Atopic Dermatitis 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
hyposensitization
effective in 60-80% of cases esp. if prolonged season of pruritis no result for 3 months!!! usually needed lifelong
26
allergic reaction to the allergy vaccine?
- 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
systemic glucocorticoid therapy for AD
- 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
systemic therapy, cyclosporine for AD
- immunomodulant (suppresses T cells and cytokines) - lifelong, takes weeks to kick in - side effects (GI, papillomatous dermatitis)
29
Oclacitinib (Apoquel) | tx for AD
- fast acting, targets pruritis - JAK inhibitor - can use BID longer than 2wk, or in dogs < 1yr
30
IL-31 monoclonal antibody (cytopoint biologic...) | tx for AD
- blocks transmission of pruritis - 1x month injectable - only use on selective patients, long term effects unknown
31
antihistamines
- effective in 50% of cases - more effective for prevention than treatment of pruritis - side effects
32
immediate relief for AD
apoquel or steroids
33
essential fatty acids for AD
``` - modulate leukotrienes (anti inflammatory) barrier function (both are adjunctive long term therapy) ```
34
topical therapy for AD
frequent cold baths, oatmeal, topical anesthetic, antihistamines, lime sulfur, steroids
35
capsaicin
used for localized pruritis (lick granuloma) - active ingredient of chilli pepper helps with pain and itch
36
tacrolimus
topical cyclosporin doesn't penetrate skin especially for localized cases for inflammation and itch DOES NOT CAUSE ATROPHY like topical steroids
37
tx to restore barrier function
phytosphingosine | ceramides, essential faty acids, emollients