Derm: Inflammatory Skin Conditions

Causes of Seborrheic Dermatitis

Elevated levels of Malassezia, worsened by emotional stress and winter

Seborrheic Dermatitis: first line treatment

Medicated shampoos containing pyrithione zinc, selenium sulfide, or ketoconazole

Medicated Shampoo: counseling points

• work shampoo into the scalp, leave lather on hair and affected areas for 3-5 mins

  • apply weekly to prevent relapse after condition is controlled

  • thoroughly wash selenium sulfide shampoos out of hair to prevent discoloration in light-colored hair

Selenium Sulfide/Pyrithione Zinc frequency

daily for 1-2 weeks then 2-3 times a week for 4 weeks

Ketoconazole frequency

twice a week for 4 weeks

Seborrheic Dermititis: topical corticosteroid use

manages greater levels of inflammation, use hydrocortisone no more than twice daily for 7 days

Cradle Cap: treatment

• massage scalp with baby oil

• use non-medicated shampoos to remove scales

• refer to pediatrician if no response

Causes of Diaper Dermatitis

occlusion, moisture, contact with urine or feces, shift in skin pH, and friction, food transitions

• higher rates in bottle-fed infants because they have more alkaline and caustic feces than breast-fed infants

Diaper Dermitits: fungal infection causes

candida albicans, usually around margins of diaper derm or in skin folds

Diaper Rash: Non-Pharm Recommendations

• keep the patient dry

• change diaper at least 6 times a day

• clean area with plain water or a bland, soft cloth or wipe

• make sure skin is dry before re-diapering

• disposable diapers decrease rates of severe diaper dermititis

Most common diaper rash protectant

zinc oxide

OTC Diaper Rash products

Desitin diaper rash, A+D original ointment, Boudreaux’s butt paste

“Triple Butt Paste” key ingredients

• protectants/emollients (always present)

  • zinc oxide, lanolin, white petrolatum

• antifungal

• antacid

• antibacterial

• anti-inflammatory

Candida Diaper Rash: appearance and treatment

• ‘satellite lesions’ that can group together

• treat with barrier cream and antifungal

Bacterial Diaper Rash: signs and treatment

• Perianal streptococcus: bright red around anus

• Staph infection: often crusted or oozing

oral antibiotics needed, can be difficult to differentiate so if there is any worries or no improvement REFERRAL

Diaper Dermatitis: OTC counseling points

• keep area clean and dry

• reapply topical after every diaper change

• know what is in topical if it is a mix

Diaper Dermatitis: exclusions for self-treatment

• lesions present >7 days

• secondary infections

• rash outside diaper region

• broken skin

• oozing, blood, vesicles, or pus at lesion sites

Contact Dermatitis: types

• irritant (fast onset)

• allergic (onset can take days)

Contact Dermatitis: first line treatment

Corticosteroids

• anti-inflammatory

• immunosuppresive

• antiproliferative

• vasoconstrictive

Astringents (calamine, witch hazel, domeboro)

• helps to dry oozing

Corticosteroids: potency class 6/7

• low potency

• safer for infants, children, long durations, and skin folds

Corticosteroids: potency class 4/5

• medium potency

• safe for short duration in infants and children

• OK on face, axillae, and genitals of adults

Corticosteroids: potency class 2/3

• high potency

• used with close supervision in children for less than 2 weeks

Corticosteroids: potency class 1

• ultra-high potency

• no occlusion

• max duration 2-4 weeks

• not safe for infants, children, face, axillae, or groin

Topical Steroids: side effects

• acneform lesions

• striae

• pigmentation changes

• folliculitis

• fungal infections, delayed wound healing

• possible perioral dermatitis

higher potency corticosteroids can cause these symptoms to present faster

Hydrocortisone OTC frequency

3-4 times daily

Contact Dermatitis: systemic corticosteroids when to use

when affected area is >20% of BSA

Contact Dermatitis: Prednisone counseling

• 0.5-1 mg/kg daily x10 days

• tapers preferred to reduce derm flares

Contact Dermatitis: exclusions for self treatment

• < 2 yo

• involvement of >20% BSA

• swelling

• genital discomfort

• involvement/irritation of mucous membranes in mouth, nose, eyes, or anus

• signs of infection

• referral after 7 days of self treatment and no improvement

Atopic Dermatitis: causes

• interactions between genetics, environment, skin barrier defects, immune system

• increased IgE levels

Atopic Dermatitis: non-pharm treatment

• avoid ‘triggers’

• hydrate skin to reduce itching

• prevent infections (no scratching)

• restore skin barrier function

• fragrance-free moisturizers

• mild cleansers

• avoid excessive bathing and hot baths

• moisturize after bathing

• use humidifiers

Atopic Dermatitis flare: first line treatment

• emollients

  • topical corticosteroids

  • eucrisa (crisaborole PDE-4 inhibitor)

  • calcineurin inhibitors

Atopic Dermatitis: eucrisa side effects

itching, hypersensitivity reactions

Atopic Dermatitis: calcineurin inhibitor side effects

burning, stinging, immunosuppression

• black box warning: long term use linked to basal cell and squamous cell carcinomas as well as lymphomas

Atopic Derm: alternative treatments (moderate-severe)

JAK inhibitors and interleukin antagonists