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Fitz 9th > 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
Q

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

A

Severe combined immunodeficiency syndrome

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26
Q

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

A

Omenn syndrome

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27
Q

Caused by mutations of Foxp3 presenting with dermatitis, recalcitrant enteropathy, and autoimmune features such as type 1 diabetes, thyroiditis, hemolytic anemia, or thrombocytopenia

A

Immune dysregulation, polyendocrinopathy, enteropathy X-linked (IPEX) syndrome

28
Q

X-linked recessive disorder characterized by an eczematous rash, thrombocytopenia, abnormalities in humoral and cellular immunity and severe bacterial infections

A

Wiskott-Aldrich syndrome

29
Q

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

A

Hyper-IgE syndrome

30
Q

Y/N: Patients with hyper-IgE syndrome are usually atopic

A

No - usually are not atopic

31
Q

Caused by mutations in the gene encoding dedicator of cytokinesis 8 protein (DOCK8) presenting with recurrent viral infections

A

Autosomal recessive HIE

32
Q

Important cause of death in patients with AR HIE starting in the second decade of life

A

Malignancy

33
Q

Many patients with DOCK8 have associated

A

Food allergies

34
Q

Patients with _____ deficiency can also present with an eczematous rash with high serum IgE and recurrent staphylococcal infections

A

Tyrosine kinase 2

35
Q

Which is better for AD: liquid or powder detergents?

A

Liquid

36
Q

Which is better for AD: basic or acidic pH?

A

Neutral or slightly acidic

37
Q

Sport that may be better tolerated by patients with AD

A

Swimming

38
Q

Bleach baths may exert their beneficial effect on AD via (antimicrobial/antiinflammatory) mechanisms

A

Antiinflammatory

39
Q

Tricyclic antidepressant with H1- and H2- histamine receptor blocking

A

Doxepin

40
Q

Cornerstone of treatment for mild AD

A

Emollients

41
Q

Have the potential to promote drying and fissuring of the skin if not followed by topical emollient use

A

Wet dressings or baths

42
Q

Cornerstone of antiinflammatory treatment in AD

A

Topical corticosteroids

43
Q

Maintenance therapy for AD

A

Twice-weekly fluticasone application to areas that have healed but are prone to developing eczema

44
Q

Amount of cream or ointment needed to cover the entire skin surface of an adult

A

30g

45
Q

Classes of corticosteroids are ranked according to their potency based on

A

Vasoconstrictor assays

46
Q

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

A

Steroid withdrawal syndrome

47
Q

Mometasone cream and ointment are approved for children aged

A

2 years and older

48
Q

Attempt to control residual disease, not just application of an active drug to unaffected ski

A

Proactive therapy

49
Q

Tacrolimus ointment 0.03% approved for children aged

A

2 years and older

50
Q

Tacrolimus ointment 0.1% approved for children aged

A

16 years and older

51
Q

Pimecrolimus cream 1% approved for children aged

A

2 years and older

52
Q

Good safety profile for treatment of up to _____ years with tacrolimus ointment and up to _____ years with pimecrolimus

A

4

2

53
Q

Frequently observed side effect with topical calcineurin inhibitors

A

Transient burning sensation

54
Q

Maintenance therapy with calcineurin inhibitors

A

Thrice weekly application of tacrolimus ointment

55
Q

Topical phosphodiesterase 4 inhibitor recently approved for the treatment of mild to moderate AD in patients older than the age of 2 years

A

Crisaborole

56
Q

Tar preparations should not be used on _____ because this often results in skin irritation

A

Tar

57
Q

Tar side effects

A

Folliculitis

Photosensitivity

58
Q

Fully human monoclonal antibody targeting the IL-4 receptor alpha subunit

A

Dupilumab

59
Q

Shared subunit of the IL-4 and IL-13 receptors

A

IL-4 receptor alpha subunit

60
Q

Expect for oral corticosteroids, _____ is the only FDA-approved systemic agent for the treatment of AD

A

Dupilumab

61
Q

Dosage of dupilumab

A

Every other week as subcutaneous injection

62
Q

Most common drug-related adverse effects of dupilumab

A

Injections site reactions

Conjunctivitis

63
Q

May predict individuals at risk for myelosuppression in individuals on azathioprine

A

Thiopurine methyl transferase levels

64
Q

Monoclonal antibody targeting IgE and is approved for allergic asthma and chronic urticaria

A

Omalizumab

65
Q

Unlike allergic rhinitis and extrinsic asthma, _____ has not been proven to be efficacious in the treatment of AD

A

Immunotherapy with aeroallergens

Fitz 9th (108 decks)

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