1. TOPICAL STEROIDS
1.1. AE: Skin atrophy, striae, burning, hypopigmentation, hypertrichosis, folliculitis,
1.2. C/I viral, fungal tubercular lesions & eyes, hypersensitivity (Pregnancy C)
1.3. MOA: anti-inflammatory, vasoconstriction, anti-pruritic
1.4. FTU - 1/hand, 3/arm, 6/leg, 7/back, 2/foot
1.5. BID X 2 WEEKS, 1 week off + occlusion
1.6. Clobetasol propionate (Clobex)
1.6.1. For dermatoses
1.6.2. cream/foam/shampoo/emollient/lotion
1.6.3. GROUP 1 .05%
1.7. Halobetasol propionate (Ultravate)
1.7.1. inflammed and itchy deramtoses
1.7.2. GROUP 1 .05%
1.8. Fluocinonide (Lidex)
1.8.1. thin layer qDay or BID
1.8.2. for psoriasis, atopic dermatitis,
1.8.3. GROUP 2 .05%
1.9. Triamcinolone (Kenalog)
1.9.1. topical for infalmmatory
1.9.2. cream/ointment/spray
1.9.3. apply BID-QID pRN
1.9.3.1. dental paste for oral
1.9.4. GROUP 4/5 .1%
1.10. Betamethasone
1.10.1. intrabursa/intra-articular/intradermal
1.10.1.1. .25-2mL injection
1.10.2. GROUP 2 .05%
1.11. Hydrocortisone
1.11.1. apply sparingly qDay or BID +/- occlusive dressing
1.11.2. GROUP 5/7
2. ANTI-ITCH
2.1. MOA: H1 blocker
2.2. Diphenhydramine (Benadryl)
2.2.1. 1-2% topically, do not exceed 3-4x daily
2.2.2. AE: rash, hives, photosensitivity
2.2.3. C/I: infants, breastfeeding
2.2.4. 1st gen
2.3. Lortadine (Claritin)
2.3.1. 10mg PO qDay, do not exceed 10mg qDay
2.3.2. AE: HA
2.3.3. 2nd Generation
2.3.4. for allergic rhinitis, urticaria, itching of the skin
2.3.5. C/I severe hepatic dysfunction
2.4. Fexofenadine (Allergra)
2.4.1. 180mg PO qDay or 60mg PO BID
2.4.2. C/I grapefruit, renal dysfunction, erythromycin, ketoconazole PREGNANCY C
2.4.3. AE: vomiting
2.4.4. 2nd generation
2.4.5. for allergic rhinitis, urticaria, itching
2.5. Cetirizine (Zyrtec)
2.5.1. 5-10mg PO qDay, do not exceed 10mg
2.5.2. AE: drowsiness, HA
2.5.3. 2nd generation
2.5.4. for allergic rhinitis, urticaria, skin picking
2.5.5. PREGNANCY B
2.6. Cyprohepatidine (Periactin)
2.6.1. 4mg PO q8hr
2.6.1.1. maintenance: 4-20mg/day
2.6.1.2. up to 32mg/day
2.6.2. C/I metyraone, selegiline, infants, nursing,
2.6.3. AE: CNS depression, weakness, tachy, hypotension, N/V/D, eczema, itching blurred vision
2.7. Hydroxyzine (Vistaril)
2.7.1. 10-25mg PO TID-QID
2.7.2. for allergic rhinitis, urticaria, anxiolytic
2.7.3. AE: drowsiness, respiratory depression
2.7.4. C/I 1st trimester
2.7.4.1. Caution in HTN, glaucoma, BPH, ETOH
2.7.5. 1st Generation
3. TOPICAL ANTI-VIRAL
3.1. Acyclovir (Zovirax)
3.1.1. HSV
3.1.1.1. 5% cream (RX)
3.1.1.2. q3hrs 6cx a day x 1 week
3.1.2. AE: burning, stinging, discomfort, pain at application site
3.1.3. XERESE: acyclovir + hydrocortisone 5%/1%
3.1.4. PREGNANCY C
3.1.5. MOA: interferes with DNA polymerase - chain termination
3.2. Penciclovir (Denavir)
3.2.1. HSV1/HSV2/VZV/EBV
3.2.1.1. 1% cream RX
3.2.1.2. q2hrs 6x a day x 4 days
3.2.2. AE: burning, stinging, discomfort, mild pain
3.2.3. MOA: triphosphate metabolite inhibits HSV
3.3. Docosanol (Abreva)
3.3.1. 10% cream 5x a day OTC
3.3.2. AE: burning, pruritis, xerosis, acne, erythema, edema
3.3.3. for oral-facial HSV
3.3.4. MOA: Inhibits fusion of virus envelope
4. ANTI-ACNE
4.1. RETINOIC ACID DERIVATIVES
4.1.1. MOA: desquamation, anti-inflammatory, prevents clogging
4.1.2. AE: dryness, burning, erythema, photosensitivity, temporary worsening
4.1.3. C/I UV exposure, waxing, nursing mothers, PREGNANCY X
4.1.4. Isotretinoin (Accutaine)
4.1.4.1. .5-1mg/kg/day PO divided BID for 15-20 wks
4.1.4.2. increase up to 2mg/kg/day
4.1.4.3. for severe cystic acne that is unresponsive
4.1.4.3.1. rosacea, hidradenitis supprativa
4.1.4.4. PREGNANCY X
4.1.4.4.1. iPLEDGE - 2 types of BC
4.1.4.5. C/I tetracyclines, St. John's wort, Vit A, progestin-only birth control, avoid blood donation
4.1.4.6. AE: birth defects, depression, dryness, elevated LFT/Chol/TRIG, low WBC, HA, blurred vision, joint/muscle aches, colitis, diarrhea
4.1.5. Tretinoin (Retin A)
4.1.5.1. pea-sized qHS
4.1.5.2. .025%, .05%, .1% lotion/gel/cream
4.1.6. Tazarotene (Tazorac)
4.1.6.1. cream/gel/foam .05%/.1%
4.1.6.2. also for psoriasis
4.1.7. Adapalene (Differin)
4.1.7.1. thin film to face qPM after washing
4.1.7.2. sensitive skin patients cream/lotion/gel .1%/.03%
4.2. KERATOLYTICS
4.2.1. MOA: releases active O2 (anareobic in pores) + desquamative effect
4.2.2. mild to moderate inflammatory acne
4.2.3. Pregnancy C
4.2.4. Benzoyl Peroxide (Benzac)
4.2.4.1. apply qDay, inc to BID/TID
4.2.4.2. AE: contact dermatitis, erythema, peeling, dryness. bleaches hair and clothes
4.2.4.3. Available OTC
4.2.5. Salicylic Acid (Aveeno)
4.2.5.1. BID cleanser/scrub/foam/gel/wipes
4.2.5.2. stinging, burning, desquamation
4.2.5.3. C/I moles, birthmarks, eyes, warts
4.3. AZELAIC ACID
4.3.1. BID
4.3.2. 15% - finacea
4.3.3. 20% - Azelex
4.3.4. AE: burning, itching, scaling, erythema
4.3.5. MOA: antibacterial, normalizes keratinization
4.3.6. for inflammatory acne, rosacea, melasma, keratosis pilaris
4.3.7. PREGNANCY B
5. TOPICAL ANTIFUNGALS
5.1. IMIDAZOLES
5.1.1. alters cell membrane permeability
5.1.2. Clotrimazole (Lotrimin)
5.1.2.1. tx: candidiasis
5.1.2.1.1. 1% - topical/vaginal/troche x 1week
5.1.2.2. OTC
5.1.2.3. C/I lomitapide, PREGNANCY B
5.1.2.4. AE: abnormal LFT's
5.1.3. Econazole (SPectazole)
5.1.3.1. tinea & candidasis
5.1.3.2. RX 1% cream qDay x 2wks
5.1.3.2.1. 4 weeks for tinea pedis
5.1.3.3. AE: erythema
5.1.3.4. PREGNANCY C
5.1.4. Ketoconazole (Nizoral)
5.1.4.1. 1% & 2% foam/cream/shampoo
5.1.4.2. seborrheic dermatitis: q12hrs x 2 weeks
5.1.4.3. tinea versicolor: shampoo 2x weekly x 4 weeks
5.1.4.4. tinea: qDay x 2 weeks (6 for pedis)
5.1.4.5. AE: irritation, itching, stinging, alopecia,
5.1.4.6. OTC/RX(2%)
5.1.5. Sertaconazole (Ertaczo)
5.1.5.1. tinea pedis: 2% cream BID x 4 weeks
5.1.5.2. AE: contact dermatitis, dry skin, burning, erythema
5.1.5.3. most lipophilic aole - s.corneum
5.2. ALLYLAMINES
5.2.1. interferes with sterol biosynthesis
5.2.2. Naftifine (Naftin
5.2.2.1. deratophytoses
5.2.2.1.1. 1% cream or gel BID
5.2.2.1.2. 2% cream or gel qDay
5.2.2.2. AE: burning, tenderness, dryness, erythema, itching
5.2.3. Terbinafine (Lamisil)
5.2.3.1. NOT for renal/hepatic
5.2.3.2. AE: HA
5.2.3.3. PO for oncymycosis
5.2.3.4. TOPICAL: 1% cream, solution, spray
5.2.3.5. 10-100x more potent than nafifine
5.3. BENZYLAMINES
5.3.1. Butenafind (Mentax)
5.3.1.1. tinea pedis: 1% cream/gel/solution BID x 1 week (RX)
5.3.1.2. tinea corporis/cruris: cream/gel/solution: qDay x 1 week
5.3.1.3. AE: burning, stinging
5.3.1.4. MOA: inhibits intermediary in synthesis of ergosterol
5.4. POLYENES
5.4.1. Nystatin
5.4.1.1. AE: N/V/D, contact dermatitis, SJS,
5.4.1.2. MOA: binds to sterols altering permeability
5.4.1.3. covers candida
5.4.1.4. 100000 USP units/g cream, ointment, powder, oral, lozenges, vaginal tablets (RX)
5.5. HYDROXYPYRIDINE
5.5.1. Ciclopirox Olamine (Loprox, Penlac)
5.5.1.1. onychomycosis - qDay lacquer
5.5.1.2. tinea pedis/corpors - cream/gel BID x 4weeks
5.5.1.3. tinea cruris/versicolor, candidasis - cream BID x 4 weeks
5.5.1.4. seborrheic dermatitis of scalp - gel/shampoo BID
5.5.1.5. AE: erythema, itching, burning, dry skin
5.5.1.6. MOA: inhibits intermediary in synthesis of ergosterol
5.5.1.7. .77% & 1% cream, gel, shampoo, lotion, 8% nail lacquer (RX)
5.6. BID X 1-4 weeks
5.7. AE: burning, stinging, pruritis, edema, erythema, blistering, peeling, hives
6. PSORIASIS
6.1. Cyclosporine A
6.1.1. severe plaque psoriasis last resort
6.1.1.1. NEVER USED
6.1.2. C/I amphotericin B, -statins, mifepristone, neomycin PO,uncontrolled HTN, kidney dysfunction, malignancy
6.1.3. AE: tremor, nephrotox, HTN, infx, HA, hirsutism
6.1.3.1. BB: immunosuppression,
6.1.4. MOA: calcineurin inhibitor - immune suppression
6.2. Methotrexate
6.2.1. severe psoriasis last resort
6.2.1.1. PO/IV/IM 20mg 1 X WEEK
6.2.1.2. + 1g folic acid
6.2.1.3. max 30g/week
6.2.2. C/I LIVE VACCINES, Pregnancy X
6.2.3. AE: reddening of skin, hyperuricemia, glossitis, gingivitis, N/V/D, anorexia, mucositis
6.2.3.1. BB: immunosuppresion
6.2.4. MOA: inhibits dihydrofolic acid reductase - blocks DNA synthesis
6.3. Fumaric Acid (Fumaderm)
6.4. Hydroxyurea (Droxia, Hydrea)
6.4.1. off-label for psoriasis
6.4.1.1. 1000-1500 mg/day PO qDay-BID
6.4.2. C/I Live vaccines
6.4.3. AE: N/V/D/C, myelosuppression, hyperuricemia, renal failure, rash, hyperpigmentation
6.4.3.1. BB: myelosuppression
6.4.4. MOA: DNA synthesis inhibition
6.5. Thioguanine (Tabloid)
6.6. Sulfasalazine
6.6.1. MOA: disease modifying antirheumatic drug
6.6.2. for inflammatory bowel disease, rheumatoid arthritis, psoriatic arthritis
6.6.3. C/I intestinal or urinary obstruction, porphyria, hypersensitive to sulfasalazine
6.6.4. NEVER USED FOR PSORIASIS
6.7. Acitretin (Soriatane)
6.7.1. 2nd generation retinoid
6.7.2. MOA: reduce epidermal hyperplasia, slowing of cell reproduction
6.7.3. similar to isotretinoin
6.7.4. used for menopausal women with psoriasis
6.7.5. need to wait 3 years before conceiving or donating blood
6.8. Apremilast (Otezla)
6.8.1. MOA: inhibits PDE4
6.8.2. for psoriasis and psoriatic arthritis
6.8.3. 30mg BID (titrate dose)
6.8.4. AE: weight loss, HA, depression, GI distress
6.8.5. Good option for people who don't want biologics
6.9. Calcipotriol (Dovonex)
6.9.1. MOA: increases differentiation and inhibits proliferation of keratinocytes
6.9.2. .005% cream BID
6.9.3. AE: skin irritation,
6.10. Calcitriol (Vectical)
6.10.1. MOA: increases differentiation & inhibits proliferation of keratinocytes
6.10.2. 3mcg/g ointment BID
6.10.2.1. MAX 200g/wk
6.10.3. AE: pruritis, hypercalcemia
6.11. Calcipotriene & betamethasone diproprionate (Taclonex)
6.11.1. .005% & .064% QD x 1 month ointment
6.11.2. MOA: synthetic VD3 analogue
6.11.3. AE: pruritus and scaly rash
7. ANTIBIOTICS
7.1. TOPICAL SKIN INFECTIONS
7.1.1. Gentamycin (Garamycin)
7.1.1.1. .1% ointment or cream TID-QID
7.1.1.2. MOA: 30S binding
7.1.1.3. for superficial skin infections
7.1.1.4. AE: erythema, pruritis, edema, photosensitivity, resistant Pseudomonas, PREGNANCY C
7.1.2. Neomycin (Myciguent)
7.1.2.1. .5% ointment or cream QD-TID
7.1.2.1.1. DO NOT USE
7.1.2.2. MOA: binds to 30S
7.1.2.3. for superfical infections, minor scrapes burns and cuts
7.1.2.4. C/I P. Aeruginosa
7.1.2.5. AE: 15% contact dermatitis, pruritis, erythema, edema, PREGNANCY C
7.1.3. Bacitracin (Baciquent)
7.1.3.1. 400-500u/g ointment TID
7.1.3.2. MOA: cell wall synthesis inhibitor
7.1.3.3. for superficial skin infections
7.1.3.4. C/I hypersensitivity
7.1.3.5. AE: irritant and allergic contact dermatitis, PREGNANCY C
7.1.4. Mupirocin (Bactroban)
7.1.4.1. TID 2% ointment or cream or nasal
7.1.4.2. S. Aureus
7.1.4.3. for superficial skin infections (MRSA)
7.1.4.3.1. furuncle, impetego, open wounds
7.1.4.4. AE: burning, stinging, tenderness, pain pruritis, PREGNANCY B
7.1.5. Retapamulin (Altabax)
7.1.5.1. MOA: inhibits bacterial protein synthesis (50S bind)
7.1.5.2. 1% ointment BID x 5 days
7.1.5.3. 9 months and older
7.1.5.4. covers S. Aureus + S. Pyogenes
7.1.5.5. for impetigo, superficial infx
7.1.5.6. AE: dermatiis, burning, itching, redness, swelling, blistering, oozing, PREGNANCY B
7.2. COMBINATIONS
7.2.1. Polymyxin B Combos
7.2.1.1. polysporin = bacitracin + polymyxin B
7.2.1.2. Neosporin = neomycin + Polymyxin B/ Bacitracin
7.2.1.3. MOA: interacts with the phospholipids of bacterial cell membranes
7.2.1.4. QD-TID, 5000-10000u/g ointment
7.2.1.5. for superficial skin infections
7.2.1.6. PREGNANCY C
7.3. TOPICALS
7.3.1. Clindamycin
7.3.1.1. for mild-mod inflammatory acne & superficial infections
7.3.1.2. QID-BID 1% gel, lotion, solution, pledgets, foam
7.3.1.2.1. +/- BPO benzaclin
7.3.1.3. MOA: inhibits protein synthesis (50S bind)
7.3.1.4. C/I hypersensitivity, eteritis, UC, abx
7.3.1.5. PREGNANCY B
7.3.1.6. AE: erythema, burning, stinging, pruritis, peeling, folliculits (-), pseudomembranous colitis
7.3.2. Sodium Sulfacetamide
7.3.2.1. 10% lotion QD-BID
7.3.2.2. MOA: inhibits nucleic acid and protein synthesis
7.3.2.3. mild-mod inflammatory acne or rosacea
7.3.2.4. C/I hypersensitivity
7.3.2.5. NOT first line
7.3.2.6. AE: xeroisis, pruritis, cross reaction, PREGNANCY C
7.3.3. Erythromycin (Akne-Mycin)
7.3.3.1. 1.5-2% solution,gel, pledgets, ointment BID
7.3.3.1.1. +/- BPO benzamycin
7.3.3.2. mild to moderate inflammatory acne
7.3.3.3. C/I hypersensitivity
7.3.3.4. PREGNANCY B
7.3.3.5. AE: erythema, burning, pruritus, peeling
7.3.3.6. MOA: inhibits protein synthesis (50S bind)
7.4. ORAL
7.4.1. Minocycline (Solodyn)
7.4.1.1. most lipid-soluable tetracycline
7.4.1.2. AE: HA, vertigo, SLE, photosensitivity, teeth staining
7.4.1.3. C/I children under 8, PREGNANCY D,
7.4.1.4. for acne, rosacea, lyme,
7.4.2. Tetracycline (Sumycin, Minocin)
7.4.2.1. for acne, rosacea, lyme
7.4.2.2. AE: photosensitivity, staining of teeth
7.4.2.3. C/I kids under 8, PREGNANCY D
8. SEBORRHEA
8.1. Pyrithione
8.1.1. shampoo
8.1.2. AE: stinging, burning, desquamation
8.1.3. MOA: fungistatic & bacteriostatic
8.1.4. head and shoulders
8.2. Selenium Sulfide (Selsun Blue)
8.2.1. tinea versicolor - 2.5% lotion/shampoo qDay x 1 week
8.2.2. seborrhea - 5-10mL shampoo BID x 2weeks
8.2.3. AE: stinging, burning, lethargy, alopecia, termor
8.2.4. MOA: cytostatic on epidermis
8.3. Ketoconazole (Nizoral)
8.3.1. 200-400mg/day PO
8.3.2. C/I -zosin, -ides, simvastatin, quinidine, procainamide, methadone, isoniazid, indapamide
8.3.3. AE: N/V, itching, abdominal pain
8.3.4. BB: hepatotoxicity, QT prolongation
8.3.5. MOA: inhibits cell membrane formation
8.4. Sulfanilamide
8.4.1. candida vulvovaginitis
8.4.1.1. 1 applicator (6g) intravaginal qD-BID x 30 days
8.4.2. C/I 3rd trimester
9. ROSACEA
9.1. Azelaic Acid (Azelex)
9.1.1. massage thin layer on face q12hrs
9.1.2. AE: burning, stinging, tingling
9.1.3. C/I avoid rosacea tirggers,
9.1.4. MOA: inhibits growth of bacteria by inhibiting protein synthesis
9.2. Metroniadazole (flagyl)
9.2.1. .75%-1% gel, cream lotion QD-BID
9.2.2. MOA: DNA breaking + anti-oxidant/inflammation
9.2.3. mild-moderate inflammatory acne/roscea
9.2.4. C/I hypersensitivity
9.2.5. AE: watery eyes, metallic taste, numbness, PREGNANCY B
10. IMMUNOMODULATORS
10.1. TACROLIMUS (PROTOPIC) & PIMECROIMUS (EIDEL)
10.1.1. MOA: inhibits phosphatase calcineurin
10.1.2. Tacrolimus - .03% 2-15y/o, .1% 16+
10.1.3. Pimecrolimus 1% BID x 6 weeks
10.1.4. for eczema, seborrheic dermatitis, lichen planus, vitiligo, psoriasis
10.1.5. C/I avoid HSV, dermatitis, herpetiformis, HSV, immunosuppression photosensitivity
10.1.6. AE: burning, irritiation, itching, erythema
10.2. IMIQUIMOD (ALDARA, ZYCLARA)
10.2.1. MOA: immumodulator binding to toll receptor 7
10.2.2. 5% or 3.75% cream
10.2.3. for HPV (anogenital), actinic keratosis, BCC, bowens, warts, keloids, lentigo maligna
10.2.4. AE: erythema, ulceration, edema, scaling, flu-like
10.2.5. PREGNANCY B
11. TOPICAL ANTI-MITOTIC
11.1. FLUOROURACIL (EFFUDEX)
11.1.1. MOA: inhibits RNA processing
11.1.2. for AK, periungal psoriasis, condyloma, Bowen's, DSAP
11.1.3. .5-5% QD 2-4weeks
11.1.4. C/I PREGNANCY X
11.1.5. AE: painful erythema, erosions, necrosis of lesions
11.2. PICATO (INGENOL MEBUTATE)
11.2.1. .015%-.05% gel
11.2.2. MOA: induces cell death
11.2.3. .015% gel for scalp/face x 3 days
11.2.4. .05% gel for body, arms, legs x 2 days
11.2.5. keep in refrigeratior
11.2.6. PREGNANCY C
11.2.7. AE: localized irritation and erythema
12. PHOTOTHERAPY
12.1. narrowband UVB (311-313nm)
12.1.1. for chronic eczema, psoriasis, vitiligo, CTCL, pruritis,
12.1.2. initial exposure: 100mJ
12.1.2.1. increase by 20-30J per tx
12.1.2.2. prior to tx: moisturizing cream will increase the effect of treatment
12.2. slows multiplication of skin cells, alters function of immune cells, darkening and thickening of skin
12.3. AE: erythema, xerosis, pruritis, blistering, HSV, photoaging, eye damage, cataracts, skin cancers
12.4. broadband UVB for psoriasis
12.4.1. psoriasis, eczema
12.4.2. poor penetration (not for palms and soles)
12.4.3. used in past with tar
12.5. PUVA
12.5.1. Psoralens - photo chemotherapy with psoriasis
12.5.2. inflammatory response that manifests as a delayed phototoxic erythema
12.5.3. AE: N/V, redness, swelling, blisters, liver damage, photoaging, AK, skin cancer, eye damage, cataracts
13. WOUND DRESSINGS
13.1. Substitutes the lost native epithelium, provides optimal environment for healing, absorb fluids, provide pressure, decrease pain
13.2. LAYERED
13.2.1. pressure vs non pressure
13.2.2. contact layer, absorbent layer, wrap layer
13.2.3. ex) telfa, cotton gauze, cover-roll
13.3. POLYMER FILMS
13.3.1. Thin, elastic self-adhesive transparent sheets
13.3.2. ex) tegaderm
13.3.3. for uncontaminated superficial wound, iv sites, skin tears, ulcers, laser wounds, mohs
13.3.4. DISADVANTAGES: difficult to handle, can adhere to wound bed, non-absorbent, bacteria accumulation
13.4. POLYMER FOAMS
13.4.1. Semi-occlusive/semi-permeable hydrophilic foam with hydrophobic backing
13.4.2. most are non-adherent and require secondary dressing
13.4.3. for chronic wounds, dermabrasion, mohs, burns
13.4.4. very absorbent, prevents leakage, contours to wound
13.4.5. frequent changing required, cannot use on dry wounds, can have a drying effect.
13.4.6. ex) reston, cutinova, lyofoam, flexzan, biopatch, crafoam, biatain
13.5. HDRYOGELS
13.5.1. 96% water
13.5.2. cooling, soothing effect, semi-permeable, semitransparent, highly absorptive
13.5.3. for dermabrasion, ulcers, burns, chemical peels,
13.5.4. in sheets, gels, impregnanted dressings
13.6. ALGINATES
13.6.1. natural complex polysaccharide from algae or kelp
13.6.2. helps with exchange of ions in wound bed
13.6.3. soluble sodium gel provides moist environement
13.6.4. hemostatic dressings, gels,
13.6.5. for highly exudative wounds, burns, mohs, decubiti and chronic ulcers
13.7. HYROCOLLOIDS
13.7.1. for burns, dermabrasion, lacerations, ulcers, bullous disorders,
13.7.2. sheets (duoderm) cuts to shape of wound, self adherent, waterproof
13.7.3. beads - gel formed prevents dressing adherence
13.7.4. can cause maceration of surrounding skin, leakage of excessive tissue exudate, yellow-brown smelly gel around wound
13.8. LEG ULCER DRESSINGS
13.8.1. need moisture retention, must be occlusive and compressing (30-40mmHg)
13.8.2. ex) polymer films & foams, hydrogels, alginates, hydrocolloids
13.8.3. Compression: Unna boot - cotton bandage impregnanted with zinc oxide, gelatin and glycerine paste
13.8.3.1. step 1) base coat - white petrolatum
13.8.3.2. step 2) paste dressing - zinc oxide, gelocast, tenderwrap, primer
13.8.3.3. step 3) elastic compression bandage - coban, ace wrap,
13.9. HYALURONIC ACID ESTER DRESSING
13.9.1. HYAFF - cell carrier of cultured keratinocytes - functions like human epidermis
13.9.2. used on exudative wounds and forms a thick gel that lasts 3 days, degrades and release HA into wound
13.9.3. in sheets and ribbons
13.10. LIVING SKIN DRESSINGS
13.10.1. for burn patients or surgical wounds
13.10.2. immediate epithelialization reduces pain
13.10.3. very expensive - applied under sterile conditions
13.11. WET DRESSINGS
13.11.1. for imflamed skin that are oozing, blistering, crusting, infection
13.11.2. apply cortisone cream or moisturizer and cover in wet disposable towels and wrap with crepe bandages
13.11.3. Burows/Domeboros solution
13.11.3.1. vinegar and water solution
13.11.4. Wet to dry dressings restricted to heavily necrotic wounds.
13.11.4.1. removes healthy tissue - non selective