Dry Skin (Xerosis) Treatment PDF

11/7/24 Skin Cross Section Dry skin (Xerosis) >75% of older...

11/7/24 Skin Cross Section Dry skin (Xerosis) >75% of older adults Environmental factors – Temperature extremes Roughness, scaling, cracking, fissuring, and redness. Usually temporary Itchy (pruritis) N'Da, David. (2014). Prodrug Strategies for Enhancing the Percutaneous Absorption of Drugs. Molecules (Basel, Switzerland). 19. 20780-20807. 10.3390/molecules191220780. 2 3 Dry Skin (Xerosis) Treatment Modification of Barrier dysfunction leading to water-holding environment and bathing capacity habits – Decreased lipid components such a ceramides, – Limited duration and free fatty acids, and cholesterol bathing in luke warm water – Leads to epidermal water loss – Moisturizers immediately Advanced age leads to thinner epithelium, after bathing- within 3 minutes and decreased lipids 3-4 times a day Also associated with dehydration, – Room humidification hypothyroidism, and renal failure – Hydration 4 5 1  11/7/24 Skin hydration Bath oils Cleansers vs soap – Mineral or vegetable oil Glycerin soap plus a surfactant – Higher oil content – Create a slippery surface – Diluted so minimally effective Colloidal oatmeal can help with itching Salts of Long chain fatty acids & (Aveeno) Alkali metals (Sodium) – act as surfactants 6 7 Moisturizers Usually 60-80% water – Evaporate and leave behind emollients which is the active ingredient Emollients – soften and smooth skin by keeping in moisture – Silicone, dimethicone oils, petrolatum – Add oil so water cannot escape Emulsifies (keep water and lipids together) – Potassium cetyl sulfate & polysorbates Hydroxyethyl urea: Humectant Humectants (Skin retain water) Glycerin: Humectant – Glycerin, alpha-hydroxy acids, urea, propylene glycol Ceramides – replace lipids. Petrolatum: Emollient Oils, plant oils, vitamins, fragrances, colors….. Apply liberally 3-4 times per day Stearyl alcohol: Emollient and Emulsifier For hands after each washing Aloe: Humectant Patient preference Glyceryl stearate: Emollient 8 9 2  11/7/24 Anti-itch properties as well – camphor and menthol - counterirritant 10 11 Vehicles Eczema Lotions and creams: Group of conditions that – Oil in water emulsions; less greasy and easily spread (except hairy areas) cause the skin to become – High patient preference itchy and inflamed – Warm weather – Red: Lighter skin tones Ointments: – Brown, purple, gray or – Water in oil emulsions- occlusive ashen: Darker skin tones – Difficult to spread Inflammation – Petrolatum- greasy texture – Do not use for oozing lesions, infected areas, lacerations in Genetics and intertriginous areas, mucous membranes, or acne prone areas environmental triggers – Not good for very warm weather Gels: feel good on skin, but have a drying effect 31 million Americans Butters: stiffer formulations (shea butter) https://nationaleczema.org/eczema/types-of-eczema/ 12 13 3  11/7/24 Eczema Atopic dermatitis Eczema: Inflammatory skin Most common type of eczema Atopic dermatitis – 15-20% of children condition with no known etiology – 1-3% of adults Contact dermatitis Begins in childhood and lasts Can have more than 1 type of chronically eczema – Usually, 2-3 months of age Neurodermatitis Different triggers – 50% diagnosed before age 1 Eczema Family history Dyshidrotic Dermatitis: Erythema and Episodic flares and periods of dermatitis inflammation remission Alterations in epidermal barrier and Nummular immune system eczema – Elevated IgE usually correlated with atopic disease Seborrheic – Overexpression of cytokines dermatitis Asthma and allergic rhinitis occur in up to 80% of patients Stasis dermatitis – Atopic triad 14 15 Figure 1 Atopic dermatitis clinical Presentation Pruritus and erythema Children Adults – Erythema and scaling of – Usually less severe in cheeks. Can progress to adults face, neck, forehead, – Elbow and behind the and extremities knee (popliteal fossae), – Pustules due to itching hands, forehead and rubbing Journal of Pediatric Health Care 2018 32S2-S12DOI: (10.1016/j.pedhc.2017.10.002) Copyright © 2018 National Association of Pediatric Nurse Practitioners Terms and Conditions 16 17 4  11/7/24 Clinical Presentation Itchy rashes Dry and discolored skin Repeated itching leads to lichenification – Thickened plaques of skin with accentuation of normal skin markings – Plaques (large, slightly elevated lesions with a flat surface) are red, scaly, exudative, and/or crusty Acute – Intense itching and papules (small, firm elevated lesions) or vesicles often associated with secretions Subacute – Dry, scaly, papules and plaques (large slightly elevated lesions) Chronic – Lichenification Secondary bacterial infections https://www.aafp.org/afp/2012/0701/p35.html 18 19 Self Care exclusions Treatment Moderate-severe with intense itching Stop itching-scratching Involvement of large area of body Maintain skin hydration 1 week – Can break open but does not further transmit Impairment of daily activities Several days usually – Can also get streaks of vesicles or Face, neck, or scalp involvement papules and plaques Final stage crusting and drying 30 31 Poison Ivy Treatment Poison Ivy Treatment Prevention Hydrocortisone 0.5-1% – Cream allows weeping lesions to Wash contaminated dry clothes separate – Avoid ointments in weeping vesicles or bullae, may trap Removal of antigen as bacteria soon as possible – 3-4 times per day – Urushiol degraded in water Lukewarm showers Burow’s solution – Wash exposed areas within – Weeping lesions 30 minutes if possible Oatmeal baths and/or calamine Post-exposure treatment lotion may help itching as well – Zanafel® Avoid topical antihistamines – Tecnu® 1st generation oral antihistamines preferred if trouble sleeping at – Dawn Dish Soap night If no improvement in rash after 1 week of treatment , refer 32 33 8  11/7/24 Neurodermatitis Dyshidrotic eczema Usually confined to 1-2 Small itchy fluid filled patches of skin blisters Can occur anywhere you Palms of hands, soles of can scratch feet and edges of fingers 12% of population and toes – Women aged 30-50 Also called pompholyx – Anxiety disorders (bubble) and foot and Begins with an itch from hand eczema something and then Women > men and progresses into a cycle of younger adults (20-40) intense itching Metals , especially nickel – Stress & anxiety can be is a common trigger triggers https://nationaleczema.org/eczema/types-of-eczema/dyshidrotic- eczema/ 34 35 Nummular eczema Dandruff Scattered circular Epidermis and confined to scalp (“coins”) itchy oozing – Small white flakes from scalp patches scaling – Minimal inflammation and Common on arms and erythema legs – Cosmetic mostly Difficult to diagnose due – Accelerated cell turnover to similarities between Involves presence of a yeast – Malassezia other types of eczema Selenium sulfide or pyrithone and ringworm. zinc shampoo – Leave on hair for 3-5 minutes Stress is a common – Use daily for 1 week , then 2-3 trigger times per week Ketoconazole shampoo Coal tar shampoo 36 37 9  11/7/24 Seborrheic dermatitis Seborrheic dermatitis Similar to dandruff treatment but more aggressive Scalp and other oily Adults Infants – Cradle Cap areas with sebaceous Regular use of – Massage scalp with baby glands such as face, oil followed by medicated shampoos sides of the nose, shampooing to remove eyebrows, ears, eyelids, Daily for 1st week, move scales and chest to 2-3 times per week, Scaly patches, red skin, then once weekly and dandruff (less inflammatory and confined to scalp) “Cradle cap” 38 39 Stasis dermatitis (Varicose eczema) Venous insufficiency Usually feet or lower legs Ankle swelling, orange- brown speckles of discoloration Hot itchy spots, dry, scaling, discoloration 40 10