Atopic Dermatitis (Eczema)

Question 1

Acute Atopic Dermatitis

Answer 1

Erythematous papules and vesicles with exudate/crusting, spongiosis (epidermal edema)

Question 2

Chronic Atopic Dermatitis

Answer 2

Dry, scaly, excoriated, Erythematous papules, lichenification and fissuring may occur over time

Question 3

Pathogenesis of Atopic Dermatitis

Answer 3

• Filaggrin deficiency
• Genetic disposition (eczema, asthma, allergic rhinitis; increased serum IgE levels and eosinophilia)
• Allergies to foods
• Hard water (calcium carbonate increased risk of atopic dermatitis)

Question 4

Mild Atopic Dermatitis

Answer 4

Infrequent itching (w or w/o small areas of redness); little impact on everyday activities, sleep, and psychosocial wellbeing

Question 5

Moderate Atopic Dermatitis

Answer 5

Frequent itching, redness (w or w/o excoriation and localized skin thickening); moderate impact on everyday activities and psychosocial wellbeing, frequently disturbed sleep

Question 6

Severe Atopic Dermatitis

Answer 6

Dry skin, constant itching, redness, severe limitation of everyday activities and psychosocial functioning, nightly loss of sleep

Question 7

To help with the itching (Atopic Dermatitis)

Answer 7

• Oral antihistamines (especially if concurrent urticaria/rhinoconjunctivitis)
  - H1 (diphenhydramine, hydroxyzine, cyproheptadine) -sedating
  
  • H2 (fexofenadine, loratidine, cetirizine)
• Topical Doxepin
• Topical Calcineurin Inhibitors: Tacrolimus ointment and pimecrolimus cream

Question 8

Atopic Dermatitis treatment

Answer 8

• Topical corticosteroids (first line for mild/moderate disease)
  
  • low potency creams/ointments for mild disease BID for 2-4 weeks (w/ emollients) - DESONIDE 0.05%
  • high potency for moderate disease for 1-2 weeks, tapered to lower potency creams - TRIAMCINOLONE 0.05%
• Face, flexures: low potency steroids daily for 5-7 days

Question 9

Alternative treatment for Atopic Dermatitis

Answer 9

• Topical Calcineurin inhibitors
• BID
• Tac 0.03% and 0.1%
• Pime 1%
• Equal strength to medium potency steroids
• slower onset

Question 10

Treatment of Atopic Dermatitis is 2 years and older

Answer 10

• Crisaborole (Eucrisa)
• BID
• PDE-4 inhibitor

Question 11

Treatment for severe Atopic Dermatitis

Answer 11

• Soak affected area in water for 15 minutes and then apply high potency steroid (except face, groin, axillae)
• Wet wraps (mild to super-potency steroids in an ointment base)
• Phototherapy (2-3 times weekly, sometimes combined with coal tar solns)
• Dupilumab (mod-severe disease when topicals don’t work or aren’t advised)
• Immunosuppressants (Cyclosporine, Methotrexate, Azathioprine, MMF) - severe disease