Self-Care II Exam 2: Atopic/Contact Dermatitis (DRUGS)

A patient with mild atopic dermatitis presents with dry, itchy skin. What is the FIRST treatment recommendation?

Emollients/moisturizers applied at least BID, especially after bathing

What is the OTC drug of choice for mild atopic dermatitis flares?

Hydrocortisone 0.5-1% cream

What is the OTC drug of choice for mild allergic contact dermatitis?

Hydrocortisone 0.5-1% cream

What is the main treatment goal for atopic dermatitis?

Restore skin hydration and skin barrier function

What is the main treatment goal for irritant contact dermatitis?

Remove the irritant and prevent future exposure

What is the main treatment goal for allergic contact dermatitis?

Remove/avoid the allergen and reduce itching/inflammation

What are the MOAs of topical hydrocortisone?

Anti-inflammatory, immunosuppressive, vasoconstrictive, and antipruritic

What is the dosing for OTC hydrocortisone?

Apply 0.5-1% cream TID-QID for up to 7 days

When should hydrocortisone NOT be used?

Large surface areas, face/eyes, broken skin, prolonged use, or under occlusion

A patient with poison ivy has a localized itchy rash on the forearm. Best OTC treatment?

Hydrocortisone 1% cream

A patient has poison ivy involving the eyelids. Recommend hydrocortisone?

No. Refer due to eye/eyelid involvement

A patient has poison ivy covering 25% of their body. Recommend OTC hydrocortisone?

No. Refer (>20% BSA for ACD)

What is the MOA of skin protectants?

Form a protective barrier and absorb fluid from oozing lesions

Examples of skin protectants?

Calamine, oatmeal, zinc oxide, and titanium dioxide

When are skin protectants most useful?

Weeping and oozing dermatitis lesions

A patient with poison ivy has itchy, oozing vesicles. Which OTC product may help?

Calamine lotion

What are the benefits of astringents?

Dry weeping lesions, reduce edema, cleanse skin, and mild antipruritic effect

Examples of astringents?

Aluminum acetate (Burow's solution) and witch hazel

A patient with poison ivy has weeping blisters. What OTC product is appropriate?

Aluminum acetate (Burow's solution)

What is bentoquatam used for?

Prevention of poison ivy/oak/sumac dermatitis

How does bentoquatam work?

Binds urushiol and blocks its absorption

When should bentoquatam be applied?

At least 15 minutes before exposure

How often should bentoquatam be reapplied?

Every 4 hours during continued exposure

A hiker with a history of severe poison ivy asks for prevention. Best OTC product?

Bentoquatam 5% lotion

Which cleanser remains effective up to 8 hours after urushiol exposure?

Tecnu

Which cleanser can be used at ANY time after urushiol exposure?

Zanfel

Minimum contact time for Tecnu?

2 mins

A patient touched poison ivy 6 hours ago but has no rash yet. Best cleanser?

Tecnu

A patient has already developed a poison ivy rash and itching. Which cleanser may still help?

Zanfel

What type of bath is recommended for atopic dermatitis?

Lukewarm bath with fragrance-free/hypoallergenic soap

Examples of appropriate soaps for AD?

Dove or Cetaphil

What type of clothing is recommended for AD patients?

Why should AD patients keep fingernails short?

Why are humidifiers beneficial in AD?

Cotton clothing, Reduce scratching and skin damage, Reduce skin dryness

When should moisturizers be applied?

Immediately after bathing and at least BID

What environmental triggers commonly worsen AD?

Dust mites, pet dander, smoke, fragrances, stress, and weather changes

What is the FIRST thing to do after poison ivy exposure?

Wash with soap and water immediately

How long after exposure can washing still provide benefit?

Up to 30 minutes

What temperature water should be used after poison ivy exposure?

Cold or tepid water (90 degrees F and lower)

Why should patients avoid vigorous scrubbing after poison ivy exposure?

It may worsen skin irritation and spread urushiol

Should patients take baths after poison ivy exposure?

No, showering is preferred

Which OTC products should be avoided in poison ivy/oak/sumac dermatitis?

Topical anesthetics, topical antihistamines, and topical antibiotics

Why should topical antihistamines be avoided in poison ivy dermatitis?

They can cause sensitization and worsen dermatitis

A 6-month-old infant has suspected atopic dermatitis. Self-treat?

Refer (<1 y/o)

A 1-year-old child has poison ivy. Self-treat?

Refer (<2 y/o)

A patient has poison ivy involving the face and eyelids. Self-treat?

Refer

A patient has severe edema and large bullae after poison ivy exposure. Self-treat?

Refer

A patient has dermatitis that has not improved after 7 days of self-treatment. What should you do?

Refer

A patient has dermatitis with signs of infection (pus, crusting, fever). What should you do?

Refer

AD = Moisturize, moisturize, moisturize.
Poison ivy prevention = Bentoquatam.
Weeping lesions = Burow's solution or calamine.
Localized inflammation/itching = Hydrocortisone 1%.
Face, eyes, genitals, severe edema, infection, large BSA, young children = REFER

KNOW