Atopic Dermatitis

Question 1

What is Atopic Dermatitis?

Answer 1

A chronic inflammatory skin condition often associated with intense itching and a defective skin barrier.

Question 2

At what age does atopic dermatitis commonly present?

Answer 2

Typically presents in infancy or early childhood but may persist or begin in adulthood.

Question 3

What are key factors contributing to atopic dermatitis?

Answer 3

Genetic predisposition, impaired skin barrier function (e.g., filaggrin mutation), immune dysregulation, and environmental factors (e.g., allergens, irritants).

Question 4

Name common triggers for atopic dermatitis flares.

Answer 4

Allergens, irritants (soaps, detergents), stress, infections, climate changes (cold or dry weather).

Question 5

What is the primary defect in the pathophysiology of atopic dermatitis?

Answer 5

Impaired skin barrier function, often linked to mutations in the filaggrin (FLG) gene.

Question 6

How does immune dysregulation contribute to atopic dermatitis?

Answer 6

Predominantly Th2-skewed immune response leads to increased IL-4, IL-13, and IgE production, driving inflammation.

Question 7

What are the hallmark symptoms of atopic dermatitis?

Answer 7

Chronic pruritus, erythema, scaling, and excoriations.

Question 8

How does the distribution of atopic dermatitis differ by age?

Answer 8

Infants: Face, scalp, and extensor surfaces.

Children: Flexural areas (e.g., antecubital and popliteal fossae).

Adults: Hands, eyelids, and generalized lichenification.

Question 9

What is lichenification?

Answer 9

Thickened, leathery skin resulting from chronic scratching or rubbing.

Question 10

Name common complications of atopic dermatitis.

Answer 10

Secondary bacterial infection (e.g., Staphylococcus aureus), eczema herpeticum (HSV infection), and psychological distress.

Question 11

How is atopic dermatitis diagnosed?

Answer 11

Clinical diagnosis based on history and physical exam; no specific lab test.

Question 12

What are the major diagnostic criteria for atopic dermatitis?

Answer 12

Pruritus.

Chronic or relapsing course.
Eczema (typical morphology and age-specific distribution).

Personal or family history of atopy.

Question 13

What are the mainstays of treatment for atopic dermatitis?

Answer 13

Emollients to restore skin barrier.

Topical corticosteroids for flares.

Topical calcineurin inhibitors for sensitive areas (e.g., face).

Question 14

What systemic treatments are used for severe or refractory atopic dermatitis?

Answer 14

Oral antihistamines (for pruritus), systemic immunosuppressants (e.g., cyclosporine, methotrexate), and biologics like dupilumab.

Question 15

Name examples of emollients used in atopic dermatitis.

Answer 15

Petroleum-based ointments, creams containing ceramides, and urea-based moisturizers.

Question 16

What are the first-line anti-inflammatory treatments for atopic dermatitis?

Answer 16

Low-to-mid potency topical corticosteroids (e.g., hydrocortisone, mometasone).

Question 17

When are high-potency topical corticosteroids used?

Answer 17

For severe flares or on thickened areas like palms and soles, but only for short durations.

Question 18

What are topical calcineurin inhibitors, and when are they used?

Answer 18

Tacrolimus and pimecrolimus, used as steroid-sparing agents for sensitive areas (e.g., face, eyelids) or long-term management.

Question 19

What are the side effects of topical corticosteroids?

Answer 19

Skin atrophy, striae, telangiectasia, and hypopigmentation with prolonged use.

Question 20

When are systemic therapies indicated in atopic dermatitis?

Answer 20

For moderate-to-severe disease unresponsive to topical treatments or causing significant quality-of-life impairment.

Question 21

Name examples of systemic immunosuppressants used in atopic dermatitis.

Answer 21

Cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil.

Question 22

What biologic therapy is approved for atopic dermatitis?

Answer 22

Dupilumab, an IL-4 and IL-13 receptor antagonist.

Question 23

What are the benefits of dupilumab in atopic dermatitis?

Answer 23

Reduces inflammation, improves skin barrier function, and decreases itch with a favorable safety profile.

Question 24

What are the limitations of systemic corticosteroids in atopic dermatitis?

Answer 24

Risk of side effects (e.g., adrenal suppression, osteoporosis) and rebound flares after discontinuation.

Question 25

Why are antibiotics sometimes used in atopic dermatitis?

Answer 25

To treat secondary bacterial infections, commonly caused by Staphylococcus aureus.

Question 26

When is phototherapy used for atopic dermatitis?

Answer 26

In moderate-to-severe cases unresponsive to topical treatments, particularly narrowband UVB therapy.