Self Care Exam 3

Genetic Predisposition to asthma + allergy + AD (exaggerated skin and mucosal reactivity in response to environmental stimuli)

Describe the Atopy Triad (Presentation of Atopic Dermatitis)

Chronic

Atopic dermatitis can be describes as ____________ (acute/chronic)

True

(True/False) Atopic dermatitis is a condition in which relapsing inflammation of face, inside of knees, elbows, collar of neck

Atopic Dermatitis

Dx Criteria of _________________ is described as:

Itchy skin + >/= 3 of the following

- Onset <2yrs of age

- Hx of skin fold involvement

- Hx of generally dry skin

- Hx of atopic disease in 1st degree relative <4yrs

- Visible flexural dermatitis or on cheeks/forehead or outer limbs in <4ys

False

(True/False) Atopic Dermatitis is a curable disease

Hydrocortisone

What OTC can provide relief from itching and inflammation of atopic dermatitis

zinc & titanium

What two ingredients in sunscreen should be avoided in those with atopic dermatitis?

True

(True/False) Bathing is OK but only for 3-5 min and application of moisturizer within 3 min after

7

Hydrocortisone cream in the treatment of atopic dermatitis should be used for no more than ____ days

Cream

(Cream/Ointment) Seeking something with moderate moisturizing and that absorbs well into the skin

Ointment

(Cream/Ointment) Greasy + Occlusive, good choice for severely dry skin

True

(True/False) Oral probiotics have shown some evidence at decreasing the severity of atopic dermatitis

2

Pharmacists should refer anyone, for atopic dermatitis, under the age of _____

Refer

(Treat/Refer) Patient presents with atopic dermatitis presenting only in skin folds.

Dry skin

What is the most common cause of pruritus especially in the winter months

emollients

Non-pharm treatment of dry skin involves proper use of ______________ and modification of bathing practices

True

(True/False) Dry skin can be treated by drinking at least 8oz glasses of water daily

Urea, lactic acid or hyaluronic acid

What three pharmacologic ingredients may be proven helpful in severe cases of dry skin?

Ammonium lactate 12%

Moisturizer containing _____________________ help skin that is cracked or fissured

keratin

Alpha-hydroxyl acids help restore normal ___________ layer

Hydrocortisone ointment

May apply __________ ______________ to decrease inflammation and itching for dry skin

colloidal oatmeal

Some bath oils are combined with _________ ____________ to reduce itching

False

(True/False) Bath oils are highly effective for helping with dry skin

glycerin

This type of soap cleanser has a higher oil content and is thought to be less drying

Cetaphil or pHisoDerm

What two bath cleansers are mild and available if patient has been told to avoid soaps (minimize lipid layer loss)

Emollients

This bath product is an occlusive agents that leave an oily film on the skin trapping in moisture. Petrolatum containing ointments

Moisturizers

This bath product is available as lotions, creams, ointments, butters.

Either oil-in-water or water-in-oil emulsions

humectants

This bath product may include glycerin, propylene glycol, phospholipids

Draw water into top layers of skin

Urea

This is a mild keratolytic and increases water uptake (used in the treatment of dry skin)

Urea

Patient has dry crusted, necrotic tissue, what OTC product would you recommend?

Alpha-hydroxy acids

The lactic acid included increases hydration with this product

Hydrocortisone

this is the only steroid available OTC

IND: temporary relief of itching and inflammation

3-4x/d application/intermittent courses

Pramoxine, lidocaine and benzocaine

Name the 3 anesthetic options to help reduce the itching of dry skin

Oral

(Topical/Oral) Diphenhydramine may be considered if dry skin is severe

gels

If recommending ______ or lotions for dermatitis in hair-bearing areas, keep in mind that gels can be very drying if used for prolonged periods

Lotions then creams

What should you try for moderate dryness

Ointments

What should you use if extremely dry or cracked skin? (Avoid in skin folds due to potential maceration)

3-5 minutes

In the treatment of dandruff, how long should medicated shampoos be left in contact with skin prior to rinsing?

2-3 times per week for 2-3 weeks, then once weekly or every other week

What is the frequency of medicated shampoos for the treatment of dandruff?

Seborrheic dermatitis

Presentation: inflammation generally occurring in scalp, face and trunk areas

- red, scaly, itchy rash

- more severe in winter and emotional stress influenced

dandruff

chronic inflammatory condition, excessive scaling of scalp, itching is common

Psoriasis

Presentation: chronic inflammatory disease

- psychologic stress, UV exposure common triggers

- Elbows, knees, lumbar back, scalp, etc.

Treat

(Treat/Refer) Psoriases has mild presentation

nonresidue shampoo (J&J Baby shampoo)

What is the first line treatment for scaly dermatoses

Pyrithione Zinc

This anti-fungal agent may be used in the treatment of scaly dermatoses

- reduces yeast count in the scalp and skin

Ex: DHS Zinc, Head & Shoulders Dandruff Shampoo

Selenium Sulfide

this anti-fungal agents may be used in the treatment of scaly dermatosis...

- more effective with longer contact time

- may discolor blond, gray or dyed hair

Ex: Selsun Blue Shampoo, Head & Shoulders Intensive Treatment shampoo

Ketoconazole

this anti-fungal agents may be used in the treatment of scaly dermatosis...

- used to treat dandruff or Seborrheic dermatitis of the scalp

Shampoo twice per week x4 weeks, at least 3 days b/w treatments (apply once weekly to maintain control)

What is the treatment dosing of Ketoconazole

Cytostatic agents

These agents slow epidermal cell replication

Coal Tar

This Cytostatic agent cross links DNA and slows excessive skin cell growth

True

(True/False) Coal tar causes increased sensitivity to the sun

Keratolytic agents

These agents help loosen and lift keratin layers but are very slow acting (weeks to see improvement)

Salicylic Acid

This keratolytic agent... decreases skin pH and helps moisturize keratin layer

Ex: X-Seb shampoo, Sebulex shampoo, Sebulare lotion

Sulfur

This keratolytic agent... increases skin sloughing

Ex: Sulray, Sulfoam shampoo

Topical hydrocortisone

What can you choose for Seborrheic dermatitis with inflammation unresponsive to medicated shampoos

Irritant

____________ (Irritant/allergic Contact Dermatitis):

Diaper rash, jobs involving work around water or irritating chemicals

*usually dry or macerated, painful, cracked, inflamed skin

allergic Contact

____________ (Irritant/allergic Contact Dermatitis):

Most common is poison ivy/oak/sumac followed by metal allergies, then latex

*usually papules, blisters, inflamed and swollen skin, and EXTREME itching

mild or hypoallergenic soap

What is general treatment for irritant contact dermatitis

False

(True/False) Topical corticosteroids are OPTIMAL treatment for irritant contact dermatitis

EmollientS

This pharmacologic treatment for contact dermatitis can provide moisture to top layer of skin and serve as a protectant from irritants

Urushiol

Allergic contact dermatitis is typically caused by this plant based oil/resin

(found in poison ivy, poison oak, poison sumac, other plants)

urushiol

this type of induced dermatitis has blisters form later and affected area begins to crust over as it heals, unwashed hands, clothing, etc may transfer the antigen and new areas show up

False

(True/False) The liquid from blisters (in allergic contact dermatitis) contains the antigen and thus may cause the inflammation to spread

Mild

(Mild/Severe) Poison Ivy/Oak/Sumac Dermatitis:

Linear streaks, swollen eyelids common as many rub their eyes

Severe

(Mild/Severe) Poison Ivy/Oak/Sumac Dermatitis:

Extensive body involvement, edema of face and limbs, eyes may swell shut

IvyBlock

What is the only FDA approved barrier application for the prevention (PRE-EXPOSURE) of allergic contact dermatitis

Anesthetics, antihistamines or antibiotics

What three component is of ointments and creams should be avoided in the treatment of itching in contact dermatitis (especially NEOMYCIN)

True

(True/False) Oral antihistamines are OK to use for itching in allergic contact dermatitis

Prednisone

What the most common Rx prescribed for itching/allergic contact dermatitis

Astringents

If allergic contact dermatitis is weeping, what can be considered (ex: aluminum acetate - Burow's solution - witch hazel or calamine)

Hydrocortisone

This is the most effective OTC for inflammation in Allergic contact dermatitis

2 weeks

If allergic contact dermatitis is present for over ____ ________ =REFER patient

Gels

This product has easy application and rapid absorption however, some contain alcohol which may sting/burn (not a great option for open wounds)

Creams

This product is best for open weeping lesions and tend to be more drying

ointments

This product holds moisture within the skin and is effective on dry/cracked skin

False

(True/False) Ointments are able to be applied to open lesions and don't trap bacteria

sprays

this is the easiest form for application and allow for even distribution without touching the affected area

Tecnu and Zanfel

List the two OTC products that can be used for Post Exposure of Urishiol Induced allergic dermatitis.

Colloidal Oatmeal, Ivy Dry Cream (Camphor, menthol, zinc acetate), IvyBlock Lotion (Benzyl Alcohol, SDA Alcohol, Bentoquatam)

List common ingredients for poision ivy treatment

Pyrithione Zinc, Selenium Sulfide, Ketoconazole

List the 3 products for the treatment of scaly dermatoses that specifically have anti-fungal properties

Permethrin

Which Lice treatment does NOT require re-treatment unless active lice is found 7-10 days after initial treatment

Synergized pyrethrins

Which lice treatment REQUIRES re-treatment

Wet

Permethrin, in the treatment of lice, requires application to _______ (dry/wet) hair

Dry

Synergized Pyrethrins, in the treatment of lice, requires application to _______ (dry/wet) hair

Benzoyl peroxide

What is the primary pharmacologic treatment of acne?

False

(True/False) In the treatment of acne, one should start at the highest dose of Benzoyl peroxide for maximum effect

45

Sunscreen has the rule of ______

DEET

What is the primary insect repelent discussed

False

(True/False) Increased concentration of DEET works better overall and has longer duration

Refer

(Refer/Treat) Patient presents with a spider bite

True

(True/False) No wart products are 100% effective

apply and remove q 48 hours (2 days)

What is the SIG for Plaster Pads (wart treatment)?

Max 2x/d, allow to harden

What is the SIG and 1 key counseling point for Collodion (wart treatment)?

apply at HS (8hours) remove in AM

What is SIG for Karaya Gum-Glycol (wart treatment)?

Corns

(Corns/Calluses) Sharply defined margins + central core

Calluses

(Corns/Calluses) Broad base + uneven borders

Salicylic Acid

What is the primary pharmacologic treatment for corns/calluses

True

(True/False) If patient has DM or has poor blood circulation they should NOT be treated with salicylic acid for corns/calluses