PC1 Mod 3 Readings

Patient Education for Atopic Dermatitis (AD) and Dry Skin

• Primary objectives include hydrating the skin, protecting the skin barrier, avoiding triggers, and preventing infections.

Atopic Dermatitis (AD)

Nondrug Measures

• Avoid known allergens, irritants, and extreme temperatures/humidity.
• Use lukewarm water for short showers or baths, or consider sponge baths.
• Use nonsoap cleanser and pat skin dry.
• Keep fingernails short, smooth, and clean, and wear cotton gloves or socks at night.

Nonprescription Medications

• Wash affected areas with a nonsoap cleanser before applying medication.
• Apply a moisturizer within 3 minutes after bathing while the skin is damp.
• Apply a thin layer of 1% hydrocortisone cream 1–2 times daily to dry lesions for no longer than 7 days.
• Expect improvement in 24–48 hours, but the condition may worsen in winter and summer.
• Seek medical attention if there's no improvement or worsening after 2–3 days of treatment.

Dry Skin

Nondrug Measures

• Limit full-body baths to 2–3 times per week with lukewarm water; use sponge baths on other days.
• Pat skin dry after bathing.
• Drink plenty of water, avoid caffeine and alcohol, and increase room humidity.
• Apply moisturizer at least 3–4 times daily, including within 3 minutes after bathing.
• Expect improvement within 24–48 hours (complete resolution may be difficult).

Nonprescription Medications

• Apply moisturizers immediately after bathing while skin is damp; ceramide-based products are suitable for more severe cases.
• If moisturizers alone are ineffective, apply a thin layer of 1% hydrocortisone before the moisturizer, 1–2 times daily for no longer than 7 days.
• Seek medical attention if dry skin worsens after 7 days of treatment.

Cortizone 10 Cream (Hydrocortisone)

• Active ingredient is 1% hydrocortisone, used as an anti-itch remedy.
• Temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to eczema, psoriasis, poison ivy/oak/sumac, insect bites, detergents, jewelry, cosmetics, and seborrheic dermatitis.
• Also temporarily relieves external anal and genital itching.
• For external use only; avoid contact with eyes.
• Do not use: in the genital area if you have a vaginal discharge or for diaper rash.
• Apply to affected area not more than 3 to 4 times daily for itching of skin irritation, inflammation, and rashes in adults and children 2 years and older.
• Discontinue use and consult a doctor if the condition worsens or symptoms persist for more than 7 days, or clear up and occur again within a few days.

Drug Delivery Systems - Types of Ointment Bases

Hydrocarbon (Oleaginous) Ointment Bases

• Insoluble in water and anhydrous.
• Examples: White petrolatum, white ointment, decolorized petrolatum.
• Forms a greasy, water-repellent film on the skin, providing good occlusiveness, emollient effect, and enhanced drug permeation.
• Greasy, not water-washable, and can stain clothing.

Absorption Ointment Bases

• Oleaginous and anhydrous, but can absorb water due to lipophilic surfactants.
• Examples: Lanolin (anhydrous), hydrophilic petrolatum, Aquaphor®.
• Forms a greasy film, is moderately occlusive, and stays on the skin for a prolonged time.
• Greasy and not water-washable.

W/O (Water-in-Oil) Emulsion Bases

• Water-in-oil semisolid emulsions that absorb less water than anhydrous absorption bases.
• Examples: Hydrous lanolin, Eucerin, cold cream.
• Oil is the continuous phase; provides moderately good emollient and protective properties.
• Still greasy and not water-washable, but generally more pleasant than anhydrous absorption bases.
• Can phase separate over time.

O/W (Oil-in-Water) Emulsion Bases

• Oil-in-water semisolid emulsions that can absorb varying amounts of water.
• Commonly referred to as creams and are water-washable.
• Examples: Hydrophilic Ointment, USP; Vanishing Cream.
• High drug concentration in the film enhances drug delivery.
• Thin, non-continuous, non-oleaginous film is less occlusive than oily ointments, providing less protection and emolliency.
• Among the most acceptable topical dosage forms due to their non-greasy feel.
• Can phase separate over time.

Key Points: Patient Education for Fungal Skin Infections

• Objectives: relieve itching, burning, and discomfort, inhibit fungal growth and cure the infection, and prevent recurrences.

Nondrug Measures

• Use a separate towel for the affected area, and avoid sharing personal items.
• Wash contaminated items in hot water and dry on a high setting.
• Cleanse skin daily with soap and water, and wear breathable clothing and shoes.
• Allow shoes to dry completely before reusing; use foot powder if needed.
• Use odor-controlling insoles in shoes, replacing them every 3–4 months.
• Stop antifungal treatment if irritation or worsening occurs.
• Wear protective footwear in shared areas like public showers.

TINACTIN (tolnaftate cream)

• Active ingredient is Tolnaftate 1% (antifungal).
• Treats most athlete's foot and ringworm; helps prevent most athlete's foot with daily use.
• For external use only; avoid contact with the eyes.
• Discontinue use and ask a doctor if irritation occurs or there is no improvement within 4 weeks.
• Apply a thin layer over the affected area twice daily (morning and night) after washing and drying the area.
• Use daily for 4 weeks.
• This product is not effective on the scalp or nails.

Lamisil AT Cream (Terbinafine HCl)

• Active ingredient is Terbinafine hydrochloride 1% (antifungal).
• Cures most jock itch and ringworm; relieves itching, burning, cracking, and scaling.
• For external use only; do not use on nails or scalp, in or near the mouth or eyes, or for vaginal yeast infections.
• Discontinue use and ask a doctor if too much irritation occurs or gets worse.
• For athlete's foot between the toes, apply twice a day for 1 week; on the bottom or sides of the foot, apply twice a day for 2 weeks.
• For jock itch and ringworm, apply once a day for 1 week.

Lotrimin AF Cream (Clotrimazole)

• Cures most athlete's foot, jock itch, and ringworm; relieves associated itching, burning, cracking, scaling, and discomfort.
• For external use only; avoid contact with the eyes.
• Discontinue use and ask a doctor if irritation occurs or there is no improvement within 4 weeks (athlete's foot and ringworm) or 2 weeks (jock itch).
• Apply a thin layer over affected area twice daily (morning and night) after washing and drying.
• For athlete's foot and ringworm, use daily for 4 weeks; for jock itch, use daily for 2 weeks.
• This product is not effective on the scalp or nails.

Lotrimin Ultra Cream (Butenafine HCl)

• Active ingredient: Butenafine hydrochloride 1% (antifungal).
• Cures most athlete's foot between the toes, jock itch, and ringworm; relieves associated itching, burning, cracking, and scaling.
• For external use only; do not use on nails or scalp, in or near the mouth or the eyes, or for vaginal yeast infections.
• Discontinue use and ask a doctor if too much irritation occurs or irritation gets worse.
• For athlete's foot between the toes, apply twice a day for 1 week or once a day for 4 weeks; for jock itch and ringworm, apply once a day for 2 weeks.

Pharmacologic Therapy for Diaper Dermatitis

• Goals: protect the skin, soothe discomfort, promote healing, and prevent secondary infections.

Skin Protectants: Overview

• Act as physical barriers, reduce friction, and absorb moisture.
• Approved for both treatment and prevention; safe for routine use.
• Apply liberally with every diaper change; avoid scrubbing off residual product.
• Improvement typically observed within 24 hours with proper application.

FDA-Approved Skin Protectants

• Zinc Oxide (1–25%): Creates a hydrophobic barrier; requires soap for removal.
• Petrolatum (30–100%): Oleaginous base; common in ointments.
• Lanolin (12.5–50%): Bacteriostatic but may cause allergies.
• Dimethicone (1–30%): Silicone-based; repels water and reduces inflammation.
• Calamine (1–25%): Zinc/ferrous oxide blend; offers antiseptic and antipruritic effects.
• Cornstarch (Topical) (10–98%): Absorbs moisture; safer than talc, but avoid inhalation.
• Avoid sodium bicarbonate or zinc acetate in children under 2 years. Consult a provider for aluminum hydroxide or glycerin use in infants younger than 6 months.

Non-Approved Ingredients (Nonmonograph)

• Examples: Aloe, beeswax, calendula, chamomile, comfrey, lavender, tea tree oil, vitamins A/D/E.
• Concerns: May cause irritation or toxicity; limited evidence supporting efficacy.

Common Products

• Desitin Maximum Strength: Zinc oxide (40%), cod liver oil, lanolin, talc.
• Aquaphor Baby Healing: Petrolatum (41%), lanolin, mineral oil.
• Burt's Bees Diaper Ointment: Zinc oxide (40%), almond oil, lavender, calendula.
• Boudreaux's Butt Paste: Zinc oxide (16%), castor oil, Peruvian balsam.
• Balmex Diaper Rash Cream: Zinc oxide (11.3%), beeswax, soybean oil, evening primrose.

Critical Safety Considerations

• Avoid talc due to inhalation risks and potential links to ovarian cancer.
• Use lanolin cautiously, especially on inflamed skin, as it may act as a contact sensitizer.
• Cornstarch is preferable to talc but avoid near the face to prevent inhalation.
• Homemade remedies lack established safety and efficacy data.
• Stick to products containing zinc oxide, petrolatum, or dimethicone; avoid talc, nonmonograph additives, and unverified mixtures.

Patient Counseling for Diaper Dermatitis

• Use gentle, non-irritating cleaning methods; avoid scrubbing.
• Minimize occlusion of the diaper area when feasible, and change diapers frequently.
• Apply nonprescription skin protectants liberally; do not remove residual product.
• Monitor for worsening symptoms, such as open sores, pus, spreading redness, fever, or other systemic symptoms, and seek medical attention if these occur.
• Patient and caregiver education is essential for effective management.

DESITIN MAXIMUM STRENGTH DIAPER RASH (zinc oxide paste)

• Active ingredient is 40% zinc oxide (skin protectant).
• Helps treat and prevent diaper rash, protects chafed skin, and helps seal out wetness.
• For external use only; avoid contact with eyes.
• Discontinue use and consult a doctor if the condition worsens or symptoms last more than 7 days.
• Cleanse the diaper area thoroughly, allow it to dry completely, and apply paste liberally with each diaper change, especially at bedtime.

Patient Education for Acne

• Goals: control mild acne, achieve effective management through long-term treatment, keep pores open, and avoid factors that worsen acne.
• Acne results from changes in the pilosebaceous unit in the skin's dermis.
• While controllable, acne is typically not curable but may resolve over time.

Nondrug and Preventive Measures

• Cleanse skin twice daily with a mild, oil-free cleanser and warm water.
• Use skin toner to remove excess dirt and oil.
• Limit exposure to environmental irritants.
• Avoid tight-fitting clothes, headbands, or helmets, and refrain from resting your chin on your hand.
• Use noncomedogenic, oil-free makeup and frequently clean cosmetic brushes.
• Avoid high-humidity environments.
• Limit stressful situations and practice relaxation techniques.
• Avoid picking/squeezing pimples.
• Sexual activity does not cause or worsen acne.

Nonprescription Medications

• Common active ingredients include adapalene, benzoyl peroxide, salicylic acid, and sulfur; adapalene and benzoyl peroxide are most effective.

Adapalene

• Normalizes skin cell development to reduce acne symptoms.
• Avoid use if sensitive skin or sensitivity to benzoyl peroxide is present.
• Increases sensitivity to sunlight; always use a broad-spectrum sunscreen (SPF 15 or higher).
• Avoid contact with eyes, lips, mouth, nose, and broken skin.
• Side effects: redness, itching, dryness, and burning may occur, but typically subside after the first month.
• Improvement takes 8–12 weeks.
• Discontinue use if you experience allergic reactions, become pregnant, or plan to become pregnant.

Benzoyl Peroxide

• Kills Cutibacterium acnes and unclogs pores through mild peeling.
• Avoid use if sensitive skin or an allergy to benzoyl peroxide is present.
• Use a broad-spectrum sunscreen (SPF 15 or higher).
• Avoid contact with eyes, lips, cuts, and dyed fabrics (as it may bleach them).
• Redness, itching, peeling, or swelling may occur.
• Start with once-daily use and gradually increase to 2–3 times daily as tolerated.
• Slight improvement in a few days; maximum results within 3–6 weeks.
• Continue use to prevent new lesions after clearing.

Salicylic Acid

• Helps unclog pores by causing mild peeling.
• Less effective than adapalene and benzoyl peroxide.
• Apply 1–3 times daily as a cleanser or gel (limited to affected areas).
• Use a broad-spectrum sunscreen (SPF 15 or higher).
• Consult a provider if no improvement after 6 weeks.

Differin Gel (Adapalene)

• Active ingredient is adapalene 0.1% (retinoid).
• For external use only.
• Do Not Use: On damaged skin, if allergic to adapalene, or if pregnant/breast-feeding.
• Limit sun exposure and apply sunscreen when outdoors. Avoid using wax hair removal on treated areas.
• Acne may appear worse during the early weeks of use—this is normal.
• Full effects may take up to 3 months with once-daily application.
• Avoid contact with eyes, lips, and mouth.
• Stop use if you become pregnant or experience allergic reactions or severe irritation; no improvement is seen after 3 months.

Clean and Clear PersaGel 10% Gel (Benzoyl peroxide)

• Active ingredient is benzoyl peroxide 10% (acne medication).
• For external use only.
• Do Not Use: If you have very sensitive skin or are sensitive to benzoyl peroxide.
• Using another topical acne medication at the same time may increase irritation or dryness. If irritation occurs, use only one product at a time.
• Avoid unnecessary sun exposure and always use sunscreen.
• Avoid contact with eyes, lips, and mouth; with hair or dyed fabrics.
• Apply a thin layer to the entire affected area, starting with once-daily application and gradually increasing to 2–3 times daily if needed.
• If irritation or sensitivity develops, discontinue both the product and sunscreen use and consult a doctor.