Atopic Dermatitis Flashcards
Clinical Feature symptoms
subacute and chronic eczematous reaction associated with prolonged severe pruritus
distribution
depends on age
<6 mo (), children >18 mo
() and adults (
what comes after relentless scratching
inflammation, lichenification, excoriations are secondary t
atopic palms:
hyperlinearity of the palms (associated with ichthyosis vulgaris)
associated with: (pathologies and factors)
keratosis pilaris (hyperkeratosis of hair follicles, “chicken skin”), xerosis, occupational
hand dryness.
associated with severe or poorly controlled psychosocial distress and psychiatric comorbidities
Epidemiology. Population affected
frequently affects infants, children, and young adults
• 10-20% of children in developed countries under the age of 5 are affected
Congenital? Patologies associated, inheritance.
• 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
•
Course
long-term condition with 1/3 of patients continuing to show signs of AD into adulthood
Pathophysiology
a T-cell driven inffammatory process with epidermal barrier dysfunction
Investigations
- clinical diagnosis
* consider: skin biopsy, patch testing if allergic contact dermatitis is suspected
Management: goal:
reduce signs and symptoms, prevent or reduce recurrences/flares
Triggers for Atopic Dermatitis
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
Management: psichiatric
be vigilant for depressive symptoms and the possible need for psychiatric referral, especially among
those with severe disease
Management
non-pharmacologic therapy
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
pharmacologic therapy
topical corticosteroids
topical calcineurin inhibitors
topical corticosteroids. action, dose, application,side effects
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
topical calcineurin inhibitors. Options. When to Use. Why. Dose.
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
topical calcineurin. local side effects:. And Warnings
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
Complications and Treatment
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
Adjunctive therapy
all before + Antihistamines
• Psychological
interventions
Severe refractory disease. What to do_
Azathioprine
• Methotrexate
• Oral cyclosporin
• Oral steroids
- Phototherapy
- Potent topical steroids
- Psychotherapeutics
