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815 > Ch. 33 - Atopic Dermatitis > Flashcards

Ch. 33 - Atopic Dermatitis Flashcards

1
Q

Functions of Skin

A
  1. Protecting the body against trauma 2. Regulating body temperature 3. Maintaining water and electrolyte balance 4. Sensing painful and pleasant stimuli 5. Participating in vitamin D synthesis
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2
Q

Epidermis

A

Outer most thin layer of the skin, provides waterproof barrier

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3
Q

Dermis

A

Beneath epidermis, contains touch connective tissue, hair follicles, and sweat glands

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4
Q

Hypodermis

A

Deeper cutaneous tissue made of fat and connective tissue

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5
Q

Transdermal Drug Absorption

A
  • Drug absorption is often through passive diffusion through the stratum corneum, followed by transport through deeper epidermal regions and then the dermis - Stratum corneum often the rate-limiting barrier to absorption -Hydration status can affect drug diffusion - Occlusion increases hydration increased transfer of most drugs - Wounds, burns, inflammation can alter the stratum corneum and cause increased drug absorption - Pediatric concerns: newborns and infants have underdeveloped stratum corneum, increased skin hydration, and largest ratio of body surface area to body weight which causes increased systemic exposure to topical drugs - Geriatric concerns: often have thinning of stratum corneum which causes increased systemic exposure to topical drugs
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6
Q

Macule

A

Flat, nonpaplpable discoloration <1 cm (brown, blue, red, or hypopigmented)

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7
Q

Papule

A

Superficial solid elevated, ≤0.5 cm, color varies

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8
Q

Vesicle

A

Circular collection of free fluid, ≤ 0.5 cm

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9
Q

Pustule

A

Vesicle containing pus

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10
Q

Bulla

A

Fluid-filled blister, >0.5 cm

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11
Q

Patch

A

Circumscribed flat discoloration, > 1 cm

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12
Q

Plaque

A

Elevated, superficial, solid lesion, > 1 cm

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13
Q

Scale

A

Flakes or plates of compacted layers of stratum corneum

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14
Q

Lichenification

A

Thickening of epidermis seen with exaggeration of skin lines

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15
Q

Crust

A

Dried serum or exudates on skin

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16
Q

Nodule

A

Palpable, solid lesion, >1 cm

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17
Q

Wheal/uriticaria

A

Transient elevation due to dermal edema, often with erythematous borders and pale centers

18
Q

Fissure

A

Crack or split in the skin

19
Q

Erosion

A

Loss of some or all of the epidermis

20
Q

Ulcer

A

Loss of the epidermis and at least part of the dermis

21
Q

Atopic Dermatits (AD)

A

-Genetic mutation in protein in the epidermal differentiation complex (filaggrim) -Increased penetration of allergens -Decrease in skin barrier proteins -Decreased ability to retain moisture -People can have unique triggers that cause flare ups

22
Q

Possible AD Triggers

A

-Food allergens -Aeroallergens -Stress -Airborne irritants -Cosmetics, fragrances, astringents -Exposure to temperature extremes -Electric blankets -Excessive hand or skin washing -Use or irritating soaps, detergents, or scrubs -Tight-fitting or irritating clothes -Dyes and preservatives

23
Q

Atopic Skin Cycle

A
  1. Disturb skin barrier function 2. Penetration of irritants/allergens 3. Inflammation 4. Itching 5. Scratching **Then starts back at 1**
24
Q

Essential Diagnostic Features

A

-Pruritis -Eczema and age-specific distribution patterns -Chronic or relapsing course

25
Q

Important Diagnostic Features

A

-Onset in infancy or early childhood -Personal and/or family history of atopy -Xerosis

26
Q

Clinical Presentation - Infants

A

-Starts around 2-3 months -Erythema, pruritis, and scaling on cheeks that can spread to other areas -Scalp, face, arms, and legs are common sites in infants and toddlers -Crust and pustules may form from scratching and running -Remission may occur by 2 y.o.

27
Q

Clinical Presentation: Kids and Adults

A

-Chronic, relapsing dermatitis -Pruritis is hallmark symptom -Asthma and allergic rhinitis can be seen in up to 80% of people with AD -AD or xerosis can continue into adulthood in about 30% of patients

28
Q

Xerosis

A

-Dry skin -Frequently seen in AD along with dehydration, malnutrition, physical damage, etc. -Results from decreased water content in the skin which causes an abnormal loss of cells from stratum corneum -Related to loss of ceramides (help form skin barrier and retain moisture) -Frequently causes pruritis in winter -Goals: restore skin hydration and barrier function -Treat with nonpharmacologics

29
Q

Infected AD Signs/Symptoms

A

-Severe itchiness -Burning sensation -Blistered skin -Fluid drainage (clear or yellow) -White or yellow pus -Flu-like symptoms

30
Q

AD Treatment Goals

A
  1. Stop itch-scratch cycle 2. Maintain skin hydration and barrier function 3. Avoid/minimize factors that trigger or aggravate the disorder 4. Prevent secondary infections
31
Q

AD Nonpharmacologics

A

-Avoid triggers -Tepid, short baths with non-soap cleansers -Pat dry after bathing -Apply moisturizer immediately after bathing -Apply cool, tap water compress for 5-20 minutes 4-6 times a day to dry weeping lesions -Keep fingernails short, smooth, and clean -Use cotton gloves at night to prevent scratching

32
Q

Non-Soap Cleansers

A

-Soap can increase skin pH to undesirably levels and worsen AD -Non-soap cleansers usually don’t have sodium lauryl sulfate and have lower pHs to prevent this -Often also hypoallergenic and fragrance free

33
Q

Colloidal Oatmeal

A

-Available in body washes, moisturizing creams, and bath treatments -Provides moisturization, barrier protection, and anti-inflammatory activity -In many Aveeno products -Three studies supporting its efficacy in improving quality of life and reducing clinical signs of AD in adults and kids as young as 8 months

34
Q

Occlusives

A
  • Physically block transepidermal water loss - Enhance penetration of ingredients - More oil, more occlusive - Ex: petrolatum, lanolin, mineral oil, silicones
35
Q

Emollients

A
  • Oil in water or water in oil preparation - Soften the skin by filling the spaces between desquamating skin cells - Includes fatty acids, cholesterol, and ceramides
36
Q

Humectants

A
  • Water-attracting substances that actively pull water from dermis and hydrate the stratum corneum - Ex: glycerin, propylene glycol, alpha hydroxyl acids, urea
37
Q

Other Moisturizer Components

A
  • Vitamins - no-known clinical effects - Fragrances - avoid in sensitive skin - Exotic oils - Preservative - enhance product elegance and stability but can cause irritation or dermatitis (Ex: parabens, benzyl alcohol)
38
Q

Lotions

A

-Thinner in consistency, easy to spread - Contain more water - High water content lotions can have drying effect - May be preferred in milder cases of dryness or in warm weather - Useful in hairy areas - Good for skin folds Ex: Lubriderm, Cetaphil

39
Q

Creams

A
  • Usually half water and half oil - Heavier than lotion - Less greasy than an ointment - Good for skin folds - Good for daily use for winter months Ex: Eucerin, Cetaphil
40
Q

Ointments

A
  • Often contain petrolatum - Useful if occlusion is desired - Good for dry, thick, or scaly lesions - Can be greasy and staining - Avoid on oozing lesions - Avoid in intertriginous areas to prevent maceration - May be too occlusive in very warm weather - Good for palms and soles - Not good for oily skin Ex: CeraVe, Vaseline
41
Q

Pharmacologic Therapy

A

-Topical Hydrocortisone -0.5% or 1% OTC -MOA: suppress cytokines associated with the development of inflammation and itching -Don’t use in patient < 2 y.o. -Apply twice a day during AD flare ups prior to applying moisturizer -Cream is acceptable for mild, dry skin -Ointment is preferred on areas of thick skin or if skin is dry, lichenified, or scaly -Avoid if lesions are weeping -Avoid all products if skin is infected, open, or cracked -Intermittent course of therapy decreases likelihood of tachyphylaxis -ASE: local atrophy after prolonged use

42
Q

When to seek medical attention…

A

-Moderate to severe condition with intense pruritus -Involvement of large area of the body -<1 y.o. -Skin appears to be infected -Involvement of face or intertriginous areas -AD doesn’t improve or worsens after 2-3 days of treatment -Dry skin doesn’t improve or worsens after 7 days

815 (24 decks)

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