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Dermatology > Atopic Dermatitis > Flashcards

Atopic Dermatitis Flashcards

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Dermatology Board Prep flashcards
1
Q

atopic dermatitis

A

genetic, relapses
pruritic with specific features, (associated with IgE allergy) T cell imbalances
Mast cell degranulation and other mediators recruit other cells

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2
Q

acute phase

A

t helper 2 cells

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3
Q

chronic phase

A

t helper 1
majority of cases in clinics
cyclosporin helps here

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4
Q

Lost ability to seal the skin, absorb more (allergens or anything topical) Some therapies are aimed at adding ______

A

filagrin

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5
Q

most AD allergic dogs require ______ treatments

A

multiple

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6
Q

routes of allergen access

A

inhalation

percutneous absorption

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7
Q

if allergen were absorbed _______ would be accurate. However?
more likely to have reliable results on?

A

blood IgE, because allergen would be systemic.
Not true in dogs because production of IgE is actually local.
skin test.

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8
Q

skin test v. serology

A

skin test is better

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9
Q

breed predilection in AD dogs

A

light colored dogs
terrier, sharpei, setters, retriever, beagles, dalmations, cockers.
genetic!

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10
Q

clinical signs of AD

A

red itchy faces and feet(front feet first).
areas with less hair also have red lesions!! ear pinna, groin axillae
(may get conjuctivitis, hives/macules but both not as common. )

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11
Q

secondary infections due to AD

A

pyoderma

malessezia dermatitis and otitis

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12
Q

clinical signs associated with chronicity of AD

A

excoriations, lichenification, hyperpigmentation

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13
Q

AD in cats

A

generalized pruritis(esp. head and neck)
miliary dermatitis
or eosinophilic granuloma complex
(all mean allergy)

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14
Q

diagnoses of AD

A

hx- young adults, seasonal course, progressively worse.
inguinal areas, face, feet… exclusion of other pruritic diseases
(scabies - margin of pinna v. whole concave pinna, scabies is elbow hock, ventral abdomen papules v. generalized redness w/o papules)
(food allergy constant)
(flea allergy has typical distribution)

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15
Q

never will go wrong by starting with?

A

fix infection and kill the fleas

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16
Q

major criteria for diagnoses of AD v. minor criteria

A

major - clinical (pruritis, facial/digital involvement, lichenification flexor surfaces, relapsing, familial history, breeds pred)
minor - positive skin test, inc. allergen specific IgE (also facial erythema, conjunctivitis, superficial pyoderma…)

17
Q

why allergy test

A

in diagnose AD and want to desensitize the dog. allergy vaccine to increase the tolerance (custom to dog will work better than a general vaccine)

18
Q

how does skin test work

A

-Small amount of allergen injected into skin.
-evaluate presence of (allergy specific) IgE in skin (via mast cell degranulation)
(need to clear infections, have clean skin, and be off steroids to have a good test)
- not typical of private practice

19
Q

evaluating skin test

A

immediate reaction, objective, subjective(erythema, induration, size)

20
Q

false positive on skin tests

A

irritant allergens, contaminated, poor technique (too deep injection)
off season testing! (IgE only last 6-8 weeks)
tranqs, steroids. lots of things, send to a specialist

21
Q

In vitro testing (serology)

A

2nd best - if a dermatologist skin test isn’t an option

  • blood sample to 2 places (she likes greer and heska)
  • usually poor correlation with IDST
22
Q

advantages of serology?

disadvantages?

A

A: no need to clip, discontinue drugs or keep antigens in stock.
D: doesnt correlate with IDST, false positives. more expensive

23
Q

therapy for AD

A 
treat other allergy/infection. 
avoid allergen (tricky)
hyposensitization (allergy vaccine)
systemic therapy (mimimize inflammation)
topical therapy
24
Q

pruritic threshold

A

allergens are additive, until hit threshold you’re not itchy.
could just get rid of one of the allergens to make animal subclinical

25
Q

hyposensitization

A

effective in 60-80% of cases
esp. if prolonged season of pruritis
no result for 3 months!!!
usually needed lifelong

26
Q

allergic reaction to the allergy vaccine?

A
  • not really, usually well tolerated in dogs.
  • anaphylaxis would look like GI upset, 10-15 minutes post injection v/d. (any v/d within an hour of giving vaccine is a serious reaction)
27
Q

systemic glucocorticoid therapy for AD

A
  • you’re not modulating anything, works less and less over time.
  • you dont want to cause iatrogenic cushing!
  • indicated in short season cases without concurrent pyoderma or demodex
28
Q

systemic therapy, cyclosporine for AD

A
  • immunomodulant (suppresses T cells and cytokines)
  • lifelong, takes weeks to kick in
  • side effects (GI, papillomatous dermatitis)
29
Q

Oclacitinib (Apoquel)

tx for AD

A
  • fast acting, targets pruritis
  • JAK inhibitor
  • can use BID longer than 2wk, or in dogs < 1yr
30
Q

IL-31 monoclonal antibody (cytopoint biologic…)

tx for AD

A
  • blocks transmission of pruritis
  • 1x month injectable
  • only use on selective patients, long term effects unknown
31
Q

antihistamines

A
  • effective in 50% of cases
  • more effective for prevention than treatment of pruritis
  • side effects
32
Q

immediate relief for AD

A

apoquel or steroids

33
Q

essential fatty acids for AD

A 
- modulate leukotrienes (anti inflammatory)
barrier function (both are adjunctive long term therapy)
34
Q

topical therapy for AD

A

frequent cold baths, oatmeal, topical anesthetic, antihistamines, lime sulfur, steroids

35
Q

capsaicin

A

used for localized pruritis (lick granuloma)
- active ingredient of chilli pepper
helps with pain and itch

36
Q

tacrolimus

A

topical cyclosporin
doesn’t penetrate skin
especially for localized cases for inflammation and itch
DOES NOT CAUSE ATROPHY like topical steroids

37
Q

tx to restore barrier function

A

phytosphingosine

ceramides, essential faty acids, emollients

Dermatology (18 decks)

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