NAME: ABDUSALIM, MOHAMMAD DIRHAM U.

BSPh 3 – B
Assessment of the Case Presented:
Symptoms and Characteristics of the disease:
1. Eczema (Atopic dermatitis):
• Characterized by itching, chronic lichenified patches, and
hyperpigmentation.
• Aggravated by irritants, excessive bathing, wide temperature variation, low
humidity, and nervous tension.
• Treatment includes wet compresses, topical steroids, and oral antipuritic
medications.
2. Psoriasis:
• Chronic disease with epidermal hyperplasia and accelerated epidermal
turnover.
• Lesions are raised, scaly, erythematous plaques and papules covered with
white or silvery scales.
• Commonly found on extensor surfaces, back, scalp, and nails.
• Treatment options depend on the extent and location of the lesions and
include topical corticosteroids, ultraviolet light, tar compounds, keratolytic
agents, and corticosteroid solutions/shampoos.
3. Scabies:
• Contagious disease caused by Sarcoptes scabiei (itch mite).
• Intense itching of the skin and excoriation from scratching.
• Mite burrows into the skin and lays eggs, resulting in a pruritic popular rash.
• Diagnosis can be made by microscopic identification of mites, larvae, or
eggs in skin scrapings.
• Treatment options include Lindane (10% gamma benzene hexachloride)
cream or lotion, or 10% crotamiton cream or lotion.
Laboratory test with abnormal values:
• Phenytoin level: 4 (above therapeutic range)
• HCO3 (bicarbonate): 19 (below normal range)
Disease associated with abnormal Laboratory result:
The abnormal phenytoin level is associated with the seizure disorder for which D.T. is
receiving phenytoin medication.
Medication given for the treatment of the disease:
• Hydrocortisone ointment 1% (prn) for eczema
• Triphasil 28 (oral contraceptive)
• Phenytoin 300 mg (anticonvulsant)
• Psyllium (prn for constipation)
• Phenolphthalein (prn for constipation)
Interactions, if any:
There are no specific medication interactions mentioned in the case presentation.
Appropriate drug/ procedure to avoid interactions or to improve patient’s
condition:
1. The phenytoin level is above the therapeutic range, indicating potential toxicity.
The dosage may need adjustment or monitoring of phenytoin levels to ensure it
remains within the therapeutic range.
2. As the patient has hypothyroidism with a palpable thyroid, further evaluation and
appropriate thyroid hormone replacement therapy may be required.
3. The patient's symptoms of depression, fatigue, weight gain, and other associated
complaints should be evaluated and managed accordingly, possibly with
psychiatric consultation and adjustment of antidepressant medication if needed.
4. Referral to a dermatologist for further evaluation and management of psoriasis,
eczema, and scabies may be necessary to optimize treatment and address the
skin-related concerns.
Questions:
1. What are the preventive measures for skin diseases?
Answer:
Preventive measures for skin diseases vary depending on the specific condition, but here
are some general guidelines to help maintain healthy skin and minimize the risk of
developing skin diseases:
1. Practice good hygiene: Regularly wash your skin with mild soap and warm water to
remove dirt, bacteria, and other potential irritants. Avoid using harsh soaps or excessive
scrubbing, as this can strip the skin's natural oils and disrupt its protective barrier
2. Moisturize regularly: Keep your skin well moisturized to prevent dryness, cracking, and
irritation. Choose a moisturizer suitable for your skin type and apply it after bathing or
showering when the skin is still slightly damp.
3. Protect your skin from the sun: Use sunscreen with a high SPF (sun protection factor)
to shield your skin from harmful UV rays. Apply it generously and reapply every two hours
or more frequently if you are sweating or swimming. Additionally, wear protective clothing,
such as hats, sunglasses, and long sleeves, and seek shade during peak sun hours.
4. Avoid excessive bathing and hot water: Prolonged exposure to hot water and frequent
bathing or showering can strip away the skin's natural oils, leading to dryness and
irritation. Limit your bathing time and use lukewarm water instead of hot water.
5. Identify and avoid triggers: If you have a known skin condition or are prone to skin
allergies, identify and avoid triggers that can worsen your symptoms. Common triggers
include certain fabrics, harsh chemicals, fragrances, certain foods, and environmental
factors like extreme temperatures or humidity.
6. Maintain a healthy lifestyle: Adopting a healthy lifestyle can have a positive impact on
your skin's overall health. This includes eating a balanced diet rich in fruits, vegetables,
and whole grains, staying hydrated, getting regular exercise, managing stress levels, and
getting sufficient sleep.
7. Be cautious with skincare products: Read ingredient labels carefully and choose
skincare products that are suitable for your skin type and free from potential irritants or
allergens. Avoid using expired products and be mindful of any adverse reactions or
sensitivity.
8. Protect against insect bites: Use insect repellents, wear protective clothing, and take
necessary precautions to prevent insect bites, which can lead to skin infections or allergic
reactions.
9. Avoid sharing personal items: Sharing personal items such as towels, clothing, razors,
or combs can potentially transmit skin infections. Keep your personal items separate and
avoid sharing them with others.
10. Regular skin checks: Perform regular self-examinations of your skin to monitor any
changes or new growths. If you notice any concerning or suspicious lesions, moles, or
changes in your skin, seek medical attention for proper evaluation and early detection of
potential skin diseases.
Remember, it's always advisable to consult with a healthcare professional or
dermatologist for personalized advice and guidance on preventive measures specific to
your individual skin condition or concerns.
2. What is the effect of prolonged use of topical steroids?
Answer:
Prolonged use of topical steroids can have several effects on the skin and the body,
including:
1. Skin Thinning: Prolonged use of potent or high-potency topical steroids can cause
thinning of the skin, known as cutaneous atrophy. This thinning can make the skin more
fragile and prone to injuries, bruising, and tearing.
2. Striae (Stretch Marks): Topical steroids can contribute to the development of stretch
marks, especially when used on areas with thin skin or under occlusive dressings.
3. Telangiectasia: Prolonged use of topical steroids can lead to the dilation of small blood
vessels near the surface of the skin, resulting in the appearance of fine, red lines called
telangiectasia.
4. Hypopigmentation or Hyperpigmentation: Topical steroids can disrupt the normal
production and distribution of melanin, the pigment responsible for skin coloration. This
can lead to either lightening of the skin (hypopigmentation) or darkening of the skin
(hyperpigmentation) in the treated areas.
5. Steroid Acne: Prolonged use of topical steroids can cause or worsen acne-like
eruptions, known as steroid acne. These eruptions may include pustules and papules on
the face, chest, and back.
6. Increased Hair Growth: In some cases, prolonged use of topical steroids can stimulate
hair follicles, leading to increased hair growth in the treated areas.
7. Skin Rebound: When topical steroids are abruptly discontinued after prolonged use,
the skin may experience a rebound effect. This can manifest as a flare-up of the
underlying skin condition or the development of new symptoms.
8. Systemic Effects: Although less common with topical use, prolonged and excessive
application of potent or high-potency topical steroids can result in systemic absorption,
leading to potential systemic side effects. These may include adrenal suppression,
Cushing's syndrome, and metabolic disturbances.
It's important to note that the risk and severity of these effects depend on factors such as
the potency of the topical steroid, duration of use, application site, and individual
susceptibility. Therefore, it is crucial to use topical steroids as prescribed by a healthcare
professional, follow the recommended duration of treatment, and be mindful of potential
side effects. Regular follow-up with a healthcare provider is also important to monitor the
response to treatment and adjust therapy if necessary.
3. Give the different topical steroids available in the market.
Answer:
There are numerous topical steroids available in the market, varying in potency and
formulation. Here are some commonly used topical steroids classified according to their
potency:
Low-potency topical steroids:
1. Hydrocortisone (1%): Available over-the-counter, used for mild inflammatory skin
conditions and itching.
Medium-potency topical steroids:
2. Triamcinolone acetonide (0.1%): Used for various inflammatory skin conditions, such
as eczema and dermatitis.
3. Fluocinolone acetonide (0.025% - 0.1%): Used for inflammatory skin conditions and
itching.
4. Mometasone furoate (0.1%): Used for eczema, dermatitis, and psoriasis.
High-potency topical steroids:
5. Betamethasone dipropionate (0.05%): Used for severe inflammatory skin conditions,
such as psoriasis and atopic dermatitis.
6. Clobetasol propionate (0.05%): Used for severe inflammatory skin conditions,
especially in resistant cases.
Super-high-potency topical steroids:
7. Halobetasol propionate (0.05%): Used for severe inflammatory skin conditions, limited
to short-term use in small areas.
8. Diflorasone diacetate (0.05%): Used for severe inflammatory skin conditions, limited to
short-term use in small areas.
It's important to note that the choice of topical steroid depends on the specific condition
being treated, the affected area, the severity of inflammation, and individual patient
factors. The selection of the appropriate potency and formulation should be determined
by a healthcare professional, taking into consideration the potential risks and benefits of
treatment.
4. What are keratolytic agents? Give the composition of each.
Keratolytic agents are substances or medications that promote the shedding or exfoliation
of dead skin cells from the outermost layer of the skin (epidermis). They help to soften
and remove the thickened, hardened, or scaly skin commonly seen in various skin
conditions such as psoriasis, calluses, and corns. Here are some commonly used
keratolytic agents along with their compositions:
1. Salicylic Acid:
- Composition: Salicylic acid is a beta-hydroxy acid derived from plants. It is available
in various concentrations ranging from 0.5% to 30% in different formulations such as
creams, gels, ointments, and solutions.
- Mechanism of Action: Salicylic acid works by breaking down the intercellular
connections between the skin cells, leading to the loosening and shedding of the outer
layer of skin. It also has mild anti-inflammatory properties.
2. Urea:
- Composition: Urea is a natural compound found in the skin. In topical preparations, it
is typically used in concentrations ranging from 2% to 40%.
- Mechanism of Action: Urea works by increasing the water content in the skin, which
helps to hydrate and soften the dry, scaly skin. It also helps to break down keratin, a
protein found in the outermost layer of the skin.
3. Lactic Acid:
- Composition: Lactic acid is an alpha-hydroxy acid derived from milk or other natural
sources. It is used in various concentrations in topical formulations.
- Mechanism of Action: Lactic acid acts as a gentle exfoliant by loosening and dissolving
the bonds between dead skin cells. It helps to promote cell turnover, resulting in smoother,
softer skin.
4. Coal Tar:
- Composition: Coal tar is a byproduct of coal processing. It is available in different
concentrations, usually ranging from 0.5% to 10%, in the form of creams, ointments,
shampoos, and bath solutions.
- Mechanism of Action: Coal tar has keratolytic, anti-inflammatory, and antifungal
properties. It helps to reduce excessive skin cell production, soften scales, and alleviate
itching and inflammation associated with various skin conditions.
It's important to note that the choice of a keratolytic agent and its concentration depends
on the specific skin condition, the severity of the condition, and individual patient factors.
It is recommended to use keratolytic agents as directed by a healthcare professional and
to follow the instructions provided with the specific product.
5. What are the common manifestations of allergic skin diseases?
Answer:
Allergic skin diseases can manifest in various ways, and the specific symptoms and
manifestations may vary depending on the type and severity of the allergic reaction. Here
are some common manifestations of allergic skin diseases:
1. Skin Rash: One of the primary manifestations of allergic skin diseases is the
development of a skin rash or hives (urticaria). These rashes are often itchy and may
appear as raised, red bumps or patches on the skin. The rash can be localized to a
specific area or spread across larger areas of the body.
2. Eczema (Atopic Dermatitis): Atopic dermatitis is a chronic inflammatory skin condition
characterized by dry, itchy, and inflamed skin. It often presents with red, scaly patches or
plaques, typically in flexural areas (such as behind the knees or in the elbow creases),
but it can affect other parts of the body as well.
3. Contact Dermatitis: Contact dermatitis occurs when the skin comes into contact with
an allergen or irritant substance, leading to a localized inflammatory reaction. It can cause
redness, itching, swelling, and the development of blisters or oozing skin.
4. Allergic Dermatitis: Allergic dermatitis refers to a delayed hypersensitivity reaction in
the skin caused by exposure to an allergen. It can present as a red, itchy rash with
swelling, blisters, and crusting.
5. Angioedema: Angioedema is characterized by swelling that occurs deeper in the skin
layers, typically affecting the lips, eyelids, face, hands, or feet. It can cause significant
swelling, pain, and a sensation of tightness or pressure in the affected areas.
6. Itchy Skin: Pruritus, or itching, is a common symptom associated with allergic skin
diseases. It can be localized or generalized and can range from mild to severe, causing
significant discomfort and distress.
7. Redness and Inflammation: Allergic reactions in the skin often lead to redness and
inflammation, giving the skin a flushed appearance. The affected area may feel warm to
the touch and can be accompanied by pain or tenderness.
8. Skin Dryness and Scaling: Some allergic skin conditions, such as eczema, can result
in dry, rough, and scaly skin. These manifestations are often associated with itching and
can contribute to further skin irritation and inflammation.
It's important to note that these are general manifestations of allergic skin diseases, and
the specific symptoms and severity can vary depending on the individual and the
underlying condition. Proper evaluation and diagnosis by a healthcare professional are
crucial to determine the specific cause of the allergic reaction and to develop an
appropriate treatment plan.