Sunburn and Dermatitis (Bellanger)

Question 1

A chronic, recurring inflammatory skin disorder (Type 1 hypersensitivity reaction). Does not have a cure and is not contagious, the goal is to ____ and ____ it,

Answer 1

Atopic dermatitis (AD) aka eczema (allergic dermatitis) prevent; control

Question 2

The atopic triad consists of ____, ____ and ____.

It [is/is not] all inclusive.

Answer 2

eczema, allergic rhinitis, asthma;

is not

Question 3

The following symptoms are indicative of…?

• -xerosis
• -pruritus
• -red, inflamed skin
• -vesicles and papules
• -recurring rash/flare ups
• -lichenification

Answer 3

Atopic dermatitis (AD) aka eczema (allergic dermatitis)

Question 4

AD locations?

Answer 4

Older children and adults: hands, neck, inner elbows, back of knees and ankles

Younger children: face, elbows, knees

Question 5

AD triggers?

Answer 5

• -Irritants
• -Infections
• -Allergens
• -Environment

Question 6

Some causes of dry skin:

• -an insufficient ____ or ____
• -____ and essential fatty acid deficiency
• -____ diseases
• -____ insufficiency
• -diuretics
• -malignancies

Answer 6

• -diet; malabsorption
• -zinc
• -systemic
• -kidney

Question 7

AD diagnosis criteria is an itchy skin condition, plus ___ or more of the following:

• -onset of age <__ y.o.
• -personal history of other atopic disease
• -visible ____ dermatitis

Answer 7

3

• -2
• -10
• -flexural

Question 8

AD self-treatment exclusions:

• ____ condition with intense ____
• involvement of ____ area of body
• <__ y.o.
• skin appears to be ____

Answer 8

• -severe; pruritus
• -large
• -2
• -infected

Question 9

AD treatment goals:

• -eliminate ____
• -control the ____
• -prevent future flare ups and maintain skin ____
• -prevent secondary infections -minimize drug ____ ____

Answer 9

• -triggers
• -itching
• -hydration
• -adverse reactions

Question 10

AD treatment

• -first line?
• -standard of care?
• -not on the ____ or children <__ y.o.

Answer 10

• -emollients
• -topical steroids (Rx or OTC)
• -face; 2

Question 11

Adjunct AD treatment

• -for patients with allergic rhinitis?
• -for oozing, weeping lesions

Answer 11

• oral antihistamine (sedating antihistamine for sleep relief)
• astringents

Question 12

What are some examples of…

• -emollients/moisturizers?
• -urea?
• -lactic acid?

Answer 12

• -Aquaphor, Eucerin, Lubriderm
• -Carmol, Lac-Hydrin
• -AmLactin

Question 13

Topical steroids of ____ to ____ potency are commonly used until flare-ups are ____. Are usually used no longer than ___ to ___ weeks at a time for self-care.

Answer 13

low; medium; controlled; 3; 4

Question 14

Topical calcineurin inhibitors (Rx) are ___ line agents for patients who have had ____ to steroids, for diseases that are ____ to steroids, or there is a large ____ of disease.

Answer 14

2nd; ADEs; unresponsive; BSA

Question 15

Calcineurin inhibitor mechanism of action

Answer 15

immunomodulator: inhibits calcineurin in the skin; blocks T-cell activation and release of cytokines leading to decreased inflammation

*will not be asked?

Question 16

Calcineurin inhibitors are applied ____ daily before ____. Should see benefits in 8 days - 6 weeks. ADEs include skin ____ and ____.

Answer 16

twice; moisturizer; irritation; burning

Question 17

Topical calcineurin inhibitors: (2)

Answer 17

pimecrolimus (Elidel) - for mild-moderate eczema; cream tacrolimus (Protopic) - for moderate-severe eczema; ointment

Question 18

You should avoid topical calcineurin inhibitors on ____ or ____ skin conditions (eg, cutaneous T-cell lymphoma) and should be used for short-term and intermittent treatment using the ____ amount. Use ____!

Answer 18

malignant; premalignant; minimum; sunscreen

Question 19

AD follow-up: consult a physician if…

• -it does not improve or worsens after __-__ days of ____ treatment
• -____ of the skin occurs while using the topical steroid

Answer 19

• -2-3; medicated
• -atrophy

Question 20

Skin condition that results when the skin comes into contact with chemicals or metals. The affected skin becomes red, itchy and inflamed or in severe cases, blisters and weeping sores may form.

Answer 20

contact dermatitis

Question 21

Contact dermatitis treatment

• -remove and avoid the ____/____
• -may use ____ potency topical ____
• -in rare instances, ____ dressings to relieve redness and itching

Answer 21

• -allergen/irritant
• -low; corticosteroid
• -wet

Question 22

Diaper dermatitis signs and symptoms may include: (2)

Answer 22

• -erythema in patches (buttocks, upper thighs, abdomen, genital region)
• -shiny, beefy-red erythema

Question 23

Diaper dermatitis treatment goals:

• -relieve the ____
• -get rid of the ____
• -prevent ____
• -prevent it from happening again

Answer 23

• -symptoms
• -rash
• -infection

Question 24

Diaper dermatitis treatment

• -many topical products can lead to ____ side effects if applied
• -use a ____ cream
• -do not use topical ____, ____, ____, or ____

Answer 24

• -systemic
• -barrier
• -antifungals, antibacterials, anesthetics, hydrocortisone

Question 25

Diaper dermatitis skin protectants: * -\_\_\_\_ ____ 1-40% and ____ 30-100% (examples: Desitin, A & D Ointment, Boudreaux's Butt Paste...) * -apply liberally to skin in diaper area every ____ \_\_\_\_ * -can continue use after rash heals for prevent recurrence

Answer 25

* -zinc oxide; petrolatum * -diaper change

Question 26

Diaper dermatitis follow-up * -\_\_\_\_ until healed if it improved after 7 days * -\_\_\_\_ if it has not healed/improved or worsened after 7 days

Answer 26

* -continue * -refer

Question 27

Sunscreen exclusions: (3)

Answer 27

* -xeroderma pigmentosum * -allergy to all sunscreen ingredients * -\<6 months of age

Question 28

Sunscreen selection: * -pick a ____ \_\_\_\_ sunscreen * -greater than or equal to ___ SPF * -for patients with sensitive skin or are allergic, avoid \_\_\_\_, consider ____ sunscreen, consider ____ chemical sunscreen

Answer 28

* -broad spectrum * -15 * -aminobenzoic acid (PABA); physical; avobenzone

Question 29

Sunscreen application: * -apply \_\_\_-\_\_\_ minutes prior to UV exposure * -\_\_\_\_ after exposure to ____ or towel drying * -reapply at least every ___ hours

Answer 29

* -15-30 * -reapply; moisture * -2

Question 30

Peripheral vasodilation in the epidermis from UV light; inflammatory reaction; erythema peaks at 12-24 hours.

Answer 30

sunburn

Question 31

Superficial burns: * -\_\_\_\_ only * -brief exposure to low heat or sunburn * -usually no \_\_\_\_ * -\_\_\_\_ can be managed by self-care * -heal within \_\_\_-\_\_\_ days

Answer 31

* -epidermis * -vesicles * -most * -3-6

Question 32

Superficial partial-thickness burns: * -epidermis and top layer of \_\_\_\_ * -more heat or longer exposure * -painful \_\_\_\_, \_\_\_\_, \_\_\_\_ * -\_\_\_\_ burns (1-2% BSA) can be managed through self-care * -heal in \_\_\_-\_\_\_ weeks

Answer 32

* -dermis * -blistering, moisture, weeping * -small * -2-3

Question 33

Self-treatment of burns exclusions: * -burn to BSA of \_\_% or more for superficial partial-thickness * -burns involving eyes, ears, \_\_\_\_, hands, feet or \_\_\_\_ * -deep partial thickness burns * -full thickness burns * -chemical burns * -electrical burns * -\_\_\_\_ or multiple medical conditions * -\_\_\_\_ patients

Answer 33

* -2 * -face; perineum * -diabetes * -immunocompromised

Question 34

Sunburn treatment goals: (4)

Answer 34

* -relieve pain * -provide physical protection * -reduce chances of infection or scarring * -minimize medication ADEs

Question 35

Sunburn treatment plan: - initial treatment is ____ (if burn occurred in the past ___ minutes, immerse in cool water) - can be any ____ of indicated OTC products dependent on symptoms and patient preference

Answer 35

- non-drug, 20 - combination

Question 36

Sunburn treatment: systemic analgesics * -prefer one with ____ properties * -longer duration of action than ____ anesthetics * -use for the first \_\_\_-\_\_\_ days

Answer 36

* -anti-inflammatory * -topical * -1-2

Question 37

Sunburn treatment: topical anesthetics ____ might be less painful

Answer 37

sprays

Question 38

Sunburn treatment: skin protectants * -help with ____ and skin irritation * -examples (2) * -apply \_\_\_\_ * -wait until after ___ hours to start using

Answer 38

* -rehydration * -cocoa butter, petrolatum * -PRN * -24

Question 39

Sunburn alternative treatment? It may decrease pain by inhibiting ____ and inflammatory process. Avoid use on broken skin and avoid internal use.

Answer 39

aloe vera bradykinin

Question 40

Burn follow-up: see physician if burn has ____ or worsened; if it has not healed in ___ days

Answer 40

progressed; 7