Atopic Dermatitis Flashcards
What is Atopic Dermatitis?
A chronic inflammatory skin condition often associated with intense itching and a defective skin barrier.
At what age does atopic dermatitis commonly present?
Typically presents in infancy or early childhood but may persist or begin in adulthood.
What are key factors contributing to atopic dermatitis?
Genetic predisposition, impaired skin barrier function (e.g., filaggrin mutation), immune dysregulation, and environmental factors (e.g., allergens, irritants).
Name common triggers for atopic dermatitis flares.
Allergens, irritants (soaps, detergents), stress, infections, climate changes (cold or dry weather).
What is the primary defect in the pathophysiology of atopic dermatitis?
Impaired skin barrier function, often linked to mutations in the filaggrin (FLG) gene.
How does immune dysregulation contribute to atopic dermatitis?
Predominantly Th2-skewed immune response leads to increased IL-4, IL-13, and IgE production, driving inflammation.
What are the hallmark symptoms of atopic dermatitis?
Chronic pruritus, erythema, scaling, and excoriations.
How does the distribution of atopic dermatitis differ by age?
Infants: Face, scalp, and extensor surfaces.
Children: Flexural areas (e.g., antecubital and popliteal fossae).
Adults: Hands, eyelids, and generalized lichenification.
What is lichenification?
Thickened, leathery skin resulting from chronic scratching or rubbing.
Name common complications of atopic dermatitis.
Secondary bacterial infection (e.g., Staphylococcus aureus), eczema herpeticum (HSV infection), and psychological distress.
How is atopic dermatitis diagnosed?
Clinical diagnosis based on history and physical exam; no specific lab test.
What are the major diagnostic criteria for atopic dermatitis?
Pruritus.
Chronic or relapsing course.
Eczema (typical morphology and age-specific distribution).
Personal or family history of atopy.
What are the mainstays of treatment for atopic dermatitis?
Emollients to restore skin barrier.
Topical corticosteroids for flares.
Topical calcineurin inhibitors for sensitive areas (e.g., face).
What systemic treatments are used for severe or refractory atopic dermatitis?
Oral antihistamines (for pruritus), systemic immunosuppressants (e.g., cyclosporine, methotrexate), and biologics like dupilumab.
Name examples of emollients used in atopic dermatitis.
Petroleum-based ointments, creams containing ceramides, and urea-based moisturizers.
What are the first-line anti-inflammatory treatments for atopic dermatitis?
Low-to-mid potency topical corticosteroids (e.g., hydrocortisone, mometasone).
When are high-potency topical corticosteroids used?
For severe flares or on thickened areas like palms and soles, but only for short durations.
What are topical calcineurin inhibitors, and when are they used?
Tacrolimus and pimecrolimus, used as steroid-sparing agents for sensitive areas (e.g., face, eyelids) or long-term management.
What are the side effects of topical corticosteroids?
Skin atrophy, striae, telangiectasia, and hypopigmentation with prolonged use.
When are systemic therapies indicated in atopic dermatitis?
For moderate-to-severe disease unresponsive to topical treatments or causing significant quality-of-life impairment.
Name examples of systemic immunosuppressants used in atopic dermatitis.
Cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil.
What biologic therapy is approved for atopic dermatitis?
Dupilumab, an IL-4 and IL-13 receptor antagonist.
What are the benefits of dupilumab in atopic dermatitis?
Reduces inflammation, improves skin barrier function, and decreases itch with a favorable safety profile.
What are the limitations of systemic corticosteroids in atopic dermatitis?
Risk of side effects (e.g., adrenal suppression, osteoporosis) and rebound flares after discontinuation.
Why are antibiotics sometimes used in atopic dermatitis?
To treat secondary bacterial infections, commonly caused by Staphylococcus aureus.
When is phototherapy used for atopic dermatitis?
In moderate-to-severe cases unresponsive to topical treatments, particularly narrowband UVB therapy.
