22 - Atopic Dermatitis Flashcards
Y/N: AD has a male preponderance
No - Female
Y/N: AD has higher prevalence rates in rural settings
No - lower
Y/N: In AD during infancy, the diaper area is usually spared.
Yes
May be the primary manifestation of AD in many adults
Chronic hand eczema
Associated with more severe disease course and allergic comorbidities
Icthyosis vulgaris
Keratosis pilaris
Hyperlinear palms
Often the first atopic disease to devolep
Atopic dermatitis
Y/N: The severity of the skin disease correlates with both the risk and severity of the comorbidity.
Yes
Y/N: No increase in prevalence of behavioral problems in children with AD compared to children without AD.
No - higher prevalence of ADHD, anxiety, conduct disorder, autism
Risk of ADHD in children and adults appears to be mediated by
Sleep disturbance
Most common infection found in AD
Superficial S. aureus
Inflamed skin increases the expression of _____ and _____, which are S. aureus binding sites
Fibronectin
Fibrinogen
Antimicrobial peptide expression is blunted, thought to be secondary to the inhibitory effect of
Type 2 cytokines
Y/N: Topical steroids alone reduce S. aureus counts
Yes
Most serious virally mediated complication of AD
Eczema herpeticum
In AD, smallpox vaccination (or even exposure to vaccinated individuals) may cause a severe widespread eruption
Eczema vaccinatum
Vaccination contraindicated inAD
Smallpox - unless there is a clear risk of smallpox
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
Eczema coxsackium - exaggerated response to coxsackie virus
Papillary hypertrophy or cobblestoning of the upper eyelid conjunctiva
Vernal conjunctivitis
Conical deformity of the eyes in patients with AD and allergic rhiniconjunctivitis
Keratoconus
Two major biologic pathways responsible for AD
- Epidermal dysfunction
2. Altered innate or adaptive immune responses
Most consistently replicated to be a major predisposing genetic factor for AD
Loss-of-function mutations involving the epidermal barrier protein filaggrin
Classification of AD based on clinical appearance and duration of illness
Nonlesional AD Acute AD (3 or fewer days after onset) Chronic AD (more than 3 days duration)
Most potent cytokines downregulating filaggrin expression by keratinocytes
TSLP
IL-4
IL-13
Small platelets seen on peripheral blood smear are characteristic of
Wiskott-Aldrich syndrome
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
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
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
X-linked recessive disorder characterized by an eczematous rash, thrombocytopenia, abnormalities in humoral and cellular immunity and severe bacterial infections
Wiskott-Aldrich syndrome
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
Y/N: Patients with hyper-IgE syndrome are usually atopic
No - usually are not atopic
Caused by mutations in the gene encoding dedicator of cytokinesis 8 protein (DOCK8) presenting with recurrent viral infections
Autosomal recessive HIE
Important cause of death in patients with AR HIE starting in the second decade of life
Malignancy
Many patients with DOCK8 have associated
Food allergies
Patients with _____ deficiency can also present with an eczematous rash with high serum IgE and recurrent staphylococcal infections
Tyrosine kinase 2
Which is better for AD: liquid or powder detergents?
Liquid
Which is better for AD: basic or acidic pH?
Neutral or slightly acidic
Sport that may be better tolerated by patients with AD
Swimming
Bleach baths may exert their beneficial effect on AD via (antimicrobial/antiinflammatory) mechanisms
Antiinflammatory
Tricyclic antidepressant with H1- and H2- histamine receptor blocking
Doxepin
Cornerstone of treatment for mild AD
Emollients
Have the potential to promote drying and fissuring of the skin if not followed by topical emollient use
Wet dressings or baths
Cornerstone of antiinflammatory treatment in AD
Topical corticosteroids
Maintenance therapy for AD
Twice-weekly fluticasone application to areas that have healed but are prone to developing eczema
Amount of cream or ointment needed to cover the entire skin surface of an adult
30g
Classes of corticosteroids are ranked according to their potency based on
Vasoconstrictor assays
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
Mometasone cream and ointment are approved for children aged
2 years and older
Attempt to control residual disease, not just application of an active drug to unaffected ski
Proactive therapy
Tacrolimus ointment 0.03% approved for children aged
2 years and older
Tacrolimus ointment 0.1% approved for children aged
16 years and older
Pimecrolimus cream 1% approved for children aged
2 years and older
Good safety profile for treatment of up to _____ years with tacrolimus ointment and up to _____ years with pimecrolimus
4
2
Frequently observed side effect with topical calcineurin inhibitors
Transient burning sensation
Maintenance therapy with calcineurin inhibitors
Thrice weekly application of tacrolimus ointment
Topical phosphodiesterase 4 inhibitor recently approved for the treatment of mild to moderate AD in patients older than the age of 2 years
Crisaborole
Tar preparations should not be used on _____ because this often results in skin irritation
Tar
Tar side effects
Folliculitis
Photosensitivity
Fully human monoclonal antibody targeting the IL-4 receptor alpha subunit
Dupilumab
Shared subunit of the IL-4 and IL-13 receptors
IL-4 receptor alpha subunit
Expect for oral corticosteroids, _____ is the only FDA-approved systemic agent for the treatment of AD
Dupilumab
Dosage of dupilumab
Every other week as subcutaneous injection
Most common drug-related adverse effects of dupilumab
Injections site reactions
Conjunctivitis
May predict individuals at risk for myelosuppression in individuals on azathioprine
Thiopurine methyl transferase levels
Monoclonal antibody targeting IgE and is approved for allergic asthma and chronic urticaria
Omalizumab
Unlike allergic rhinitis and extrinsic asthma, _____ has not been proven to be efficacious in the treatment of AD
Immunotherapy with aeroallergens
