Self-Care II Exam 2: Diaper Dermatitis + Acne Vulgaris

Diaper Dermatitis

• AKA _____

• _____ + _____

• Occlusion, moisture, bacteria, _____ pH, mechanical chafing

• Tight-fitting, unchanged, or cloth diapers

• Appearance: _____, _____, _____ lesions

Complications

• _____ infections

• _____ infections

• Skin _____, _____

Diaper rash, children, older adults, alkaline, red, small, perineal, fungal, bacterial, maceration, ulceration

Exclusions Criteria for Diaper Dermatitis

• Lesions >_____ or lack of improvement

• S/sx of secondary infection

• Diaper dermatitis _____

• Possible _____ (older populations, burning/stinging urination)

• Broken skin, blood, vesicles, or pus

• Comorbid conditions

• Severe or systemic symptoms

• Chronic, frequent, or recurrent Sxs

• Significant behavioral changes associated with _____ (incessant _____, lethargy)

7 days, outside diaper area, UTI, rash, crying

Prevention of Diaper Dermatitis

• Change diapers frequently

• Clean area with baby wipes OR Use _____ + _____

• Allow area to _____ before rediapering

• Use _____ → _____ base (_____, _____)

• Consider a diaper holiday → using less diapers

• Use disposable diapers

soft cloth, warm water, air dry, skin protectants, inert, petrolatum, zinc,

_____

• Barrier between the skin + external irritants

• Lubricate areas of friction

• Prevent direct contact with moisture

• Allows body’s normal healing processes to work

_____ + _____ formulations

Topical _____, _____, and/or _____ → NOT be recommended

Skin protectants, semisolid, powder, antibiotics, antifungals, steroids

Skin Protectants

• _____ (Desitin) → _____

  • Requires _____ for removal

Zinc Oxide, thick paste, soap

Skin Protectants

• _____ (A&D, Vaseline)

  • _____ bases

Petrolatum, Ointment

Skin Protectants

• _____ & _____ → spread over _____ surface area of body

  • Reduce moisture + friction

  • _____ warning → _____ issues (causes flare-up)

  • _____ possibly carcinogenic

Talc, Cornstarch, larger, Inhalation, asthma/respiratory, Talc

Know Your ABCDE’s

A = _____

• Allow diaper area skin to air dry frequently; allow diaper free time

B = _____ 

• Apply barrier skin protectant liberally to diaper area with each diaper change to prevent + treat diaper dermatitis

C = _____ 

• Gently cleanse the diaper area with a soft cloth + warm water, or with a baby wipe when stool is present

D = _____

• Change the diaper frequently (_____) and as soon as it is soiled, if possible 

• Use absorbent disposable diapers if affordable

E = _____ 

• Educate parents/caregivers about nonpharmacologic diaper hygiene practices and pharmacotherapy, while verifying understanding

Air, Barrier, Cleansing, Diaper, every 2 hours, Education

Clinical Features for Acne Vulgaris

• More _____ in men + more _____ in women

• Primary in _____

• Onset: _____ onset

• Hormones (_____) during puberty

  • Testosterone → DHT → increase size/activity of sebaceous gland sebum production

  • Proliferation of Cutibacterium acnes leading to inflammation, tissue destruction

• Hyperkeratinization + abnormal exfoliation

• More likely to experience if a first-degree relative has

severe, persistent, adolescents, puberty, androgens

Clinical Features for Acne Vulgaris

• _____ Acne

  • Closed comedo → _____ heads

  • Open comedo → _____ heads

• _____ Acne

  • Small, red pumps with a little inflammation → _____

  • Protruding pustules with more inflammation → _____

Non-Inflammatory, White, Black, Inflammatory, Papular, Pustular

Signs + Sxs of Acne Vulgaris

• Physical _____

• _____

• _____

• _____ impact/stigma

scarring, erythema, hyperpigmentation, psychosocial

Development/Exacerbation of Acne Vulgaris

• Irritation/friction from clothing, excessive contact between face and hands

• _____-based cosmetic use, other health and beauty products

• Occupational (dirt, cooking oils, industrial chemicals, etc)

• Picking/squeezing lesions, stress

• Humidity, sweating

• Medications (PIMPLES)

  • _____, _____, _____, _____, _____, _____, _____ 

• Western diet (fast foods, American foods)

  • _____ glycemic index foods

  • _____ (increases IGF-1)

Oil, Phenytoin, Isoniazid, Moisturizers, Phenobarbital, Lithium, Ethionamide, Steroids, high, Milk

_____ Acne

• Few erythematous papules and occasional pustules mixed with comedones

_____ Acne

• Many erythematous papules and pustules and prominent scarring

_____ Acne

• Extensive pustules, erythematous papules, and multiple nodules on an inflamed background

Mild, Moderate, Severe

Acne Rosacea

• Pimple-like _____, but no _____

• _____, _____, and _____ eyes/eyelids (vision problems)

• Redness in _____ (cheeks, forehead, nose, or chin)

• _____

• Visible _____

• Very _____

breakouts, blackheads, bloodshot, red, swollen, center of face, Large pores, blood vessels, sensitive skin

Exclusion Criteria for Acne Vulgaris

• _____ acne presenting as

  • Primarily _____ + _____

  • _____

  • _____ and/or _____

• Exacerbating factors

  • Comedogenic medications (e.g. “_____”)

• Possible acne _____

moderate to severe, papules, pustules, nodules, inflammation, scarring, PIMPLES, rosacea

Lifestyle Modifications/Nonpharm for Acne Vulgaris

• Identification and avoidance of patient specific exacerbating factors

• Gently cleansing skin with warm water + mild soap _____

• Maintain _____ to limit inflammation

• Use _____ to prevent oily skin, remove makeup, dirt (may increase skin irritation with overuse)

• Dietary changes

  • Lower _____ index foods

  • Reduce _____ and _____-fatty acids

  • Reduce consumption of _____, _____

  • Increase fruit + vegetable consumption

BID, hydration, facial toners, glycemic, saturated, trans, milk, chocolate

Physical Treatments for Acne Vulgaris

• _____ (Pimple Patches)

  • Examples: 

    • Biore® Ultra Deep Cleansing Pore Strips

    • Clean and Clear® Oil Absorbing Sheets

  • Aids in extraction of _____

  • Better alternative to picking acne (_____)

• Professional comedone extraction

  • Removes _____ ($$$)

• _____-based treatments

  • Target reduction of _____

  • Disruption of _____ function

Acrylate Glue-Based Material Strips, impacted comedones, scarring, blackheads, light, C. acnes, sebaceous gland

_____ (_____®)

• Rx to OTC; 1st line option

• MOA:

  • Anti-inflammatory

  • Comedolytic

  • Improves dyspigmentation

  • Maintain acne clearance

• Full strength retinoid product

• Apply a thin layer to affected, intact skin QHS

• ADRs: redness, scaling, dryness, itching

• Patient Counseling:

  • Protect from sun, SPF 15 or higher

  • Acne may worsen in 1st few weeks; need 8–12 weeks for full effect

  • If acne lesions worsen or improvement does not occur in 3 months with proper use of the agent, refer

  • Stop use if pregnant or planning on becoming pregnant

  • Discontinue and refer if no improvement or acne worsens within 3 months

Adapalene Gel 0.1%, Differin

Adapalene Gel 0.1% (Differin®)

• Rx to OTC; _____

• MOA:

  • _____

  • _____

  • Improves _____

  • Maintain acne clearance

• Full-strength _____ product

• Apply a thin layer to affected, intact skin _____

• ADRs: redness, scaling, dryness, itching

• Patient Counseling:

  • Protect from sun, SPF _____

  • Acne may worsen in _____; need _____ for full effect

  • If acne lesions worsen or improvement does not occur in _____ with proper use of the agent, refer

  • Stop use if _____ or _____

  • Discontinue and refer if no improvement or acne worsens within _____

1st line option, anti-inflammatory, comedolytic, dyspigmentation, retinoid, QHS, 15 or higher, 1st few weeks, 8-12 weeks, 3 months, pregnant, planning on becoming pregnant, 3 months

_____

• OTC: 2.5, 5, and 10% strengths; also available Rx

• MOA:

  • Antibacterial, keratolytic, and comedolytic

  • Prevents, eliminates treatment-resistant C. acnes

• Application:

  • Apply to 1-2 small AAs over three days to test tolerance

  • If tolerate, may increase from QD to TID applications PRN, can also increase concentration

  • Can reduce concentration and/or application frequency to reduce ADRs

• ADRs: skin irritation (increases with increased concentration), drying, peeling/scaling, erythema

• Patient Counseling:

  • May bleach hair + dye fabric

  • Avoid excessive sun exposure; use sunscreen with SPF of 15 or higher

  • Mild stinging or peeling is normal and diminishes with continued use

Benzoyl Peroxide

Benzoyl Peroxide

• OTC: 2.5, 5, and 10% strengths; also available Rx

• MOA:

  • _____, _____, and _____

  • Prevents, eliminates treatment-resistant _____

• Application:

  • Apply to 1-2 small AAs over _____ to test tolerance

  • If tolerate, may increase from _____ to _____ applications PRN, can also increase concentration

  • Can reduce concentration and/or application frequency to reduce _____

• ADRs: _____ (increases with increased concentration), _____, _____/scaling, erythema

• Patient Counseling:

  • May _____ hair + _____ fabric

  • Avoid excessive sun exposure; use sunscreen with SPF of _____

  • Mild _____ or _____ is normal and diminishes with continued use

antibacterial, kertolytic, comedolytic, C. acnes, 3 days, QD, TID, ADRs, skin irritation, drying, peeling, bleach, dye, 15 or higher, stinging, peeling

_____ (2nd Line Agent)

• OTC: 0.5-2% strengths

• Alternative to retinoids, benzoyl peroxide (milder, less effective)

• MOA:

  • Keratolytic, Comedolytic

• Application

  • 1-3 times daily PRN

  • Can reduce concentration and/or application frequency to reduce ADRs

• ADRs: burning sensation, erythema, pruritus, stinging, salicylism

• Up to 20% of dose can be systemically absorbed

• Patient counseling

  • Do NOT apply over extensive areas because of potential for systemic toxicity (tinnitus, loss of hearing, N/V, dizziness, lethargy, hyperpnea, diarrhea, psychic disturbances)

  • Avoid drug exposure to eyes, nose, mouth, or broken/injured skin areas

  • Protects against UVB, still need to wear sunscreen → SPF 15 or higher

Salicylic Acid

Salicylic Acid (_____)

• OTC: 0.5-2% strengths

• Alternative to _____, _____ (milder, less effective)

• MOA:

  • _____, _____

• Application

  • _____ PRN

  • Can reduce concentration and/or application frequency to reduce _____

• ADRs: _____ sensation, erythema, _____, _____, salicylism

• Up to _____% of dose can be systemically absorbed

• Patient counseling

  • Do NOT apply over _____ areas because of potential for _____ (tinnitus, loss of hearing, N/V, dizziness, lethargy, hyperpnea, diarrhea, psychic disturbances)

  • Avoid drug exposure to _____, _____, _____, or broken/injured skin areas

  • Protects against _____, still need to wear sunscreen → SPF _____

2nd line agent, retinoids, benzoyl peroxide, keratolytic, comedolytic, 1-3x QD, ADRs, burning, pruritus, stinging, 20, extensive, systemic toxicity, eyes, nose, mouth, UVB, 15 or higher

_____

• Monotherapy: 3-10% strengths

  • Adjunct to existing products

  • MOA:

    • Keratolytic, antibacterial

    • Comedolytic, but comedogenic over time/continued use

  • ADRs: odor, dry skin

• Combination: 3-8%, with 2-3% resorcinol

  • Resorcinol enhances the effects of sulfur

  • Resorcinol additional effects

    • Antibacterial

    • Antifungal

    • Keratolytic

  • ADRs: dry skin, irritation

Sulfur, Sulfur/Resorcinol

Sulfur, Sulfur/Resorcinol

• Monotherapy: 3-10% strengths

  • Adjunct to existing products

  • MOA:

    • _____, _____

    • _____, but comedogenic over time/continued use

  • ADRs: _____, _____

• Combination: 3-8%, with 2-3% resorcinol

  • _____ enhances the effects of _____

  • Resorcinol additional effects

    • Antibacterial

    • _____

    • Keratolytic

  • ADRs: _____, _____

keratolytic, antibacterial, comedolytic, odor, dry skin, Resorcinol, Sulfur, antifungal, dry skin, irritation

Gels (_____)

• Astringent

• Remains on skin _____

• _____

Best for oily skin, longest, non-greasy

Solutions/Washes (_____)

• _____

• Astringent

2nd line for oily skin, non-greasy

Ointments

• _____ (occlusive, greasy)

Avoid

Creams and Lotions (_____ or _____)

• _____

• Less _____

• May counteract _____

• Good for _____ skin

Better for dry/sensitive skin, during winter time/dry air, Moisturizing, irritating, drying and peeling, dry/sensitive

Selected Dietary Supplements

• _____ (not recommended, not enough studies)

  • Antibacterial

  • Antifungal

  • Anti-inflammatory

• _____ (RECOMMENDED)

  • _____

  • Alternative to tetracyclines

  • _____

• _____ (Not recommended, not enough studies)

  • Natural retinol

  • 300,000 IU (women)

  • 500,000 IU (men)

  • Fat soluble vitamin

• _____ (not enough studies)

  • Vitamin B3 derivative

  • Anti-inflammatory

  • Decreases sebum production

Topical Tea Tree Oil, Oral Zinc, bacteriostatic, N/V/D, Oral Vitamin A, Nicotinamide

General Acne Counseling Points

• Minimize/eliminate specific exacerbating factors

• Regardless of therapy, need to wash face _____, don’t pick/squeeze acne

• Stress adherence to therapy

  • Refer after _____ if no response (_____, _____)

  • Refer after _____ (_____)

• Recommend _____ and cosmetics as appropriate

• Start with low strength → then increase to optimal concentration to minimize irritating effects

• Decrease application frequency/strength if excessive _____ or _____ occur

• Supplements for _____ ONLY

BID, 6 weeks, Benzoyl Peroxide, Salicylic Acid, 8-12 weeks, Adapalene, oil free moisturizers, peeling, other ADRs, adjunct treatment