ATOPIC DERMATITIS

Patient presents with skin manifestations

suggestive of atopic dermatitis

2
DIAGNOSIS. Do
history &physical ALTERNATIVE DIAGNOSIS
exam confirm NO
atopic dermatitis

YES

Patient suffers acute Patients suffer Disease

Flare up of pruritus persistence of frequent

& inflammation. Recurrences.

 ACUTE FLARE UP TREATMENT MAINTAINANCE TREATMENT

A- Non Pharmacologic Treatment A- Non Pharmacologic Treatment

 Patient/caregiver education  Same as acute flare up
 Avoidance of trigger factors  Investigate precipitating factors of each
 Skin care flare up
 Moisturizers
B. Pharmacological Therapy
B. Pharmacologic Theraphy
Start the earliest sign of local recurrence:
Any of the following agents:
 Calcinerium inhibitor(topical) or
 Corticosteriod (topical)
Long term:
 Calcinerium Inhibitor (topical)

If skin infection is present:  Calcinerium inhibitor (topical), combined with

 Corticosteroids (topical), intermitten use
 Appropriate antibiotics, antifungals, aand
antivirals (oral/or atopical) If skin infection is present:

Symtomatic relief of pruritus:  Antibiotics, antifungals,antivirals (oral or/ topical)

 Antihistamine ( Oral) Symptomatic relief of pruritus:

 Antihistamine (oral)
 Continue non
pharmacological
EVALUATION TREATMENT
therapy
 Discontinue topical YES NO See Next Page
Disease
corticosteroid and or
calcinerium inhibitor remission

TREATMENT OF SEVERE REFRACTORY ATOPIC DERMATITIS

 Except referral is recommended

 Psychotherapeutic/psychopharmacological options may be combines
with the therapies listed below
A Non- Pharmacological Therapy

 Continue as previous page

 Phototherapy

B Pharmacological Therapy
 Potent corticosteroids (topical)
 Systemic corticosteroids
 Immunosuppressant (oral)
 1 ATOPIC DERMATITIS

 A familial, chronic relapsing inflammatory skin disease characterized by intense itching, dry skin, with
inflammation and exudation that commonly presents during early infancy and childhood , but can persist or
start in adulthood

Signs & Symptoms

Infants <2 years usually present w/:

 Signs of inflammation usually develop during the 3rd month of life
 Patient commonly presents w/ dry skin
- Lesions (red papules w/ oozing, crusting & scaling) usually found on the facial cheeks &/or chin
- Lip licking may result in scaling, oozing & crusting on the lips & perioral skin, eventually leading to
secondary infections
 Continued scratching or washing will create scaling, oozing, red plaques on cheeks
- Infant may be restless or agitated during sleep
 A small number of infants may present w/ generalized eruptions
- Papules, redness, & scaling
- Diaper area is usually not aff ected

12 years-adults usually present w/:

 Inflammation in the flexural areas (eg neck, wrists, ankles, antecubital fossae)
 Rash may be contained to 1 or 2 areas
- May progress to involve more areas eg neck, antecubital & popliteal fossae, wrists & ankles
 Papules that quickly change to plaques then lichenifi ed when scratched
 Scratching & chronic inflammation may lead to areas of hypo- or hyperpigmentation

Adolescents’ ≥12 years old usually present with:

 Resurgence of inflammation that recurs near puberty onset

 It is unusual for adults w/ no history of dermatitis in earlier years, to present w/ new onset dermatitis
 Pattern of inflammation is similar as in a child 2-12 years w/ additional lesions on nape & hands
 Dry, erythematous papules & plaques.

Severe Atopic dermatitis

 Characterized by intensely pruritic, widespread skin lessions that are often complicated by persistent infections
->20% skin involvement (or 10 %if the affected areas include the eyelids, hands or intertriginous areas)
-extensive skin involvement with risk of exfollation
 There is significant disruption of quality of life (eg:sleepless nights, lost school days)
 Generally erythrodermic
 Ocular or infectious complications maybe also be present
 Requires on going or frequent treatment with high potency topical steroids or oral steroids
 May require hospitalization for severe eczema or skin infections
 2 DIAGNOSIS

 Diagnosis is based on patient’s history, cutaneous fi ndings (atopic stigmata), & physical exam
 Investigate exacerbating factors
- Eg Aeroallergens, foods, irritating chemicals, emotional stress, extreme temperature
- Not very useful clinically

Criteria for Diagnosis (Based on criteria developed by Hanifi n 1991)

Major Features
(must have ≥3)

 Pruritus
 Typical morphology & distribution
 Facial & extensor involvement in infants & children
 Flexural lichenifi cation & linearity in adults
 Dermatitis - chronic or chronically relapsing
 Personal or family history of atopy - asthma, allergic rhinitis, atopic dermatitis

Minor/Less Specific Features

 Cheilitis
 Hand/foot dermatitis
 Scalp (cradle cap) dermatitis
 Ichthyosis, hyper linearity, keratosis pilaris
 Periauricular fi ssures
 Eczema - perifollicular accentuation
 Xerosis
 Recurrent conjunctivitis
 Keratoconus
 Anterior subcapsular cataract
 Pityriasis alba
 White dermographism
 IgE reactivity (increased serum IgE, radioallergosorbent, or prick test reactivity)
 A
NON-PHARMACOLOGICAL THERAPHY

Patient/Caregiver Education

 Discuss the chronic nature of atopic dermatitis, exacerbating factors & appropriate treatment options
- Emphasize that atopic dermatitis tends to decrease w/ increase in age

 Convey the goal of treatment is control rather than “cure”

 Discuss that many factors probably contribute to fl are-ups & usually a specifi c cause cannot be found
 Educate the patient about proper skin care (eg bathing, hydration & use of moisturizers)
- Patient/caregiver should be instructed to apply emollients liberally 3 minutes after taking a bath 2-3 times
daily or frequently as the skin gets dry even in the absence of symptoms
- Studies showed that correct & adequate instructions for use & application of moisturizers when done properly
reduces disease severity & overall topical corticosteroids use
 Explain potential side eff ects of medications when used over extended periods of time
- Apply topical steroid 10-15 minutes after application of emollients
 Keep fingernails trimmed short
 Use of cotton gloves at night to limit scratching

Avoidance of Trigger Factors

All irritants
 Lipid solvents (soap detergents )
 New clothes should be laundered before wearing to decrease levels of formadehyde and other chemicals added
 When washing, use liquid soap instead of powder detergent, and do another rinse cycle to remove detergent
completely from clothes
 Disinfectants (swimming pool chlorine)
 Occupational irritants
 Household fluids (meals, juices from fresh fruits)

Contact And Aeroallergens

 Dust mites
 Avoidance include use of dust mite proof encasing on pillows and matresses, washing bedding in hot water wkly,
remove bedroom carpeting, decrease indoor humidity level by air conditioning, avoid upholstered sofa
 Furry animals (cats, dog)
 Molds
 Human dander (dandruff)
Others

 Foods
 Skin prick test (SPT) & measurement of specific IgE are used to determine sensitization to a particular food at any
age
 Dietary restriction of eggs maybe beneficial in patients with IgE reactivity to egg
 Climate
 Consider temperature and humidity control to avoid increased pruritus due to heat & perspiration
 Prolonged sun exposure may increase evaporative losses due to sweating
 Hormones(menstral cycle)
 Psychological factors
 Emotional factors (eg:anxiety &anger ) cause disease exacerbation, include immune activation & increase pruritus
 & scratching
 Psychological evaluation & counseling should be considered in the patients who have difficulty with emotional
triggers or who have psychological problems
Skin Care

 Hydration of skin w/ emollients is essential to treatment of atopic dermatitis

Bathing

 Soap substitutes w/ minimal defatting activity, moisturizer-containing, fragrance-free, hypoallergenic, & a

neutral to low pH are preferred
 If possible, limit soap use to hands, feet, genitalia, axillae
 Limit bathing to once daily for 5-10 minutes using warm water
 Salt baths may also be used to help shed dead keratin materials from the skin
 Oatmeal products added to bath may be soothing but do not increase water absorption by the skin
 Topical medications are best applied after bathing because of greater penetration of hydrated skin

Moisturizers

 Water-in-oil emollients are preferred; occlusive agents & humectants also used
 Patient preference &treatment area will determine formula used in emollients (eg palmitoylethanolamide)(PEA) liqid
paraffin, mineral oils, glycerine, etc)
 Effects: Moisturizers help re establish & preserve the stratum corneum
 Can decrease the need for topical cortecosteriods
 Should be applied all over at least twice daily or as often as possible, regardless of the presence of active dermatitis
 Avoid products with preservatives or fragrances
 If product stings, it should be used

Wet dressing
 Maybe used on weeping lessions or severely affected areas
 Combine with topical corticosteroids can be effective can be effective in treating refractory cases

Phototherapy
 Broad band UVB & UVA, narrow- band UVB & UVA-1 or combined UVA & UVB can be useful atopic dermatitis
 Relapse after therapy cessation frequently occurs
 Photochemotheraphy with Psoralens & UVA should be restricted to patients with widespread severe atopic dermatitis
 UV theraphy should be restricted to patients >12 year except when absolutely necessary
 Adverse Reactions:
 Short term: Erythma, skin pain, pigmentation, itching
 Long term: Premature skin aging & potential cutaneousmalignant disease

Prevention

 Identification and elimination of triggering factors in the mainstay for preventionof flatters as well as for the long- term
treatment of atopic dermatitis
 Breastfeeding or feeding w/ hypoallergenic hydrolyzed formula milk was shown to be benefi cial
- If the patient w/ atopic dermatitis is also diagnosed w/ food allergy, the mother should be advised to eliminate
all identified food allergen from her diet
 Probiotics may also reduce the incidence or severity of atopic dermatitis, however, more studies are needed
 to prove this benefit

Corticosteroids

 Used as 1st-line treatment for mild to severe atopic dermatitis

 Moderately potent and potent corticosteroids should be used for treatment of clinical exacerbation over short periods of
time.
 Mildly potent corticosteroids are recommended for maintenance therapy
 Anti-Inflammatory & anti pruritic activity through several mechanisms
 Alteration in leucocyte number and activity
 Suppression of mediator release (histamine, prostaglandins)
 Enhanced response to agents that increases cyclic adenosine monophosphate( prostaglandin E 2, & histamine via
the histamine 2 receptor)
 Rapid symptomatic relief of acute flare-ups
 Continuous use can lead to adverse effects
 Follow the recommended restrictions regarding intensity & duration of use on delicate skin areas (eg: face, neck, skin
folds)
 Topical costercosteriods are available in different potencies from mild to very potent
 Potency is also affected by vehicle the product is formulated in (eg. Cream, oint)
 Choice of product will depend on severity of flare-up distribution of lesion& other factors(eg:humidity)
 Least potent but effective products should be used
 Rebound flaring can occur if higher potency preparations are discontinued abruptly
 A gradual decrease in potency should follow use of higher potency preparations
 Therapy resistant lesions may require potent topical corticosteroids used under occlusions

Calcinerium Inhibitors (Topical)

 Inhibitor inflammatory cytokine transcription in activated T cells & other inflammatory cells through inhibitionof
calcineurin
 Maybe used on all body locations for extended periods of time
 All preparations are of standard potency
 Not recommended for patients <2yr of age

Pimecrolimus

 Safety & effi cacy have been shown in children >2 years of age & adults w/ mild-moderate atopic dermatitis
- Pruritus relief has been seen as early as day 3 of use; does not cause atrophy
- Prevents fl are-ups & results in signifi cant steroid-sparing eff ect when used for up to 12 months
 When used in early stages of disease, it has shown to be therapeutically advantageous over typical moisturizers
plus topical corticosteroids in long-term use

Tacrolimus

 Indicated for moderate to severe atopic dermatitis

 Maybe used for up to 1 year old without loss of effectiveness, increase in infection risk or other no
application site adverse effects
 Well- tolerated with transient skin burning/irritation

 Studies have confirmed the efficacy of Tacrolimus 0.03% compared to low potency topical corticosteroids in
children
Skin Infections

 Clinical infections at the treatment sites should be cleared before starting anti inflammatory agents
 May need to treat reservoirs of the infection to prevent recurrence (eg: nose, groin)

Bacterial Infections

 S. aureus is commonly cultured from eczematous skin 7 is often the cause of localized infections
 Topical Theraphy
 May be used to treat mild & localized secondary infection
 Fusidic acid, Mupuricin, neomycin are treatment options
 Neomycin may cause allergic contact dermatitis

 Oral therapy
 Usually necessary to treat widespread infected lessions
 Anti staphylococcal penicillins, macrolides, 1st and 2nd generation cephalosporins & clindamycin aretreatment
options

Viral Infections

 Patients may develop secondary herpes infections inclusive of eczema herpecticum (kaposi’s varicella form eruption)&
may require systemic acyclovir treatment in hospital setting.
 Propilactic oral anti-viral agents may be used to suppress recurrent cutaneous herpetic infections

Fungal Infections

 Role of fungi in atopic dermatitis is questionable

 Suoerficial dermatophytosis & pityrosporum ovale maybe treated with systemic or topical anti fungals

Anti- Histamines

 Oral sedating anti histamines maybe useful in the patients has comorbidities(allergic rhinitis, urticaaria or
dermatographism) & sleep disturbance
 They are best used at bedtime since pruritus is typically worse at night

 Studies of oral non sedating antihistamines have shown variable results in controlling pruritus, however they may be
useful in a small group of patients with associated urticarial
 Topical antihistamines are usually not helpful relieving pruritus and may cause allergic contact dermatitis

Systemic Corticosteroids

 Should be considered in treatment resistant atopic dermatitis

 Improves lessions but rebound flare up usually occurs upon discontinuation
 Use short term & decrease chance of rebound effect by tapering oral form slowly while increasing topical
corticosteroid treatment and continuously hydrating the skin.
Immunisuppresant Oral

Ciclosporin

 Effective for short term use in severe refractory disease

 Condition tends to return after discontinuation of theraphy but not always at the original severity level

 Long term use is not justified because of risk of hypertension and renal dysfuction

Azathioprine

 Safer than Ciclosporin & has been used in long term

 Most patients respond to low doses

Adverse Reaction:

 Nausea, fatigue, myalgia, liver dysfuction & bone marrow depression in patients deficient in thiopurine methyl
transfuse
 CALCINEURIN INHIBITORS (TOPICAL)

CALCINEURIN INHIBITORS (TOPICAL)

DRUG AVAILABLE DOSAGE REMARKS
STREnGHT

Pimecrolimus 1% Cream ≥yr: Apply Application

12 hourly  Apply a thin layer to affected skin and rub in gently & completely

Adverse reactions
 Local effects : burning, sensation of warmth which usually
decreases with continued use, application site reactions (eg:
irritation, erythemia, itching)
 Less common: bacterial &viral infections
 Higher dose than used in humans, shortened time to skin tumor
formation in animal photocarcinogenicity study

Special Instructions

 Do not apply to areas of acute cutaneous viral infections

 Bacterial and fungal infections should be treated appropriately. If
infections does not resoleved, discontinue Pimecrolimus until
infections clears
 In long term treatment, should be used at 1 st sign of atopic
dermatitis to prevent flare-up and continued as long as signs and
symptoms persist
 If no improvement with in 6 weeks, patient should be reevaluated
 Should not be used with in occlusive dressing
 Patient should be minimize or avoid natural or artificial sunlight.

Tacrolimus 0.03 % oint 2-15yr: Application

Apply  Apply thin layer to affected skin and rub in gently
0.03% completely
OINT
12 Adverse Reaction
HOURLY
 Local effects: Burning, stinging, pruritus which usually
decreases with continued use
  Less common: bacterial and viral infections

 If lymphanedenophaty occurs, the cause should be

investigated and if no clear cause, Tacrolimus should be
discontinued

 Higher dose than used in humans, shortened time to skin

tumor formation in anImal photocarcinogenicity study

Special Instructions

 Do not apply to areas of acute cutaneous viral infections

 Clinical cutaneous infections should be cleared before

application of tacroliums

 Continue for 1 week after cleaning of signs & symptoms

of atopic dermatitis

 Should not be used with occlusive dressing patient should

be minimize or avoid natural or artificial sunlight
 CORTICOSTEROIDS TOPICAL

DRUG AVAILABLE DOSAGE REMARKS

STRENGTH

Very Potent (Group IV)

Clobetasol 0.05 cream, Apply 12- Application

Propionate gel, oint, 24 hourly
scalp  12-24 hourly applications are recommended for most
application agents. More frequent administration maybe necessary
for palms or soles of feet.
Potent (GroupIII)  Every other day or weekend application has been used
to treat chronic conditions
 Length of cream, oint squeezed from tube can be
Amcinonide 0.1%cream, Apply 8- measured by finger tip unit (FTU) which is tip of adult
lotion 12 hourly index to 1st crease
ointment  1 FTU (approx. 500mg)is sufficient to cover 2x the size
of the adult hand
 Recommended used of very high potency agents is for
Beclometasone 0.05%cream, Apply 28 1-2 weeks (max 3 weeks) following with weaker
Dipropionate ointment, to 24 potency preparations as the condition improves
solution hourly
Adverse Reaction
0,064%
cream,  the more potent agent, the more chance of adverse
ointment reactions
solution  Local effects: Thinning of skin which may be restored
after stopping treatment, worsening of underlying
infection, contact dermatitis, acne at site application,
Betamethasone 0.25%cream Apply 12 hypopigmentation which may be reversible, irreversible
Dipropionate hourly telangiectasia & striae atrophica
 Systemic effect: Absorption through the skin can cause
pituitary-adrenal-axis suppression, growth retardation,
Betamethasone 0.025% cream Apply 8- hypertension & Cushing syndrome
Valerate 24 hourly  Absorbtion is increased by thin and or raw skin,
intertriginous areas or occlusion
 Absorption is more likely when used nover very
Betamethasone 0.025% cream Apply 24 large areas and in children
Valerate 0.05% cream hourly
Special Instructions
Betamethasone 0.05%cream Apply 8-  Mildly potent preparations are preffered for face&
Valerate 24 hourly intertriginous areas
 Very potent agents should not be in used in patients
Desoximetasone 0.06% cream Apply 8- <1yr of age
(Desoxymetasone 24 hourly
 Moderately potent & potent agents will rarely cause side
effects if used for <3 months(except if used on face or
Diflucortolone 0.1%cream, Apply 8- intertigrinous areas)
Valerate lotion 24 hourly
ointment
solution  Intermittent therapy is usually preferable to long
term continuous therapy
Fluclorolone 0.25% cream Apply 6-
Acetonide ointment 12hourly  Mildly potent agents will rarely cause side effects

Fluocinonide 0.01% cream Apply 8-  Intermittent therapy is usually preferable to long

ointment0.025 24 hourly term continuous therapy specially if large areas are
cream, gel treated
ointment
0.2% cream

Fluocinonide 0.05 % cream Apply 8-

lotion 12hourly
ointment

Fluocortolone/ 0.25%, 0.25% Apply 8-

Fluocortolone cream 24 hourly
Caproate

POTENT (GROUP III)

Application
Fluticasone 0.05%crea Apply 12-
Propionate 0.005%oint 24 hourly  12-24 hourly applications are recommende for most
agents. More frequent administration may be
necessary for palms or soles of feet
Halometasone 0.05% cream Apply 12-
24 hourly  Every other day or weekend application has been
used to treat chronic conditions
Hydrocortisone 0.127% Apply 12-
Aceponate cream, oint 24 hourly  Length of cream or ointment squeezed from tube
can be measured by fingertip unit (FTU) which is
tip of index finger to 1st crease
Methylprednisolo 0.1%cream, Apply 24
ne oint, hourly  1FTU (approx. 500mg) is sufficient to cover 2x the
Aceponate flat adult hand
 0.1%cream,
Mometasone Apply 24  Recommended use of very high potency agents is
furoate fatty oint, gel, hourly for 1-2 week (max 3 weeks) following with weaker
lotion, oint potency preparations as the condition improves

Prednicarbate 0.25% cream Apply 12- Adverse Reaction

24 hourly
 the more potent the agen, the more chances of adverse
reactions

 Local effects: Thinning of skin which may be restored

after stopping treatment, worsening of underlying
infection, contact dermatitis, acne at site application,
hypopigmentation which may be reversible, irreversible
telangiectasia & striae atrophica

 Systemic effect: Absorption through the skin can cause

pituitary-adrenal-axis suppression, growth retardation,
hypertension & Cushing syndrome

 Absorbtion is increased by thin and or raw skin,

intertriginous areas or occlusion

 Absorption is more likely when used nover very

large areas and in children

Special Instructions

 Mildly potent preparations are preffered for face&

intertriginous areas

 Very potent agents should not be in used in patients <1yr

of age

 Moderately potent & potent agents will rarely cause side

effects if used for <3 months(except if used on face or
intertigrinous areas)
 Intermittent therapy is usually preferable to long
term continuous therapy

 Mildly potent agents will rarely cause side effect

 Intermittent therapy is usually preferable to long
term continuous therapy specially if large areas are
treated
 Moderately Potent (Group II)
Application
Alclometasone 0.05% cream Apply 8-12
Dipropionate hourly  12-24 hourly applications are recommende
for most agents. More frequent
administration may be necessary for palms
or soles of feet

 Every other day or weekend application has

been used to treat chronic conditions

 Length of cream or ointment squeezed from

tube can be measured by fingertip unit
(FTU) which is tip of index finger to 1st
crease

 1FTU (approx. 500mg) is sufficient to cover

2x the flat adult hand

 Recommended use of very high potency

agents is for 1-2 week (max 3 weeks)
following with weaker potency preparations
as the condition improves

Clobetasone 0.05% cream, Apply up to 6 Adverse Reaction

Butyrate oint houly
 the more potent the agen, the more chances of
adverse reactions
Desonide 0.05 cream, Apply 6-12
lotion, oint hourly  Local effects: Thinning of skin which may be
restored after stopping treatment, worsening of
underlying infection, contact dermatitis, acne at
Flumetasone 0.02% oint Apply 8-12 site application, hypopigmentation which may
hourly be reversible, irreversible telangiectasia & striae
atrophica

Fluprednidene 0.01% cream Apply 12-24

Acetate hourly  Systemic effect: Absorption through the skin can
cause pituitary-adrenal-axis suppression, growth
retardation, hypertension & Cushing syndrome
Hydrocortisone 0.01% cream, Apply 6-12
Butyrate oint, soln hourly  Absorbtion is increased by thin and or raw
skin, intertriginous areas or occlusion

Triamcinolone 0.1%cream, Apply 6-12  Absorption is more likely when used nover
very large areas and in children
Acetonide lotion, oint hourly
scalp lotion Special Instructions
0.2%cream,
0.2% cream  Mildly potent preparations are preffered for
0.5% cream face& intertriginous areas

 Very potent agents should not be in used in

patients <1yr of age

 Moderately potent & potent agents will rarely

cause side effects if used for <3 months(except if
used on face or intertigrinous areas)
 Intermittent therapy is usually preferable to
long term continuous therapy

 Mildly potent agents will rarely cause side effect

 Intermittent therapy is usually preferable to
long term continuous therapy specially if
large areas are treated

Mild Potent (Group 1)

Hydrocortisone 1% lotion; Apply 6-12 Application

cream, oint hourly
2.5% lotion  12-24 hourly applications are
recommende for most agents. More
frequent administration may be
necessary for palms or soles of feet

 Every other day or weekend application

Prednisolone 0.5% cream Apply 8-24 has been used to treat chronic
hourly conditions

 Length of cream or ointment squeezed

from tube can be measured by fingertip
unit (FTU) which is tip of index finger
to 1st crease

 1FTU (approx. 500mg) is sufficient to

cover 2x the flat adult hand

 Recommended use of very high

 potency agents is for 1-2 week (max 3

 weeks)following with weaker potency

preparations as the condition improves

Adverse Reaction

 the more potent the agen, the more chances

of adverse reactions

 Local effects: Thinning of skin which may

be restored after stopping treatment,
worsening of underlying infection, contact
dermatitis, acne at site application,
hypopigmentation which may be reversible,
irreversible telangiectasia & striae atrophica

 Systemic effect: Absorption through the

skin can cause pituitary-adrenal-axis
suppression, growth retardation,
hypertension & Cushing syndrome

 Absorbtion is increased by thin and or

raw skin, intertriginous areas or
occlusion

 Absorption is more likely when used

nover very large areas and in children

Special Instructions

 Mildly potent preparations are preffered for

face& intertriginous areas

 Very potent agents should not be in used in

patients <1yr of age

 Moderately potent & potent agents will

rarely cause side effects if used for <3
months(except if used on face or
intertigrinous areas)
 Intermittent therapy is usually
preferable to long term continuous
therapy
  Mildly potent agents will rarely cause side
effect
 Intermittent therapy is usually
preferable to long term continuous
therapy specially if large areas are
treated

EMOLLIENTS’

DRUG AVAILABLE INDICATION ADMINISTRATION

STRENGTH

CERAMIDE Lotion; Bar - Dry sensitive skin - Uses as a soap substitute

- Symptomatic relief of - Moisturizers &/or for treatment:
mild to moderate atopic apply 8-12 hourly
dermatitis & skin rashes - Bath : use as a liquid cleanser

DEXPANTHENOL 5% OINT - Diaper rash - Apply once as needed

- Dry / damage skin (after each diaper change)

DIMETICONE CREAM - Helps relieve, repair - Massage unto skin in the

& protect very dry morning & at night after shower
and damage skin as needed
- Helps increase skin
moisture & enhance
skin flexibility,
softness &
smoothness

GLYCERIN SOAP; 10% ; - Cleansing treatment - Use as often as required

15 % WASH for itchyosis,
xerosis,dry sensitive
skin, pruritus,
eczema, allergic
dermatitis, soap
intolerant skin areas,
sun damage skin,
infant and elderly
skin
LACTIC ACID LIQUID - Antiseptic in topical - Use as a soap substitute
SOAP dermatitis, seborrheic
dermatitis, eczema,
pruritus, mycosis,
invertigo & seborrhea
- Diaper rash infant
hygiene

- Emollient moisturizer
LOTION for dry skin, xerosis, Apply as required
senile pruritus, atopic
dermatitis & chafing

LIQUID PARAFIN 7.5% BAR - Treatment of

itchthyosis, xerosis, - Shower : apply to the whole
85% BATH dry skin associated affected area while skin is wet.
OIL with dermatitis, Then rub & massage gently.
eczema, geriatric Rinse off
70% therapy, chronic - Bath: Apply a small amount to
TOPICAL psoriasis, wint itch wet skin after normal cleansing
GEL (pruritus heimalis) & massage in gently. Rinse off.
- Bar: Work up a rich lather with a
little water & cleanse affected
areas. Refrain from rinsing
excessively to allow a thin film
of oil to remain on the skin. Pat
dry

PARAFIN BAR, - Itchy, irritated, dry, - Cream: Apply to the affected

(MINERAL OIL) CREAM, sensitive skin area& rub in well. Use as often
EMOLLIENT; as required. It is particularly
GEL; beneficial if applied immediately
SHOWER after washing to counter react
loss of essential oils from the
skin
- Emollient : add to bath water or
rub onto wet skin.

SACCHARIDE CREAM - Symptomatic relief of - Apply 12 hourly or as often as

ISOMERATE LOTION dry skin secondary to needed especially after shower.
chronic dermatitis,
eczema,
 psoriasis,itchthyosis

UREA 10%, 20% - Emollient hyper - Apply sparingly and rub into the
CREAM keratotic or excessive affected area8-12 hourly and as
LOTION dry skin conditions required.
(eg xerosis, contact
irritant dermatitis,
pruritus)

VITAMIN A OINT - Diaper rash, chafing, - Apply 8-12 hourly

minor burns,
sunburns, small
wounds & dry skin

VITAMIN E LOTION - Dry skin - Appy as needed

ZINC OXIDE 7.5%, 10 % - Prevents and - Infants: Apply at each diaper

32%, treatment of diaper change at bedtime.
310MG/G rash by preventing
CREAM wetness from coming
40%, into direct contact
200MG/G with the skin
OINT - Promotes healing of
TOPICAL minor skin irritation,
POWD non infected wounds
and burn
- Soothes and protects
in eczema and slight
excoriation.