Self-Care Dermatology: Skin Health

• Self-care dermatology involves taking good care of skin.

The Skin

• The skin maintains the body's form.
• The skin helps excrete bodily waste.
• The skin provides protection from infection, dehydration, and temperature changes.
• The skin protects the body against the sun and helps generate Vitamin D.
• The skin facilitates the sense of touch, pressure, pain, heat, and cold.
• The stratum corneum, granulosum, spinosum, and germinativum are layers of the skin.
• The epidermis, capillary network, and sebaceous gland are all components of skin.
• The dermis, hair shaft, hypodermis, and blood vessels are further components of the skin

Atopic Dermatitis and Dry Skin

• Atopic dermatitis is a common, pervasive inflammatory condition of the epidermis and dermis.
• Atopic dermatitis is characterized by episodic flares and periods of remission.
• 50% of cases of atopic dermatitis appear in the first year of life; most have remission by age 2, but 30% continue into adulthood.
• Atopic dermatitis may be considered a genetically predisposed exaggerated skin and mucosal reactivity to environmental stimuli.
• Atopic dermatitis presents as deficient skin barrier properties, decreased ability to retain moisture and increased allergen penetration.
• The atopic triad is asthma, allergic rhinitis, and AD.
• Children are not simply small adults when considering AD.
• There are racial differences in the phenotypic expression of AD.
• Both genetic and immune mechanisms can lead to skin barrier dysfunction.
• Inconsistent estimates of AD prevalence within and between countries make it difficult to extrapolate the effect of ethnicity on the risk of developing AD.
• The estimated prevalence of AD is 19.3% in African Americans, 16.1% in Whites, and 7.8% in Hispanics based on the 2005-2006 National Health and Nutrition Examination Survey.

Treatment Goals

• Goals of treatment for AD include stopping the itch/scratch cycle.
• Goals of treatment also include maintaining skin hydration and barrier function.
• Goals of treatment also involve avoiding or minimizing factors that trigger or aggravate the disorder.
• Prevent secondary infection.
• Goals of treatment for dry skin include improving skin hydration and minimizing water loss.
• Goals of treatment for dry skin include restoring the skin's barrier function.
• Goals of treatment for dry skin include educating the patient about prevention/treatment of this chronic disorder.

Exclusions for Self-Care

• Exclusions for self-care include moderate to severe conditions with intense pruritis.
• Exclusions include involvement of a large area of the body.
• Exclusions include being under 1 year of age.
• Exclusions include skin that appears infected (yellow crusty).
• Exclusions include involvement of the face or intertriginous areas (where two skin areas may touch or rub together).

Ointments vs. Creams vs. Lotions

• Ointments have the greatest oil content; with key point being patient preference, protective film (impeded water evaporation), traps moisture and may trap heat.
• Creams have a greater oil-to-water ratio and are emulsions that allow some fluid to pass through.
• Creams are best for broken skin and are easier to apply and remove versus ointments.
• Lotions have a greater water-to-oil ratio and are easy to spread and apply or remove.
• Lotions are not as beneficial for dry skin and AD.

OTC Treatment

• Hydrocortisone is available as a cream or ointment in 0.5% or 1% strength.
• Apply a thin film of Hydrocortisone to the affected area 1-2 times daily for no more than 7 days without a physician's approval.
• Hydrocortisone is useful when skin is itching or inflamed.
• Avoid ointment formulation with Hydrocortisone if skin is weeping.
• Avoid Hydrocortisone if skin is infected and refer to a medical professional.
• OTC strength steroids are safe for use on the face or groin area

Nondrug Measures

• Avoid exacerbating factors/triggers.
• Clip nails and cover hands with socks/gloves at night.
• For AD with weeping lesions, apply a cool compress for 5-20 minutes, 4-6 times daily.

Bathing Techniques

• Consider bath oil with colloidal oatmeal.
• Bathe every other day and briefly.
• Use Tepid water.
• Air/pat dry and avoid excessive rubbing.
• Apply moisturizer 3 minutes after bathing.
• Use fragrance-free products.
• Avoid common bar soaps and use mild non-soap cleansers like Cetaphil instead.

Dry Skin

• Dry skin is characterized by roughness, scaling, loss of flexibility, fissures, inflammation, and pruritis.
• Dry skin is characterized by decreased water content with resultant abnormal loss of cells from the stratum corneum.
• Dry skin may be caused by detergents, malnutrition, physical damage, or systemic disorders such as hypothyroidism or dehydration.
• Dry skin is characterized by a decreased amount of ceramides which leads to water loss.
• Advancing age results in thinner epidermis.
• Emollients fill the space between skin scales and rehydrate stratum corneum, examples being petrolatum like Vaseline and Aquaphor.
• Humectants promote retention of moisture and keratolytic which helps loosen and shed the outer layer of skin, such as Urea 10% lotion.
• Alpha Hydroxy Acids exfoliate and moisturize in Ammonium Lactate Cream, found in brands like Amlactin or Lac-Hydrin.
• Ceramides are lipid additives for additional skin barrier protection, such as CeraVe.

Irritant Contact Dermatitis and Allergic Contact Dermatitis

• Irritant contact dermatitis is a condition caused by irritation or allergy.

Application Exercise 2

• A mother and her 8-year-old daughter approach with the daughter having a rash on her hands.
• The daughter reports itching and stinging along with the rash, and her hands are very dry.
• The patient is a grade school student who is currently in in-person classes.
• The patient reports using slime at home and loves it.
• The patient has no known allergies and is not taking any medications.
• The patient hasn't tried any treatment yet.
• The likely primary problem is irritant contact dermatitis.
• Remove the offending agent and prevent future exposure to the irritant is a goal for treatment.
• Prevent development of chronic dermatitis or secondary infection is another treatment goal.
• Relieving inflammation, dermal tenderness, and irritation is also a treatment goal.
• Educating the patient on self-management to prevent or treat recurrences is important.
• Wash the area with cold water and avoid soap.
• Avoid further contact with the irritant.
• Apply emollient to the area.
• Counsel the patient on using nonprescription medication(s) and nondrug measures.
• Ensure understanding of the dose/frequency.
• Discuss the maximum number of days to use the treatment and expected results.
• Review potential adverse drug reactions.
• Go over non-drug measures.
• Discuss what to do if the condition worsens or persists.
• Answer all questions the patient has.
• Arrange a time for follow up and assess patient outcomes.

Irritant Contact Dermatitis

• Irritant Contact Dermatitis typically appears on the face, hands, and forearms after single or multiple exposures to an irritant.
• The best treatment option is to find out what is causing the irritation and remove the irritant.
• Wash with tepid water and mild soap.
• Avoidance can include wearing protective clothing or gloves.
• Use emollients or moisturizers.
• Use colloidal oatmeal baths to relieve itching.
• Hydrocortisone may help with inflammation.

Application Exercise 3

• A 38-year-old male and his 8-year-old daughter mention they had a family camping trip this weekend, and both have rashes, which the father believes is poison ivy.
• There is a history of poison ivy in the past.
• They have no known allergies or are taking any medications.
• The symptoms appeared 3 days after exposure.
• An appropriate treatment goal is to relieve itching and excessive scratching.
• Also to treat the inflammation.
• Allergic contact dermatitis is a likely primary problem.
• When presented, consult the rule of 9's to determine body surface area.
• Keep fingernails trimmed as non-pharmacologic therapy.
• After exposure to poison ivy there are several steps to follow to avoid additional spreading of the irritating oil.
• Apply hydrocortisone 1% cream 3-4 times daily for up to 7 days as pharmacologic therapy.
• For weeping lesions, apply Burow's solution compress for 20-30 minutes, 4-6 times per day.
• Counsel patients on the use of nonprescription medications.
• As well as non-drug measures.
• Follow up is important to assess outcomes and determine whether the condition is improving.

Allergic Contact Dermatitis

• Characteristics of the causing plants should be known and removed.
• The rash appears within 24-48 hours after exposure.
• It may cause papules and vesicles.

Rule of nines

• Used to Estimate body surface area and measure burn damage
• The adult body is divided into sections, each accounting for 9% of the total body surface

Zanfel

• Can remove urushiol by binding with it to create an aggregated cluster and wash away with water, and can be used at any time after exposure.
• It can be applied to any external body area, including the face and genitals and is safe for use by children and pregnant or nursing women.

Tecnu Extreme Medicated Poison Ivy Scrub

• A product to apply on the affected area to remove urushiol.
• Use within 8 hours post-exposure to remove urushiol before the rash begins.

Tecnu Original Outdoor Skin Cleanser

• Can be applied to dry skin and rubbed vigorously for 2 minutes; then rinsed with cool water to remove urushiol within 8 hours post-exposure.
• It can also remove any oil from clothing or pet fur.

Allergic contact dermatitis

• First-generation oral antihistamines can help sleep
• Astringents such as whitchhazel. and aluminum acetate can help weeping
• Topical antibiotics should be avoided
• Topical antihistamines should be avoided