dermatologic symptoms in your pharmacy: the management of ... · activity, dermatologic symptoms in...

Dermatologic Symptoms in Your Pharmacy The Management of Rosacea and Atopic Dermatitis

June 3 2015 200PM ndash 400PM EDT

Presented by

Gail Newton PhD RPh and Daniel Krinsky MS RPh

copy 2015 by the American Pharmacists Association All rights reserved


Activity Description

Many patients with skin conditions do not seek medical care and are likely to need advice regarding self-care treatments A large body of evidence supports the use of topical products to manage symptoms of rosacea and atopic dermatitis (AD) and indicates that such treatment is associated with improved long-term outcomes As drug information experts pharmacists can facilitate successful treatment of AD and rosacea In addition pharmacists can provide patient education to help diminish the stress and anxiety experienced by patients and caregivers In this live webinar experts will use a case-based approach to explore strategies that pharmacists can recommend to patients with rosacea and atopic dermatitis

Learning Objectives

At the completion of this application-based activity participants will be able to 1 Describe the epidemiology and clinical presentation of rosacea and atopic dermatitis (AD) 2 Recommend appropriate self-care treatment for patients with rosacea or AD with regard to the

efficacy and safety of available therapeutic options 3 Discuss areas where pharmacists interventions can improve the care of patients with rosacea

and AD

Target Audience Pharmacists Activity Type Application-based Learning Level 2 Date of Activity Wednesday June 3 2015 Location Virtual meeting Time 200 PMndash400 PM EDT (20 hours)

Speakers

Gail Newton PhD RPh Associate Professor Purdue University School of Pharmacy and Pharmaceutical Sciences West Lafayette Indiana

Daniel Krinsky MS RPh Associate Professor Northeast Ohio Medical University (NEOMED) College of Pharmacy Rootstown Ohio

Disclosures

Gail Newton PhD RPh and Daniel Krinsky MS RPh declare no conflicts of interest real or apparent and no financial interests in any company product or service mentioned in this activity including grants employment gifts stock holdings and honoraria For complete staff disclosures please see the Education and Accreditation Information section at wwwpharmacistcomeducation


Accreditation Information

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education (CPE) This activity Dermatologic Symptoms in Your Pharmacy The Management of Rosacea and Atopic Dermatitis is approved for 20 contact hours of CPE credit (020 CEUs)

The ACPE Universal Activity Number assigned to this activity by the accredited provider is 0202-0000-15-058-L01-P To obtain CPE credit for this activity participants will be required to actively participate in the entire activity and complete the online assessment and evaluation forms located at wwwpharmacistcomlive-activities by Monday July 6 2015 If you claimed credit for the live offering of this course on March 30 2015 at the APhA Annual Meeting in San Diego California you are NOT eligible to receive credit for this offering

Development and Support

This activity was developed by the American Pharmacists Association and is supported by educational grants from Johnson amp Johnson Consumer Companies and Bayer HealthCare Pharmaceuticals Inc

How to Obtain Your CPE Credit

Go to wwwpharmacistcomlive-activities and under the Live Activities list select the Claim Credit link for Dermatologic Symptoms in Your Pharmacy The Management of Rosacea and Atopic Dermatitis

You will need to enter your pharmacistcom Username and Password If you do not have an account you can create a guest account for free Then continue with the following instructions to obtain your CPE credit for this activity

Select Add to Cart or Enroll Now from the left navigation and successfully complete the Assessment (use Attendance Code DERM) and Evaluation You will need to provide your NABP e-profile ID number to claim credit

Please visit wwwpharmacistcomcpe-monitor for any questions regarding your NABP e-profile ID number (Note that it may take up to 3 hours for your NABP e-profile ID number to become activated)

The filing deadline for this CPE activity is Monday July 6 2015 at 500 PM Eastern Time No credit will be issued after this date

If you have any questions or require additional information to claim your credit please contact Anthony Gary Senior Manager Education Department at the American Pharmacists Association by e-mailing agaryaphanetorg or calling 202-429-7515


1

Dermatologic Symptoms in Your

Pharmacy The Management of

Rosacea and Atopic Dermatitis

Gail Newton PhD RPh

Associate Professor

Department of Pharmacy Practice

Purdue University School of Pharmacy and Pharmaceutical Sciences

Daniel Krinsky MS RPh

Associate Professor

NEOMED College of Pharmacy

Manager MTM Services Giant Eagle Pharmacy

2


This activity was developed by the American

Pharmacists Association and is supported by

educational grants from Bayer HealthCare

Pharmaceuticals Inc and

Johnson amp Johnson Consumer Companies Inc

3

Disclosuresbull Gail Newton PhD RPh and Daniel Krinsky MS RPh

ldquodeclare no conflicts of interest real or apparent and no

financial interests in any company product or service

mentioned in this activity including grants employment

gifts stock holdings and honorariardquo

The American Pharmacists Association is accredited by the Accreditation

Council for Pharmacy Education as a provider of continuing pharmacy

education


4

Attendance Code

DERM

To obtain CPE credit for this activity you are

required to actively participate in this session The

attendance code is needed to access the

assessment and evaluation for this activity

Your CPE must be filed by July 6 2015 in order to

receive credit

5


The American Pharmacists Association is accredited by theAccreditation Council for Pharmacy Education as a provider of continuing

pharmacy education This activity Dermatologic Symptoms in Your Pharmacy The Management of Rosacea and Atopic Dermatitis is approved for 20 hours of continuing pharmacy education credit (020 CEUs) The ACPE Universal Activity Number assigned by the accredited provider is 0202-0000-15-058-L01-P

To obtain continuing pharmacy education credit for this activity participants will be required to actively participate in the entire webinar and complete an assessment and evaluation located at wwwpharmacistcomlive-activities by July 6 2015

Initial Release Date June 3 2015

Target Audience Pharmacists

ACPE Activity Type Application-based

Learning Level 2

Fee There is no fee for this activity

6

Learning Objectives

At the completion of this application-based activity

participants will be able to

1 Describe the epidemiology and clinical presentation of

rosacea and atopic dermatitis (AD)

2 Recommend appropriate self-care treatment for patients

with rosacea or AD with regard to the efficacy and safety

of available therapeutic options

3 Discuss areas where pharmacists interventions can

improve the care of patients with rosacea and AD


7

1 The SCORAD (SCORing Atopic

Dermatitis) Index

A Assesses a patientrsquos severity of atopic dermatitis

B Provides patients with a list of therapeutic options

C Defines how long patients should use self-care

D Lists diagnostic criteria for atopic dermatitis

8

2 Which of the following therapies does not

have supportive evidence of benefit nor has it

shown potential for management of symptoms

associated with atopic dermatitis (AD)

A Colloidal oatmeal

B First-generation antihistamines

C Vitamin D

D Probiotics

9

3 Which of the following would be a key

counseling point for a patient interested in

using OTC hydrocortisone for AD

A Use the product on affected area(s) 3-4 times daily for a

minimum of 14 days

B OTC hydrocortisone is ineffective for any symptoms

associated with AD make an appointment with your primary

care provider or dermatologist

C Newer data suggests the best response is achieved with

applications 1-2 times daily for maximum of 2 weeks then

stop for 2 weeks and can resume if needed

D Only apply this product on your arms and legs do not apply on

any other part of your body


10

4 Which of the following patients is at highest

risk for developing rosacea

A 20-year-old college student who works as a fry cook at a

local diner

B 45-year-old ad executive of Mediterranean descent who

plays racquet ball three times a week

C 37-year-old stay-at-home mom who had nodular acne as a

teenager

D 52-year-old professor with fair skin who blushes easily

11

5 Which of the following types of rosacea can be

managed in part by daily gentle skin cleansing

A Erythematotelangiectatic rosacea

B Papulopustular rosacea

C Phymatous rosacea

D All of the above

12

6 Which of the following types of rosacea may

require ablative laser therapy



C Phymatous rosacea

D None of the above


13

Atopic Dermatitis (AD) IntroBackground

Incidence and prevalence

bull Inflammatory condition of the epidermis and dermis

bull Characterized by episodic flares and periods of remission

bull AD is estimated to affect from 10 to 20 of children - many of

these individuals have symptoms into adulthood

bull 60 patients diagnosed in first year of life

bull 30 lt5 years of age

bull Adult prevalence 1-3 overall lifetime prevalence 7

Ref Chapter 32 Atopic Dermatitis and Dry Skin in Handbook of

Nonprescription Drugs 18th ed 2015 APhA

14

Atopic Dermatitis IntroBackground

bull Atopic triad asthma allergic rhinitis and atopic dermatitis

bull Asthma and allergic rhinitis can occur in up to 80 of patients with

AD

bull 80 of AD classified as mild and can be safely treated with

nonprescription products

bull 70 of cases atopic family history

ndash 1 parent atopic 50 chance child will have symptoms

ndash 2 parents 79 chance



15

Atopic Dermatitis Cause

bull A protein in the epidermal differentiation complex filaggrin (FLG)

is related to the development of AD

bull Any FLG mutation increases onersquos risk of AD (35 known

mutations) mutation leads to irritation in atopic skin caused by

ndash Increased penetration of allergens

ndash Decrease in skin barrier proteins

ndash Higher peptidase activity

ndash Lack of protease inhibitors

bull Also decreased moisture retention due to lower concentration of

lipid and ceramides




16

Atopic Dermatitis Assessment

bull The SCORAD (SCORing Atopic Dermatitis) index is used to

assess severity of AD rate the following 7 factors

ndash Erythema

ndash Edema

ndash Papulation (formation of papules)

ndash Excoriations (abrasion of the epidermis by trauma)

ndash Lichenification (increased epidermal markings)

ndash Oozingcrusting

ndash Dryness

bull Index also includes visual analogue scale

bull A SCORAD index lt25 = mild 25-50 moderate and gt50 = severe



17

Atopic Dermatitis Diagnosis



TABLE 32-1 Diagnostic Criteria for AD

A pruritic skin disorder plus three or more of the following criteria

bull Onset at younger than 2 years

bull History of skin crease involvement (including cheeks in children younger than 10

years)

bull History of generally dry skin

bull Personal history of other atopic disease that is asthma (or history of any atopic

disease in first-degree relative in children younger than 4 years)

bull Visible flexural dermatitis (or dermatitis of cheeksforehead and other outer limbs in

children younger than 4 years)

18

Atopic Dermatitis Clinical Presentation

bull Initial symptoms erythema and scaling of the infantrsquos cheeks

bull May progress to affect the face neck forehead and extremities

bull Major symptom carrying over to adulthood is xerosis (dry skin)

bull Adults with AD ndash cause usually environmental exposure to

chemicals or skin trauma




19


3 clinical forms of AD

bull Acute AD pruritic erythematous papules or vesicles over

erythematous skin often associated with excoriation and serous

exudate

bull Subacute AD erythematous excoriated papules and scaly

plaques

bull Chronic AD thickened skin plaques and accentuated skin

markings usually involves symptoms seen in all 3 stages

All pts at risk of infection other conditions related to compromised

skin



20

Atopic Dermatitis Treatment

Treatment Goals

bull No cure symptom management

bull The goals of self-treatment of AD are to

1 Stop the itch-scratch cycle hydrocortisone

2 Maintain skin hydration emollients and moisturizers

3 Avoid or minimize factors that trigger or aggravate

the disorder

4 Prevent secondary infection



21

Atopic Dermatitis Nonpharmacologic

bull Bathing can hydrate the stratum corneum remove allergens and

irritants cleanse and debride crusts and enhance the effects of

moisturizers and topical steroids

ndash Recommended time 3-5 minutes and every other day

ndash Water should be tepid

ndash Add colloidal oatmeal

bull To maintain skin hydration and patency recommend

ndash Emollients

bull Both occlusive and moisturizing used to prevent or relieve the

signs and symptoms of dry skin

bull Apply at least twice daily for preventive and maintenance therapy

bull Creams or ointments better (than lotions) for enhancing softness

and hydration




22

bull Bath Oils

ndash Mineral or vegetable oil plus a surfactant help with skin lubrication

may decrease frequency of bathing

bull Cleansers

ndash Avoid traditional bath soaps ndash remove harmful and beneficial

substances

ndash Better option glycerin soaps ndash more soluble closer to neutral pH

less drying

bull Emulsifiers maintain water + lipids in one continuous phase

bull Humectants help draw water into the stratum corneum and to

retain water often added to emollient bases

bull Other key ingredients lubricants and moisturizers 3-4xday




23

Atopic Dermatitis EBM Guideline

Most recent guideline from the American Academy of Dermatology

bull Moisturizers

ndash Xerosis is one of the cardinal clinical features of AD and results from

a dysfunctional epidermal barrier topical moisturizers are used to

combat xerosis and transepidermal water loss with traditional agents

containing varying amounts of emollient occlusive andor humectant

ingredients

bull Emollients (eg glycol and glyceryl stearate soy sterols)

ndash Lubricate and soften the skin occlusive agents (eg petrolatum

dimethicone mineral oil) form a layer to retard evaporation of water

whereas humectants (eg glycerol lactic acid urea) attract and hold

water

Ref Eichenfield LF et al Guidelines of care for the management of atopic

dermatitis section 2 Management and treatment of atopic dermatitis with topical

therapies J Am Acad Dermatol 2014 Jul71(1)116-32 doi

101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9

Nonpharmacologic options for treatment of AD

bull Strong evidence of the benefit of moisturizers ndash integral to

management ndash reduce severity + need for pharmacologic tx

ndash Apply soon after bathing to maximize hydration

bull Bathing suggested ndash no standard for frequency or duration

ndash Insufficient evidence any of the following offer value when added to

bath water Oils emollients other additives

bull Limited use of nonsoap cleansers (neutrallow pH hypoallergenic

fragrance-free) recommended

bull Use of wet-wrap therapy +- topical corticosteroid appropriate for

pts with moderatesevere AD ndash reduce symptom severity and

water loss during flares


25

bull Multicenter randomized double-blind controlled trial ndash compared

5 urea cream with a reference cream

bull Urea cream significantly better than reference cream in

preventing eczema relapse in patients with AD (HR 0634

pthinsp=thinsp0011)

bull Risk of eczema relapse was reduced by 37

bull At 6 months

ndash 26 of the patients in the test cream group were still eczema free vs

10 in the reference cream group

Ref Aringkerstroumlm U et al Comparison of moisturizing creams for the prevention of

atopic dermatitis relapse a randomized double-blind controlled multicentre clinical

trial Acta Derm Venereol 2015 Jan 16 doi 10234000015555-2051

Atopic Dermatitis Moisturizers

26

bull Colloidal oatmeal suspensions bath soaps shampoos shaving

gels and moisturizing creams

bull The diverse chemical polymorphism of oats translates into

numerous clinical utilities for AD and eczema

bull Avenanthramides

ndash Principal polyphenolic antioxidants in oats

ndash Anti-inflammatory and antipruritic properties in rodent models

ndash Also antioxidant properties

bull Positive effect in pts with AD

Ref Fowler JF Jr Colloidal oatmeal formulations and the treatment of atopic

dermatitis J Drugs Dermatol 2014 Oct 113(10)1180-3

Atopic Dermatitis Colloidal Oatmeal

27

bull METHODS

ndash Four extracts of colloidal oatmeal were made with various solvents

and tested in anti-inflammatory and antioxidant assays

ndash Assessment of benefit in 29 female patients with bilateral mild to

moderate itch with moderate to severe dry skin on their lower legs

used a colloidal oatmeal skin protectant lotion

bull RESULTS

ndash In vitro study Colloidal oatmeal extract activity reduced pro-

inflammatory cytokines

ndash 29 pts colloidal oat skin protectant lotion showed significant clinical

improvements in skin dryness scaling roughness and itch intensity

Ref Reynertson KA et al Anti-inflammatory activities of colloidal oatmeal

contribute to the effectiveness of oats in treatment of itch associated with dry

irritated skin J Drugs Dermatol 2015 Jan 114(1)43-8



28


bull Although emollients are recommended in the management of AD

regimens for emollient maintenance therapy are awaiting

validation

bull International multicenter open-label trial to assess the effects of a

3-month maintenance treatment regimen with a sterile

preservative-free emollient cream containing oat plantlets in

children (ages 6 mos-6 yrs) with moderate AD

bull After a 14-day run-in stabilization phase using a topical

corticosteroid (TCS) treatment of medium potency 108 children

with a SCORAD index of 20 or less were included in the study

Ref Mengeaud V et al An innovative oat-based sterile emollient cream in

the maintenance therapy of childhood atopic dermatitis Pediatr Dermatol

2014 Dec 22 doi 101111pde12464 [Epub ahead of print]

29


bull Emollient was applied twice daily for 3 months rescue topical

corticosteroid (TCS) treatment used for flare-ups

bull The SCORAD index Patient-Oriented SCORAD (PO-SCORAD)

index number of flares TCS use and tolerance were assessed

monthly x 3 months

bull Results AD severity improved with a highly significant decrease

in the SCORAD and PO-SCORAD indexes 2nd and 3rd months

(p lt 0001)

bull of flares and TCS use significantly decreased by the 3rd month

(both p lt 0001)

bull Intervention = significant improvement of clinical symptoms with

no adverse events




30

Bathing is a therapeutic measure commonly advised in atopic dermatitis

(AD) Whether baths improve skin condition remains unclear Objectives of

this study

bull What is the effect of one month of tap water bathing on the bathed skin of

patients with AD

bull How many pts favor baths

bull Interventional studies measuring skin changes after tap water bathing

were selected for the first analysis

bull Observational studies reporting the proportion of AD patients who favor

baths were selected for the second analysis

Ref Sarre ME et al Are baths desirable in atopic dermatitis J Eur Acad

Dermatol Venereol 2015 Jan 27 doi 101111jdv12946

Atopic Dermatitis Bathing


31

bull 7 of 271 studies met the selection criteria

bull Pooled effect size of skin changes after baths was minimal (-010)

bull 291 of patients favored baths

Authors conclude

bull No evidence of a positive effect of 1-month tap water bathing on

skin changes in AD

bull Discuss pros and cons with pts before deciding whether baths are

appropriate and if so frequency products to add to improve

response




32

Can probiotics offer benefit in the management of AD

bull Meta-analysis included randomized controlled trials (RCTs)

measuring the effects of probiotics or synbiotics in patients

diagnosed with AD

bull The primary outcome SCORAD values between the treatment

and placebo groups

bull 25 RCTs (n = 1599)

bull Significant improvement in SCORAD values in pts taking

probiotics (mean -451 95 CI -678 to -224)

Ref Kim SO et al Effects of probiotics for the treatment of atopic dermatitis a

meta-analysis of randomized controlled trials Ann Allergy Asthma Immunol 2014

Aug113(2)217-26 doi 101016janai201405021 Epub 2014 Jun 20

Atopic Dermatitis Probiotics ndash Study 1

33

Population subgroups

bull Pts 1 to 18 years old (-574 95CI -727 to -420)

bull Adults (-826 95CI -1328 to -325)

bull Infants (lt1 year old) no positive effect

Response to specific probiotic strains

bull Use of a mixture of different bacterial species or Lactobacillus

species showed greater benefit than did use of Bifidobacterium

species alone






34

Double-blind prospective randomized placebo-controlled study in

220 children with moderatesevere AD

Evaluated effects of 2 strains of Lactobacillus (and combined) on

disease severity QOL and certain measures of immune function

ndash Lactobacillus paracasei (LP)

ndash Lactobacillus fermentum (LF)

bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo

Ref Wang IJ et al Children with atopic dermatitis show clinical

improvement after Lactobacillus exposure Clin Exp Allergy 2015 Jan 20

doi 101111cea12489 [Epub ahead of print]


35

bull All pts given 3 months of therapy

bull Response evaluated myriad ways standard evaluation via

SCORAD scores

bull LP LF and LP+LF mixture groups demonstrated benefit via lower

SCORAD scores compared with the placebo group (plt0001)

bull Benefit seen up to 4 months after discontinuing the probiotics

bull In subgroup analyses significant benefit in the following

ndash Younger than age 12

ndash Breast fed gt6 months

ndash Those with documented mite sensitization





36

bull Small prospective controlled trial assessed association of

Streptococcus thermophilus ST10 and tara gum complex and the

activity of Lactobacillus salivarius LS01 administered at high

doses to adults with AD

bull Why this complex Improves adherence to intestinal mucus

bull 25 patients randomized to placebo (n=12) or active formulation

(n=13)

bull SCORAD used to evaluate response

bull Also evaluated bacterial counts (for Staphylococcus aureus and

clostridia)

Ref Drago L et al Treatment of atopic dermatitis eczema with a high

concentration of Lactobacillus salivarius LS01 associated with an innovative

gelling complex a pilot study on adults J Clin Gastroenterol 2014 Nov-Dec48

Suppl 1S47-51



37

bull At 1 month study group showed significant improvement in

SCORAD index

bull A slight decrease in fecal S aureus count was observed in

probiotic-treated patients

bull Authors concluded the probiotic strain + tara gum complex =

quicker response and greater efficacy

bull What does this mean Need more data but probiotic

supplementation could offer benefit




Suppl 1S47-51


38

bull Lactobacillus salivarius LS01 in children with AD

bull 43 pts (0 to 11 yrs)

bull Response evaluated by changes in itch index and SCORAD index

bull Those using probiotics showed significant benefit in both

measures

bull Effects sustained for 4 weeks after supplement stopped

Ref Niccoli AA et al Preliminary results on clinical effects of probiotic

Lactobacillus salivarius LS01 in children affected by atopic dermatitis J Clin

Gastroenterol 2014 Nov-Dec48 Suppl 1S34-6


39

Atopic Dermatitis Pharmacologic Tx

Antipruritics 3 Options

1 Local anesthetics pramoxine lidocaine and benzocaine

2 Antihistamines

ndash Topical diphenhydramine may be effective as an antihistamine in

addition to having some mild anesthetic properties however may

cause sensitization so use is not recommended

ndash Systemic pruritus with AD likely not related to histamine so most

agents probably not effective also concern regarding adverse effects

(anticholinergic drowsiness) and time to response

3 Hydrocortisone

ndash Dose Apply to Affected Area (AAA) 1-2 timesday




40

bull H1 antihistamines often used as antipruritic

ndash Pruritus is a significant QOL issue

bull Recent Cochrane systematic review no reliable high-level

evidence to support the use of these drugs in AD particularly as

monotherapy

bull No randomized trials comparing an oral H1 antihistamine with

placebo or control

bull However there may be some value in using an H1 antihistamine ndash

weigh risks and benefits

Ref Church MK et al H1 -Antihistamines and itch in atopic dermatitis Exp

Dermatol 2015 Jan 3 doi 101111exd12626

Atopic Dermatitis Antihistamines

41

Atopic Dermatitis Steroids

Topical Hydrocortisone

bull Mainstay of OTC therapy for AD hydrocortisone in an oil-in-water

base

bull Pts ge2 years old

bull Apply anywhere up to twice daily for flare-ups

bull Response may diminish with continued use (tachyphylaxis) ndash

recommend intermittent rounds of therapy



42

bull Some concern about steroid addiction syndrome ndash is there

evidence of topical corticosteroid (TCS) withdrawaladdiction

bull Authors performed a systematic review of the current literature

ndash 34 studies met inclusion criteria

ndash TCS withdrawal seen primarily in women and when used on the face

and genital area

bull Individuals experiencing adverse effects were using TCS for

inappropriate duration

Ref Hajar T et al A systematic review of topical corticosteroid withdrawal

(steroid addiction) in patients with atopic dermatitis and other dermatoses J Am

Acad Dermatol 2015 Jan 12 pii S0190-9622(14)02209-9 doi

101016jjaad201411024 [Epub ahead of print]

Atopic Dermatitis Steroids-Study 1


43

bull Most common symptoms

ndash Burning stinging erythema

bull Data not conclusive low quality of evidence lack of controlled

studies to evaluate this effect BUT worth knowing there may be

adverse effects if TCS used inappropriately

bull More of a concern with Rx products but OTC products can be

abused






44

bull May 2014 American Academy of Dermatology published a new

guideline regarding topical therapy in AD

bull Included discussion of topical steroid addiction (TSA) or red

burning skin syndrome

ndash In milder cases the rebound eruption simply consists of flushing or

erythema with or without exudative edema

ndash More severe cases a myriad of skin manifestations including

papules pustules or erosions can be seen

ndash May be accompanied by a high fever (~102degF)

ndash The peak of the rebound reaction may occur from several days to a

few months

Ref Fukaya M et al Topical steroid addiction in atopic dermatitis Drug

Healthc Patient Saf 2014 Oct 146131-8


45

bull AD usually involves the neck knees or elbows

bull TSA the appearance of a skin lesion is not limited to those sites

bull The only areas not affected by TSA or the rebound eruption are

the palms and soles

bull Longer periods of application and more potent strength of the TCS

lead to more frequent addiction

ndash Data hard to collect

ndash Skin atrophy usually evident after 6 wks of regular use

bull Based on author review of the data recommend TCS should not

be used continuously for longer than 2 weeks off x 2 weeks then

could resume 2 weeks of therapy





46

Background Children with AD have skin colonized with

Staphylococcus aureus more than children wo AD

bull Researchers determined prevalence of S aureus skin and nares

colonization in children with AD and their association with allergy

AD severity and serum vitamin D (25(OH)D)

bull 114 patients with a mean age of 57 yrsplusmn 41 (3 mos to 14 yrs)

bull + S aureus on nasal swabs equated to

ndash S aureus presence on the skin

ndash Lower 25(OH)D levels

bull Authors conclude S aureus colonization is associated with allergy

and severity in AD lower serum 25(OH)D levels

Ref Gilaberte Y et al Correlation between serum 25-hydroxyvitamin D and

virulence genes of staphylococcus aureus isolates colonizing children with atopic

dermatitis Pediatr Dermatol 2014 Dec 10 doi 101111pde12436 [Epub ahead

of print]

Atopic Dermatitis Vitamin D-Study 1

47

bull This article provides an overview of the evidence supporting the

link between vitamin D deficiency and microorganisms (skin

colonizationsensitization) in AD pathogenesis

bull Vitamin D supplementation plays a major role against

microorganisms in the development of AD and should be

considered when treating patients

Ref Benetti C et al Microorganism-induced exacerbations in atopic

dermatitis a possible preventive role for vitamin D Allergy Asthma Proc

2015 Jan36(1)19-25 doi 102500aap2015363807


48

bull Is there an association between serum vitamin D levels sensitization

to food allergens and the severity of AD in infants

ndash 226 infants with AD or food allergies evaluated regarding serum 25-

hydroxyvitamin D (25[OH]D) and specific immunoglobulin E levels to

common or suspected food allergens

ndash Significant differences in 25(OH)D levels were found between groups on

number and degree of food sensitization

ndash Infants with sensitivities significantly lower levels of 25(OH)D

ndash Vitamin D deficiency increased the risk of sensitization to food allergens

(OR 50 95 CI 18-141) especially to milk (OR 104 95 CI 33-

327) and wheat (OR 42 95 CI 11-158)

bull Also a relationship between vitamin D deficiency and worse

prognosis of AD

Ref Baek JH et al The link between serum vitamin D level sensitization to

food allergens and the severity of atopic dermatitis in infancy J Pediatr 2014

Oct165(4)849-54e1 doi 101016jjpeds201406058 Epub 2014 Aug 6



49

Study aimed to assess the effect of vitamin D supplementation on

winter-related AD

bull Randomized double-blind placebo-controlled trial of Mongolian

children with winter-related AD

bull 107 pts 2-17 years AD score 10 to 72 using the Eczema Area and

Severity Index (EASI)

bull Winter-related AD (eg history of AD worsening during the fall-to-

winter transition)

bull Subjects randomly assigned to oral cholecalciferol (1000 IUday)

versus placebo for 1 month

bull All children and parents received emollient and patient education

about AD and basic skin care

Ref Carmargo CA Jr et al Randomized trial of vitamin D supplementation

for winter-related atopic dermatitis in children J Allergy Clin Immunol 2014

Oct134(4)831-835e1 doi 101016jjaci201408002


50

bull The main outcomes were changes in EASI score and in

Investigators Global Assessment

bull 1-month follow-up data were available for 104 (97) children

bull Clinically and statistically significant improvement in EASI score in

those taking vitamin D

bull Positive change in Investigators Global Assessment

Should AD patients supplement with vitamin D



Oct134(4)831-835e1 doi 101016jjaci201408002


51

Atopic Dermatitis Key Points

bull AD is more prevalent in infants and pediatric patients than adults

bull Goals of self-treatment include reducingstopping pruritus

maintain hydration trigger avoidance and preventing secondary

infection

bull Nonpharmaceutical options include colloidal oatmeal bath oils

moisturizers emollients

bull Other therapies with proven or suspected benefit include topical

hydrocortisone vitamin D probiotics


52

7-year-old girl with recent onset of rash on upper extremities

bull Review the case and determine how yoursquod handle this situation

Is the patient a candidate for self-care

bull If so what would you recommend and why

bull If not what would you recommend and why

Atopic Dermatitis Case Study

Ref Image courtesy of Microsoft Clipart accessed 2-3-2015

53

Rosacea

54

Rosacea

bull Cutaneous disorder of uncertain

etiology

bull Often referred to as adult acne

bull Estimated to affect 13 million

Americans

bull Risk factors include

ndash Gender

ndash History

ndash Fair complexion

ndash Age


55

Rosacea Aggravating Factors

bull Hot foods and drinks

bull Spicy foods

bull Ethanol

bull Temperature extremes

bull UV exposure

bull Stress anxiety

embarrassment

bull Hot water bathing

bull Corticosteroids

bull Vasodilators

bull Exercise

56

Rosacea Demodex Mites

bull 20-80 adults have skin

mites

bull Stress illness age-related

skin changes allow growth

bull Rosacea patients have 10x

more mites

bull Dead mites release bacteria

that cause symptoms

57

Rosacea Clinical Presentation

bull In 2002 the National Rosacea Society convened a consensus

committee to develop classification system for rosacea signs and

symptoms

bull The system was reviewed and approved by 21 experts worldwide and

is used to conduct research analyze results compare information from

different studies and serve as a diagnostic reference in practice


58

Rosacea Subtype 1

bull Erythematotelangiectatic

rosacea

ndash Flushing persistent

erythema on central face

ndash Telangiectases common but

not essential

ndash Stinging swelling roughness

and scaling also common

59

Rosacea Subtype 2

bull Papulopustular rosacea

ndash Persistent erythema with

papules pustules that

come and go on central

face

ndash No blackheads present

ndash Burning stinging may

also occur

60

Rosacea Subtype 3

bull Phymatous rosacea

ndash Thickening skin irregular

surface nodules and

enlargement

ndash Rhinophyma most

common

ndash May occur after or

concurrent with subtypes

1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea

ndash Watery or bloodshot eyes

periocular erythema

conjunctival

telangiectases

ndash Blepharitis conjunctivitis

ndash Foreign body sensation

burning stinging light

sensitivity blurred vision

62

Rosacea Management Overview

bull Therapeutic alternatives for relief of signs and symptoms

are intended as a menu of options versus a treatment

protocol

bull Most clinicians recommend a multidimensional treatment

approach that includes proper skin care and trigger

avoidance measures

63

Rosacea Drug Therapy

bull Papules pustules nodules plaques and perilesional erythema can be

treated with prescription drugs approved by the FDA for this purpose

ndash Topical metronidazole

ndash Topical azelaic acid

ndash Oral controlled-release doxycycline 40 mg

bull Topical sodium sulfacetamide-sulfur also has been used for years

bull Other antibiotics are also used on an off-label basis to treat a variety of

signs and symptoms


64

Rosacea Laser and Light Therapy

bull Nonablative lasers and polychromatic light-emitting devices

can be used to reduce erythema flushing and

telangiectases

bull Ablative lasers can be used to destroy excess tissue

associated with phymatous rosacea

65

Rosacea Self-Care

bull Patients should identify and avoid only those lifestyle

factors that trigger or worsen their symptoms

bull Patients can record daily contact with the most common

triggers and other possible factors and then look for those

triggers that seem to worsen their symptoms

66

Rosacea Self-Care

bull The goal of routine skin care is to maintain the integrity of the skin

while avoiding ingredients that irritate the skin

bull As a rule of thumb avoid ingredients that contain either sensory

provoking ingredients volatile substances irritants allergens

botanicals or unnecessary ingredients

bull Broad spectrum sunscreens with a sun protection factor of 15 or higher

should be appliedreapplied as directed on the label during sun

exposure


67

Rosacea Self-Care

bull Patients should wash their faces with nonirritating

cleansers and avoid using abrasive washcloths loofahs

and facial brushes

bull Patients should blot the skin dry and wait 30 minutes

before applying topical medications and cosmetics to the

face because stinging most often occurs when the skin is

wet

68

Rosacea Self-Care

bull Avoid all cosmetics that irritate the skin

bull Cosmetics with either a yellow or green tint can help mask redness

bull Avoid waterproof cosmetics because they can be difficult to remove

without the use of irritating agents

bull Purchase new cosmetics often to minimize contamination

bull Use brushes and avoid sponge application because brushes are less

irritating and easier to clean

69

Rosacea Self-Care

bull Patients with ocular rosacea

ndash Use artificial tears to relieve symptoms of dryness stinging itching

and burning

ndash Use warm compresses and cleanse eyelashes twice daily with

baby shampoo on a soft washcloth gently rubbed onto the upper

and lower lashes of the closed eyes for the relief of blepharitis

symptoms


70

Rosacea Key Points

bull Rosacea is a cutaneous disorder of uncertain etiology that affects

convex areas of the central face and is classified according to lesion

type location and severity

bull It affects approximately 13 million Americans

bull This incurable disorder can be managed with prescription medications

light and laser therapy

bull Pharmacists are in a unique position to recommend self-care options

that can enhance the effectiveness of these treatments

71


Dermatitis) Index

A Assesses a patientrsquos severity of atopic

dermatitis

B Provides patients with a list of therapeutic

options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days


associated with AD make an appointment with your

primary care provider or dermatologist

C Newer data suggest the best response is achieved with

applications 1-2 times daily for maximum of 2 weeks

then stop for 2 weeks and can resume if needed

D Only apply this product on your arms and legs do not

apply on any other part of your body

74



A 20-year-old college student who works as a fry cook at

a local diner

B 45-year-old ad executive of Mediterranean descent

who plays racquet ball three times a week

C 37-year-old stay-at-home mom who had nodular acne

as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM

To obtain CPE credit for this activity go to bull Pharmacistcomlive-activities

bull Login

bull Click ldquoclaim creditrdquo

bull ldquoEnrollrdquo in the activity

bull Complete the assessment and evaluation

Your CPE must be filed by July 6 2015 in order to receive credit

DERM Handout_Pt 1 060115pdf

DERM Handout_Pt 2 060215



Activity Description

Many patients with skin conditions do not seek medical care and are likely to need advice regarding self-care treatments A large body of evidence supports the use of topical products to manage symptoms of rosacea and atopic dermatitis (AD) and indicates that such treatment is associated with improved long-term outcomes As drug information experts pharmacists can facilitate successful treatment of AD and rosacea In addition pharmacists can provide patient education to help diminish the stress and anxiety experienced by patients and caregivers In this live webinar experts will use a case-based approach to explore strategies that pharmacists can recommend to patients with rosacea and atopic dermatitis

Learning Objectives

At the completion of this application-based activity participants will be able to 1 Describe the epidemiology and clinical presentation of rosacea and atopic dermatitis (AD) 2 Recommend appropriate self-care treatment for patients with rosacea or AD with regard to the

efficacy and safety of available therapeutic options 3 Discuss areas where pharmacists interventions can improve the care of patients with rosacea

and AD

Target Audience Pharmacists Activity Type Application-based Learning Level 2 Date of Activity Wednesday June 3 2015 Location Virtual meeting Time 200 PMndash400 PM EDT (20 hours)

Speakers

Gail Newton PhD RPh Associate Professor Purdue University School of Pharmacy and Pharmaceutical Sciences West Lafayette Indiana

Daniel Krinsky MS RPh Associate Professor Northeast Ohio Medical University (NEOMED) College of Pharmacy Rootstown Ohio

Disclosures

Gail Newton PhD RPh and Daniel Krinsky MS RPh declare no conflicts of interest real or apparent and no financial interests in any company product or service mentioned in this activity including grants employment gifts stock holdings and honoraria For complete staff disclosures please see the Education and Accreditation Information section at wwwpharmacistcomeducation















1




Gail Newton PhD RPh

Associate Professor




Associate Professor



2







3








education


4

Attendance Code

DERM






receive credit

5








Learning Level 2


6

Learning Objectives











7


Dermatitis) Index





8





A Colloidal oatmeal


C Vitamin D

D Probiotics

9





minimum of 14 days










10




local diner




teenager


11





C Phymatous rosacea

D All of the above

12





C Phymatous rosacea

D None of the above


13












14




AD








15











lipid and ceramides




16




ndash Erythema

ndash Edema





ndash Dryness





17








years)






18










19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login





















1




Gail Newton PhD RPh

Associate Professor




Associate Professor



2







3








education


4

Attendance Code

DERM






receive credit

5








Learning Level 2


6

Learning Objectives











7


Dermatitis) Index





8





A Colloidal oatmeal


C Vitamin D

D Probiotics

9





minimum of 14 days










10




local diner




teenager


11





C Phymatous rosacea

D All of the above

12





C Phymatous rosacea

D None of the above


13












14




AD








15











lipid and ceramides




16




ndash Erythema

ndash Edema





ndash Dryness





17








years)






18










19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








4

Attendance Code

DERM






receive credit

5








Learning Level 2


6

Learning Objectives











7


Dermatitis) Index





8





A Colloidal oatmeal


C Vitamin D

D Probiotics

9





minimum of 14 days










10




local diner




teenager


11





C Phymatous rosacea

D All of the above

12





C Phymatous rosacea

D None of the above


13












14




AD








15











lipid and ceramides




16




ndash Erythema

ndash Edema





ndash Dryness





17








years)






18










19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








7


Dermatitis) Index





8





A Colloidal oatmeal


C Vitamin D

D Probiotics

9





minimum of 14 days










10




local diner




teenager


11





C Phymatous rosacea

D All of the above

12





C Phymatous rosacea

D None of the above


13












14




AD








15











lipid and ceramides




16




ndash Erythema

ndash Edema





ndash Dryness





17








years)






18










19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








10




local diner




teenager


11





C Phymatous rosacea

D All of the above

12





C Phymatous rosacea

D None of the above


13












14




AD








15











lipid and ceramides




16




ndash Erythema

ndash Edema





ndash Dryness





17








years)






18










19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








13












14




AD








15











lipid and ceramides




16




ndash Erythema

ndash Edema





ndash Dryness





17








years)






18










19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








16




ndash Erythema

ndash Edema





ndash Dryness





17








years)






18










19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








19





exudate


plaques




skin



20


Treatment Goals






the disorder




21









ndash Emollients





and hydration




22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








22

bull Bath Oils



bull Cleansers


substances


less drying








23



bull Moisturizers





ingredients





water




101016jjaad201403023 Epub 2014 May 9

24





101016jjaad201403023 Epub 2014 May 9














25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








25





pthinsp=thinsp0011)


bull At 6 months







26













27

bull METHODS






bull RESULTS










28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








28




validation











29






monthly x 3 months



(p lt 0001)


(both p lt 0001)


no adverse events




30



this study


patients with AD










31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








31




Authors conclude


skin changes in AD



response




32




diagnosed with AD


and placebo groups

bull 25 RCTs (n = 1599)







33



bull Adults (-826 95CI -1328 to -325)





species alone






34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








34







bull Groups

ndash LP

ndash LF

ndash LP+LF mixture

ndash placebo





35



SCORAD scores












36







(n=13)



clostridia)




Suppl 1S47-51



37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








37


SCORAD index










Suppl 1S47-51


38





measures






39




2 Antihistamines







3 Hydrocortisone





40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








40





monotherapy


placebo or control






41




base







42






and genital area









43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








43







abused






44











few months




45




the palms and soles












46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








46















of print]


47









2015 Jan36(1)19-25 doi 102500aap2015363807


48











327) and wheat (OR 42 95 CI 11-158)


prognosis of AD






49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








49


winter-related AD






winter transition)







Oct134(4)831-835e1 doi 101016jjaci201408002


50










Oct134(4)831-835e1 doi 101016jjaci201408002


51





infection






52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








52








53

Rosacea

54

Rosacea


etiology



Americans


ndash Gender

ndash History


ndash Age


55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








55



bull Spicy foods

bull Ethanol


bull UV exposure

bull Stress anxiety

embarrassment



bull Vasodilators

bull Exercise

56



mites




more mites


that cause symptoms

57




symptoms





58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








58

Rosacea Subtype 1


rosacea




not essential



59

Rosacea Subtype 2





face



also occur

60

Rosacea Subtype 3



surface nodules and

enlargement


common



1 or 2


61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








61

Rosacea Subtype 4

bull Ocular rosacea


periocular erythema

conjunctival

telangiectases





62




protocol



avoidance measures

63









signs and symptoms


64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








64




telangiectases



65

Rosacea Self-Care






66

Rosacea Self-Care








exposure


67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








67

Rosacea Self-Care



and facial brushes




wet

68

Rosacea Self-Care








69

Rosacea Self-Care



and burning




symptoms


70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








70

Rosacea Key Points









71


Dermatitis) Index


dermatitis


options



72




associated with AD

A Colloidal oatmeal


C Vitamin D

D Probiotics


73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








73





minimum of 14 days









74




a local diner




as a teenager


75





C Phymatous rosacea

D All of the above


76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login








76





C Phymatous rosacea

D None of the above

77

Attendance Code

DERM


bull Login







dermatologic symptoms in your pharmacy: the management of ... · activity, dermatologic symptoms in...

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