Self-Care II Exam 2: Atopic + Contact Dermatitis

______

• Inflammatory condition - episodic flares with periods of remission

  • Epidermis + dermis

• Most often diagnosed under the age of ______ y/o

• Increasing prevalence

• Climate, urbanization, diet, pollution/tobacco smoke

• Often seen with asthma and allergic rhinitis “atopic triad”

• Most instances of AD are relatively mild and can be self-treatable in persons > ______ y/o

• Diagnostic criteria

  • Presence of ______ and ______

  • Important factors

    • Early age at onset

    • Atopy

    • Xerosis

Atopic Dermatitis (AD), 1-5, 2, pruritus, eczema

Contact Dermatitis:

• Two Types:

  • ______ contact dermatitis (______)

  • ______ contact dermatitis (______)

• General signs/Sxs:

  • ______

  • ______

  • ______

  • ______

  • Vesicle, bullae, pustule formation

Irritant, ICD, Allergic, ACD, inflammation, erythema, pruritus, burning/stinging

______

• Most often reactions appear on exposed skin surfaces

  • ______

  • Intertriginous spaces on ______

  • Top of ______, ______

• Single exposure or multiple exposure with an irritant

  • Harsh chemicals vs. mild detergents (see list)

  • Disruption of skin barrier, release of inflammatory markers

• Magnitude of response determined by

  • Pre-existing skin conditions (e.g. ______) will increase ICD response

  • Quality/concentration of substance

  • Ambient temperature, humidity

• Chronic exposure may lead to

  • ______ changes

  • ______ of skin

• Etiologies (detergents, soaps, hand sanitizer, water, cooking oils, flour, acids/alkalis, resigns, etc.)

ICD, Face, hands, hands, forearms, atopic dermatitis, pigmentation, necrosis

______

• Immunological reaction caused by exposure to an allergen

  • Induction, followed by activation of sensitized T-cells upon re-exposure

  • Delayed hypersensitivity (range 1-21 days)

  • Release of inflammatory mediators, dermatitis

  • In previously sensitized individuals, dermatitis appears ______ later

ACD, 24-48 hours

ACD

• Primary causes

  • ______: most common plant responsible for ACD + can grow up walls/trees and along roads/trails (climbing shrub)

  • ______: Western (Diversilobum) and Eastern (Toxicarium) species + low-lying plant + grows along streams, wooden slopes, and dry woodlands

  • ______: Appears as a shrub or small tree (odd number of leaves per stem + highly antigenic) + grows in bogs and swamps

Poison Ivy, Poison Oak, Poison Sumac

ACD

• Poison Ivy, Oak, and Sumac

  • Represents __ species of Toxicodendron plants

  • 80% of population is sensitive, 80-90% of all cases of CD

  • ______ on leaves responsible for ACD

  • Cross sensitivity/cross reactions possible

    • ______ tree

    • ______ tree

    • Japanese lacquer tree

5, Urushiol resin, cashew nut, mango

ACD

• Urushiol released secondary to damage to plant

  • Look for black ink-like lacquer on plant leaves

• Urushiol can remain on fomites, dead/dried plant parts

  • Common cause of ACD during the “off season”

• Urushiol binds to skin proteins within 10 minutes of contact

  • Initial sensitization period

  • Re-exposure, delayed hypersensitivity reaction

KNOW

Signs and Sxs of ACD

• Intensity/magnitude of ______ depends on ______ of patient

• Mild, moderate, or severe presentation possible:

  • ______: localized rashes in unprotected/exposed areas, pruritic, linear streaks from scratching

  • ______: vesicles/bullae, edema in addition to pruritus, erythema, inflammation

  • ______: severe edema to extremities or face, closure of eyelids, larger vesicles/bullae, large areas of body affected

rash, baseline sensitivity, Mild, moderate, severe

______

• Erythema + scaling on facial cheeks

  • May spread to rest of face, neck, extremities

• Crusts, pustules (especially with scratching, rubbing)

• Often less severe in adults

  • Behind the ______, ______, ______

  • Environmental triggers (chemicals, skin trauma)

• ______ is hallmark symptoms; can lead to the itch-scratch cycle

  • ______ development (lichenification)

  • Excoriation

Atopic Dermatitis (AD), knees, neck, hands, pruritus, plaque

• ______

  • Intense pruritus, erythematous papules or vesicles, on top of erythematous skin; excoriation and exudation

• ______

  • Erythematous excoriated papules and plaques; scaly

• ______

  • Lichenification and accentuated skin markings

Acute AD, Subacute AD, Chronic AD

Referral Criteria for AD

• ______ condition with intense ______

• Involvement of ______ area of body

• Involvement of ______ or in intertriginous areas of body

• < ______

• Presence of skin infection

  • S. aureus, S. epidermidis, C. bovis, C. mastitidis

  • Viruses (rare)

moderate to severe, pruritus, large, face, 1 y/o,

Referral Criteria for ICD and ACD

•  < ______old

• Sxs present for > ______; ______

• Sxs develop after ______

• > __% BSA effected (ICD); > __% BSA effected (ACD)

• Severe Sxs: ______, numerous large ______ formation, ______

• Involvement of genitalia, mouth, eyes/eyelids, nose, anus, face, scalp, neck

• Secondary infection present

• Failure of self-care after ______

• Impairment of ADLs

2 y/o, 1 week, chronic, sun exposure, 10, 20, itching, vesicle/bullae, edema, 7 days

Non-Pharm for AD:

• Consider patient-specific factors

  • Identify + eliminate triggers (dust mites, cat dander, molds, grass, pollen, smoke, traffic exhaust, fragrances, tight-fitting clothes, excessive washing, food allergens, stress, electric blankets, weather)

• ______

• Avoid sudden, extreme changes in ______ and ______

• ______, ______ fingernails

• ______ sheets and clothing; laundering thoroughly new sheets and clothes

• Bathing in ______ water, hypoallergenic/fragrance-free soaps (e.g. Dove®)

• ______ for moisturizing (______); especially after bathing

• ______ (children)

  • ______

  • Recommended when recurrent skin infections

  • ½ cup bleach per 40 gallons of water (full bathtub)

• ______ (wet dressing, put on over the area, layer with dry dressing, leave overnight)

Humidifiers, temperature, humidity, short, clean, cotton, lukewarm, Emollients, BID, Diluted Bleach bath, BID, Wet Wrapping

Non-Pharm for ICD

• Wash the area with copious amounts of ______

• Cleanse with either

  • ______ or ______ soap (Cetaphil, Dove), OR

  • ______ (1 tsp salt in 1 pt water)

tepid water, mild, hypoallergenic, saline soak

Treatment of of Poison Ivy/Oak/Sumac

• AVOID: topical ______, ______, ______

• Treated or untreated- most cases resolve in ______

anesthetics, AHs, antibiotics, 10-21 days

Non-Pharm for Poison Ivy/Oak/Sumac

• Wash AA with mild soap + water immediately, efficacy seen up to ______

• ______ fingernails

• Avoid vigorous ______ or use of harsh ______

• Wash contaminated clothing

  • Remove affected clothing

  • Wash separately from other clothes

  • Use regular detergent

• Showering beneficial to relieve pruritus

  • ______ temperatures (i.e. ≤ 90 °F)

  • Hypoallergenic soap

  • Scrub under fingernails

• Avoid ______

30 mins, clip, scrubbing, cleansers, cold or tepic, bathing

Prevention of Poison Ivy/Oak/Sumac

• Avoidance of Toxicodendron plants, habitats

• Wearing protective clothing to prevent accidental contact

  • ______ shirts

  • ______ pants

  • ______ boots

  • ______

Long-sleeved, long, hiking, hats

Prevention of Poison Ivy/Oak/Sumac

• ______

  • MOA: binds to urushiol and blocks its absorption

  • ADR’s

    • Faint white coloring on skin

    • Erythema

    • Minor skin irritation

  • Patient counseling

    • Apply to clean, dry skin at least ______ before exposure risk

    • Let dry

    • Reapplication necessary after ______

Bentoquatam 5% Lotion, 15 mins, 4 hours

Topical Skin Cleansers

• ______ Outdoor Skin ______

  • Removes urushiol that has bound to the skin

  • Effective up to ______ after urushiol exposure; may also use after rash formation

  • Minimum contact time with skin: 2 minutes

  • Reapply PRN

Tecnu, Cleanser, 8 hours, 2 mins, PRN

Topical Skin Cleansers

• ______ Wash

  • Removes urushiol that has bound to the skin

  • Effective at any point after urushiol contact

  • Wash affected areas until ______ resolves

    • 75-80% of rash should resolve w/in ______

  • ______ may be necessary if pruritus returns

Zanfel Poison Ivy, pruritus, 24 hours, 2nd application

Astringents

• Useful in reducing ______ of ______

  • Promotes ______ of lesions

  • Reduces ______

  • ______ skin

  • Mildly ______

• Examples:

  • ______ 1:40 (Burrows Solution)

  • ______

oozing/weeping, vesicle fluid, drying, edema, cleanses, antipruritic, Aluminum Acetate, Witch Hazel

Skin Protectants

• MOA:  Forms a barrier over skin which facilitates healing and absorbs fluids from oozing/weeping lesions

• Product examples

  • ______

  • ______

  • ______

  • ______

• Apply ______ to the AA

Oatmeal, Zinc Oxide, Titanium Dioxide, Calamine Lotion, PRN

Topical Corticosteroids

• DOC: ______ 0.5-1% cream ______ x______

• Multiple MOAs:

  • ______ and ______

  • ______ of blood vesicles in dermis

  • ______

• Avoid use

  • Over ______ surface areas, ______

  • ______ skin

  • ______ use

  • Over ______

Hydrocortisone, TID to QID, 7 days, anti-inflammatory, immunosuppressive, vasoconstriction, antipruritic, large, eyes/eyelids, occluding, prolonged, broken skin

Treatment Goals: 

• ______ → maintain skin hydration + barrier function

• ______ → remove agent, prevent future exposures (safety precautions, skin protectants), chronic dermatitis, and relieve inflammation + irritation

• ______ → remove and avoid further contact with agent, treat inflammation, relieve itching + prevent excess scratching, and relieve accumulation of debris from oozing, crusting, scaling

AD, ICD, ACD