Atopic Dermatitis

Question 1

Clinical Feature symptoms

Answer 1

subacute and chronic eczematous reaction associated with prolonged severe pruritus

Question 2

distribution

Answer 2

depends on age
<6 mo (), children >18 mo
() and adults (

Question 3

what comes after relentless scratching

Answer 3

inflammation, lichenification, excoriations are secondary t

Question 4

atopic palms:

Answer 4

hyperlinearity of the palms (associated with ichthyosis vulgaris)

Question 5

associated with: (pathologies and factors)

Answer 5

keratosis pilaris (hyperkeratosis of hair follicles, “chicken skin”), xerosis, occupational
hand dryness.
associated with severe or poorly controlled psychosocial distress and psychiatric comorbidities

Question 6

Epidemiology. Population affected

Answer 6

frequently affects infants, children, and young adults

• 10-20% of children in developed countries under the age of 5 are affected

Question 7

Congenital? Patologies associated, inheritance.

Answer 7

• associated with personal or family history of atopy (asthma, hay fever), anaphylaxis, eosinophilia
• polygenic inheritance: one parent >60% chance for child; two parents >80% chance for child
•

Question 8

Course

Answer 8

long-term condition with 1/3 of patients continuing to show signs of AD into adulthood

Question 9

Pathophysiology

Answer 9

a T-cell driven inffammatory process with epidermal barrier dysfunction

Question 10

Investigations

Answer 10

• clinical diagnosis

* consider: skin biopsy, patch testing if allergic contact dermatitis is suspected

Question 11

Management: goal:

Answer 11

reduce signs and symptoms, prevent or reduce recurrences/flares

Question 12

Triggers for Atopic Dermatitis

Answer 12

Irritants (detergents, solvents, clothing,
water hardness)
• Contact allergens
• Environmental aeroallergens (e.g. dust
mites)
• Inappropriate bathing habits (e.g. long
hot showers)
• Sweating
• Microbes (e.g. S. aureus)
• Stress

Question 13

Management: psichiatric

Answer 13

be vigilant for depressive symptoms and the possible need for psychiatric referral, especially among
those with severe disease

Question 14

Management

non-pharmacologic therapy

Answer 14

moisturizers
apply liberally and reapply at least twice a day with goal of minimizing xerosis
include in treatment of mild to severe disease as well as in maintenance therapy
bathe in plain warm water for a short period of time once daily followed by lightly but not
completely drying the skin with a towel; immediately apply topical agents or moisturizers aer this
use fragrance-free hypoallergenic non-soap cleansers

Question 15

pharmacologic therapy

Answer 15

topical corticosteroids

topical calcineurin inhibitors

Question 16

topical corticosteroids. action, dose, application,side effects

Answer 16

effective in reducing acute and chronic symptoms as well as prevention of flares
choice of steroid potency depends on age, body site, short vs. long-term use
apply 1 adult fingertip unit (0.5 g) to an area the size of 2 adult palms bid for acute flares
local side effects: skin atrophy, purpura, telangiectasia, striae, hypertrichosis, and acneiform
eruption are all very rarely seen

Question 17

topical calcineurin inhibitors. Options. When to Use. Why. Dose.

Answer 17

tacrolimus 0.03%, 0.1% (Protopic®) and pimecrolimus 1% (Elidel®)
use as steroid-sparing agents in the long-term
advantages over long-term corticosteroid use: sustained eect in controlling pruritus; no skin
atrophy; safe for the face and neck
apply 2x/d for acute ares, and 2-3x/wk to recurrent sites to prevent relapses

Question 18

topical calcineurin. local side effects:. And Warnings

Answer 18

local side eects: stinging, burning, allergic contact dermatitis
U.S. black box warning of malignancy risk: rare cases of skin cancer and lymphoma reported;
no causal relationship established, warning is discounted by both the Canadian Dermatology
Association and the American Academy of Dermatology

Question 19

Complications and Treatment

Answer 19

infections
treatment of infections
topical mupirocin, retapamulin, ozenoxacin or fusidic acid (Canada only, not available in US)
oral antibiotics (e.g. cloxacillin, cephalexin) for widespread S. aureus infections

Question 20

Adjunctive therapy

Answer 20

all before + Antihistamines
• Psychological
interventions

Question 21

Severe refractory disease. What to do_

Answer 21

Azathioprine
• Methotrexate
• Oral cyclosporin
• Oral steroids

• Phototherapy
• Potent topical steroids
• Psychotherapeutics