Atopic Dermatitis Flashcards
Atopic Dermatitis
chronic, inflammatory pruritic skin disorder occurs in children more frequently and also adults. Fluctuating, multi-factorial disease characterized by acute and chronic skin eruptions.
AD a/w increased serum levels of
IgE, and a personal/family hx of atopy (asthma, allergic rhinitis, eczema)
Epidemiology
Most children will develop it in their first year of life. 20% of children worldwide.
AD in children
most will see a resolution as they get older, 47% of children with AD at age 7 will continue until age 11. 50-80% will develop another atopic disease like asthma, allergic rhinitus
Pathogenesis
cause of AD is unknown, immune dysregulation causing IgE sensitization and epidermal barrier dysfunction will contribute to the disease process, genetics and the environment also may play a role
Clinical Features
dry skin and very pruritic, erythematous plaques and papules. Scratching of dry skin causes release of proinflammatory mediators of the itch-scratch cycle
Infants and Toddlers s/s
scaly, pruritic crusted lesions common on the cheeks, scalp, extensor arms and legs, trunk. Acute: vesicles with serous exudate and generalized xerosis. Diaper area usually free from lesions
Older children and adolescents
reduced exudative lesions, lichenified plaques in ac and popliteal fossa, wrists, ankles, neck
Adult s/s AD
Face is common, esp forehead and the eyes. Xerosis. Brown macular ring around the neck. Lichenified plaques of flexoral areas of hands, feet, wrists, ankles.
Dx AD
Clinical presentation, hx, morphology, lesion distribution, clinical signs. Look for: eczematous changes vary with age, chronic and relapsing, early age onset, atopy, xerosis, hx asthma, hay fever or in a 1st degree relative, pruritus, onset < 2 years
Tx AD
moisturizer, anti-inflammatory agents, anti pruritic agents, anti bacterial agents
Moisturizer in AD
Petrolatum based needs to be integral part of tx. Ointments are better but less adherance. Will reduce disease severity and prevent need for pharm tx, apply soon after bathing, wet wraps w or without steroid for mod-severe AD during a flare
Anti inflammatory tx AD
Topical corticosteroids once/twice weekly to prevent flares (mild steroid) and for acute exacc. face low potency, ointment > creams. use with emollients.
s/e topical corticosteroids
striae, telangiectasias, atrophy, acne.
topical calcineurin inhibitors (TCIs)
protopic, elidel, for acute and chronic tx, good for sensitive areas like groin, face, armpit. will prevent flares once disease is controlled
pt education with lymphoma risk with steroid use
d/t black box warning. in pts who use TCI there is no greater incidence in developing lymphoma than the general population.
Anti pruritic agents
h1 - hydoxyzine, diphenhydramine. anti itch plus sedation. Topical anti itch like camphor/menthol. minimally effective relief is short term.
Crisaborole (Eucrisa)
PDE4 inhibitor, 2% applied BID, > 2 years old, s/e: application site pain, burning, stinging
Dupiumab (Dupixent)
IL4 receptor blocker for adults with AD in a pre filled 300mg syringe. Loading dose is 2 300mg syringes subq then 300mg q other week. Adverse rxn: injection site rxn, conjunctivitis, blepharitis, herpes viral infection, dry eyes. Serious reactions: keratinitis, hypersensitivity.
Antibacterial
bleach baths, mupirocin for mod-severe. Staph is most common, Group A Strep also may be present. If weepy and substantial yellow crust do a bacterial cx. may need systemic abx if severe disease. If severe: consider UV or Cyclosporin (not okay for children)
Educational interventions
provide tools for self efficacy and long term adherance to tx, early follow up after initial encounter, practical demonstrations, written action plans, national eczema society support
