DERMATITIS

Activity 1.
1. Present the medical management of dermatitis by highlighting:
a. Pharmacological therapy in MNEMONIC form
2. Make a nursing care plan for patient with dermatitis.
a. Contact dermatitis
b. Atopic dermatitis
c. Seborrheic dermatitis
3. Make your own pathophysiology of:
a. Contact dermatitis
b. Atopic dermatitis
c. Seborrheic dermatitis
4. Mr. Russ is an 84-year-old man who was admitted from home to the medical surgical unit after a fall
that fractured his femur. He has a history of type 2 diabetes. He had an open reduction and internal
fixation of his femur and is now in a brace. He is 6 ft tall and weighs 160 pounds. His appetite is poor; his
wife states he has lost 15 lb. in the last 3 months. He is occasionally incontinent of urine.
a. What preventive measures can be taken to prevent skin breakdown in this patient?
Name of Drug Mechanism of Dosage Indication Contraindication Adverse Effect Nursing Alert
Action

 Description:  Adult: As  Used to treat a  Untreated Significant: For external use only.
Clobetasol Clobetasol is a 0.05% variety of skin bacterial, Hypothalamic-
very potent topical oint/cream/l conditions fungal or viral •Do not use on open wounds
pituitary-adrenal
(CLOBENATE
glucocorticoid w/ otion/gel/sc (e.g., eczema, skin lesions, (HPA) axis •Apply sparingly to occlusive
CLOBEX
anti-inflammatory, alp son: psoriasis, rosacea, suppression or
DERMACARE) dressings
antipruritic, and Apply dermatitis, perioral hypercriticism (i.e.
vasoconstrictive thinly and DRUG
allergies, STUDY dermatitis, Cushing’s syndrome, •Should not be used in the presence of
effects. It rub gently rash).
“CAD” MNEMONICS acne, and open or weeping lesions.
hyperglycemia,
promotes onto the plaque
glycosuria), contact • Drug treatment isn’t recommended
induction of affected psoriasis.
phospholipase A2 area once  Children <1 dermatitis, skin in patients younger than age 12.
inhibitory proteins daily or bid, yr. irritation.
(lipocortins), reduced if (oint/cream/lot Patient Teaching
Nervous: Numbness
subsequently necessary. ion/gel/scalp
of fingers. • Inform patient of potential adverse
inhibiting the Max dose: soln); <2 yr.
reactions.
release of 50 g wkly. (shampoo). CV: Intracranial HTN
arachidonic acid, Max e.g. bulging • Advise patient to avoid contact with
thereby depressing duration of fontanelles, eyes.
the formation, therapy: 4
headaches, bilateral
release, and wk. • Warn patient not to use drug for
papilledema.
activity of  Child: >1 longer than 14 days.
endogenous yr. Same as Dermatologic:
chemical adult dose. • Advise patient that contents of Olux
Burning and stinging
mediators of Max foam are under pressure and not to
sensation, tingling,
inflammation (e.g. duration of puncture or incinerate container.
cracking, irritation,
histamine, therapy: 5 Warn patient not to expose container
leukotrienes, itching, dryness,
days. to heat or store at temperatures above
prostaglandins). hypopigmentation,
120° F (49° C).
maceration, erythema,
folliculitis, perioral • Contents are flammable. Avoid
dermatitis, skin flame and smoking during and
atrophy, acneiform, immediately following application.
Description:
Azathioprine is an CNS: Fever, malaise If WBC count decreases rapidly or
imidazolyl derivative  The usual remains significantly and consistently
 In the GI: Abdominal pain,
of mercaptopurine starting dose low, expect to reduce dosage or
 which inhibits RNA is 50mg management  Hyper- diarrhea, hepatoxicity discontinue azathioprine.
Azathioprine and DNA synthesis, daily for 2 of psoriatic sensitivity to (elevated liver
weeks. arthritis, azathioprine or WARNING Monitor patient closely
and antagonizes function test results),
(IMURAN) atopic eczema for abnormal signs and symptoms
purine synthesis. It its components nausea, pancreatitis,
(unlicensed), suggestive of lymphomas, especially
interferes w/ cellular steatorrhea, vomiting
chronic in adolescent and young adult males
metabolism by
contact HEME: Leukopenia, who have a history of inflammatory
inhibiting coenzyme
dermatitis macrocytic anemia, bowel disease, in patients who have
functioning and
(unlicensed), pancytopenia, received a renal transplant, or in
formation; may also immunoblots thrombocytopenia patients with rheumatoid arthritis,
inhibit mitosis. diseases because the majority of patients who
(unlicensed), MS: Arthralgia,
develop a lymphoma fall into one of
cutaneous myalgia
these categories.
lupus and
other SKIN: Acute febrile
Patient Teaching
dermatological neutrophilic
conditions. dermatosis (Sweet’s • Advise patient to take oral drug with
Syndrome), alopecia, food or meals to minimize GI upset.
cancer, rash
RESP: Reversible
interstitial
pneumonitis Other:
Infection, lymphomas
and other neoplasms,
negative nitrogen
balance

Adult:
CNS:
PO Allergic Pruritic skin
Confusion, dizziness,
Diphenhydramin Description: conditions; disorders Bladder neck drowsiness WARNING:
e Diphenhydramine, a Motion obstruction,
Allergic CV: Arrhythmias, Teach patient to recognize and report
monoethanolamide sickness 25-50 hypersensitivity
(BENADRYL, conditions; palpitations, signs of infection, such as sore throat
derivative, is an mg 3 or 4 to diphen-
BENADRYL Motion sickness tachycardia and fever and to seek medical
antihistamine with times/day. hydramine or its
ALLERGY) attention for any abnormal signs and
sedative and Max: 300 components, EENT:
symptoms that might be suggestive of
antimuscarinic mg/day. For lower respiratory Blurred vision,
a malignancy.
properties. It prevention of tract symptoms diplopia
competes with motion (including When use this medication, avoid
histamine for H1 sickness, asthma), MAO GI: Epigastric
alcohol and use caution when driving
receptor sites on administer 30 inhibitor therapy, distress, nausea
or working around machinery.
effector cells in the minutes before narrow angle HEME:
blood vessels, exposure to glaucoma, • Expect to discontinue drug at least
Agranulocytosis,
gastrointestinal tract, motion. pyloroduodenal 72 hours before skin tests for allergies
hemolytic anemia,
and respiratory tract obstruction, because drug may inhibit cutaneous
Pruritic skin thrombocytopenia
stenosing peptic histamine response, thus producing
disorders as RESP: Thickened false negative results.
ulcer,
2% cream: bronchial secretions
symptomatic Patient Teaching
Apply to
benign prostatic
affected SKIN:
hyperplasia • Instruct patient to take
area(s) up to Photosensitivity
diphenhydramine at least 30 minutes
max bid for before exposure to situations that may
not more than cause motion sickness.
3 days.
• Advise her to take drug with food to
minimize GI distress.
 NURSING CARE PLAN FOR CONTACT DERMATITIS

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

Subjective:
“I extremely feel pain  Impaired skin integrity  After 4 hours of  Clean, dry, and  After 4 hours of
and later I observe blisters related to contact nursing intervention, moisturize skin, nursing
and a little bit itchy” as dermatitis as the patient relieve particularly bony intervention, the
verbalized by the patient. manifested by mild discomfort due to prominences, patient relieve
rash and itchiness skin irritation, rashes twice daily or as discomfort due to
and itchiness. indicated by skin irritation,
incontinence or rashes and
Objective: sweating. Avoid itchiness.
 Red rash  The patient also hot water. If
 Itching reduces powder is
 Dry, cracked, inflammation of the desirable, use  The patient also
scaly skin skin caused by medical grade verbalized
 Bumps and irritant or allergens cornstarch; avoid absence of
blisters, and talc. inflammation of
crusting the skin caused by
 Swelling, burning  Encourage the irritant or
or tenderness implementation of allergens
pressure-relieving
devices
commensurate
with degree of
risk for skin
impairment

 Wrap blisters with

gauze or apply a
hydrocolloid
dressing.
 NURSING CARE PLAN FOR ATOPIC DERMATITIS

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

 
SUBJECTIVE DATA: Impaired comfort related After 4 hours of nursing Assess the patient for a After 4 hours of nursing
“Clearing brush outside to pruritus secondary to intervention, the patient satisfactory comfort rating intervention, the patient
the garage and the next poison ivy as evidence will rate itching and to help measure if medical will rate itching and
day woke up with extreme patient itching poison ivy discomfort less than a 3 treatments are proficient discomfort less than a 3 on
itching and “these red lesions, grimacing on face, on a 1-10 discomfort within 1 hours of a 1-10 discomfort rating
remarks” all over my and verbalizing rating scale admission. scale
body.” As stated by the discomfort.
patient. After 4 hours of nursing Assess the patient
intervention, the patient discomfort rating by using
will display decrease a 1-10 scale. After 4 hours of nursing
emotions of grimacing intervention, the patient
and action of itching Administer per doctor’s will display decrease
skin lesions ordered Benadryl 50 mg emotions of grimacing and
OBJECTIVE DATA: IV every 6 hours as action of itching skin
 With impaired skin Patient will verbalize needed for itching. lesions
integrity extending how to properly take
throughout the body discharged home Educate the patient by
with some weeping medications of by verbalizing and providing Patient will verbalize how
lesions.  mouth Benadryl and by printed material on how to to properly take
mouth corticosteroids properly take discharged home
 Observe pain from by discharge. corticosteroids medications of by mouth
the itching  medications by discharge. Benadryl and by mouth
corticosteroids by
 Grimacing and Educate the patient by discharge.
scratching the lesions. verbalizing and providing
printer material on
 VS: Benadryl, common side
HR: 100, effects, and how to take it
BP: 150/86, properly by discharge.
Temperature: 99.2,
O2 sat 98% on RA. 
NURSING CARE PLAN FOR SEBORRHEIC DERMATITIS
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

SUBJECTIVE DATA:  Impaired skin  After 8 hours of  Encourage the patient After 8 hours of
“Magatol po syang grabe integrity related to nursing intervention, to adopt skin care nursing intervention,
and dae ko maiwasang
seborrheic the patient will have routines to decrease the patient will have
mag kagaw” as verbalized
by the patient. dermatitis as an improvement in skin irritation such as an improvement in
manifested by skin integrity with bathing and applying skin integrity with
itchiness and flaking decrease in itching topical lubricants. verbalized decrease
of the skin and decreased in in itching and
OBJECTIVE DATA: flaking.  Apply topical steroid decreased in flaking.
 Inflammation creams and
 Dry, flaky skin
ointments.
 Erosions
 Excoriations
 Fissures  Advice the client not
 Pruritus to scratch the affected
 Pain blisters areas.

 Prepare the patient

for phototherapy or
photochemotherapy.
 PATHOPHYSIOLOGY OF CONTACT DERMATITIS

Invasion of the contacted allergen to the skin

Penetrations of allergens to stratum corneum

Allergens taken by Langerhans cells

Processing of Langerhans cells by antigen

  Langerhans cells will migrate towards regional lymph nodes.

Langerhans cells taken from antigen comes to adjacent T-lymphocytes

Clonal expansion Cytokine-induced proliferation

Antigen-specific t lymphocytes get created

Travel through the blood and into the epidermis.

Langerhans cells containing the antigen interacts with the antigen-specific T-lymphocytes

Triggers a cytokine-induced proliferation

 PATHOPHYSIOLOGY OF ATOPIC DERMATITIS

External Stimuli Filaggrin mutation

Increase PH

Barrier Disruption Kallikrein activation

Protease containing-antigen exposure

Mechanical Injury

PAR-2 activation Increased PH

TSLP upregulation

TH2 induction
 PATHOPHYSIOLOGY OF SEBORRHEIC DERMATITIS

Malassezia ecosystem and interaction with the epidermis

Initiation and propagation of inflammation

Disruption of proliferation and differentiation processes of the epidermis

Physical and functional barrier disruption