treatment of skin inflammation (Howe, 2022c). Exacerbating factors in atopic dermatitis that disrupt an abnormal epidermal barrier include excessive bathing without subsequent moisturization, low-humidity environments, emotional stress, xerosis (dry skin), overheating skin, and exposure to solvents and
detergents. Avoiding these situations is helpful for acute flares and long-term management. Since atopic individuals respond more readily to pruritic stimuli, anything that tends to induce itch in an individual should be avoided (Howe, 2022c).
Mild to moderate symptoms Initial Treatment
calcineurin inhibitors (United Kingdom National Institute for Health and Care Excellence [NICE], 2021). Second-Line Therapies Second-line treatment options for mild to moderate disease include crisaborole (adults and children) and topical ruxolitinib (adults and children older than age 12).
Patients with mild to moderate atopic dermatitis should be initially treated with topical corticosteroids and emollients. The choice of corticosteroid potency should be based on the patient’s age, body area involved, and degree of skin inflammation. For patients with atopic dermatitis involving areas at high risk of atrophy (e.g., face, skin folds), the suggested treatment is topical Moderate to severe symptoms Recommendations call for dupilumab rather than nontargeted immunosuppressant agents (e.g., cyclosporine, methotrexate) as first-line treatment for adult and pediatric patients with moderate to severe disease unresponsive to topical therapy alone. Tralokinumab, abrocitinib, and upadacitinib are newly approved agents that may be an alternative treatment option for adult patients with inadequate response to dupilumab (NICE, 2021). For adults and adolescents with moderate to severe disease, narrowband ultraviolet B (NBUVB) phototherapy is an alternative first-line treatment if available and acceptable to the patient. Phototherapy is usually administered in the office two to three times per week. Topical corticosteroids and emollients can be continued during phototherapy (NICE, 2021). NP Consideration: Disney Rash Disney rash is another name for exercise-induced vasculitis (EIV). It typically occurs when a person engages in prolonged exercise in hot temperatures, such as walking, golfing, or running. It is more commonly seen in women older than age
Figure 8. Disney Rash
50. The rash can present with the following. ● Red or purple-colored blotches or spots ● Swelling (edema) in the affected areas ● Itching, pain ● Stinging or burning sensations
Rosser1954. (2018). Cutaneous vasculitis, ankle area. https://commons. wikimedia.org/wiki/File:Cutaneous_vasculitis,_ankle_area.jpg. CC BY-SA 4.0 Maintaining Skin Hydration Skin hydration is a key component of the overall management of patients with atopic dermatitis. To maintain skin hydration, emollients should be applied at least twice daily and immediately after bathing or hand-washing. Thick creams, which have a low water content, or ointments (e.g., petroleum jelly), which have zero water content, have been generally preferred, as they are thought to provide better protection against xerosis (Howe, 202b2). rash in some cases. Children have high fevers but are generally less symptomatic than adults during the febrile phase. The febrile phase lasts 3 to 7 days, after which most patients recover without complications (Thomas et al., 2022). Headache, eye pain (i.e., pain with eye movement), and joint pain occur in 60% to 70% of cases. The rash occurs in approximately half of all cases, and it is more common during primary infection than secondary infection. When present, the rash generally occurs 2 to 5 days after the onset of fever (Thomas et al., 2022). It is typically macular or maculopapular and may occur over the face, thorax, abdomen, and extremities. It may be associated with pruritus. Additional manifestations may include gastrointestinal symptoms (anorexia, nausea, vomiting, abdominal pain, and diarrhea) and respiratory tract symptoms (cough, sore throat, and nasal congestion). Travel history becomes an important history component. Patients traveling to the Caribbean and southeastern U.S. should be screened for dengue.
Although it typically resolves by itself, a person can elevate the leg and take nonsteroidal anti-inflammatory agents to help reduce the symptoms. Disney rash is harmless and will normally disappear on its own in about 3 to 10 days (Brennan, 2021).
Dengue Dengue is a febrile illness caused by infection with one of four dengue viruses (DENV) transmitted by Aedes aegypti or A edes albopictus mosquitoes while taking a blood meal. Infection may be asymptomatic or present with a broad range of clinical manifestations, including mild febrile illness and life-threatening shock syndrome. Numerous viral, host, and vector factors are thought to impact the risk of infection, disease, and disease severity. It is estimated that over 390 million DENV infections occur each year, and approximately 96 million are clinically apparent (Thomas et al., 2022). Three phases can be seen in the setting of dengue infection: A febrile phase, a critical phase, and a recovery phase; however, the critical phase is not seen in all infection categories. The febrile phase of the infection is described further in the sections below as the rash might develop. Febrile Phase The febrile phase of DENV infection is characterized by sudden high-grade fever (≥38.5°C or 101.3°F) accompanied by headache, vomiting, myalgia, arthralgia, and a transient macular
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