Dermatitis and Scaly Dermatoses (PHR 913 BLOCK1)

What is an appropriate nonprescription medication for allergic contact dermatitis?

Topical corticosteroid — hydrocortisone

What location of allergic contact dermatitis requires medical referral?

Involvement inside the mouth or nose

What is an appropriate non-pharmacologic recommendation for diaper dermatitis?

Increase the amount of time the affected area is exposed to air.

What is an appropriate nonprescription medication for diaper dermatitis?

Skin protectant — zinc oxide

What is the difference between irritant contact dermatitis and allergic contact dermatitis?

Irritant contact dermatitis is an inflammatory reaction caused by direct contact with an irritant, while allergic contact dermatitis is an allergic reaction caused by exposure to an antigen.

What are common causes of irritant contact dermatitis?

Acids, alkalis, detergents, soaps, and solvents, usually with repeated exposure.

What are common causes of allergic contact dermatitis?

Plants, nickel, latex, fragrances, cosmetics, and skin products.

What causes diaper dermatitis?

Contact with urine and feces in the diaper-covered area.

Where does irritant contact dermatitis commonly occur?

The dorsal surfaces of the hands and forearms, usually sharply limited to the area of exposure.

Where does allergic contact dermatitis commonly occur?

At the site of direct exposure, with possible spread to the surrounding area.

Where does diaper dermatitis commonly occur?

The diaper-covered area; severe cases may spread outside the diaper area.

What are the typical symptoms of irritant contact dermatitis?

Stinging, swelling, pain, itching, and dry, cracked, rough skin. Chronic cases may cause skin thickening.

What are the typical symptoms of allergic contact dermatitis?

Itching, papules, vesicles, and linear or patterned lesions that may crust or dry during later stages.

What does diaper dermatitis typically look like?

A scalded appearance with red to bright-red patches and shiny, wet-looking patches or lesions; it may appear maroon or purplish on darker skin.

How quickly does irritant contact dermatitis develop after exposure?

Within a few hours.

How quickly does allergic contact dermatitis develop after exposure?

Usually after a 24-48+ hour delay.

Does allergic contact dermatitis normally occur after the first exposure to an allergen?

No. There is typically no reaction with the first contact.

What are occupational risk factors for irritant contact dermatitis?

Frequent handwashing and occupations such as hairstyling and manufacturing.

What factors increase the risk of diaper dermatitis?

Tight-fitting or rough diapers, infrequent diaper changes, occlusive covers, and medications or foods that affect the GI tract.

What factors increase the risk of allergic contact dermatitis?

Outdoor activities such as hiking, yard work, and camping, as well as exposure to a new detergent, soap, or skin-care product.

What plants are major sources of urushiol-induced allergic contact dermatitis?

Poison ivy, poison oak, and poison sumac.

How quickly can urushiol enter the skin after a plant is damaged?

Within approximately 10 minutes.

Why should poison ivy, poison oak, or poison sumac never be burned?

Urushiol particles in the smoke can affect the lungs and body.

What age generally excludes a patient with contact dermatitis from self-treatment?

Under 2 years old, except for diaper dermatitis.

How long can general contact dermatitis symptoms be present before medical referral is recommended?

More than 1 week.

What body areas affected by contact dermatitis require referral rather than self-treatment?

The mucosa, mouth, nose, anus, eyes, face, or genitalia.

What percentage of body surface area excludes general contact dermatitis from self-treatment?

More than 10% BSA.

What severe symptoms exclude general contact dermatitis from self-treatment?

Extreme itching, swelling, irritation, severe vesicle formation, or symptoms that impair daily activities.

What other findings exclude general contact dermatitis from self-treatment?

Sun exposure association, signs of infection, chronic involvement causing permanent skin changes/scarring, or complicated causes/comorbid conditions.

What are the main pharmacologic treatment options for irritant contact dermatitis?

Emollients, colloidal oatmeal, and topical steroids.

What is the purpose of emollients in irritant contact dermatitis?

To return moisture to the skin, improve skin-barrier function, and decrease irritation.

What ingredients may be found in emollients used for irritant contact dermatitis?

Mineral oil, petrolatum, ceramide, and dimethicone.

What products should be avoided when selecting an emollient for irritant contact dermatitis?

Products containing salicylate or lactic acid.

What is the role of colloidal oatmeal in irritant contact dermatitis?

Symptomatic relief of itching.

What is the role of topical steroids in irritant contact dermatitis?

To reduce inflammation and relieve itching.

What nonpharmacologic measures are recommended for irritant contact dermatitis?

Identify and avoid the irritant, use gloves/protective clothing/barrier creams, wash with mild soap and lukewarm water after exposure, use Burow's solution if needed, and moisturize multiple times daily.

When should moisturizer be used to help prevent irritant contact dermatitis?

Multiple times daily, including before expected exposure.

What is the most effective OTC treatment for mild-to-moderate allergic contact dermatitis according to the slides?

Hydrocortisone 1% cream, provided there is no edema or extensive body involvement.

How should hydrocortisone 1% cream be used for allergic contact dermatitis?

Apply to localized areas 3-4 times daily to relieve inflammation and itching.

Why is hydrocortisone cream preferred over ointment for weeping allergic contact dermatitis lesions?

Cream allows the lesions to continue weeping.

Where should hydrocortisone NOT be applied?

The eyes or eyelids.

Should an area treated with hydrocortisone for allergic contact dermatitis be covered?

No.

What is the purpose of calamine in allergic contact dermatitis?

It relieves itching and promotes drying of weeping lesions.

How should calamine be used?

Shake well and apply to the affected area 3-4 times daily as needed.

What counseling point should patients know about calamine?

It leaves a pink film that can stain clothing.

What is Burow's solution used for in allergic contact dermatitis?

As an astringent soak or compress to dry weeping lesions.

How long should an affected area be soaked in Burow's solution?

15-30 minutes, repeated 3-4 times daily as needed.

How is Burow's solution used as a compress or wet dressing?

Soak a clean, soft cloth in the solution and loosely apply it for 20-30 minutes, repeating 4-6 times daily as needed.

Should Burow's solution be reused?

No. Discard the solution after each use.

How is colloidal oatmeal used for allergic contact dermatitis?

Dissolve a packet in a lukewarm bath and soak for 15-30 minutes up to 3 times daily, then pat dry.

What symptom does colloidal oatmeal primarily relieve?

Itching.

How can an isotonic saline solution be prepared according to the slides?

Mix 1 teaspoonful of salt with 2 cups of tap water.

What inexpensive alternatives are listed for allergic contact dermatitis?

Saline solution, ¼ cup vinegar in 1 pint of water, or baking soda mixed with water to form a paste.

How long and how often can the inexpensive topical alternatives be applied?

Liberally for 20-30 minutes, 3-4 times daily.

What preventive measures should be recommended for allergic contact dermatitis?

Identify and avoid exposure, wear protective clothing/gloves/masks, and wash exposed skin, clothing, tools, and objects with mild soap and lukewarm water.

Why should fingernails be clipped and cleaned in allergic contact dermatitis?

This is included as a patient-education measure to reduce problems associated with scratching and contamination.

When should allergic contact dermatitis be referred if it is not healing?

If it has not healed within 7 days

What diaper dermatitis findings require medical referral?

Lesions lasting over 7 days, secondary infection or constitutional symptoms, complicated causes/comorbid conditions, spread outside the diaper area, broken skin, bullae, oozing, blood, vesicles, pus, chronic/frequent recurrence, or significant behavior changes.

What medications/products are considered safe and effective for diaper dermatitis without medical referral?

Skin protectants.

What are common skin protectants for diaper dermatitis?

Aluminum hydroxide, calamine, petrolatum, zinc oxide, and lanolin.

What important caution is associated with lanolin?

Lanolin can cause sensitization.

What ingredients should generally be avoided in diaper dermatitis products?

Fragrances and unnecessary additives.

How should skin protectants be applied for diaper dermatitis?

Apply liberally with each diaper change.

Should the old layer of skin protectant be completely removed at every diaper change?

No. Do not remove the old layer unless it is soiled.

How do skin protectants help diaper dermatitis?

They create a physical barrier, provide lubrication, absorb moisture, or prevent moisture from contacting the skin.

Which drug classes should NOT be routinely used for self-treatment of diaper dermatitis according to the slides?

Antibiotics, antifungals, analgesics, and steroids.

Why should combination products for diaper dermatitis be checked carefully?

They may contain antibiotics, antifungals, analgesics, steroids, fragrances, or other inappropriate ingredients.

What does ABCDE stand for in the nonpharmacologic management of diaper dermatitis?

Air, Barrier, Cleanse, Diaper, Educate.

When should diaper dermatitis be referred if it is not healing?

If it has not healed within 7 days.

How do dandruff, seborrheic dermatitis, and psoriasis differ?

Dandruff: minimal/no inflammation. Seborrheic dermatitis: yellow, oily scales on red skin. Psoriasis: silvery-white plaques.

What organism is associated with dandruff and seborrheic dermatitis?

Malassezia yeast.

What are exclusions to self-treatment for scalp disorders?

Age

What is the treatment progression for dandruff?

Nonmedicated shampoo → pyrithione zinc/selenium sulfide → ketoconazole → coal tar/salicylic acid/sulfur.

How should medicated dandruff shampoo be used?

Daily × 1 week → 2-3×/week × 2-3 weeks → weekly maintenance; leave on ≥5 minutes.

What ingredients should be avoided in nonmedicated dandruff shampoo?

Sodium lauryl sulfate and sodium laureth sulfate.

What are the first-line medicated dandruff agents?

Pyrithione zinc and selenium sulfide; both reduce Malassezia.

What counseling is important for selenium sulfide?

Rinse thoroughly to prevent hair discoloration; frequent use may cause odor and oily scalp.

How is ketoconazole used for dandruff?

Second-line; use twice weekly × 4 weeks, at least 3 days apart.

What are the key third-line dandruff agents and their mechanisms?

Coal tar (halts cell proliferation), salicylic acid (increases skin hydration), sulfur (increases sloughing; dandruff only).

How is cradle cap treated?

Massage with baby oil, then wash with a nonmedicated shampoo to remove scales.

How is adult seborrheic dermatitis treated?

Medicated shampoo; add hydrocortisone ointment ≤2×/day for

How does ketoconazole's place in therapy differ between scalp conditions?

Second-line for dandruff; first-line for seborrheic dermatitis.

When can psoriasis be self-treated and with what?

Mild psoriasis (

What are the main nonpharmacologic measures for psoriasis?

Tepid baths 2-3×/week, gently remove scales, and apply emollients within 3 minutes up to 4×/day.

How can hydrocortisone's effect be enhanced, and what is the long-term risk?

Cover with petrolatum after 30 minutes for occlusion. Long-term risk: local skin atrophy.