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ghada kamal

on 18 April 2013

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Transcript of ceutix

OTC products for Skin Disorders The skin’s main function is to provide a barrier against dirt, germs and chemicals from the outside. We don’t notice this barrier unless it gets dry, and then it’s scaly, rough and tight. Dry skin is brittle, moist skin is soft and flexible. Minor Wounds
what are minor wounds? Wound is an injury in which the skin is broken . can call the wound minor if it 1)affects only the top layers of skin and covers a small area ,if fat or muscle or bone is visible this is an indication that wound is serious 2)bleeds for less than ten minutes if more the wound is serious 3) can be cared for without professional medical assistance but this does not mean that the wound does not require any care . the sun could discolor a minor wound
and make it more unsightly than it would be -people with diabetes must be extra cautious even when they are dealing with minor wounds this is especially true if the wound is a sore on the foot . Misconceptions it is best to let a minor wound heal over with a scab Fact : scabs actually impede the healing process by creating barrier between healthy skin cells ,the cells have to work their way under the scab in order to form new tissue and heal , in addition scabs can be easily torn or scratched which leads to re-injury
How to treat minor wounds we have 2 GOALS 1-stop bleeding 2-induce the healing process
we can do the two things by following the easy regimen
"clean ,treat ,protect" clean: antiseptic
treat : antibiotic
protect : bandage - all minor wounds should be cleansed with an antiseptic wash as soon as possible to remove dirt
all minor wounds should be cleansed with an antiseptic wash as soon as possible to remove dirt Antiseptic washes Then treated with an antibiotic ointment to
stave off possible infection
Antibiotic ointments and creams
available in the Egyptian market
1)Dermazin® cream
Silver sulphadiazine 1%
250gm 11 L.E
Alternative drugs
sulphargine cream®
Flamazine cream®
Argiderm cream ®
2)Edcocycline ® ointment
Tetracycline 3%
15gm 2.8 L.E
3)Anaflex® ointment
Polyoxin 10%
20gm 3.9 L.E

4)Baneosin® ointment
Bacitracinzinc 250 u\gm
Neomycin 5000u\gm
20gm 4 L.E
5)Farcocin ®ointment
Gentamycin sulphate 0.1% The third step is to protect the wound from the environment and protect the environment from the wound by using a bandage . Misconception :
it is better to leave the wound uncovered Fact: covering a wound with a bandage is essential to wound care.a bandage provides extra cushioning and protection from any re-injury that may occur as well as preventing exposure to water ,germs and dirt . The ideal bandage should consists of contact layer, absorbent layer and outer layer. it also should satisfy these points
1-be sterile and inert
2-stay in close contact but not stick to the wound
3-be very absorbent
4-be free of particles or fibers that might shed to the wound
5-conform to all shapes
6- minimize pain Bandages for minor wounds available in the Egyptian market 1)profix ®wound dressings
Available sizes :
2) Opifix® dressings.
3) Pharmaplast typical first aid bandage®.
4) Pharmaplast antimicrobial first aid bandage®.
5) Pharmaplast haemostatic antimicrobial first aidbandage®.
6) Cure-aid®.
Individually packed first aid bandage with absorbent pad made of different packing materials like poly ethylene film, poly urethane film, rigid fabric, elastic fabric, elastic non woven, rigid non woven, PE foam, printed PE filmwith children designs. Minor Burns Is a broader term than many think. Most people believe heat causes burns, but the medical definition of a burn has more to do with the depth of damage, not the cause. Burns can be : OTC product for skin disorders Atopic and contact dermatitis and dry skin Scaly Dermatoses 1- Thermal (from extremes of heat or cold), . Minor Burns Minor Wounds Diaper Rash and Prickly Heat 2- Chemical (such as acid), 3-Radiant ; (sunburn, x-rays or artificial ultraviolet rays from a tanning booth). All the mechanisms cause skin damage
and you should treat them similarly. New classification of Burns Atopic and contact dermatitis and dry skin The old "first, second, and third degree" naming system is still common with the public, but doctors now use : a. Partial thickness burns a.Dermatitis (first degree and second degree)
usually heal well and are easier to care for. This is because new skin can grow upward from the dermis (over the body surface area of 15% or less and can be treated using OTC products ) b. Full thickness burns Aetiology: (third degree burn)
the dermis is destroyed, no skin can grow back in that area and deep scarring develops unless skin grafting is performed so it must be referred to physician . sun burns Atopic eczema: atopic eczema is a chronic fluctuating inflammatory condition of the skin with no known cause, although there is often a genetic link and a family history of allergic sensitivity. For the classic sun burn (first degree burn) with redness, slight swelling, and mild pain, home treatment is safe and works well for up to 50% of the body surface. 1. Irritant dermatitis Blistering burns (second degree) can be self-treated in many cases but should be seen by a physician if: 1- More than 1% of your skin surface is involved
(more than the size of the patient’s palm). 2- Face, neck, genital area, hands, or feet are involved. 3-Any child under 12. You should never self-treat a full thickness burn, no matter how small. The risk of infection and scarring is too high. Any electrical, steam, or inhalation burn (such as smoke, chemical, or extremely hot air or vapors) must be evaluated by a physician right away. These types of burns can have unusual complications despite mild symptoms at first. prevention Since nearly all burns are accidental prevention is mostly a matter of basic safety avoiding extreme heat, caustic chemicals, etc But there is one type of burn that people practically seek out: Sun Burn Irritant agents include: detergents and household cleaning materials; hair tints and perming solutions; building and gardening products.
The conditions maybe chronic, e.g. from continual wetting of the skin. Results of direct damage to the skin on first exposure to strong irritant or repeated exposure to a milder one.
Irritant substances can then pass the damaged keratin layer into the cells of the epidermis and cause an inflammatory reaction. Because it isn’t immediately painful, is associated with fun activities, and results in a pleasant skin tone if you don’t go too far, many people are willing to risk a little first degree burning. The terms ‘eczema’ and ‘dermatitis’ are used to describe a range of inflammatory skin conditions of which the principle symptoms and dryness, erythema and itch, often with weeping and crusting. The term ‘eczema’ applies to conditions with endogenous cause in atopic individuals and ‘dermatitis’ to reactions to external agents. Irritant dermatitis Allergic dermatitis There are 2 types of Contact dermatitis: Results of direct damage to the skin on first exposure to strong irritant or repeated exposure to a milder one. Irritant substances can then pass the damaged keratin layer into the cells of the epidermis and cause an inflammatory reaction. 2. Allergic dermatitis Results of hypersensitivity to a sensitizing agent. It can occur after a couple of exposures or may take several years of repeated exposure to develop. Once established, sensitivity usually remains for life. Signs and symptoms b. Dry skin \ This is characterized by roughness, scaling, fissures, inflammation and pruritus. Possible triggering factors for dry skin The skin’s main function is to provide a barrier against dirt, germs and chemicals from the outside. We don’t notice this barrier unless it gets dry, and then it’s scaly, rough and tight. Dry skin is brittle, moist skin is soft and flexible. Internal factors causing dry skin Health Age Family History History of other medications Like asthma, allergies and atopic dermatitis.
In particular those with thyroid disease are more prone to developing dry skin External factors cauing dry skin Low humidity and exposure to the wind Over-washing with harsh soaps Overuse of sanitizers and cleaning agents (alcohol) Cold temperature Symptoms of Atopic dermatitis Small, raised bumps, which may leak fluid and crust Red brownish-grey colored patches (1) (2) Itching (3) Thickened, cracked or scaly skin Occur in folds of the elbows, backs of the knees or the front of the neck (4) Red rash or bumps Allergic contact dermatitis Also, itching and pain or tenderness Blisters and draining fluid from the involved skin in severe cases Caused by physical contact with an irritant or allergen include rubber, costume jewellery, perfume, cosmetics, hair dyes and weeds. Irritant contact dermatitis Red rash or bumps, Skin rash is limited to the exposed area Results from repeated contact with a substance, such as soap, cosmetics or skin products, including deodorant, Dry, red patches, which may resemble a burn ` Scaly dermatosis A variety of skin disorders characterized by scale formation due to high rate of skin turnover: Dandruff Seborrhoea Psoriasis Chronic non inflammatory condition, due to a naturally increased horny substance production and cell turnover on the scalp.
Characterized by scaling and occasional pruritus.
Commonly associated with the Yeast Pityrosporum ovale fungal infection. Sometimes associated with raised androgen levels.
It occures in early adulthood, and less prominant after 75 years. Yellowish greasy scales appear over the scalp and forehead. Accompanied by pruritus and redness.
In severe cases, the lesions extend to part of the face eye browse eye lashes, nasal folds or even the back and chest. In such case refer to dermatologist.
It’s more common in infants.
It’s more severe in winter.
It’s commonly found in people with Parkinsonism. Silvery Scales “known as plaque” that are on top and pink to dull red beneath, common on the knees and elbows. Scalp lesions are well defined; raised salmon pink to full red in colour. Scalp psoriasis often extends just below the scalp margin, leaving an inflammatory scaly border.
In plaque psoriasis skin rapidly accumulate at the epidermis. 1. Gently washing your baby’s hair and scalp may prevent a buildup of flakes.
2. Massaging a small amount of baby oil, olive or petroleum jelly into the scalp at night may help soften the patchy scales.
3. In the morning, using soft baby brush gently removes any loose particles, and then wash the hair with a baby shampoo.
4. If Cradle Cap become inflamed or infected, a course of antibiotics or anti-fungal cream or shampoo such as ketoconazole may be prescribed by a doctor.
5. Also we can use hydro cortisone for inflamed rash. cradle cap condition It is infantile neonatal Seborrhoeic dermatitis, also known as crusty lactea, milk crust, and honeycomb disease. It is yellowish patchy, greasy, scaly and crusty skin rashes that occur on the scalp of recently born babies. It’s usually not itchy. Occur in the first 3 months. The rash is prominent around the ear, the eyebrow. When it occurs in other locations it is called Seborrhoeic dermatitis. 1. Appearance of dry scales on baby scalp. These scales will become greasy and may turn red, brown or yellow.

2. Patches of scales can cover a child’s entire head and they can take a crusty appearance.

3. Cradle cap is not painful, but it can become irritant or itchy to children. Symptoms Treatment Cradle cap requires no specific treatment and will clear up on its own with time. However we might try: 1.Persisting or even worsend dandruff despite treatment.
2.Severe seborrhoeic dermatitis.
3.Sudden onset of seborrhoeic dermatitis for the first timein a middle aged person which may be a sign of HIV infection.
4.Psoriasis (of any degree). Refer to dermatologist incase of:  
1.Irritant diaper dermatitis IDD is characterized by joined patches of erythema and scaling mainly seen on the convex surfaces, .with the skin folds spared  
2.Candidal dermatitis Distinctive clusters of erythematous papules and pustules are present, which later coalesce into a beefy red confluent rash with sharp borders

Satellite lesions frequently are found beyond these borders.

Skin folds commonly are involved.
occurs when fungal origin is identified Complications: Diaper dermatitis with secondary bacterial or fungal involvement tends to spread to concave surfaces (i.e. skin folds), as well as convex surfaces, and often exhibits a central red, beefy erythema with satellite pustules around the border. FDA doesn't recommend OTC dispensing of:
1. External analgesic.
2. Antifungal.
3. Hydrocortisone. Diaper rash Is an acute dermatitis of skin in the diaper area. Can occur in elderly people and is termed incontinence dermatitis. Symptoms Aetilogy Irritant diaper dermatitis Candidal dermatitis Ammonical dermatitis Other aggravating factor Sensitizing agents include: rubber in household gloves and footwear; nickel in costume jewellery, zips and belt buckles; resins in glues; ingredients of cosmetics; some plants; and paints. Strong pruritus, erythema and swelling “mild edema” When acute, vesicles on an erythematous base in the lesion area When chronic, skin is dry and scaly, also fissures may appear. (lichenified i.e. hard leather skin may result from scratched atopic dermatitis lesions) Atopic eczema: involves inside elbows, behind knees, cheeks, forehead and outer limbs.
Contact/allergic dermatitis is only limited to the irritant/allergen contact area, although chronic exposure to allergen may cause widespread allergic dermatitis Genetics Moisturizers and emollients Emollients Bath products Bath oils, oatmeal products Humectants Vaseline, mineral oils and lanoline based products (e.g. Oilatum ointment®) Glycerol or propyl glycerol soaps and creams. Bath oil deposits a thin layer of oil on the skin upon rising from the water.
Creams are used when more emollience is required on these latter areas.
Ointments are prescribed for drier, thicker, more scaly areas.
Humectant/keratolytics are particularly important in management of the ichthyoses.
Oilatum Emollient is indicated in the treatment of contact dermatitis, atopic dermatitis, senile pruritus, ichthyosis and related dry skin conditions. Product selection Oral antihistaminic A. Sedating (1st generation) Allergyl tab dramenex Primalan tab Oral antihistaminic Sedating
(1st generation) Non-sedating long acting (2nd generation) Topical
anti-histaminic Tavegyl treatment antiseptics as alc.60-95% , hydrogen per
oxide 10% .povidone iodine 5-10% soln (Betadine) 1- polymyxine + bacitracin +neomycin topical antibiotics 2- bacitracin powder 3- tetracyclines ointments 1- panthenol healing promotors 2-beta setosterol (mebo cream ) Antihistamines may make young children sleepy or may stimulate the nervous system, causing hyperactivity
In rare cases, diphenhydramine can cause severe side effects in children, such as hallucinations, tremors, and coma. In children Antihistamines may cause drowsiness, weakness, blurred vision, dry nose, mouth, and throat, difficulty urinating, or stomach upset also can occur. Side effects of antihistaminic In older children and adults This medication is contraindicated in patients with urinary retention, narrow-angle glaucoma, and concurrent use of monoamine oxidase (MAO) inhibitor antidepressants. Contraindications B. Non-sedating long acting (2nd generation) Dosage adjustment in renal/hepatic impairment:
Children <6 years: Cetirizine use not recommended
Children 6-11 years: <2.5 mg once daily
Children >/= 12 and Adults. Dosage adjustment in renal impairment: Clcr </= 30 mL/minute:
Children 2-5 years: 5 mg every other day
Children >/= 6 years and Adults: 10 mg every other day. Loratadine tablets/syrup (Claritin®) Cetirizine tablets/syrup (Zyrtec®) Common side effects Some people experience drowsiness while headache, nervousness and fatigue are common in children 2-12 years old. Pregnancy and lactation: avoid. Driving: possible effects. contraindicated for children under 2 years. C. Topical antihistaminic Dimethindine maleate (Fenistil®) Chlorphenoxamine cream (Allergex®) Might help in mild cases, should be tried before topical corticosteroids. Topical corticosteroids Hydrocortisone 1% (hydrocortisone ointment®), clobetasone butyrate 0.05% (Eumovate® cream/ointment) are the only topical corticosteroids approved for OTC sale to treat mild to moderate eczema/dermatitis. Because they are soft steroids. Soft steroids : Soft steroids are topical steroids with a low rate of side effects in relation to their anti-inflammatory potency. However, side effects, such as cutaneous addiction with the development of uncomfortable and unsightly dermatoses, can occur with just one 15gm tube of moderate steroid over a period of one year What is 'Soft Steroids' ? They are used to suppress the inflammation in the skin that causes flare-ups of eczema. They are not a cure as they have no effect on the underlying cause of the inflammation, but they do control the flare-up and relieve the symptoms, such as itching and redness.
Controlling the itching reduces the desire to scratch and therefore reduces the chance of the eczema getting infected. 1. OTC dispensing of these product is limited to adults and children aged 10 (hydrocortisone) or 12 (globetasone) and over and for no more than 7 days of continuous treatment without occlusion.
2. Do not dispense for lesions: on the groins genitals or between the toes, on the face, on broken or weeping skin. Precautions and warnings: The thin skin of the eyelids and face absorb topical steroids rapidly; therefore a group VI or VII steroid should be used in these areas. Any of the higher groups significantly increase the risk of side effects.. Areas where skin touches skin such as the groin, rectal area, and armpits absorb topical steroids rapidly requiring a lower potency steroid. The skin of infants and young children absorb topical steroids more readily, also requiring a lower potency steroid. -Usual Adult Dose for Dermatitis& eczema:
Topical cream, ointment, solution, gel, or lotion:
*Apply to the affected area 2 to 4 times a day.
*For treatment of resistant dermatoses, hydrocortisone may be used with occlusive dressings.

Butyrate cream, ointment or solution:
Apply to the affected area once or twice a day. To prevent tachyphylaxis, a topical steroid is often prescribed to be used on a week on, week off routine. Some recommend using the topical steroid for 3 consecutive days on, followed by 4 consecutive days off..
Long-term use of topical steroids can lead to secondary infection with fungus or bacteria ,skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility. So, why is it restricted to use corticosteroids in each of the 3 site/case? Dosage form selection Patient advice concerning dosing and application Miscellaneous A. Keratin softeners:
*Hydroxyl acids. 1. Urea 10-30% (Carbamide® cream 10%)
2. Lactic acid 2-5% (lacticare® lotion 2%) For ichthyosis, dry or lichenified skin in atopic eczema and otherchronic dry skin conditions. B. Astringents Used for oozing dermatitis C. Local anaesthetics To relief pruritus Pharmacological class/indication:

1. Cytostatic agents

2. Fungicidal agents

3. Cross linking with DNA (DNA-blockage)

4. Keratolytic agents

5. Topical corticosteroids 1. Cytostatic agents Zinc pyrithione 0.3-2%
(Head and shoulders® shampoo) Selenium sulfide 1% (Selsun blue® shampoo) *Not for children under 5 years.
*Contraindicated in the 1st trimester.
*Highly toxic if ingested orally.
*If micronized Seleniumsulfide is used, only 0.6%is approved as OTC. Massage into wet scalp, lather well and rinse leaving lather on scalp for 3-5 minutes. For best results use at least twice a week or as directed by a doctor. 2. Fungicidal agents Ketoconazole 1% (Nizoral® shampoo) Sulphur 2-5% (Sacnel® soap; also contains salicylic acid and resorcinol) For both dandruff and seborrhoeic dermatitis. 3. Cross linking with DNA (DNA-blockage) Coal tar (Polytar® shampoo) *Cause skin discoloration and has a bad smell.
*Causes photosensitization of skin and shouldn’t be used before exposure to sunlight.
*Mainly used for Psoriasis under medical supervision. 4. Keratolytic agents Salicylic acid 2-3% (Vavo® shampoo) Coal tar/Salicylic acid ointments are very useful for scalp psoriasis. 5. Topical corticosteroids Betamethasone is POM
(Betnovate® scalp lotion) Hydrocortisone 1% (hydrocortisone ointment®) *Mostly used for the inflammation associated with psoriasis.
*Rarely in seborrhea.
*Not used in dandruff. oral analgesics 1-acetaminophene
2- ibuprofen
3- aspirin lignocaine 5%gel and lidocaine 10% spray Burn Treatment topical
antibiotics healing
promotor oral and local
analgesics local analgesics recommended products Adaptic Mycitracin I Aleve (non-stick wound dressing). This type of dressing in a second degree burn has several advantages, including easier and less painful dressing changes, much quicker healing, and preventing maceration (break down of skin due to excessive moisture). naproxen sodium 220 mg). This quick acting anti-inflammatory gives 8-12 hour pain relief (longer than other OTC anti-inflammatories). Because inflammation is a main factor in burn pain, Aleve can be more effective than acetaminophen products. This longer acting anti-inflammatory works well with faster topical anesthetics such as Dermoplast. (polymyxin B 10,000 IU/g, bacitracin zinc 500 IU/g, neomycin sulfate 5 mg/g). If prevention of infection in second degree burns is important, there is no stronger OTC antibiotic than this product. Applied 2-3 times a day it is very helpful in combination with good wound care for preventing infectious complications of burns. Dermoplast spray (benzocaine 20%, menthol .5%). For the sometimes severe pain of first degree burns (as opposed to the raw open wounds of second degree burns), this product can provide instant but temporary relief from the surface burning sensation. Quick acting surface anesthetics like these work well in combination with longer acting, but slower onset anti-inflammatories such as Aleve. Betadine Ceteal Dermobacter povidine iodine 10 % 200 ml
10.5 L.E chlorethexidine 0.5
chlorocresol 0.3 %
250 for 9 L.E benzakoniumchloride solution 0.985 gm
chlorhexidine di glucoulate sol. 1.065 gm
125ml for 4 L.E
300 ml for 7.5 L.E dermazin cream Anaflex ointment silver sulphadiazine 1 %
250 gm 11 L.E edcocyclin ointment tetracycline 3 % polyoxin 10 % baneocin ointment farcocin ointment ... small Prickly heat It is a transient inflammation of the skin that appears as a very fine red rash in any part of the body. Etiology It happens when sweat can't escape through the sweat glands and then leaks into the skin layers below.
This can cause tiny spots and bumps to appear on your skin.
Even if you don't sweat very much, small amounts of sweat
can still block your sweat glands and cause prickly heat. The condition is usually
made worse by: 1. Hot humid weather. 2. Fever associated with
excessive sweating 3. over clothing 4. Poor bathing habits. prickly
heat Miliaria
crystalline Miliaria
rubra Miliaria
profunda Miliaria crystalline Is when the blockage is in the top of the upper layer of your skin (epidermis).
This is common in newborn babies as well as in adults who have a fever or who have recently entered a tropical climate Small, clear spots. Not itchy In babies:On the head, neck
and the upper part of the torso.
In adults:on the torso Miliaria rubra Is when the blockage in your sweat gland is in a deeper part of your epidermis. It commonly affects babies (who are one to three weeks old) and adults in hot, humid environments Red spots on skin, and the skin around
the rash is also usually red. Very itchy and prickling sensation In babies and young children: on the neck, groin and armpits.
In adults:on neck, scalp, the upper part of chest and back Miliaria profunda
Is caused by a blockage in the deep layer of your skin known as the dermis.
It’s less common than the other two types of prickly heat.
You may get it after having repeated bouts of Miliaria rubra Large spots with a flesh-colored head. on torso, arms and legs Prickling sensation on skin Complications heat stroke skin infection This is a serious condition that develops when your body becomes overheated very quickly.
The symptoms of heatstroke include headache, dizziness, confusion and a body temperature over 40°C.
If heat stroke is not treated and the body is not cooled, death can occur Heat stroke skin infection According to Health line, bacteria that are normally found on the skin block the glands, preventing sweat from escaping. In addition to the discomfort from the rash, it can also cause bacterial infections.
One common infection is a staph skin infection. It usually presents as skin sores such as boils or crusted ulcers.
The severity of the infection varies per person and is usually treated by antibiotics.
Fungi can become trapped in the glands as well. Fungal infections are generally denoted by itching or burning skin as well as rashes with defined edges. Treatment approches 1) Take a cool bath with cornstarch,
oatmeal or baking soda 2) Gently clean the prickly heat rash area
with a mild body soap to remove germs, sweat and dirt.
After soaking in the tub, gently pat the area
dry with a clean towel 3) Apply hydrocortisone cream
to relieve itching
Prevention of prickly heat 1. Try not to go to hot places 2.try to become acclimatized to the heat slowly
and stick to cool, air-conditioned places as much as possible 3.Wear loose, lightweight clothing in hot climates Spread a product that contains salicylic acid
(such as acne treatment pads) over the bumps. This will assist in drying the rash and unclogging the pores. Cooling creams such as those containing menthol
or calamine may help if your rash is particularly itchy or uncomfortable. Try not to wear tight clothing,
particularly when you’re doing physical activity Stick to cooler climates or
air-conditioned environments 5. HIV. Causes of Seborrhea 1.Over production of skin oil. 2.Yeast of malassezia. 3.It appears to run in families. 4.Parkinsonism disease and stroke. It occurs in young adults. It is characterized by red spots appear on upper trunk and proximal extremities. Types of psoriasis It characterized by red rash covered with silvery white scales. It is the most common type of psoriasis. It appear on the knee, elbow and the lower back. 1- Plaque psoriasis (psorasis vulgaris): 2- Guttate psoriasis It is characterized by presence of red shiny spots. It occur under breast and other folds. It occurs due to irritation by excess sweating. It is more common in people with increased weight. 3-Inverse psoriasis: 4-Pustular psoriasis: It is characterized by presence of blisters surrounded by red skin. It is fiery redness. It causes congestive heart failure, protein and fluid loss and pneumonia. Patients with this type of psoriasis must be hospitalized. Doctor may give cortisone orally and may give coal tar with high concentration. 5-Erythrodermic psoriasis: treatment skin
protectant anti fungal anti microbial skin protectant zinc olive lotion Calamine lotion
(CalamylR lotion) talc powder White petrolatum (VaselineR ),
Mineral oil (Johnson's baby oil). Antimicrobial Benzalkoniumchloride
cetrimide cream
and topical antibiotics Antifungal OTC products 1-Nystatine 2-clotrimazole 3-micronazole nitrate Old classification of burns Old classification of burns 1st degree 2nd degree 3rd degree 1st degree burns 2nd degree burns 3rd degree burns Special burns Mechanism of skin irritation When urea breaks down in the presence of fecal urease, it increases pH because ammonia is released, which in turn promotes the activity of fecal enzymes such as protease and lipase. These fecal enzymes increase the skin's hydration and permeability to bile salts which act as irritants in and of them. Other aggravating factor Effects of diet Resulting breakdown of the stratum corneum. Increased skin pH caused by urine and feces Prolonged wetness The interaction between fecal enzyme activity and IDD explains the observation that infant diet and diaper rash are linked because fecal enzymes are in turn affected by diet. 1. Effects of diet Diaper rash is diagnosed by: a. Infants 8–12 months old, perhaps in response to an increase in eating solid foods and dietary changes around that age that affect fecal composition. b. Infants treating with antibiotics, which affect the intestinal microflora. c. Infants who have suffered from diarrhea in the previous 48 hours, which may be because fecal enzymes such as lipase and protease are more active in feces which have passed rapidly through the gastrointestinal tract. Repeat these steps every three to four hours
to relieve the itching and heal the rash 3. Ammoniacal dermatitis When the ammonical odour from the diaper is very pronounced and accompanied by irritation of the skin of the diaper region.
The lesion may consist only of diffuse redness but not infrequently vesicles and papules with more or less excoriation occur.
So the dermatitis is caused directly by the ammonia. The incidence of diaper rash is lower among breastfed infants—perhaps due to their lower enzymatic activity and the less acidic nature of their urine and stool. The stratum corneum's function:
a. Reduce water loss.
b. Repel water.
c. Protect deeper layers of the skin from injury.
d. Repel microbial invasion of the skin.
In infants, this layer of the skin is much thinner and more easily disrupted. stratum corneum 1. Use diapers made up of single layer porous soft cloth (nappies) or superabsorbent disposable diapers with a central gelling material.
2. Change cloth nappies as soon as they are soiled.
3. Don’t over tighten diapers.
4. Don’t scrub baby’s bottom. Prevention Babies wearing superabsorbent disposable diapers with a central gelling material have fewer episodes of diaper dermatitis compared with their counterparts wearing cloth diapers.

Whether wearing cloth or disposable diapers they should be changed frequently to prevent diaper rash, even if they don't feel wet. Non-pharmacological measures To reduce the incidence of diaper rash, disposable diapers have been engineered to pull moisture away from the baby's skin using synthetic non-biodegradable gel. 1. External analgesic due to deficient clinical data demonstrating safety in babies. FDA doesn't recommend OTC dispensing of: 2. Antifungal as fungal infections associated with diaper rash are not suitable for diagnosis by pharmacists. 3. Hydrocortisone as the excessive usage of minimally concentrated hydrocortisone cream and the use of increased potency hydrocortisone preparations are notorious for causing secondary side effects. So they should only be used under the guidance of a pediatrician or another physician who is fully familiar with their application to infants. Role: Skin protectant, soothes irritated skin. Safety: Mildly antiseptic. Without causing irritation. skin layers the distinction is critical ,as the treatment is
completely different (anti fungal ) Babies on antibiotics generally develop this type of rash that appears in thighs and abdomen. These bright red diaper rashes cause immense irritation to the babies Role: Skin protectantantipruritic (topical)
Safety: Problems in humans have not been documented
For external use only; keeping away from eyes and other mucous membranes such as the mouth, nose, and an genital region. Role: Various moisture-absorbing powders.
Safety: There have been numerous reports of babies having life-threatening episodes from inhaling the powder which is made up of finely grounded particles.
Role: Skin protectant, water repellant, a barrier Not so safe with debates on its use for diaper dermatitis It is advised not to use topical antibiotics to treat diaper rash in infants due to the antibiotic resistance that can develop when antibiotics are overused. thank you :)
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