Atopic Dermatitis

Question 1

what is Atopic derm?

Answer 1

chronic
usually starts in childhood

S and S: pruritic eczema, dry skin, increased skin infections, atopy, vascular reacitivy

Question 2

what is atopy?

Answer 2

sensitization of skin and mucous membranes againts environmental stimulus

Question 3

what is happening to the ceramide?

Answer 3

reduced production of ceramide, an intracellualr lipid found in the epidermis
- reduced levels can be have negative impacts on barrier and permebility functions of the stratum corneum

Question 4

what immune signs?

Answer 4

type 1 allergic reactions, increased eoisinophils, hyperreleasable basophilds and mast cells

Question 5

who gets AD?

Answer 5

infants within first year of life (15-30%)
less then 5 (30%)
adults (2-10%)

flare ups and exacerbations are common

persist into adulthood

with age it usualy gets milder

Question 6

etiology

Answer 6

filaggrin gene (FLG) muttaion or defincey. results in abnormal epidermal differentiation and altered skin permeability

immune system dystfucntion: genes coding for cytokines and IgE synthesis (more T2 helper T -cells)

non-genetic risk factors ( environmental)

Question 7

risk factors

Answer 7

family history of atopy or eczema (esp. mother)
Asscoited allergic diseases (asthma, allergic rhicintius)

Question 8

some predisposing factors

Answer 8

-climate (too hot= sweat=puritus, too cold= dry skin=pruritis)

• aeroallergens (dust mitts, pollen, mold, cigarrete smoke, dander from animal hair or skin)
• fungal, bacterial and viral infection (Staph aures infections can be second to AD)
• heat, perspiration, abrasive clothing, detergents and soaps
• stress
• alcohol
• certain foods( allergies and histamine release)
• other allergens (neomycin, bacitracin, lanolin, pentolin H)

Question 9

whats important to note about AD and pregencnay

Answer 9

can cause onset, can make worse, can make better, or make it worst

most common dermatosis in pregnancy is AD

46% of women’s AD gets worst due tp pregancy or menstrul acycles

25% get better during prgenancy

Question 10

how do we differentiante the S and s of infant, vs child, vs adult

Answer 10

infant - extensors, generlized

childhood - flexural, extremities

Adults - hands

chidlren:
- intense itching, dry and cracked skin
- susceptibilty to skin infections
- abnormal keratinization

adults:
-typically have hyerpsesnitive skin whihc is easily irriatted causing itching and inflammatory changes

Question 11

typical S and s

Question 12

the otch in AD

Answer 12

key part
scrating it or itching will make it worse

Question 13

what is allokinesis

Answer 13

when a nonpruritic substance makes you itch

Question 14

what is the SCORAD

Answer 14

severity scoring of AD or PO-SCORAD

based on:
a - extnet
b- intensity of lesions
c- subjective symptoms: pruritus and sleep disturbances

Question 15

what is mild, moderate and sever based on the SCORAD scores?

Answer 15

mild less then 25 - trasnient
moderate 25-50 - recurrent
sever more then 50 - perisitent

Question 16

comorbities of AD

Answer 16

sleect allerguc, atopic, immune mediate, mental helath, bone health and skin comorbidieties

Question 17

what kinds of treament are needed for mild, moderate and sever (vague)

Answer 17

reactive therapy

proactive outpatient therpay

hospitalization and systmeic immunosuppressnats

Question 18

non-pharm

Answer 18

-proepr bathing
- moisturer
-humidify the air (>=50)
- avoid harch soaps and chemcials
- avoid triggers (food allergies - egg milk peanuts soy wheat and fish, alcohol produtcs like wipes, dust mites or other neivormental aeroallergens)
-avoid acrtching, occlusive clothing
- avoid excessive cold or heat
- wet wrap therpay (+/- TCS)

Question 19

how should we manage the itch (pharm and non-pharm)

Answer 19

• avoid tirggers
• cool compresses, oatmeal baths, lotions containing menthol or phenol
• TCS or topcial calcineurin inhibtors (tacrolimus, pimecrolimus)
• oral antihistamines at bedtime as they make you sleepy