cornstarch powders * Apply products liberally as needed * Hydrocortisone is contraindicated!

Answer 46

* Inflammatory skin reaction caused by an irritant | * Most cases related to occupation

Answer 47

* Often occurs on exposed skin surfaces * Disruption of skin barrier * Changes in epidermis * Release of proinflammatory cytokines * Many factors affect magnitude of skin response * Existing skin conditions * Quantity and concentration of substance * Chemicals, acids, bases are more severe * Contact time with irritant

Answer 48

* Symptoms are often delayed * Inflammation and swelling * Erythematous * Itching and burning * Dry, painful, cracked skin * Generally resolves in several days after irritant removed * Chronic exposure to irritant: * Skin remains inflamed * Fissures or scales may develop * Skin may be hypo- or hyperpigmented * Leathery thickening of skin * Lichenification

Answer 49

* Acids, alkalis * Detergents, soaps, hand sanitizers * Epoxy resin * Ethylene oxide * Fiberglass * Flour * Oils * Oxidants, plasticizers and activators in athletic shoes * Solvents * Urine/feces * Water * Wood dust and products

Answer 50

• Remove the irritant • Prevent further exposure to irritant • Relieve inflammation, irritation and tenderness (non-pharm and pharm options)

Answer 51

``` ● Avoid further irritant exposure ● Wash area of initial irritant exposure • Warm water and mild soap • Reduces contact time with irritant • Helps localize symptoms ● Protective clothing and equipment Skin protectants/ointments ● Colloidal oatmeal baths ● Topical corticosteroids - not recommended ```

Answer 52

* Warm water and mild soap * Reduces contact time with irritant * Helps localize symptoms

Answer 53

Apply to the affected area • Helps restore moisture to stratum corneum • Protectant from further exposure • Dimethicone containing products help repair epidermal barrier

Answer 54

May help relieve itching *Topical corticosteroids - not recommended

Answer 55

Inflammatory dermal reaction after exposure to allergen

Answer 56

* Poison ivy, oak, sumac * Nickel (jewelry) * Latex (gloves, healthcare workers) * Cosmetics and fragrances * Benzocaine * Neomycin sulfate

Answer 57

Toxicodendron plants • “Leaves of 3, let it be” • Urushiol is the antigen released by direct damage to the plant • Allergic response occurs within 10 minutes of contact • Unwashed contaminated hands can transfer urushiol to other body surfaces and other individuals • ~80% of those in the US are estimated to be sensitive to urushiol • Reduced sensitivity in elderly

Answer 58

* Papules * Small vesicles * Pruritus * Erythema (streaky/patchy) * Inflammation * Lichenification * Affected area eventually crusts and dries * Presentation varies based on severity * Typically resolves in 10-21 days

Answer 59

* <2 years old * ACD present >2 weeks * Involvement of >20% of skin surface * Extreme itching, irritation, or severe vesicle and bulla formation * Swelling of the body or extremities * Swollen eyes or eyelids swelling shut * Discomfort in genitalia d/t itching, irritation, swelling * Involvement/itching of the mucous members of the mouth, eyes, nose, anus * Signs of infection * Failure of self-care after 7 days * Impairment of daily activities

Answer 60

* Protective clothing * Barrier products block urushiol from absorbing into skin (IvyBlock- FDA approved) * Plant eradication * Urushiol is inactivated by wet conditions * Remains active within dead plants or innate objects * Cold showers with hypoallergenic cleansers

Answer 61

* May reduce chance and severity of reaction * Wash are with soap and water (10 minutes) * Nonprescription wash to prevent or relieve rash * Zanfel * Technu Outdoor Skin Cleanser * Similar efficacy to soap – consider costs

Answer 62

* Allergen activates sensitized T cells after initial contact * Next time allergen has contact: * T cells migrate to site of contact * Release inflammatory mediators * Type IV delayed hypersensitivity reaction * Cell-mediated immune reaction * Can take 24 hours to 21 days to develop * If previously sensitized → rash and symptoms usually develop 24-48 hours after exposure

Answer 63

Oral diphenhydramine (NOT topical)

Answer 64

``` Astringents: Decrease edema and exudation • Aluminum acetate/Burrow’s solution • 1 tablet to 1 pint of water • Soak area 15-30 mins 2-4x day • Calamine lotion ```

Answer 65

* Hydrocortisone * Most effective for mild-moderate ACD * Cream preferred to ointment * Allows weeping lesions to dry

Answer 66

Chronic, mildly inflammatory scalp disorder

Answer 67

diffuse scaling at crown of | head +/- pruritus

Answer 68

Hyperproliferative epidermal disorder • Shedding of large, white scales • Role of Malassezia yeast species?

Answer 69

Reduce epidermal turnover rate • Minimize cosmetic concerns • Minimize itch

Answer 70

• Regular non-medicated shampoo typical is sufficient for mild/moderate dandruff • Nonprescription medicated shampoos suppress replication of Malassezia species and reduce yeast count in the scalp and skin • Refer to PCP if dandruff persists after 4-8 weeks with medicated shampoo

Answer 71

``` Nonprescription medicated shampoos • Pyrithione zinc (Head and Shoulders shampoo) • Selenium sulfide (Selsun Blue) • Ketoconazole • Coal tar shampoo ```

Answer 72

Anti-fungal shampoo with anti-Malassezia activity

Answer 73

* Decrease rate of epidermal replication * Second-line * Limited efficacy * Discolor light hair and clothing

Answer 74

Wash hair and scalp daily or every other day for one week, then taper down • Contact time is key to effectiveness • Massage shampoo into scalp and leave for 3-5 minutes before rinsing • Repeat rinsing to ensure residual is removed

Answer 75

Inflammatory condition primarily near sebaceous gland

Answer 76

* Accelerated epidermal proliferation caused by elevated levels of Malassezia * Epidermal cell turnover is 9-10 days compared to 25-30 days normally

Answer 77

* Dull, yellowish, oily, scaly areas on red skin * Pruritus is common * Common locations: Scalp, eyebrows, eyelids, cheeks, paranasal areas, beard area, sternum, central back, around ears, intertriginous areas * Infantile form * Cradle cap * Usually clears without treatment by 8-12 months * Adult stages * Yellow, greasy scales on scalp to face

Answer 78

* Reduce inflammation and epidermal turnover * Minimize or eliminate erythema, scaling, and pruritus * Educate about chronic condition – control symptoms, not cure

Answer 79

Infants • Usually self-limited with time • Use non-medicated shampoos • Gently massage scalp with baby

Answer 80

Shampooing is the foundation of treatment REGARDLESS of skin lesion location • Medicated shampoos: Pyrithione zinc, Selenium sulfide, Ketoconazole • Topical corticosteroids may be useful to treat inflammation in seborrheic dermatitis • NOT typically useful in treating dandruff • 7 day maximum use before refer

Answer 81

Chronic inflammatory disease • Plaque psoriasis most common • Remissions and exacerbations are unpredictable • Lesions may clear spontaneously

Answer 82

* Accelerated epidermal proliferation * Excessive scaling on raised plaques * Lesions may last a lifetime or disappear * May leave skin hyper- or hypo-pigmented

Answer 83

* Lesions start as small papules and unite to form plaques * Well-circumscribed, sharply demarcated * Overlying thick white scales * Most common sites * Exterior surfaces of elbows and knees * Lumbar region of back * Scalp * Posterior auricular area * Inflammation and itching

Answer 84

* Environmental * Physical, chemical * Infections and immune status * Certain drugs and corticosteroid withdrawal * Ex: beta-blockers, lithium * Psychological stress and hormones * Obesity * Use of alcohol and tobacco

Answer 85

* Control or eliminate signs/symptoms | * Prevent or minimize flare-ups

Answer 86

* Only mild cases can be self-treated * Up to a few isolated lesions, no larger than a quarter * Bathing will help remove loose scales which disrupts plaque formation * Emollients to moisturize/soften skin * Apply liberally with gentle rubbing 4x daily * Hydrocortisone (OTC) * Most effective for acute bright red flare lesions * Refer to dermatologist for moderate to severe cases over large areas

Answer 87

Less than 2 years of age • Worsening or no improvement after 1-2 weeks of proper use of OTC medication options • >5% body surface area involvement for psoriasis

Lecture 16: Dermatology I Flashcards

(112 cards)