Dermatitis, Dermatoses, and Prickly Heat

Lotions

contain the most water

perfect for individuals who live in warm climates or have oily skin

Creams

Less water than lotions

works for smoothing dry elbows, feet, and moisturizing dry itchy winter skin

Ointment

seal in moisture to heal areas that are dry, chapped, or cracked

keep moisture on minor wounds under a bandage

Atopic Dermatitis risk factors

• allergic rhinitis/ asthma history

• family history of dry skin/eczema

• environmental irritants

• allergens (soaps, perfumes)

• pollution

• stress

• weather changes

Atopic dermatitis symptoms

• Pruritus (itching)

• Erythema (redness)

• Xerosis (dry)

• Erosions

• crusting or scaling

• oozing

• edema (swelling)

Refer Atopic Dermititis

• open heavily oozing skin lesions

• signs of infection (overt redness, heat, pus, colored discharge)

Non-Pharm treatment for atopic dermitits

Shower once daily (soak and smear technique)

• avoid irritants

Moisturizers: aquaphor, eucerin

• creates a protective barrier on the skin that is an ideal healing environment, while allowing flow of excess fluids and oxygen

Wet-wrap therapy: apply moisturizer and wrap skin

Pharm treatment for atopic dermatitis

topical corticosteroids:

• after failure of wet wrap therapy

• Hydrocortisone (0.5% or 1%)

• safe for 2 years or older

Beneficial to use moisturizer 30 minutes before applying topical corticosteroids to act as a occlusive dressing

Allergic Contact Dermatitis is caused by what

• poison ivy, oak, sumac, urushiol

• metal allergy (nickle)

• latex

Symptoms of allergic contact dermatitis

• doesn’t appear at first contact

• rash that has papules, small vesicles, larger bullae

• inflamed and swollen skin

• prominent itching

When to refer allergic contact dermatitis

• <2 years old

• failure of self care for 7 days

• involvement of >20% bsa

• extensive swelling of body (eye)

• involvement of genitalia or mucous membrane

Allergic contact dermatitis treatment

Astringents:

• cool and dry skin

• vasoconstriction

• safe for 2 years or older

Ex) aluminum acetate, witch hazel

Topical corticosteroids:

• use no longer than 7 days

Ex) hydrocortisone cream

Anti-itch:

• Cetirizine (Zyrtec): 1 year or older

• Diphenhydramine (benadryl): 6 years and up

Ex) calamine lotion, colloidal oatmeal baths, topical antihistamines

Zanfel:

works in 30 seconds (best effect if used in first hour of contact)

• safe for pregnancy and nursing patients

How to prevent allergic contact dermatitis

clothing:

• wear long sleeves and pants

Hygiene:

• wash exposed area

• keep nails trimmed and avoid itching

Bentoquatam (Ivy block):

• protects against exposure

Irritant contact dermatitis symptoms

• inflammation

• swelling

• minor redness

• itching

• stinging

• burning

Irritant contact dermatitis causes

• chemical exposure

• cleaning substances

• water exposure

Irritant contact dermatitis

• severe lesions

• purulent or colored discharge

Treatment for Irritant contact dermatitis

Colloidal oatmeal baths

Moisturizers:

• assist in repairing the skin

Ex) aquaphor or eucerin

Do not use topical corticosteroids or topical anesthetics

Diaper dermatitis causes

• tight fitting diapers

• moisture

• microbes

• mechanical chafing

• high sugar foods or dairy

Diaper dermatitis symptoms

• bright red rashes

• shiny

• wet looking lesions

Referral for diaper dermatitis

• lesions for more than 7 days

• signs of infection

• rash outside of diaper area

• significant behavior changes

Diaper dermatitis treatment

Skin protectants:

• serves as a physical barrier between skin and irritants

• can absorb or prevent moisture

Ex) zinc oxide, mineral oil, petrolatum, lanolin, dimethicone

Dandruff symptoms

white flaky skin coming from scalp

• scaling and sloughing of large white flakes

• pruritus

• on head

• little to no redness or inflammation

Referral for dandruff

• open skin lesions

• pain in the scalp

Dandruff pharm treatment

1st line:

• medicated shampoo with a cytostatic agent

  • Ex) pyrithione zinc, selenium sulfide

2nd line:

• 12 years and older

Ex) ketoconazole, coal tar, salicylic acid, sulfur

Seborrheic Dermatitis symptoms

• pale yellow

• oily

• scaly

• red surrounding skin

• pruritus is common (itching)

Seborrheic dermatitis

• elevated levels of malassezia

• children (cradle cap)

• immunocompromised status

Seborrheic dermatitis referral

• open skin lesions

• pain in the affected area

• purulent discharge from affected area

Seborrheic Dermatitis Treatment

Infants (cradle cap):

• baby oil

• if no response refer

Cytostatic agent:

• pyrithione zinc

• selenium sulfide

• ketoconazole

• coal tar

• salicylic acid

• sulfur

Topical corticosteroids:

• used for redness no more than 7 days

  • 2 years an up

  • Ex) hydrocortisone cream

Psoriasis symptoms

raised plaques on the skin

• lesions start as small papules then unite to form plaques

• well circumscribed

• sharply demarcated

• pink/red/white scales

• locations: elbows, knees, scalp, lower back

Referral for psoriasis

• only mild cases should be treated with otcs

• > 5% of BSA

• involvement of face

• joint pain

• children < 2

Pharm treatment for psoriasis

topical corticosteroids

• use corticosteroids then 30 minutes later apply moisturizer

Prickly heat symptoms

• raised, red, pinpoint lesions

• Locations: axillae, chest, back of neck, abdomen, inguinal area

Referral for prickly heat

• signs of infection

• persistent rash

• sever pain or lesions

• lasts longer than 10 days

Prickly heat pharm treatment

hydrocortisone cream, moisturizing lotions, colloidal oatmeal baths