Atopic Dermatitis and dry skin

What are the anatomical layers of the skin

Epidermis: outmost layer

Dermis: middle layer

Hypodermis: base layer

What is stratum corneum?

it’s the outermost layer of the epidermis, acting as the brick and mortar (barrier).

Topical drug absorption

Can cross the stratum corneum via passive diffusion

*compromised or inflamed skin allows greater drug penetration and higher risk of systemic absorption; use caution potent agent over large area.

What does leaky skin mean?

Lose water, = lead to lost of water

Atopic Dermatitis (AD)/ Eczema key pathyophysiology

A common, chronic relapsing remaining inflammatory skin disorder affecting 10% to 30 % children and 2%=-10% of adults.

AD and Eczema is atopic Triad, waht does that mean?

Often linked to personal or family history of AD, asthma, and allergic rhinitis.

What drives the inflammation and skin damage for atopic Dermatitis and eczema

The itch scratch cycle

What are the factors that involved in Atopic dermatitis?

Environmental factors—> Immunologic factors—> genetic factors

Stages of AD

Acute: oozing ± crusting

Subacute; typically ticker, paler, scaly

Chronic: demarcated area of dry, thickened scaly patches

What is the treatment goal?

to stop the itchy scratch cycle, maintain hydration/barrier function, avoid/minimize triggers and prevent secondary infections. No cure, the focus is controlling flares and preventing relapses.

What are the exclusion to selfcare (when to refer to the doctor)?

Moderate to severe conditon with itnese pruitus

involvement of a large body area

age < 1 year old

signs of skin infection (oozing, weeping, yellow crusting)

Non-pharmacologic management

• bathing

• moisturizer applcation

• trigger avoidance

• weeping lesion: treat oozing area with tepid tap water compresses or OTC astringents

What are nonpharmacologic products to recommend?

• Ointment (petrolatum, Aquaphor)

• Cream (CeraVe, Cetaphil, Vanicream) are alternatives if ointments aren’t tolerated or for weeping lesions

pharmacology therapy

• Topical hydrocortisone (0.5%-1%-low potency): First line pharmacologic therapy for acute flares when non drug measures work

• Antihistamine: routine is not recommended for AD because it’s not purely histamine driven. Sedating oral antihistamines may occasionally help with sleep if nocturnal itching is severe.

Dry skin. (xerosis)

causes by decreased water holding capacity and lipid deficiency in the stratum corneum (not a lack of natural oils). Highly prevalent in older adults(≥75%)

what can you suggest for oozing or weeping lesions?

Treat three oozing areas with tepid water compresses or OCT astringent (aluminum acetate/ Burrow’s solution) for 20 minutes, 4-6 times a day

What are humectants?

A substance that attracts and binds water molecules from the surrounding air or from deeper layers of tissue. (water magnet)

What is the most suitable time to apply an emollient?

within 3 minutes of bathing or showering while the skin is still damp

Recommend 2 selfcare emollient cream based product

CeraVe

Cetaphil

Vanicream

Eucerin

Aveeno

Soap can dry out the skin and aggravate AD. Therefore,

non-soap-based cleansers should be recommended for

use.

Give two examples of soap substitute cleansers/bars and

their active ingredients?

Cetaphil gentle skin cleanser bar (it has mild surfactant/lipid bases designed to cleanse without stripping natural oil)

Key components/active base: contains ceramides (lipid additives to restore the skin barrier), hyaluronic acid( a humectant to retain moisture)