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LEARNING OBJECTIVES

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  1. Accurately identify the most likely etiology when patients present with a skin rash or other dermatological condition, through history, diagnostic tests, and patient findings on examination to enable the pharmacist to appropriately recommend effective self-care treatment or referral of the patient to an appropriate provider.

  2. Use the knowledge of the pathophysiology, etiology, and presentation of common dermatological diseases to review prescription orders for appropriateness and to accurately educate patients about their disease and its treatment.

  3. Use the knowledge of the pathophysiology, etiology, and presentation of common dermatological diseases to enable the pharmacist to advise providers regarding the most appropriate prescription therapy.

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INTRODUCTION

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There are little data on the prevalence of dermatological disorders in various populations. Estimates and extrapolation of survey results reveal that anywhere from 12% to 31% of visits to physicians involve dermatological problems, depending on location, age, ethnicity, and type of medical provider. Pharmacists are routinely asked for assistance with diagnosis and treatment of many common skin conditions. Therefore, it is important for pharmacists to recognize common skin disorders, so they can make appropriate recommendations about self-care and referral.

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GLOSSARY

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Macule Colored spot <1.5 cm
Patch Colored spot >1.5 cm
Papule Bump <1.5 cm
Nodule Bump >1.5 cm
Pustule Papule or nodule filled with pus seen in folliculitis, acne vulgaris
Vesicle Papule or nodule filled with serous fluid seen in allergic contact dermatitis
Bullae Vesicle >2 cm
Plaque Raised patch usually seen in psoriasis
Wheal Raised, itching, red areas seen in IgE-mediated allergic reactions
Urticaria Raised, itching, red areas seen in IgE-mediated allergic reactions
Hive Raised, itching, red areas seen in IgE-mediated allergic reactions
Crust Dried residue of serum/pus/blood
Scale Dry flakes of skin
Lichenification Thickened skin with lots of wrinkles indicating a chronic dermatosis
Atrophy Tissue paper thin skin, with highly visible arterioles and capillaries—an adverse effect of prolonged topical corticosteroid use
Excoriation Scratched

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ECZEMATOUS DISORDERS

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Eczema is a general term to describe any lesion that is red, and has unclear margins and dry flaky skin. Severe cases can present with widespread lesions including cracks in the skin (fissures), weeping, and excoriation. Chronic forms of eczematous conditions become lichenified (thick, wrinkled skin) with multiple lesions.

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Atopic Dermatitis (Atopic Eczema)

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Atopic dermatitis is one of the most common skin conditions. It has several common characteristics that make the diagnosis relatively simple in most cases. First, it is associated with other allergic disorders. Most patients have a personal or family history of allergic rhinitis, asthma, or atopic dermatitis (aka atopic disease). Fifty percent of patients have allergic rhinitis, 60% have asthma, and 75% to 80% have a positive family history for one of the three disorders. In roughly 80% of patients, the atopic dermatitis is primarily IgE mediated and their complete blood count will reveal ...

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