NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
Advanced Nursing Practice I Exam 1
Dermatitis
Contact Dermatitis
● Cause can be an irritant or allergy
o Irritant- chemicals, solvents, bleach alcohol
▪ Location- usually hands
▪ Symptoms- burning, pruritus, pain
▪ Surface appearance- dry fissured skin
▪ Lesion borders- less distinct
o Allergy- nickel (jewelry), medications, poison oak, personal products
▪ Location- exposed areas, usually hands
▪ Symptoms- mainly pruritus
▪ Surface appearance- vesicles and bullae
▪ Lesion borders- distinct angles, lines and borders
● Diagnostic tests- usually not necessary, unless secondary infection is suspected
o KOH, culture, punch test to id contact allergen (dermatologist)
● Management- symptom management, id and avoid the causative substance, prevent
secondary infection
o Pharmacologic Treatment
▪ Calamine lotion, cool colloidal oatmeal baths for itching
▪ Benadryl 25-50 mg PO
▪ Mild cases- hydrocortisone cream in non Rx strength ex. 0.1%
▪ Mid-or high potency topical steroids BID, such as triamcinolone 0.1%
(Kenalog, Aristocort) or clobetasol 0.05% (Temovate)
▪ Barrier cream zinc oxide may help protect skin and retain moisture
▪ When to use Rx topical corticosteroids?
- If rash does not improve or continues to spread after 2-3 days of
self- care or if itching/pain is severe Rx corticosteroids topically)
▪ When to use PO or IM systemic steroid therapy?
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
,NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
- If reaction covers a relatively large portion of skin (20%), periorbital,
genital region or is severe, Rx PO or IM injection steroid- systemic
steroid therapy is often required and offers relief within 12-24 hours,
5 days of prednisone, 0.5-1 mg per kg daily, is recommended. If the
patient is comfortable after this initial therapy, the dose may be
reduced by 50% for the next 5-7 days
▪ Antihistamines- not proven to reduce itching but side effects can help
Atopic Dermatitis
● Associated with Asthma and hay fever, is most common in Asians and African Americans,
● Clinical findings
o Dry skin
o Flexural surface
o Lichenfication and scaling
● Itchy skin with at least 3 of the following
o Hx of asthma or allergic rhinitis
o Hx of flexural involvement
o Hx of generalized dry skin
o Onset of rash before 2 years of age
o And visible flexural dermatitis
● Management
o 3 goals of management
▪ Alleviate pruritus
▪ Decrease dryness and inflammation
▪ Prevent infection
o Pharmacologic Treatment
▪ Pruritus
● Benadryl 25-50 mg PO Q4-6 hours max 300 mg24 hours
● Atarax 25 mg tid/qid
▪ Inflammation
● Topical steroid- hydrocortisone
o Fluticasone propionate (Cutivate; cream 0.05%)
o Short-term (2-4 weeks)- avoid atrophy
o D/C when inflammation subsides, emollient should
be continued
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
,NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
o Potency depends on location and clinical presentation
● Nonsteroidal calcineurin inhibitor
o Moderate-severe, concern of topical steroid s/e, use short-
term and intermittent
o Tacrolimus 0.03% and 0.1% and Elidel 1%
o Maintenance 2/weekly x 12 months
● Systemic steroids
o Intermittent (1-2x/year) IM can help during flare
o More commonly used is oral
o Typical ER “dose pak” course 4-6 days in insufficient,
often requires 2-3 weeks
o Taper 60mg/40mg/20mg over 15-21 days
o Non-pharmalogic
▪ Tepid bath/soak for acute flare up
▪ Limit bathing- do not use hot water- prevent drying skin
▪ Super-fatted soaps
▪ Follow bath or soaks with emollient- hydrated petroleum (Cetaphil, Eucerin,
Aquaphor, CeraVe)
o Other
▪ Follow up in 2 weeks and 6 to 8 weeks
▪ If severe flare up, increase potency x2 weeks
▪ Moisturize!
▪ Avoid/treat secondary infection
o Indications for referral
▪ Uncertain diagnosis
▪ Attempts at management have not controlled symptoms
▪ Atopic dermatitis on face that has not responded to treatment
▪ Patient has frequent flare-ups or severe atopic dermatitis
▪ Patient requires systemic therapies for flare-ups or maintenance
▪ Condition is causing significant psychosocial disturbances (sleep
disruption, school or work absences)
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
, NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
▪ Contact allergic dermatitis is suspected (especially on the face, eyelids,
or hands)
Tinea Infections
Tinea corporis/cruris
● Lesion Assessment
o Well-circumscribed, red, scaly plaque usually on the trunk
o May occur in groups of 3 or more
o Pruritic
● Risk Factors
o Close contact with animals
o Warm climate
o Obesity
o Immunocompromised/prolonged steroid use
● Diagnosis
o Diagnostic tests
▪ KOH scraping
▪ Woods lamp (may not fluoresce if bathed recently)
● Treatment
o Topical antifungal cream- if not responsive to antifugl, consider other Dx
▪ Clotrimazole (Lotrimin) BID
▪ Miconazole (Monistat-Derm) OD to BID
▪ Ketoconazole (Nizoral) OD
▪ Terbinafine (Lamisil) OD to BID
**2 weeks treatment
Tinea pedis
● Clinical findings
o Red, itching scaling on the feet
● Diagnosis
o Appearance
o KOH prep
o Wood’s lamp
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
Advanced Nursing Practice I Exam 1
Dermatitis
Contact Dermatitis
● Cause can be an irritant or allergy
o Irritant- chemicals, solvents, bleach alcohol
▪ Location- usually hands
▪ Symptoms- burning, pruritus, pain
▪ Surface appearance- dry fissured skin
▪ Lesion borders- less distinct
o Allergy- nickel (jewelry), medications, poison oak, personal products
▪ Location- exposed areas, usually hands
▪ Symptoms- mainly pruritus
▪ Surface appearance- vesicles and bullae
▪ Lesion borders- distinct angles, lines and borders
● Diagnostic tests- usually not necessary, unless secondary infection is suspected
o KOH, culture, punch test to id contact allergen (dermatologist)
● Management- symptom management, id and avoid the causative substance, prevent
secondary infection
o Pharmacologic Treatment
▪ Calamine lotion, cool colloidal oatmeal baths for itching
▪ Benadryl 25-50 mg PO
▪ Mild cases- hydrocortisone cream in non Rx strength ex. 0.1%
▪ Mid-or high potency topical steroids BID, such as triamcinolone 0.1%
(Kenalog, Aristocort) or clobetasol 0.05% (Temovate)
▪ Barrier cream zinc oxide may help protect skin and retain moisture
▪ When to use Rx topical corticosteroids?
- If rash does not improve or continues to spread after 2-3 days of
self- care or if itching/pain is severe Rx corticosteroids topically)
▪ When to use PO or IM systemic steroid therapy?
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
,NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
- If reaction covers a relatively large portion of skin (20%), periorbital,
genital region or is severe, Rx PO or IM injection steroid- systemic
steroid therapy is often required and offers relief within 12-24 hours,
5 days of prednisone, 0.5-1 mg per kg daily, is recommended. If the
patient is comfortable after this initial therapy, the dose may be
reduced by 50% for the next 5-7 days
▪ Antihistamines- not proven to reduce itching but side effects can help
Atopic Dermatitis
● Associated with Asthma and hay fever, is most common in Asians and African Americans,
● Clinical findings
o Dry skin
o Flexural surface
o Lichenfication and scaling
● Itchy skin with at least 3 of the following
o Hx of asthma or allergic rhinitis
o Hx of flexural involvement
o Hx of generalized dry skin
o Onset of rash before 2 years of age
o And visible flexural dermatitis
● Management
o 3 goals of management
▪ Alleviate pruritus
▪ Decrease dryness and inflammation
▪ Prevent infection
o Pharmacologic Treatment
▪ Pruritus
● Benadryl 25-50 mg PO Q4-6 hours max 300 mg24 hours
● Atarax 25 mg tid/qid
▪ Inflammation
● Topical steroid- hydrocortisone
o Fluticasone propionate (Cutivate; cream 0.05%)
o Short-term (2-4 weeks)- avoid atrophy
o D/C when inflammation subsides, emollient should
be continued
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
,NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
o Potency depends on location and clinical presentation
● Nonsteroidal calcineurin inhibitor
o Moderate-severe, concern of topical steroid s/e, use short-
term and intermittent
o Tacrolimus 0.03% and 0.1% and Elidel 1%
o Maintenance 2/weekly x 12 months
● Systemic steroids
o Intermittent (1-2x/year) IM can help during flare
o More commonly used is oral
o Typical ER “dose pak” course 4-6 days in insufficient,
often requires 2-3 weeks
o Taper 60mg/40mg/20mg over 15-21 days
o Non-pharmalogic
▪ Tepid bath/soak for acute flare up
▪ Limit bathing- do not use hot water- prevent drying skin
▪ Super-fatted soaps
▪ Follow bath or soaks with emollient- hydrated petroleum (Cetaphil, Eucerin,
Aquaphor, CeraVe)
o Other
▪ Follow up in 2 weeks and 6 to 8 weeks
▪ If severe flare up, increase potency x2 weeks
▪ Moisturize!
▪ Avoid/treat secondary infection
o Indications for referral
▪ Uncertain diagnosis
▪ Attempts at management have not controlled symptoms
▪ Atopic dermatitis on face that has not responded to treatment
▪ Patient has frequent flare-ups or severe atopic dermatitis
▪ Patient requires systemic therapies for flare-ups or maintenance
▪ Condition is causing significant psychosocial disturbances (sleep
disruption, school or work absences)
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
, NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
▪ Contact allergic dermatitis is suspected (especially on the face, eyelids,
or hands)
Tinea Infections
Tinea corporis/cruris
● Lesion Assessment
o Well-circumscribed, red, scaly plaque usually on the trunk
o May occur in groups of 3 or more
o Pruritic
● Risk Factors
o Close contact with animals
o Warm climate
o Obesity
o Immunocompromised/prolonged steroid use
● Diagnosis
o Diagnostic tests
▪ KOH scraping
▪ Woods lamp (may not fluoresce if bathed recently)
● Treatment
o Topical antifungal cream- if not responsive to antifugl, consider other Dx
▪ Clotrimazole (Lotrimin) BID
▪ Miconazole (Monistat-Derm) OD to BID
▪ Ketoconazole (Nizoral) OD
▪ Terbinafine (Lamisil) OD to BID
**2 weeks treatment
Tinea pedis
● Clinical findings
o Red, itching scaling on the feet
● Diagnosis
o Appearance
o KOH prep
o Wood’s lamp
NUR 611 ANP I Exam 1 Study Guide: Dermatitis and Skin Conditions
