Treatment Guide to Common Skin Conditions Prepared by Loren Regier, BSP, BA, Sharon Downey -www.RxFiles.ca Revised: Jan 2004
Dermatitis, Atopic Dry Skin Psoriasis
Step 1 - General Treatment Measures
• Avoid contact with irritants or trigger factors
• Avoid wool or nylon clothing.
• Wash clothing in soap vs detergent; double rinse/vinegar
• Limit use of soap to axillae, feet, and groin
Step 2
• Colloidal oatmeal bath products
• Lanolin-free water miscible bath oil
• Intensive skin hydration therapy
• “Soapless” cleansers for sensitive skin
Step 3
• Oral antihistamines (1st generation)for sedation & relief of
itching give at bedtime +/- a daytime regimen as required
• Topical hydrocortisone (0.5%) for inflammation
apply od-tid; ointments more effective than creams
may use cream during day & ointment at night
Step 4
• Prescription topical corticosteroids: use lowest potency
steroid that is effective and wean to twice weekly. Short
courses of higher potency topical steroids may be required.
• Topical/oral anti-Staphylococcals (fusidic acid, mupirocin,
cloxacillin, macrolides, clindamycin) to bacterial load
Step 1 - General Treatment Measures
• Use cool air humidifiers
• Lower house temperature (minimize perspiration)
• Avoid frequent or prolonged bathing; twice weekly
recommended but daily bathing permitted with
adequate skin hydration therapy (apply moisturizer
immediately afterwards)
• Limit use of soap to axillae, feet, and groin
• Apply lubricating emollients such as petrolatum to
damp skin (e.g. after bathing)
Step 2
• Colloidal oatmeal bath products
• Water miscible bath oil
• Humectants: urea, lactic acid, phospholipid
Step 3
• Oral antihistamines for sedation & relief of itching
give at bedtime +/- a daytime regimen as required
ideally not more than a 2 week course
Step 1
• Non-pharmacologic measures (general health issues)
• Moisturizers (will not clear skin, but will ↓ itching)
• Topical Steroids
• Coal Tar
• Anthralin
• Vitamin D3
• Topical Retinoid Therapy
• Sunshine
• Salicylic acid
• Bath additives (tar solns, oils, oatmeal, Epsom salts)
Step 2
• Phototherapy (UVB)
• Photochemotherapy (Psoralen + UVA)
• Combination Therapies (from Step 1 & 2 treatments)
Step 3
• Methotrexate; Oral retinoids (etretinate); Cyclosporin
• Rotational Therapies
Agents used in Common Skin Conditions
Allantoin – keratin-dispersing activity makes it useful in treating chronic scaling
dermatoses. Also a skin protectant. May bind sensitizing substances making them
nonsensitizing. e.g. Tegrin Cream
Anthralin – prescription topical compounds used to treat psoriasis. They have few
serious side effects but can burn normal skin around lesions and stain skin and clothing.
Antihistamines, oral – useful in relieving itching associated with dry skin. 1st
generation preferred if no allergic component; 2nd generation effective for urticaria. Can
cause drowsiness, gastrointestinal disturbances and paradoxical excitability &
nervousness. e.g. see OTC chart for agents and dose
Bath products – soothing to itchy skin. They may help to lock in moisture if used
toward end of bath (add to the last 5 minutes of a 15-20 minute bath)
e.g.Bath oils e.g. Alpha Keri Bath Oil; Oatmeal, colloidal e.g. Aveeno Bath
Powder; Combination: oatmeal & oil e.g. Aveeno Oilated bath Powder
Coal tar – anti-inflammatory and antipruritic activity. They are messy, drying, have
an unpleasant odor, and can stain skin and clothing. Other side effects may include
folliculitis, acne, and photosensitivity. Higher concentrations useful in psoriasis. e.g.
Doak Oil Forte, Oxipor Lotion, Tegrin Shampoo, and lower concentrations useful in
seborrea and dandruff e.g. Tegrin Cream & Shampoo; Polytar Shampoo
Salicylic Acid – keratolytic action makes it useful in removing scales in psoriasis &
seborrhea. e.g. Sebulex Shampoo; Keralyt Gel; Oxipor Lotion; Sebutone Shampoo
Emollients – have water-retaining properties; useful in replacing natural skin oils,
covering tiny fissures , and providing a protecting film.
Petrolatum occlusive & very effective. e.g. Vaseline Petroleum Jelly
Mineral oil - common emollient e.g. Lubriderm Lotion;Nutraderm Cr/Lot
Lanolin – more soothing than petrolatum; some irritate e.g. Lubriderm Lotion
Humectants – have water attracting properties so help draw water into the skin vs.
trapping water already present; hydrate and soften skin
Glycerin – hydrating properties e.g. Wibi Glycerin Lotion
Urea – hydrating properties; also has keratin softening action at
concentrations 20% or higher. e.g. Uremol Cream & Lotion
Lactic Acid an α-hydroxy acid which softens keratin in addition to its
moisturizing properties. e.g. Lubriderm AHA Cream/AHA Lotion
Lecithin – naturally occurring phospholipid found in skin;water binding agent
that can form a complex with 15 molecules of water eg. Complex 15
Topical Corticosteroids – useful in relieving itching & inflammation.
Hydrocortisone 0.5% creams & ointments are OTC. Stronger agents require a
prescription. Short courses of higher potency topical steroids are required for initial
control of certain skin conditions/areas. Lower potency agents &/or less frequent
application is recommended if long term treatment required for maintenance therapy.
The goal is to use the lowest potency agent which will control the skin condition
thereby minimizing the risk for side effects; ideally, wean to twice weekly application
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