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FD9 > 22 - Atopic Dermatitis > Flashcards

22 - Atopic Dermatitis Flashcards

1
Q

Y/N: AD has a male preponderance

A

No - Female

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2
Q

Y/N: AD has higher prevalence rates in rural settings

A

No - lower

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3
Q

Y/N: In AD during infancy, the diaper area is usually spared.

A

Yes

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4
Q

May be the primary manifestation of AD in many adults

A

Chronic hand eczema

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5
Q

Associated with more severe disease course and allergic comorbidities

A

Icthyosis vulgaris
Keratosis pilaris
Hyperlinear palms

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6
Q

Often the first atopic disease to devolep

A

Atopic dermatitis

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7
Q

Y/N: The severity of the skin disease correlates with both the risk and severity of the comorbidity.

A

Yes

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8
Q

Y/N: No increase in prevalence of behavioral problems in children with AD compared to children without AD.

A

No - higher prevalence of ADHD, anxiety, conduct disorder, autism

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9
Q

Risk of ADHD in children and adults appears to be mediated by

A

Sleep disturbance

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10
Q

Most common infection found in AD

A

Superficial S. aureus

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11
Q

Inflamed skin increases the expression of _____ and _____, which are S. aureus binding sites

A

Fibronectin

Fibrinogen

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12
Q

Antimicrobial peptide expression is blunted, thought to be secondary to the inhibitory effect of

A

Type 2 cytokines

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13
Q

Y/N: Topical steroids alone reduce S. aureus counts

A

Yes

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14
Q

Most serious virally mediated complication of AD

A

Eczema herpeticum

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15
Q

In AD, smallpox vaccination (or even exposure to vaccinated individuals) may cause a severe widespread eruption

A

Eczema vaccinatum

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16
Q

Vaccination contraindicated inAD

A

Smallpox - unless there is a clear risk of smallpox

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17
Q

Hand and foot vesicles or papules that resemble typical hand, foot, and mouth disease, but lesions tend to be more severe and hemorrhagic and involve additional areas with eczema

A

Eczema coxsackium - exaggerated response to coxsackie virus

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18
Q

Papillary hypertrophy or cobblestoning of the upper eyelid conjunctiva

A

Vernal conjunctivitis

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19
Q

Conical deformity of the eyes in patients with AD and allergic rhiniconjunctivitis

A

Keratoconus

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20
Q

Two major biologic pathways responsible for AD

A
  1. Epidermal dysfunction

2. Altered innate or adaptive immune responses

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21
Q

Most consistently replicated to be a major predisposing genetic factor for AD

A

Loss-of-function mutations involving the epidermal barrier protein filaggrin

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22
Q

Classification of AD based on clinical appearance and duration of illness

A 
Nonlesional AD
Acute AD (3 or fewer days after onset)
Chronic AD (more than 3 days duration)
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23
Q

Most potent cytokines downregulating filaggrin expression by keratinocytes

A

TSLP
IL-4
IL-13

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24
Q

Small platelets seen on peripheral blood smear are characteristic of

A

Wiskott-Aldrich syndrome

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25
Infants presenting in the first year of life with failure to thrive, diarrhea, a generalized scaling erythematous rash, and recurrent cutaneous or systemic infections should be evaluated for
Severe combined immunodeficiency syndrome
26
Autosomal recessive SCID caused by mutations in RAG1 and RAG2 that can present with erythrodermic rash (can be eczematous with pachydermia), elevated IgE, eosinophilia, diarrhea, lymphadenopathy, hepatosplenomegaly, and susceptibility to infections
Omenn syndrome
27
Caused by mutations of Foxp3 presenting with dermatitis, recalcitrant enteropathy, and autoimmune features such as type 1 diabetes, thyroiditis, hemolytic anemia, or thrombocytopenia
Immune dysregulation, polyendocrinopathy, enteropathy X-linked (IPEX) syndrome
28
X-linked recessive disorder characterized by an eczematous rash, thrombocytopenia, abnormalities in humoral and cellular immunity and severe bacterial infections
Wiskott-Aldrich syndrome
29
Autosomal dominant disorder caused by STAT3 mutations characterized by recurrent deep-seated bacterial infections, skeletal abnormalities with coarse facial features and prominent frontal bossing, dental anomalies with retained primary teeth, bone fractures and osteoporosis
Hyper-IgE syndrome
30
Y/N: Patients with hyper-IgE syndrome are usually atopic
No - usually are not atopic
31
Caused by mutations in the gene encoding dedicator of cytokinesis 8 protein (DOCK8) presenting with recurrent viral infections
Autosomal recessive HIE
32
Important cause of death in patients with AR HIE starting in the second decade of life
Malignancy
33
Many patients with DOCK8 have associated
Food allergies
34
Patients with _____ deficiency can also present with an eczematous rash with high serum IgE and recurrent staphylococcal infections
Tyrosine kinase 2
35
Which is better for AD: liquid or powder detergents?
Liquid
36
Which is better for AD: basic or acidic pH?
Neutral or slightly acidic
37
Sport that may be better tolerated by patients with AD
Swimming
38
Bleach baths may exert their beneficial effect on AD via (antimicrobial/antiinflammatory) mechanisms
Antiinflammatory
39
Tricyclic antidepressant with H1- and H2- histamine receptor blocking
Doxepin
40
Cornerstone of treatment for mild AD
Emollients
41
Have the potential to promote drying and fissuring of the skin if not followed by topical emollient use
Wet dressings or baths
42
Cornerstone of antiinflammatory treatment in AD
Topical corticosteroids
43
Maintenance therapy for AD
Twice-weekly fluticasone application to areas that have healed but are prone to developing eczema
44
Amount of cream or ointment needed to cover the entire skin surface of an adult
30g
45
Classes of corticosteroids are ranked according to their potency based on
Vasoconstrictor assays
46
Prolonged daily use of topical corticosteroids, especially on the face, can lead to _____, a condition characterized by severe erythema, swelling, and burning upon TC discontinuation
Steroid withdrawal syndrome
47
Mometasone cream and ointment are approved for children aged
2 years and older
48
Attempt to control residual disease, not just application of an active drug to unaffected ski
Proactive therapy
49
Tacrolimus ointment 0.03% approved for children aged
2 years and older
50
Tacrolimus ointment 0.1% approved for children aged
16 years and older
51
Pimecrolimus cream 1% approved for children aged
2 years and older
52
Good safety profile for treatment of up to _____ years with tacrolimus ointment and up to _____ years with pimecrolimus
4 | 2
53
Frequently observed side effect with topical calcineurin inhibitors
Transient burning sensation
54
Maintenance therapy with calcineurin inhibitors
Thrice weekly application of tacrolimus ointment
55
Topical phosphodiesterase 4 inhibitor recently approved for the treatment of mild to moderate AD in patients older than the age of 2 years
Crisaborole
56
Tar preparations should not be used on _____ because this often results in skin irritation
Tar
57
Tar side effects
Folliculitis | Photosensitivity
58
Fully human monoclonal antibody targeting the IL-4 receptor alpha subunit
Dupilumab
59
Shared subunit of the IL-4 and IL-13 receptors
IL-4 receptor alpha subunit
60
Expect for oral corticosteroids, _____ is the only FDA-approved systemic agent for the treatment of AD
Dupilumab
61
Dosage of dupilumab
Every other week as subcutaneous injection
62
Most common drug-related adverse effects of dupilumab
Injections site reactions | Conjunctivitis
63
May predict individuals at risk for myelosuppression in individuals on azathioprine
Thiopurine methyl transferase levels
64
Monoclonal antibody targeting IgE and is approved for allergic asthma and chronic urticaria
Omalizumab
65
Unlike allergic rhinitis and extrinsic asthma, _____ has not been proven to be efficacious in the treatment of AD
Immunotherapy with aeroallergens

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