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Small Animal medicine Dermatology Section > Atopic Dermatitis > Flashcards

Atopic Dermatitis Flashcards

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Dermatology Board Prep flashcards
1
Q

Pathogenesis of Atopic Dermatitis

A
  1. Damage/dysfunction of the epidermal barrier
    • allows increased exposure to allergens
    • secondary infections
  2. Genetic predisposed to type I hypersensitivity
    • Allergens access body via through skin
  3. Shift in cytokines that regulate immune responses
    • Atopic animals have a shift from Th1 lymphocytes to Th2 cells
    • Promotes more of an inflammatory response
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2
Q

Secondary infections associated with Atopic Dermatitis

A
  • increased adherence of bacteria and yeast
  • Damage tot he epidermal barrier
  • result in increased carriage of bacteria such as Staphylococcus pseudintermedius
  • Atopy is the most common primary factor of:
    • Pyoderma
    • Malassezia dermatitis
    • Otitis externa
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3
Q

Clinical categories of allergens

A

pollens

molds

epidermal allergens

Miscellaneous: house dust mites etc.

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4
Q

what are clinical features of Atopic Dermatitis

A

breed predilections -Terriers

Pruritus is the hallmark sign associated with this

  • licking, rubbing, scratching, chewing
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5
Q

Clinical causes of itch

A

Parasites

infectious

Allergy

Inflammatory

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6
Q

Historical features associated with an Atopic dermatitis infection

A
  • Initial clinical signs generally begin 1-3 years of age.
  • Problem is often seasonal and progressing to year-round signs
  • Pruritus is the key clinical feature
    • Responds to glucocorticoid therapy if secondary infections are not present
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7
Q

If you have severe itch, what are the potential differentials?

A

sarcoptic mange, flea allergy, Malassezia, seborrhea (dandruff) /combinations

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8
Q

What are physical findings associated with Atopic Dermatitis

A

erythema, excoriations, scale

Chronic lesions include:hyperpigmentation, lichenification

Secondary bacterial and yeast infections are very common

  • Staphylococcus pseudintermedius
  • Malassezia pachydermatis
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9
Q

What are the common locations for Atopic Dermatitis

A

Thin-skinned Areas: Periocular skin, interdigital areas, axillae, ventral abdomen

Perianal pruritus: leading to recurrent anal sac inflammation and infection

Recurring otitis externa, and acral lick dermatitis

Clincial Symptoms: Licking feet, rubbing the face, scratching axillae

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10
Q

Diagnosis of Atopic Dermatitis

A

signalment

history (response to treatment)

Physical findings

Data base

Allergy testing (intradermal skin testing)

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11
Q

intradermal skin testing

A

used to confirm the diagnosis of Atopic Dermatitis.

Provides information for hyposensitization.

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12
Q

In-Vitro Allergy Testing

A

Detection of circulating, antigen-specific IgE

There is a tendency to give false positive results

Advantage: rapid, easy, and no special supplies are required

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13
Q

management goals for Atopic Dermatitis

A
  1. Provide support to the epidermal barrier
    • using topical formulations and or Omega 6’s proper hydration of the skin is essential.
  2. Control secondary infections
    • treat infections
    • Prevent or reduce recurrence and severity
  3. Decrease itch
    • glucocorticoids, cyclosporine, iL-31 blocing agents, allergen-specific immunotherapy
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14
Q

Antihistamines and fatty acids in regards to Atopic Dermatitis?

A

Synergy with the two combined

Each has been shown to reduce the amount of glucocorticoid needed to control itch 20-25%

Highly recommended for any dog on steroids

May help to reduce anxiety and support the barrier.

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15
Q

What are appropriate glucocorticoids for the treatment of Atopic Dermatitis

A

Prednisone (drug of choice in dogs)

Prednisolone (drug of choice in cats)

Methylprednisolone

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16
Q

What is the dosage of Prednisone and Prednisolone for Atopy

A

1.1mg/kg, q24h, PO 5-7 days then 1.1mg/kg, q48h, 14-21 days then slowly decrease the dose by 10-20% every 10-21 days

Maintenance 0.5-1.1mg/kg q48hr.

17
Q

What are the disadvantages of glucocorticoid therapy

A

Adverse-effects

(increasing appetite and can lead to obesity. Increased drinking, and increased urination)

Easy to screw up the dosing

18
Q

Temaril-P

A

Antihistamine combined with prednisolone.

Allows lower glucocorticoid doses. This allows us to give 1/5 the amount of glucocorticoid, but the same side effects are happening.

19
Q

What is a side effect of excess Glucocorticoid administration

A

Iatrogenic Hyperadrenocorticism

Depositions of Calcium on the epidermal surface

20
Q

Are topical glucocorticoids a good option for Atopic therapy?

A

no use these as infrequently as possible.

Best used as a spot treatment or occasional adjunct therapy

21
Q

Is cyclosporine therapy a good option for Atopic Dermatitis treatment

A

This is used to control severe pruritus

Dose can be reduced by adding ketoconazole.

This takes up to 6 weeks to kick in.

Works 70% of the time

22
Q

Adverse effects of Cyclosporine Therapy

A

Vomiting

Disturbances in glucose metabolism

Papillomatosis and other cutaneous neoplasms

gingival hyperplasia

Infections

Can be very expensive.

23
Q

Apoquel and its use against Atopic Dermatitis

A

messes with Interleuken 31- cytokine messenger that stimulates pruritus. this binds to the Jack Stat receptors on nerves.

this can interfere with RBC and WBC production

24
Q

cytopoint and atopic dermatitis treatment

A

IL-31 monoclonal antibiody.

binds directly to IL-31 which initiates pruritus

25
Q

Apoquel as a treatment for Atopic Dermatitis

A

Not to be used in dogs under 1 year of age because of the potential enhanced development of demodicosis

Advantages: effective in ~70% of patients, works fast, few adverse effects at label doses in short-term

Disadvantages: GI upset, demodicosis

26
Q

What are indications for apoquel use?

A

great for rapid response

Great for induction period of immunotherapy (up to 9 months)

Long term safety appears to be good.

May need to adjust dosage, time of day dosing

Price point is variable, depending on size

27
Q

Cytopoint advantages

A

Minimal adverse effects

Doesn’t have the “ups and downs” seen with Apoquel

Reduces some of the client compliance issues

Price point is variable

28
Q

Immunotherapy associated with atopic dermatitis

A

Essentially a gradual exposure to increasing doses of allergens.

this reduces the triggering of mast cells and basophils. Results in the shift form TH2 to TH1 cells

formation of IgG as a blocking antibody

29
Q

Why would you consider using immunotherapy.

A

This is a great option for younger dogs 2-3 years, as this may prevent progression of disease

This is the best chance for a cure

30
Q

What is a major contraindication for Immunotherapy

A

Diabetes mellitus

31
Q

When would you use glucocorticoids and when would you not?

A

When to use:

  • Need rapid response
  • need anti-inflammatory effects
  • if need seasonally or short-term
  • Cost is a factor

When to NOT use:

  • Concurrent health issues
  • Patient can not tolerate
  • Plan to allergy test
32
Q

When is it indicated and contraindicated to use Cyclosporine?

A

Incidated:

  • Small dog (cost associated)
  • Some anti-inflammatory effect is desired and GC are not an option

contraindicated

  • concurrent infections
  • Diabetes mellitus
  • Cost is a factor especially in larger dogs
33
Q

When is the use of Oclacitinib (Apoquel) indicated and contraindicated?

A

Indicated:

  • Need rapid response
  • Prior to allergy testing
  • While waiting for immunotherapy
  • Cost is somewhat a factor

Contraindicated:

  • Long term use
  • Does not provide 24 hours of relief
34
Q

What drug is Oclacitinib?

A

Apoquel

35
Q

When is Lokivetmab indicated and contraindicated

A

Indicated:

  • Client compliance is an issue
  • Convenience factor
  • Adverse effects to other options

contraindicated:

  • clients are not mobile (?)
  • Large dogs
36
Q

What drug is Lokivetmab

A

Cytopoint

37
Q

When is immunotherapy indicated and contraindicated?

A

indicated:

  • Younger dogs
  • infections/otitis are the main manifestation
  • Owners prefer to treat the disease vs. masking the symptoms

contraindicated:

  • Client compliance/ability to administer treatment
  • Owners want/expect short term gratification
38
Q

end of deck

A

Small Animal medicine Dermatology Section (7 decks)

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