10- Drugs for atopic dermatitis and auto-immune disease Flashcards
What key factors are involved with the therapy of atopic dermatitis
controlling inflammation and pruritus
allergen avoidance and allergen- specific immunotherapy
improving the skin barrier
control of flare factors
What therapy is used to control inflammation and pruritus
glucocorticoids
oclacitinib (Apoquel)
Lokivetmab (cytopoint)
Ciclosporin
What pathways does oclacitinib block
JAK-1 pathway
How does lokivetmab work
antibody which acts against IL-31 cytokine
Describe oclacitinibs effects
good antipruritic with some anti-inflammatory action
Describe lokivetmabs effects
good antipruritic but minimal anti-inflammatory action
Describe ciclosporins effects
potent anti-inflammatory but onset of action too slow for acute flare
What is allergen specific immunotherapy?
Administer small amounts of relevant allergen to induce tolerance
up to 12 months to assess efficacy
Describe how you would improve the skin barrier
topical moisturisers
oral/ topical essential fatty acids
essential oils
What flare factors are involved in atopic dermatitis?
control microbial populations
good ectoparasite control
avoid overheating
What is the initial aim of autoimmune skin disease therapy?
Rapid control of lesions
Often systemic treatment is usually required
Use of glucocorticoids at immunosuppressive doses (high)
How long do you continue induction/inital treatment in autoimmune skin disease?
Until most lesions are healed
No new lesions are seen for 2 wks
What do you do after the initial doses of GCC’s in autoimmune skin disease
Taper them to lowest effective maintenance dose
Often need adjunctive treatments to help maintain clinical control (due to lesions recurring at lower doses of GCCs)
Prognosis of autoimmune skin disease
Not the best- guarded
Normally go on high doses of GCCs which are dangerous
When bought down from this auto-immune disease often reacuurs
Side effects of GCCs are common reason for euthanasia
