Lecture 8: Non-Infectious Dermatology

Layers of the Skin:

EPIDERMIS (top) :

• Contains _________ __________

• regulates _______ content of skin

• controls ______ _______ into lower layers and systemic circulation

DERMIS (middle):

• middle layer

• 40x thicker/thinner than the epidermis

• contains nerve endings, vasculature, and hair follicles

________ (innermost):

• provides nuroushment and cushioning for upper 2 layers

EPIDERMIS:

stratum corneum

water

drug transport

DERMIS:

40x thicker than the epidermis

HYPODERMIS:

Role of skin in drug absorption:

• what are the two functions of the skin?

• What factors play a role in completing these tasks?

functions = protect + retain moisture

factors =

• age

• immunologic status

• underlying disease state

• stratus cornueum condition

• When the skin loses water there is a loss of ________ and increased __________

• Main barrier to absoprtion = _______ _____________

• _________ limit water loss and INCREASE permability of drugs

• Wounds, burns, and other leasions change the _______ of skin

• loss of elasticity and increased permeabiltiy

• main barrier = STRATUM CORNEUM

• Occlusives

• permeability

Approach to dermatologic self care:

Make a decision based on these 4 things and gather which treatments have been tried in the past to prevent treating a rash simply because it looks familar phsyically.

Appearance
Duration
Symptoms
Exposures

Atopic Dermatitis + Xerosis:

• Atopic dermatitis is the most common form of ________

• 80% of individuals affected by atopic dermatitis experience disease onset PRIOR to ____ years old

• usually individuals with family history of ______, ________ or ______ have higher risk (not enough to make diagnosis though!)

eczema

6 years old

excema, asthma, allergies

nonspecific term for many dermatologic disorders characterized by any erythma (redness of skin) and inflammation

dermatitis

designation that encompasses a group of inflammatory skin disorders that are often of unknown etiology

eczema

type of eczema where the skin is chronically scaly,

erythematous, edematous, papular, and crusty

atopic dermatitis

common complaint in many skin disorders

dry skin (xerosis)

Atopic Dermatitis and Xerosis:

Cutaneous manifestation of a systemic disorder that also gives rise to asthma, food allergy, and allergic rhinitis

• all characterized by elevated serum _____ levels and peripheral _______

Inadequate production of _________ leads to a REDUCED ability to maintain HYDRATION and to restrict trasepidermal WATER LOSS

Inadequate skin barrier may lead to infiltration of ________ leading to an inflammatory response

Some identified biomarkers have been identified including _____, T cells, cytokines, and chemokines

Most commonly associated lab features

• elevated total and or allergen specific serum ____ level BUT this may not be present in nearly 20% of affected individuals

• elevevated IgE and peripheral esosinophilia

• filaggrin

• allergens

• igE

• IgE

what are some common Atopic Dermatitis triggers?

1. aeroallergens (MOST COMMON)

2. food allergens

3. phsycological stress

4. airborne irritants

5. cosemtics, fragrances, astringents

6. extreme temperatures

7. excessive hand washing, bathing, or showering

8. tight or irritating clothings

What would you tend to see in the physical assesment of a person with atopic dermatitis / xerosis?

1. atopic pleat (extra fold beneath lower eyelid)

2. cheilitis (dry irritated cracked lips)

3. hyperlinear palms (increased lines or prominence of lines on palms)

4. hyperpigmented eyelids

5. ichthyosis (causes dry scaly skin)

6. keratosis pilaris

7. lichenification

8. papules

9. urticaria

Atopic Dermatitis Diagnosis:

Diagnosis of AD remains clinical because there is currently NO reliable biomarker that can distinguish the disease from other disease states

What are esential features that are REQUIRED for a patient to be diagnosed with Atopic Dermatitis?

Which features could suggest Atopic Dermatitis but doe’t HAVE to be there for diagnosis?

patient MUST have

• pruritis

• eczema

• chronic or relapsing history

• typical morphology and age specifc patterns

patient COULD have

• early age of onset (usually less than 6)

• personal and/or family history

• IgE reactivity

• Xerosis

What are the goals of Atopic Dermatitis?

• maintain healthy skin barrier

• supress immune system

• control itch

• manage infectious triggers

• prevent secondary infections

What are the three general approaches to treamtment of Atopic Dermatitis?

1. nonpharmacological

2. topical pharmacological

3. medical refferal

What are non-pharmacological treatments for Atopic Dermatitis?

• lifestye changes

• avoid irritating fabrics or fragrances

• take LUKEWARM and SHORT baths

• moistorize IMMEDIATELY after bathing

• Use mild non-soap cleansers (hypoallergenic, fragrance free, neutral to LOW pH)

NON-pharmacologic treatment for Atopic Dermatitis = MOISTURIZER

________ such as glycol and glyceryl stearate, soy sterols) lubricate and soften the skin

______ agents (petrolatum, dimethicone, mineral oil) form a layer to retard evaporation of water

__________ (glycerol, lactic acid, urea) attract and hold water

emollients = lubricate and soften

Occlusives = layer to trap (prevent evaporation) of water

Humectants = attract and hold water

What is the PHARMACOLOGICAL treatment of atopic dermatitis for when nonpharmacological moisturizers don’t work?

topical HYDROCORTISONE

Pharmacological Tx of Atopic Dermatitis = Hydrocortisone

• high/low potency corticosteroid

• can it be found OTC?

• safe when used as directed for a ____ period of time

• What age can you start using hydrocortisone?

• Does it have high or low systemic absorption?

• Cream is the most tolerable but _______ are preffered for THICK skin or for dry, lichenified, or scaly lesions

• How often do you apply it?

• How long after you dont see results should you go see a doctor?

• low potency

• yes found otc

• 2+

• low absorption

• OITMENT for thick lichenified

Apply twice daily for 2-4 weeks

See doctor if no improvement after 2-3 DAYS

_______ are maintenance/ barrier therapy for ATOPIC DERMATITIS while _________ treats inflammaiton and flare

moisturizer = maintenance

hydrocortisone = treat inflammation

Who should NOT be treating their atopic dermatitis on their own?

• moderate-severe conditon with INTENSE PRURITIS

• involvement of LARGE AREA of body

• less than 1 years old

• infected skin

• involveement of FACE or interiginous (rub against each other) areas

Cousneling Points for Atopic Dermatitis:

1. encourage ____ ______ measures

2. educate on _______ avoidance and skin _____

3. apply _______ after bathing

4. apply HYDROCORTISONE ______ times dailty to releive itching

5. Contact health care providor if it worsens or doesnt improve in __ - __ days

1. non-pharmacologics

2. trigger avoidance and skin hydration

3. emollients (lubricant and softens) after bath

4. hydrocortisone 1-2 times daily

5. 2-3 days no progress = see doctor

Xerosis Background:

• result of decreased _____-_____ capacity of the skin

• enviornmental factors such as extreme _______ and frequent ______ can aggravate

• what age group is most impacted?

• prevention and appropriate skin care is major focus!

• Decreased water-holding capacity

• extreme temperatures + frequent showering

• older population

What are the non-pharmacological therapies for Dry Skin (xerosis)?

1. CLEANSE w/ gentle, soap-free cleanser + lukewarm water (fragrance-free)

2. MOISTURIZE immediately after bathing + reapply throughout the day

3. AVOID/LIMIT: hot water, harsh fragranced soaps, bath oils as SOLE therapy

What are some non-prescription products that are available for Xerosis (dry skin)?

1. cleansers (gentle non-soap or glycerin soaps w/ higher oil content)

2. Bath oils (minimally effective due to DILUTION in bath water)

3. moisturizers

What are the common ingredients for moisturizers?

1. humectants (Draw water into the stratum corneum)

2. emollients (fill spaces in between skin cells and soften the skin)

3. occlusives

Draw water into the stratum corneum

Helps with rough or scaly skin; consult if skin is actively inflamed or cracked, or else it will BURN!

• glycerin

• urea

• lactic acid

• ammonium lactate

humectants

Fill spaces in between skin cells and soften the skin

ex.

• shea butter

• cocoa butter

• fatty acids/lipids

emolients

Reduce transepidermal water loss

• petrolatum

• mineral oil

• dimethicone

occlusives

yellow exudates despite already using hydrocortisone could mean it is due to an infection so refer the patient to a dermatologist

ask if he can potentially shower less frequently with luke-warm water instead of hot and moisturize RIGHT after

Scaly Dermatosis:

• invovles the _________

• general goal of self-treatment is to reduce _____ rate of skin cells which causes scaly lesions

• controlling ________ and reducing _____ is key

epidermis

REDUCE turnover rate of skin cells

control inflammation and reduce itching

What are examples of scaly dermatosis?

1. dandruff

2. seborrheic dermatitis

3. psoriasis

Dandruff:

• ________ of epidermis and abnormal _________ resulting in mild inflammation, flaking, and pruririts which typically involves the precesnce of ________ _______

• clinical presentation = scalp scaling nad sloughing of small white/grey loosley bound flakes

• what are the treatment goals =

  • reduce epidermal turnover by reducing _______ fungi

  • minimize cosmetic embarrassment of visible scaling

  • minimize itch

hyperproliferation of epidermis and abnormal kertiinazation

malassezia yeast

malassezia

What is the dandruff treament approach?

1. non-medical dandruff shampoo —>

2. cytostatic agents —>

3. ketoconazole shampoo —>

4. coal-tar shampoo

how do you use non-medicated dandruff shampoo?

shampoo daily or every other day for sufficient mild-mod cases

What are the two cytostatic agents?

How do you use cytostatic dandruff agents?

pyrithione zinc + selenium sulfide

Massage into scalp and leave on for 3-5 minutes and repeat rinsing

Use DAILY for 1 whole week, then 2-3 x weekly for 2-3 weeks, then once weekly

what is second line for dandruff treatmnet due to its tolerability issues?

coal-tar shampoo

Sebhorrheic Dermatitis:

• CHRONIC ______ disorder that occurs predominantly in the areas of greatest _______ _____ activity (scalp, face, chest)

• commonly manifests as red, scaly, itchy rash affecting infants and young adults OR adults?

• more commonly men or women?

• most severe during the _____ and in low ____- humidity enviornements

• inflammatory sebaceous gland

• more common in infants and children

• most common in men

• winter and in low-humidity environments

Suborrheic Dermatitis:

• involves _____ species and accelerated epidermal _______

• areas w/ dense distribution of _____ glands are predominantly affected and exhibit MORE/less inflamation compared to dandruff

Clinical Presentation:

• can involve the scalp, eyebrows, glabella, eyelid margins, cheeks, paranasal areas, nasolabial folds, beard area, pre-sternal area, central back, and retro-auricular creases

• demarcated, dull, ______, oily, scaly, ______ skin

• infantile form - ______ _____ w/ scalp concentration

• darker-skinned individuals may have ______pigmentation and lack the yellow scales

malassezia

proliferation

yellowish, reddened

infantile = CRADLE’S CAP

darker skinned = HYPOpigmentation

What is the Sebhorrheic Dermatitis Treatment:

• FIRST LINE = _______ __%

• what are some alternative OTC options?

• If thick/ adherant scale is present

• If inadequate response?

• first line = ketokonazle 1% (leave on for 3-5 minutes then rinse —> use every 3-4 days for 8 weeks THEN use as needed

What are some alternative OTC alternatives for sebhorrheic dermatitis after ketonazole 1%?

1. Prythione Zinc 1-2%

2. Selenium Sulfide 1%

adequate contact time before rinsing

what can you try if you are using ketoconaozole or pyrithione zinc or selenium sulfide and there is a THICK/adherent scale present ?

mineral oil can help loosen scale before shampooing

Keratolytic shampoos such as salicylic acid help remove scales

What would you do if you are getting inadequate responses from sebhorrheic dermatitis treatment?

confirm if the patient is using the product correctly

consider switching to new active ingredient

refer when symptom fail or wworsen after 2 WEEKS OF OTC treatment

Dandruff vs Sebhorrheic Dermitits:

• which has more inflammation?

• which is yellowishm oiley/greasy scale on erythematous skin

• which is common on the eyebrows, nasolabial folds, beard, ears, chest ?

• Which has malassezai fungal involvement

• how are the symptoms different?

• How intense are the treatments?

• What are OTC options for each?

• subhoreic = more inflammation

• subbhoreic

• subhorreic

• BOTH have malassezai

• flaking ± pruritis = dandruff wheras scaling erythema + pruritis (HAS PRURITIS) = suborrheoc

• intentivity = both antidandrugg shampoos but subhoreic may need more aggressive tx

OTC for both = SAME

• ketokonazole

• pyrithione zinc

• selenium sulfide

Psoriasis (systemic disease):

CHRONIC ________ disease

_______ often localized but they become generalized over much of the body surface

Although the cause of psoriasis is UNKNOWN exacerbations can be caused by …

inflammatory

lesions

exacerbated by

• environmental factors: physical, UV, chemical injury

• infectious

• prescription use (antimalarials, b blockers, interferons, lithium, nonsteroidal antiinflammatory drugs)

• withdrawl of systemic corticosteroids

• emotional and psychological stress

• alcohol + tabacco use

Psoriasis:

• immunologic mechanisms such as ____-cell induction, ________ production, and _______ and _____ proliferation

• genetic predispositions

• ______ cell turnover is about 88x SHORTER in psoriatic patients (not enough time)

• t cell, cytokine, epidermal and keratinocyte proliferation

• epidermal

The following is describing which clinical presentation?

⚬ Symmetrical

⚬ About 90% of patients present with a plaque

⚬ Well demarcated and covered with a silvery-white scales

⚬ Painful and itchy

⚬ Common sites: extensor surface of elbows/knees, lumbar region of the back,

scalp, trunk, genital area

⚬ Auspitz Sign: when scale is lifted and pinpoint bleeding occurs

psoriasis

How do you treat MILD cases of psoriasis?

hydrocortisone to remove loose scale

MOST will require medical reffereal (especially if joints are involved incase rhematoid arthritis)

What are some counseling points for Psoriasis?

1. bathe with lubricating products

2. Apply EMOLLIENTS to lesions within minutes of bathing

3. gently remove scales w soft cloth

4. avoid physical, chemical, UV trauma to skin

5. avoid precipitating factor such as stress, skin irritation, physical trauma

What are the three sytostatic agents that can be used after ketoconazole?

1. pyrithione zinc - anti malasszeria

2. selenium sulfide -anti malasszeria + rinse from hair throroughly to prevent HAIR DISCOLORATION

3. coal tar - cross link w/ DNA and arrest EXCESIVE cell proliferation

   1. can treat dandruff, seborrheic dermatitis, and psoriasis

   2. tolerability issues and significant adverse events

What are some exclusions to self care in terms of scaly dermatoses?

• less than ____ years old

• worstening symptoms w/ no improbvement after ___ ______ of OTC meds

Psoriasis specifically:

• involvement more than ___% of body surface area

• ivolvement of FACE

• presence of ____ pain

• More than a few ______ which are larger than a quarter

2 years old

2 weeks

5%

joint

lesions

dandruff shampoo once daily for a week —> then 2-3 times a week for 2-3 weeks —> then once daily (ingredients = zinc and selenium sulfide

Contact Dermatitis:

characterized by inflammation, redness, and often vesicles and pustule formation with

symptoms of pruritus, burning, and stinging, that develops after contact with an inciting

exogenous substance

______ contact dermitis is caused by an irritating substance

_______ contact dermitisis is caused by immunologic skin reacts from an antigen formed in response to contact with an allergic substance

MAJOR cause of workplace disability

irritant

allergicc

Irritant contact dermatitis occurs in people with frequent _____ _______, ____ handling or in comntact with irritaing substances like _____ _________ and health proffesionals who use _____ ______

frequent hand washing

handling food

hair stylists

purple wipes

What is the pathophsyiology of irritant contact dermatitis and how do patients present?

• irritation and _______ of _____ _______

• stimulation of _______ ______

• release of proliferative _________

clinical presenation:

• skin that is inflamed

• delayed onset

• dry or ______, painful _______skin

• CHRONICALLY it can cause _______ and skin ________

• history of REPEATED exposure = clue

disruption of skin barrier

stimulated epidermal cells

released proinflammatory cytokines

macerated, cracked

lichenification + skin discoloration

What are some common irritants in terms of IRRITANT CONTACT DERMATITIS?

DONT NEED TO MEMROIZE !

Acids, strong (e.g., hydrochloric, nitric, sulfuric, hydrofluoric)

• Alkalis, strong (e.g., sodium, potassium, calcium hydroxides)

• Detergents, soaps, and shampoos (e.g., sodium lauryl sulfate)

• Disinfectants and antiseptics (e.g., hand sanitizers, benzalkonium

chloride)

• Fiberglass

• Foods – garlic, onion, pineapple, citrus fruits, corn, carrots

• Industrial chemicals – resins, solvents, reducing agents, oxidizing agents

• Oils (e.g., cutting, lubricating)

• Radiation

• Sunscreen

How do you treat irritant contact dermitis?

1. Remove the irritant (wash w/ lukewarm water and hypoallergenic cleanser)

2. ,Soothe and relieve the acute irritation

   1. Burrows solution (alluminum acetate 5%)

   2. cooling/astrigent effects

   3. removes residual irritants

3. repair (restore the skin barrier)

   1. apply emollients liberally (soften and lubricate skin by filling gaps)

   2. use barrier creams

   3. restore moisture to statum corneum (especially helpful when future exposure cant be avoided helps form barrier between irritant

REMOVE —> RELIEVE —> RESTORE SKIN BARRIER

what should you do to prevent Irritant Contact Dermitis?

Can repeated irritant exposure lead to chronic dermatitis?

1. protect w/ gloves

2. change protection often

3. use barrier creams to protect + maintain skin barrier

YES

What NOT to use for contact dermatits!

should you target pathophysiologic process of ICD?

1. topical corticosteroids (DONT target pathophysiologic process of ICD)

2. caine type anesthetics (lidocaine + benzocaine)

3. therapeutic products (salicyclic acid + lactic acid- exfoliating agents)

SHOULD BE AVOIDED BECAUSE OF THEIR ABILITY TO FURTHER CAUDE IRRITATION AND POTENTIAL ALLERGIC CONTACT DERMITITS

Who should NOT get treated for Irritant Contact Dermitis?

• less than __ years old

• involvement of which body parts?

• dermatitis involving ____ % of BSA

• no improvement after ____ ____of self-treatment

2 years old

eyes, mouth, face, neck, genitals

1 week

Allergic Contact Dermitis (ACD):

• _______ chemicals have been classified as substances causing ACD

• What are the most common causes of ACD in the US?

• _____ allergy is common for healthcare workers and those who wear them often

3000

poison ivy, oak, sumac

latex

Allergic Contact Dermatitis Pathophysiology:

• ________ hypersensitivity reaction resulting from exposure to a foreign substance that

acts as an allergen

• Sensitized___ _________ are activated and migrate to the site of contact to release

inflammatory mediators

• Does the rash ordinarily appear on first contact OR AFTER the exposed person has been previously sensitized to the allergen?

• In persons previously sensitized, the rash and related symptoms typically appear ___– ___

hours after exposure

DELAYED

t cells activated

NOT on first contact but after person has already been exposed to it before

after SECOND encounter it usually appears 24-48 hours after expsosure

HOW TO TREAT ALLERGIC CONTACT DERMITIS:

1. remove allergen

2. control inflammation (hydrocortisone 0.5-1% cream if mild localized) + astringent (shrink or contract body tissues by precipitating their surface) compress + lukewarm baths

3. relieve symptoms (w/ calamine lotion + colloidal oatmeal bath)

Urashiol Induced Allergic Contact Dermititis:

• ___% of the US population is estimated to be sensitive to urushiol

• Urushiol is the ___ or ____ which contains the allergen

• _______ plants indigenous to north america

  • Poison _______ (toxicodendron RADICANS , toxicodendrom RYDBERGII)

  • Posion ________ Eastern (toxicodentrol TOXICARUM) or Western (toxicodendron DIVERSILOBUM)

  • Poison _______ (toxicodentron VERNIX)

80%

sap or resun

TOXICODENDRON

• posion ivy = radicans or rydbergii

• poison oak eastern (toxicarium) western (diversilobum)

• sumac = vernix

URISHIOL INDUCED ACD:

• can posiion ivy spread from person to person?

• Does the blioster fluid spread the rash?

• What needs to be washed after exposure?

• why does the rash seem to spread over several days?

• NO contact w/ oil not person with poisoning

• blister fluid does NOT contain urshiol does not spread through rash

• anything oil may have touched (skin, clothing, shoes, tools, pets)

• different areas devellop symptoms at different times depending on exposure, skin thickness, and sensitivity

How soon should you wash off poison ivy and what can you use to wash off the oil?

• can wash up immediately to 30 MINUTES

• soap and water is ENOUGH dont need zanfel or tecnu

Pharmacologicacl Treatment of Urushiol:

topical steroids —> decrease inflammation (most useful if used early)

oral antihistamines (symptom relief- itching) —→ may help relieve sleep if nightime itching (BUT doesnt solve underlying issue)

IF SEVERRE (more than 10% of BSA or eyes/face involved) —> REFER

wear gloves

keep nails short

avoid harsh soaps

gentle cleanser —> APPLY thick moistorizers after each wash

Diaper Dermatitis + Prickly Heat:

• ______ inflammation of skin in the perineum, buttocks, lower abdomen, inner thighs

• Can occur to ANYONE using diaper for _________

• Is it caused by irritatnt contact dermitiis or allergic contact dermitis?

• Majority of children experience at least ONE before theyre out of diapers

ACUTE inflammation

incontinence

can be used for BOTH allergic and irritant

Diaper Dermatitis Pathophysiology:

• increased/decreased moisture of the stratum corneum (weakens skin barreir —> brone to irritation)

• _____ and _____ contribute to skin breakdown bc/ _____ contains urea which has bacteria that converts urea to_______ and raised/lowered____ comprises skin barrier (activates more enzymes that irritate)

• INCREASED moisture from urine/fecal natter trapped by diaper

• feces and urine bc/ urine has urea which has bacteria to convert urea —> amomonia (RAISED pH compromises skin barrier)

Diaper Dermatitis Clinical Presentation:

• Red to bright red (erythematous), sometimes ________, wet looking patches and lesions

on the skin

• Full-blown rash can appear in a matter of ______ yet can often take days to

completely resolve

• Can progress to ______, papule formation, presence of vesicles or bullae, oozing

erosion or skin, ulceration (rare)

• __________ infections (bacterial, viral, fungal)

• Manifestation of deeper underlying condition (________ syndrome, CMV, ________

deficiencies) or primary infection

• shiny

• hours

• maceration

• secondary

• kawasaki nutritional deficiencies

Iritant Diaper Dermatitis vs Candida Diaper Dermatitis:

• which is caused by over exposure to urine, stool, moisture, and friction?

• which has BEEFY red erytematous plaques

• which SPARES skin folds?

• Where is each spread?

• What is the treatment for each?

• irritant

• candida

• irritant (involved in candida)

• irritant = convex surfaces in contact w/ diaper / candida= diaper area INCLUDING folds

• tx for irritant = barrier protection + frequent diaper change tx for candida= topical antifungal +barrier protection + REFER

What is the ABCDEs of NONpharmacological treatement of diaper contact dermatitis?

A= air (let skin dry frequently + diaper free time to decrease moisture)

B = barirer (use barrier skin protectant libereally w/ EACH change)

C = cleansing (w/ soft cloth or wipe)

D = change diaper every 2 hours and as SOON as it is soiled + use absorbent diapers

E= education

What are examples of pharmacologic treatments for diaper dermatitis - skin protectants?

1. zinc oxide (destin / butt paste)

2. zinc oxide + petrotalum based formulaiton (triple paste)

3. petrolatum

WHEN shoud you apply skin protectants for diaper contact dermatits? (zinc oxide/ petrolam)

HOW should you apply skin protectants for diaper contact dermatitis?

WHY should you apply it when and how you do?

when = EVERY diaper change (ESPECIALLY before bed or prolonged exposure to wetness)

how = THICK layrer - DONT rub COMPLETELY into the skin

why = BLOCKS moisture + blocks irritants + reduces friction

What CANT you use while using zinc oxide for diaper contact dermatitis?

1. topical antibiotics + antibiotics

2. topical anesthetics

3. hydrocortisone

often they contain more irritating agents

WHO CANNOT be SELF treated for contanct diaper dermititis?

• lesions persist for _____ days or more even w/ care

• therapy complicated by secondary ________

• prescence of diaper dermaittis ________ of diaper area

• presence of ______ skin

• Oozing, _____, vesicles, or pus at site

• singicant behavtioral changes in patient

• 7 days

• infection

• OUTSIDE

• broken

• blood

Prickly Heat:

What is it?

• Temporary blockage of _______ _______

• Traps ______ beneath the skin

• Causes localized __________

What does it look like?

• Fine, ____________ red papules

• Often clustered

• Itching, stinging, “prickly” sensation

• Occurs in areas prone to _____________

Who gets it?

• Most common in _______

• Triggered by _____ + _______ + ______

• Usually self-limited (main goal to remove cause of sweat)

• sweat ducts

• sweat

• inflammation

• pinpointed

• sweating/occlusion

• infants (lack of development of sweat ducts)

• heat, humidity, and sweating

What are the treatment goals for prickly heat?

1. eliminate occlusion of skin

2. protect skin from further irritation

3. promote healing of skin

4. prevent secondary infection

What are the non-pharmacologic treatment for prickly heat?

decreasing sweating

wearing loose, light colored, lightweight clothing

DO NOT APPLY OCCLUSIVES (prevent MORE sweat from comming out)

What are pharmacological approaches for prickly heat?

1. emollients

2. antipruritics

3. skin protectants