Atopic Dermatitis Treatment Flashcards
1
Q
Treatment for AD (3)
A
- Hydration
- Moisturizer or Get them hydrated using warm bath - Soak and seal – take out of bath and within 3 minutes rub with a cream or ointment
- Also use anti-pyretics
- Hydroxazine and ada
2
Q
Clinical Guidelines for AD treatment (4)
A
- Clinicians should use a systematic, multipronged approach that includes skin hydration, topical anti-inflammatory medications, antipruritic therapy, antibacterial measures, and elimination of exacerbating factors.
- Clinicians should evaluate the success of the approach and modify the treatment plan, if needed. (A)
-Intensity of Atopic dermatitis treatment depends on
A.Severity of illness
B. Effect on the quality of life The clinician should establish treatment - Establish goals with the patient
- Reduced skin barrier is characteristic of AD and Leads to enhanced water loss and dry skin;
- Hydration of the skin with warm soaking baths for at least 10 minutes followed by the application of a moisturizer
3
Q
What is first line of treatment for AD and why? (4)
A
MOISTURIZER!!!!
- Xerosis contributes to the development of epithelial microfissures and cracks, which allow entry of microbes and allergens.
- Xerosis gets worse in dry environments; can use the below formula
- Recipe for aveno: ½ oatmeal, ¼ cup fresh cristo, 1 cup of water = use on xerosis
- Mix in a very clean jar
- Hydrates and soothes the skin - Exacerbated during the dry winter months and aggravated in certain work environments.
- Addition of oatmeal or baking soda to the bath water can have a soothing antipruritic effect for certain patients but does not increase water absorption.
4
Q
How does moisturizer help AD? (4)
A
- Help control pruritus
- Maintaining a soft texture to the skin.
- When applied to dry skin and after bathing to maintain hydration of the epidermis.
- Consistent use has a corticosteroid-sparing effect
5
Q
Types of moisturizers (6)
A
- Emolliate with a moisturizer.
- Lubricants maintain the skin’s hydration - An ointment-based emollient
- e.g., Vaseline, petrolatum jelly, Crisco, vegetable oil, whipped petrolatum, Aquaphor) can be applied just before getting out of the bath water or just after getting out of the bath while still damp. - If patients do not like the greasy feel of an ointment, other topical creams (e.g., Vanicream contains no chemicals, Cereve, Cetaphil) can be used.
- This is also a good time to apply TCPs because absorption of the agent is more effective if the skin is hydrated. - Emollients can be applied three or four times a day as needed, such as fragrancefree
- Eucerin cream, Crisco (plain, not butter flavored), Aveeno, Moisturel,
- Neutrogena, Dermasil, Curel, or petroleum jelly (an occlusive agent). - If a child is sensitive to fragrances, scented creams, such as Nivea and Vaseline
- Intensive Care, should be avoided.
- TriCeram is a moisturizer that repairs the stratum corneum barrier function. Like
- Cereve, it is a ceramide-dominant, lipid-based emollient. - Urea-containing products, such as Aquacare cream or lotion and Ureacin Crème,
- Soften and moisturize dry skin.
- Stinging is a side effect when using urea containing product on fissured or flaring skin.
6
Q
Description of how different treatments affect AD (4)
A
- Frequent bathing may exacerbate their pruritus and thus aggravate their skin problems.
- Bathing must be limited in these patients and emollients used.
- If a child experiences stinging when bathing during acute exacerbations, adding 1 cup of table salt into the bath may reduce the stinging sensation.
- When moisturizers fail, low-potency corticosteroids are recommended for maintenance therapy, whereas intermediate and high-potency corticosteroids should be used for the treatment of clinical exacerbation over short periods of time.
7
Q
Topical corticosteroids for AD (5)
A
- No potent fluorinated corticosteroids for use on the face, eyelids, genitalia, and intertriginous areas or in young infants
- TCPs reduce inflammation and pruritus.
- The classification of the TCP should be known because potent and very potent TCPs are associated with more side effects such as thinning of the skin or adrenal axis suppression than milder preparations
- A proactive approach to the treatment of AD includes twice weekly application of a low dose TCP for up to 4 months once the lesions are quiet
- The rationale for this approach is that the skin is actually not normal and has a defect in hydration, which can be treated using an intermittent approach
8
Q
Application of TCP (2)
A
- Finger tip method: The amount of steroid should be from the distal interphalangeal joint to the top of the adult finger for an area equaling two adult palms. Apply a thin layer of TCP to affected areas marked with acute exacerbations twice a day or once a day if using a newer formulation
- When applied over large areas of dermatitis or if occlusion (covering with plastic wrap) is used, the possibility of significant systemic absorption is greatly increased, especially in infants and young children.
9
Q
Topical Steroid Overview (5)
A
- 7 levels of steroid with class 1 being very high potency to class 7 being the lowest potency
- Greater caution is needed when applying the steroids to the face, neck and skin folds as the skin is thinner and there is higher risk of systemic absorption
- Tapering of the strength of the steroids should occur only once the outbreak is fully controlled and then the child is switched to once a twice weekly application of a low dose
- TCS at areas of outbreak to reduce the relapse.
- The baseline moisturizing skin care should continue with a low strength TCS once to twice a week to reduce inflammation
10
Q
Topical Steroid Strengths (5)
A
- Remember to look at the class not the percentage
- Note that clobetasol 0.05% is stronger than hydrocortisone 1% - When several are listed, they are listed in order of strength
- Note that triamcinolone ointment is stronger than triamcinolone cream or lotion because of the nature of the vehicle - Low potency topical corticosteroids are safe when used for short intervals
- Can cause side effects when used for extended durations - High potency steroids must be used with caution and vigilant clinical monitoring for side effects in children
- Potent steroids should be avoided in high risk areas such as the face, folds, or occluded areas such as under the diaper
11
Q
Topical calcineurin inhibitors (8)
A
- TCI are second line therapy that is useful in both acute and chronic AD.
- The two agents are available—topical tacrolimus (Protopic) ointment 0.03% and 0.1% strengths and pimecrolimus (Elidel) 1% cream—have been shown to be as effective as mid-strength TCS.
- They can be combined with TCS in the treatment of patient’s whose AD has not responded to TCS. They are considered a steroid sparing agent
- Tacrolimus 0.03% and pimecrolimus 1% is approved for use at age 2 and over where as tacrolimus 0.1% is approved in children over 15 years of age
- TCI do have black box warnings due to the higher rate of lymphoma in rats given high dosages of these drugs.
- These drugs block calcineurin, which is a protein phosphatase that causes T-cell activation.
- Great for around the eyes or an irritant contact dermatitis
- The lower dosage is approved for age 2 and over, higher dose is approved for 15 and over
12
Q
Topical calcineurin inhibitor side effects (4)
A
Most common side effect is
1. itching, stinging, or burning, which starts 5 minutes after the application and can last for an hour but usually decreases after 1 week, usually during the first several days of administration and in severe cases of AD.
- Sun protection is needed with their use (Atkins and Leung, 2011).
- Patients need to be informed of the black box warning and the pros and cons of their use discussed.
- There is an increased theoretical risk of cutaneous viral infections with the use of TCI
13
Q
Emollient devices (4)
A
- Skin barrier repair and treatment: Drugs that improve the skin hydration barrier are available by prescription.
- Used twice a day.
- Unique ratios of lipids that resemble endogenous compositions
- Expensive and not covered by all insurance plans.
14
Q
Tar preparations for AD
A
- No randomized controlled studies have demonstrated their efficacy
- Newer coal tar products are more cosmetically acceptable, with respect to odor and staining
15
Q
Antihistamines for AD
A
- May relieve pruritus associated with AD
2. Topical antihistamines not recommended due to potential cutaneous sensitization
