Podcast
Questions and Answers
What is a recommended frequency for applying zinc shampoo initially for seborrheic dermatitis?
What is a recommended frequency for applying zinc shampoo initially for seborrheic dermatitis?
Which population should exercise caution when using medicated shampoos for seborrheic dermatitis?
Which population should exercise caution when using medicated shampoos for seborrheic dermatitis?
How long should ketoconazole shampoo be left on the hair for maximum effectiveness?
How long should ketoconazole shampoo be left on the hair for maximum effectiveness?
What should be done if symptoms of stasis dermatitis persist or worsen despite treatment?
What should be done if symptoms of stasis dermatitis persist or worsen despite treatment?
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What is a characteristic symptom of stasis dermatitis?
What is a characteristic symptom of stasis dermatitis?
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How often should medicated shampoos for seborrheic dermatitis be used after the initial treatment phase?
How often should medicated shampoos for seborrheic dermatitis be used after the initial treatment phase?
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What additional care is recommended for infants with cradle cap beyond medicated shampoo?
What additional care is recommended for infants with cradle cap beyond medicated shampoo?
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What is the primary cause of stasis dermatitis?
What is the primary cause of stasis dermatitis?
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Which of the following is a common trigger for dyshidrotic eczema?
Which of the following is a common trigger for dyshidrotic eczema?
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What is a key self-care exclusion for an individual with itchy rashes?
What is a key self-care exclusion for an individual with itchy rashes?
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What type of skin lesion is most associated with chronic eczema?
What type of skin lesion is most associated with chronic eczema?
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What is the treatment recommendation for weeping lesions associated with poison ivy?
What is the treatment recommendation for weeping lesions associated with poison ivy?
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Which demographic is more likely to experience neurodermatitis?
Which demographic is more likely to experience neurodermatitis?
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What should be avoided in the treatment of weeping vesicles or bullae?
What should be avoided in the treatment of weeping vesicles or bullae?
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Which condition is characterized by scattered circular itchy oozing patches?
Which condition is characterized by scattered circular itchy oozing patches?
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What is the optimal way to manage persistent rash that does not improve after a week of treatment?
What is the optimal way to manage persistent rash that does not improve after a week of treatment?
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Which of the following treatments is suitable for acute eczema with intense itching?
Which of the following treatments is suitable for acute eczema with intense itching?
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Which statement regarding skin hydration in eczema treatment is correct?
Which statement regarding skin hydration in eczema treatment is correct?
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What is the primary concern for management of moderate-severe eczema?
What is the primary concern for management of moderate-severe eczema?
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In which population is dandruff most commonly observed?
In which population is dandruff most commonly observed?
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What skin condition's lesions are primarily described as red, scaly, and exudative?
What skin condition's lesions are primarily described as red, scaly, and exudative?
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Which statement correctly describes the use of ointments for skin conditions?
Which statement correctly describes the use of ointments for skin conditions?
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What is the primary indication for using petrolatum on the skin?
What is the primary indication for using petrolatum on the skin?
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Which of the following should be avoided as a treatment area for ointments?
Which of the following should be avoided as a treatment area for ointments?
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What is the primary characteristic of gels used on the skin?
What is the primary characteristic of gels used on the skin?
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Which of the following is a contraindication for using petrolatum?
Which of the following is a contraindication for using petrolatum?
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What is a common cause of eczema in patients?
What is a common cause of eczema in patients?
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What is the population mostly affected by atopic dermatitis?
What is the population mostly affected by atopic dermatitis?
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Which formulation is best for high patient preference and ease of use in warm weather?
Which formulation is best for high patient preference and ease of use in warm weather?
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What should be avoided when treating eczema?
What should be avoided when treating eczema?
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Which type of dermatitis is characterized mainly by erythema and inflammation?
Which type of dermatitis is characterized mainly by erythema and inflammation?
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What is often correlated with atopic diseases in patients with eczema?
What is often correlated with atopic diseases in patients with eczema?
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Which of these is a common form of eczema that usually appears in childhood?
Which of these is a common form of eczema that usually appears in childhood?
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When treating sensitive areas of the skin, which formulation is often preferred?
When treating sensitive areas of the skin, which formulation is often preferred?
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Which skin condition is primarily caused by genetics and environmental factors?
Which skin condition is primarily caused by genetics and environmental factors?
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Study Notes
Skin Cross Section
- The skin is comprised of epidermis, dermis, and hypodermis layers
- The epidermis is the outermost layer and contains multiple sublayers
- Structures like hair follicles, nerve fibers, and glands (sweat/sebaceous) are present in the dermis and hypodermal layers
Dry Skin (Xerosis)
- Affects 75% of older adults
- Environmental factors like temperature extremes contribute to dry skin
- Common symptoms include: roughness, scaling, cracking, fissuring, redness and itching
- Treatment focuses on modifying environment and bathing habits with warm water and moisturizers immediately after bathing for optimal absorption.
Dry Skin (Xerosis)
- Barrier dysfunction leads to water-holding capacity issues
- Lipids (ceramides, free fatty acids, cholesterol) are decreased
- Epidermal water loss is increased
- Advanced age causes thinner epithelium and reduced lipids
- Associated with dehydration, hypothyroidism, and renal failure
Skin Hydration
- Bath oils can create a slippery surface
- Colloidal oatmeal provides relief from itching
Moisturizers
- Ingredients like emollients, humectants, ceramides are crucial for hydration
- Moisturizers are applied liberally 3-4 times per day
- Patient preference plays a significant role in moisturizer choice.
Lotions and Creams
- Oil-in-water emulsions (less greasy and easy to spread, for hairy areas)
- High patient preference (warm weather)
- Ointments (water-in-oil, occlusive), greasy texture - not used in oozing/infected areas or intertriginous areas (not recommended for oozing lesions, or hot weather)
- Gels feel good on skin but dry
- Butters (like shea butter) are stiffer formulations
Eczema
- Group of conditions causing itchy and inflamed skin.
- Skin tone influences appearance of redness (lighter tones).
- Genetics, environmental factors are triggers
- Affects ~31 million Americans
Atopic Dermatitis
- Most prevalent eczema type
- Affects 15-20% of children and 1-3% of adults
- Chronic, beginning in childhood, with episodes and remissions.
- Associated with elevated IgE, alterations in the epidermal barrier, and immune system disturbances, also often accompanied by asthma and allergic rhinitis (up to 80% of patients).
- Can be triggered by dry skin, harsh substances (soaps/detergents), seasonal changes, heat, sweating, infections, stress, and food allergies.
Clinical presentation
- Itchy rashes and dry/discolored skin
- Repeated itching can cause thickened, rough skin (lichenification)
- Flakes, secondary infections, and/or crusty skin are possible
- Acute eczema is marked by intense itching, papules, or vesicles
- In subacute cases, dry scaly and papules and plaques are present
- Chronic stage is characterized by lichenification, secondary bacterial or viral infections.
Self-Care Exclusions
- Moderate-severe eczema with intense itching
- Extensive skin involvement, <1 year of age
- Appearance of infection with pustules/vesicles/crusting, or involvement in sensitive areas (facial/intertriginous)
- No improvement or worsening within 2-3 days of treatment
Treatment
- Stop itching and scratching behavior
- Maintain adequate skin hydration
- Avoid known triggers
- Prevent infections.
Non-Pharmacological Treatment
- Avoid triggers (chemicals/detergents)
- Limited water exposure with lukewarm water
- Use moisturizers immediately post-bath
- Avoid identified allergens
- Maintain adequate hydration.
- Keep fingernails short
OTC Pharmacologic Therapy
- Moisturizers are the standard of care
- Topical corticosteroids suppress cytokines for inflammation and itching (Rx/OTC)
- Hydrocortisone (1%) is a common OTC steroid
- Oral antihistamines may aid sleep (not routine treatment)
- Wet wraps are helpful for steroids and/ or emollients for skin care
Contact Dermatitis
- Includes irritant and allergic forms
- Irritant contact dermatitis (ICD) is inflammation, redness, vesicles/pustules development
- Common in individuals with dry, cracked/inflamed skin accompanied by itching, burning, and stinging.
- Allergic contact dermatitis (ACD) manifests similar but is associated with a delayed hypersensitivity reaction.
ICD Treatment
- Remove offending agent
- Wash exposed area with mild soap
- Burow's solution (Domeboro) provides cooling, anti-bacterial and anti-inflammatory effects
- Use emollients (petrolatum, Aquaphor), barrier creams
- Preventive measures include applying barrier creams before exposure
Allergic Contact Dermatitis
- Allergic Contact Dermatitis (ACD) involves 3000 documented chemicals, as well as reaction to poison ivy/oak/sumac (urushiol).
- A delayed hypersensitivity reaction involves T cells and inflammatory mediators.
- Urushiol is the active component in these plants. This leads to intense itching, erythema, vesicles and bullae.
Poison Ivy Treatment
- Immediate washing with water and removal of contaminated clothing
- Avoid direct contact with the allergen
- Topical corticosteroids can help reduce itching and inflammation
- Other treatments include using Burow's solution and wet compresses for weeping lesions
- Oatmeal baths or calamine lotion may be supportive.
Neurodermatitis
- Usually confined to 1-2 patches
- Can occur anywhere on the skin (often on areas prone to scratching)
- Common in people aged 30-50 years of age.
- Triggered by stress/anxiety.
Dyshidrotic Eczema
- Small, itchy fluid-filled blisters localized to palms, soles, and edges of fingers/toes
- Women > men
- Triggers such as metals (especially nickel) are common
Nummular Eczema
- Scattered, circular, itchy patches (coin-shaped lesions)
- Typically present on arms and legs
- Stress is also a frequent trigger
Dandruff
- Scaling of the scalp with minimal inflammation
- Malassezia yeast is often involved
- Treatment options include shampoos containing selenium sulfide, pyrithione zinc, or ketoconazole.
Seborrheic Dermatitis
- Scalp and other oily areas with sebaceous glands (face, nose, eyebrows, ears, chest; cradle cap in infants)
- Flaky, red skin
- Treatment for adults includes medicated shampoos (used daily initially). Infants are treated with baby oil and shampoo.
Stasis Dermatitis
- Venous insufficiency leads to ankle swelling, orange-brown discolored/hot spots, and scaling, itchiness in the legs (lower extremities)
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Description
Test your knowledge on the structure of skin, its layers, and conditions like dry skin (xerosis). Explore various factors affecting skin hydration and examine treatment options for maintaining skin health. Perfect for students learning about dermatology or human biology.
