Chapter 5: Atopic Dermatitis Flashcards
What is atopy?
Designates a group of patients who had a personal or family history of one or more of the following diseases: hay fever, asthma, very dry skin, and eczema
What are the major criteria of atopic dermatitis
Must have three or more
Pruritus Typical morphology and distribution flexural lichenification in adults facial and extensor involvement in infants and children dermatitis personal or family history of atopy
What affect does IgE have on patients with atopic dermatitis
Serum levels of many patients are increased, but 20% of atopic dermatitis patients have normal serum IgE
What is chronic dermatitis
The result of scratching over an extended period, resulting in the thickened skin, accentuated skin markings (lichenification), and fibrotic papules
What are the three phases of atopic dermatitis
- Birth to two
- Childhood
- Adult
Discuss the infant phase (birth to two years) of atopic dermatitis
Typically develops the first signs of inflammation during the third month of life.
Inflammation spares the perioral and paranasal areas
How does atopic eczema affect growth in kiddos
The growth in children with eczema affecting less than 50% of the skin surface area appears to be normal, and impaired growth is confined to those with more extensive disease.
Discuss childhood phase (2 to 12 years) of atopic dermatitis
Most common in characteristic appearance of atopic dermatitis is inflammation in the flexural areas
The active perspiring stimulates burning and intense itching and initiates the itch-scratched
What affect will constant scratching have with atopic dermatitis
Constant scratching may lead to destruction of melanocytes, resulting in areas of hypo pigmentation that become more obvious when the inflammation subsides.
What is the adult phase (12 years to adult) of atopic dermatitis
Begins to the onset of puberty.
May have no history of dermatitis.
- Hand dermatitis
- inflammation around the eyes
- the lichenificationof the anogenital area
What soaps are safe to use with dry skin
Dove
Cetaphil
What is ichthyosis vulgaris
A disorder of keratinization characterized by the development of dry, scales
What is dominant ichthyosis vulgaris
White translucent quadrangular scales on the extensor aspect of your arms and legs.
This form is significantly associated with atopy
Who is affected by sex-linked ichthyosis vulgaris
affects only males
Scales are smaller and lighter in color than the large, brown polygonal scales of sex linked ichthyosis vulgaris
This condition tends to improve with age. Application of 12% ammonium lactate lotion or cream or urea cream is very effective
What is keratosis pilaris
Very common it seems to occur more often and more extensively in patients with AD
The posterior lateral aspects of the upper arms and anterior thighs are frequently involved, but any area, with the exception of the palms and soles, may be involved.
Most cases are asymptomatic, but lesions may be red, inflammatory, and pustular and resemble bacterial folliculitis, particularly on the thighs.
What are hyper- linear palmer creases
Atopic patients are frequently found to have in accentuation of the major skin creases of the palms.
This accentuation may be present in infancy and become more prominent as age and severity of skin inflammation temperature
What is pityriasis alba
A common disorder that is characterized by an asymptomatic, hypopigmented, slightly elevated, fine, scaling plaque with indistinct borders
The loss of pigment is not permanent as it is in vitiligo
Tinea versicolor is rarely located on the face, and the hypopigmented areas or more numerous and more confluent.
What is atopic pleats
The appearance of an extra line on the lower eyelid (Denny-Morgan infraorbital fold)
an unreliable sign of the atopic state
What are some triggering factors for atopic patients
- Temperature change and sweating.
- Decreased humidity
- Excessive washing
- Contact with irritating substances.
- Contact allergy.
- Aero allergens
How does cigarette smoking affect atopic dermatitis?
Smoke may provoke eczematous lesions on the eyelids. The inflammation is frequently interpreted as an allergic reaction by patients who claim they are allergic to almost everything they touch.
How is treatment handled for atopic dermatitis
Treatment goals consists of attempting to eliminate inflammation and infection, preserving and restoring the stratum corneum barrier by using emollients, using anti-pruritic agents to reduce the self-inflicted damaged and controlling exacerbating factors.
How should patients bathe with atopic dermatitis
Bathing hydrates the skin, when moisturizer is applied immediately after bathing before the water has a chance to evaporate (within three minutes), thus retaining the hydration keeping the skin soft and flexible
How is acute inflammation treated with atopic dermatitis
Topical steroids for rapid control and then switching to pimecrolimus or tacrolimus to complete treatment
What level of steroids should be initiated for treatment of atopic dermatitis in adults
use mid-strength to high-strength (adults) steroids as initial treatment.
Limit treatment to two weeks
Ointment-based medications are preferred for dry skin
Introduce patients to pimecrolimus cream (Elidel) or tacrolimus ointment (Protopic)
What steroid should be started in children with atopic dermatitis
The group V topical steroid fluticasone propionate cream 0.05% appears to be safe for the treatment of severe eczema for up to four weeks.
What are the topical non steroidal anti-inflammatory agents
Pimecrolimus (Elidel) and tacrolimus (Protopic) are immunosuppression topical medications that inhibit a calcium-activated phosphatase called calcineurin
What are the indications for pimecrolimus
Long-term therapy in the treatment of mild to moderate atopic dermatitis and non-immune compromised patients two years of age and older
What is the dosage and administration of pimecrolimus
Apply a then layer to the affected skin twice daily. May be used up to six weeks or until symptoms resolve
Pimecrolimus cream should not be used with occlusive dressings
*Burning does not occur
Is burning more likely to occur with Protopic or Elidel
Protopic
Burning (mild-to-moderate) at the site of application is the most frequent adverse event, occurring in 31 to 61% of those treated
How should you treat children and adults with lichenified plaques
Respond to group II through V topical steroids used with occlusive dressings. Occlusive therapy for 10 to 14 days is preferred if the plaques are resistant to treatment or are very thick
Should systemic steroids be used for severe atopic dermatitis
Severe AD may be treated with prednisone. Prednisone administered at dosage of 20 mg twice each day for at least seven days, as an alternative schedule for severe widespread inflammation
The relapse rate is high, with inflammation returning shortly after the medication is discontinued
How does restoring moisture to the skin affect healing
Increases the rate of healing and establishes a durable barrier against further drying and irritation.…
When are lubricants most effective
Most effective immediately after a bath.
The patient should gently pat the skin dry with a towel and immediately apply the lubricant to seal in the moisture.
What are some mild soaps that are safe to use with atopic dermatitis
Cetaphil Dove keri purpose Oilatum
Ivory soap is very drying and should be avoided
What role does oral antihistamines play with atopic dermatitis
Antihistamines generally have offered only marginal therapeutic benefit. Sedating antihistamines may be useful in relieving pruritus at night
What is a topical antihistamine
Doxepin HCl (zonalon cream)
Mechanism of action is unknown.
Indicated for the short term (up to eight days) management of moderate pruritus in adults with AD and lichen simplex chronic
a thin film of cream is applied to four times each day with intervals of at least three hours between applications.
What light therapy is available for A.D.
Combined UVA – UVB and UVA or UVB have been shown in the past to be effective
The dosage is considerably lower than that for UVB treated psoriasis patients
What is the American Academy of dermatology recommend for the use of cyclosporine for the treatment of severe AD
Recommends the use of cyclosporine for the treatment of severe AD on the basis of randomized controlled trials. Cyclosporine is not approved by the FDA for treating AD
Can be prescribed on a short-term basis, both in adults and in children. Long-term treatment up to one year should be considered only in exceptional cases they cannot be controlled by short-term therapy
What five foods account for 90% of the positive oral challenges seen in children for food hypersensitivity
Eggs peanuts milk soy wheat
What should be suspected in a child less than seven years old with AD that is unresponsive to routine therapy
Greater than 50% chance of having a food hypersensitivity
How does diet exclusion affect eczema in infants
Eczema develops and fewer children who receive a casein hydrolysate as compared with those receiving soy or cows milk formula
Milk and soy allergies usually disappear with aging; egg and fish allergies tend to remain
What were the top three Aero allergens
- House-dust mite
- Grass pollen
- Cat epithelium
