Atopic Dermatitis Care Plans September 2016
Friday Moriches:
Dx: moderate AD with current flare
Tx during flare:
- BID moisturizing (recommend aquaphor). If showering, to be applied after shower while skin is damp. Should not shower too frequently.
- may do bleach baths daily
- use fragrance-free soaps
- medium potency topical corticosteroid. Amount should be enough to cover 2 adult hands with a thin layer
Maintenance tx:
- fragrance-free soaps
- BID moisturizing (recommend aquaphor)
- bleach baths 1-2x/week
- low potency topical corticosteroid
Follow up with PMD in 2 weeks.
Tuesday Moriches
-Start medium potency topicalcorticosteroids (class III or IV) to be used on affected areas 1-2 timesweekly or low potency topical corticosteroids (class V-VII) once or twice daily
-See patient in office to reevaluate in one week
-If better: maintain on maintenancedose
-If not better: assess for compliance
-continue frequent dailymoisturizer treatment and trigger avoidance (stop wearing wool sweater)
-reminder about:FTU, wet-wrap therapy, dilute beach bath
-if Flare occurs in the future: increase dose of medium potency topical CS to twice daily for no longer than 7 days, return to maintenance dose once resolution occurs
Thursday Islip
-trigger avoidance: remove/not wear wool sweater. Wear cotton undergarments
-use Fragrance free detergents
-moisture 5 minutes after baths
-start medium potency topical steroid cream. Discuss appropriate interval and dosing
Tech Park- Monday
10 month old with moderate atopic dermatitis
Eczema Action Plan:
Triggers: clothing, scented products, weather, foods
Green Zone:
Moisturizing, infrequent baths, uses creams rather than lotions, non-soap cleansers
Avoid triggers
Yellow zone:
Medium potency corticosteroids 1-2 times a day for 1 week
Red zone:
No improvement in 1 week
Severe itching, worsening
Superinfection
f/u with physician
Follow up: in 1-2 weeks to assess treatment
Patchogue CCC
Basic management strategies
-avoid flare triggers (irritating clothing like the wool sweater, scented soups and other products)
-continue hydration of skin regularly with aquaphor and other nonscented creams
-warm baths, mild soaps, no excessive bathing
-antiseptic bleach baths one to two times weekly
Maintenance management strategies
-topical steroids, medium potency for all areas except face (low potency)
-topicalcalcineurininhibitors one to two times weekly
Flare therapy
-higher potency topical steroids twice daily for up to three days after rash subsides
-return to doctor to reassess clinical status
CCC from Thursday Patchogue clinic 9/15/16
Things learned:
1. Atopic dermatitis is disease of exclusion, r/o psoriasis, contact dermatitis, scabies or viral exanthema
2. Basic therapy regardless of disease severity is: skin hydration/moisturizer, antiseptic measure, trigger avoidance
3. Moderate-severe AD exacerbation need TCI (topical calcineurin inhibitors) or medium potency steroids once/twice daily
4. Lotions have high water content and can be drying, ointments have higher oil content and may be preferable
Three ways to incorporate what we learned into practice
1. Won’t refer to dermatologist until evaluated and treated per recommendations
2. Can recommend bleach bath with careful guidance/instructions for mild/moderate exacerbations
3. Will use ointment likely vs. lotions due to the higher oil content
Two things to research further
1. Wet wrap therapy with or without corticosteroids and how to guide families to complete this appropriately
2. Further laboratory tests that would be helpful in diagnosis/management/tx of AD
Once pearl of knowledge
1. Giving appropriate counseling on correct amount of medication that can be used based on patients surface area, FTU’s
Patchogue Clinic – Friday afternoon
List four (4) things you have learned from the article you read.
1. Primary care doctors should be able to treat at least mild form of AD
2. A written plan may help parents better treat AD
3. Dilute bleach baths is a treatment option for mild AD
4. Low potency steroids can be used in the face
Prepare to discuss three (3) ways you will incorporate what you have learned into your practice (ie, what will you do differently in caring for patients with AD?)
1. Start recommending dilute bleach baths
2. Provide written materials/AD plans to patients
3. Increased comfort with steroid prescription for AD
List two (2) things about this topic you would like to research further.
1. Wet wrap
2. Steroid potencies
Write one (1) ‘pearl’ you consider essential knowledge regarding this topic
* Moisture is key