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Q5 Dermatology > Childhood Atopic Dermatitis > Flashcards

Childhood Atopic Dermatitis Flashcards

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Dermatology Board Prep flashcards
1
Q

Atopic dermatitis:
Definition
Prevalence

A

Chronic pruritic inflammatory skin dz with wide range of severity

One of most (c) skin dos in developed countries (affects 20% of kids & 1-3% of adults)

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2
Q

atopic dermatitis: typical ages

A

most pts: AD develops <5 years and clears by adolescence

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3
Q

Primary sx of atopic dermatitis

A

pruritis (itch): the “itch that rashes”

scratching to relieve AD gives rise to ‘itch-scratch’ cycle & can exacerbate the dz

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4
Q

Atopic dz: course

A

periods of remission & exacerbation

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5
Q

Atopic Dermatitis: clinical findings (general)

A

lesions begin as erythematous papules, which then coalesce to form erythematous plaques that may display weeping, crusting or scale

xerosis is a common characteristic of all stages

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6
Q

Atopic Dermatitis distribution in infants & toddlers

A

eczematous plaques appear on the cheeks forehead, scalp & extensor surfaces

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7
Q

Atopic dermatitis distribution: older children & adolescents

A

lichenified, eczematous plaques in flexural areas of the necl elbows, wrists and ankles

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8
Q

Atopic dermatitis distribution: adults

A

lichenification in flexural regions & involvement of the hands, wrists, ankles, feet & face (particularly the forehead & around the eyes)

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9
Q

What percentage of children with atopic dermatitis also have or will develop asthma or allergic rhinitis

A

50-80% of children will have another atopic disease

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10
Q

Atopic Triad

consists of?

A

Asthma
Atopic dermatitis
Allergic rhinitis

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11
Q

Typical AD for infants & toddlers

A

cheeks, forehead, scalp & extensor surfaces:

erythematous, ill-defined plaques on CHEEKS W/OVERLYING SCALE & CRUSTING

erythematous, ill-defined plaques on the LATERAL LOWER LEG W/OVERLYING SCALE

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12
Q

typical atopic dermatitis for older children

A

affects flexural areas of neck, elbows, knees, wrists & ankles:

  • licenified, erythematous plaques behind the knees
  • erythematous excoriated papulse with overlying crust in the antecubital fossa
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13
Q

relationship between atopic dermatitis & eczema?

A

eczema: nonspecific term that refers to a group of inflammatory skin conditions characterized by PRURITIS, ERYTHEMA & SCALE

atopic dermatitis is a specific TYPE of eczematous dermatitis

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14
Q

Atopic dermatitis: pathogenesis

A

cause is multifactorial & not completely understood

thought to play varying roles:

  1. genetics
  2. skin barrier dysfunction
  3. impaired immune response
  4. environment
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15
Q

Atopic dermatitis treatment: overall strategy

A

combo:
short term tx to manage flares
&
longer-term strategies to help control sxs between flares

gentle skin care
identify & avoid triggers & irritants

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16
Q

Atopic dermatitis: skin care recommendations

A

gentle skin care:

  1. tepid baths without washcloths or brushes
  2. mild soaps
  3. pat dry
  4. emmolients: petrolatum & moisturizers
    - use ointments or thick creams (no watery lotions)
    - apply once to twice daily to whole body within 3 minutes of bathing for optimal occlusion
17
Q

Atopic dermatitis: 1st line treatment of acute inflammation

and potential SEs

A

topical corticosteroids
ointments preferred over creams

face: low potency
body & extremities: medium pot

potentical local SEs a/w topical corticosteroids: striae, telangiectasias, atrophy & acne

18
Q

What can reduce the risk of steroid atrophy & other SEs?

A

use stronger steroid for short periods & milder steroid for maintenance

19
Q

2nd line therapy for atopic dermatitis

when are the indicated

A

topical calcineurin inhibitors

used when continued use of topical steroids is ineffective or when use of topical steroids in inadvisable

20
Q

Atopic dermatitis: tx of pruritis

A

antihistamines help break the itch/scratch cycle

standing night-tine 1st generation H1 antihistamines (e.g. hydroxyzine) are helpful

21
Q

Atopic dermatitis: treatment of coexisting skin infections

A

systemic antibiotics

22
Q

When to refer an atopic dermatitis patient to a dermatologist (3)

A
  1. patients have recurrent skin infections
  2. patients have extensive and/or sever disease
  3. symptoms are poorly controlled with topical steroids
23
Q 
Super high potency topical steroids:
class(es)
example agent(s)
A

I

Clobetasol 0.05%

24
Q 
High potency topical steroid
class(es)
example agent(s)
A

II

Fluocinonide 0.05%

25
Q 
Medium potency topical steroid
class(es)
example agent(s)
A

III-IV

Triamcinolone ointment 0.1%
Triamcinolone cream 0.1%
Triamcinolone lotion 0.1%

26
Q 
Low potency topical steroid
class(es)
example agent(s)
A

VI-VII

Fluocinolone 0.01%
Desonide 0.05%
Hydrocortisone 1%

27
Q

Topical Steroid Dosing in Kids

A

low potency topical corticosteroids safe for short intervals
(can cause SEs when used for extended durations)

high potency steroids: use with caution & vigilant clinical monitoring for SEs

avoid potent steroids in high risk areas: face, folds or occluded areas s/a under the diaper

28
Q

Key to success when using topical steroids in kids

A

parent education & written instructions

“action plans” provide easy to follow tx recommedations & guidance

29
Q

relationship between allergens & atopic dermatitis

A

controversial
many AD pts are sensitive to food & environmental allergens
BUT
evidence of allergen sensitization is not proof of a clinically relevant allergy

UNCOMMON for AD to cause or exacerbate food allergies

if an AD pt has a CONFIRMED FOOD ALLERGY, elimination of food allergens can lead to clinical improvement

30
Q

Topical antibiotics in atopic dermatitis

A

NOT usually effective

many AD pts are colonized w/S. aureus so local tx w/abx (U) not effective

31
Q

When do you take a skin bacterial culture in atopic dermatitis?

A

consider during hyperacute, weepy flares of AD & when pustules or extensive yellow crust are present

32
Q

Patients with AD are susceptible to what?

how do you treat that?

A

a variety of secondary cutaneous infections such as:
Staphylococcus aureus
and
Group A Streptococcal infections

-these infections are a (C) cause of AD exacerbations

tx with SYSTEMIC antibiotics

33
Q

Pityriasis alba:
What is it?
How does it present?
Typically found in what population?

A

Pityriasis alba
mild, often asymptomatic form of AD of the face

presents as poorly marginated, hypopigmented, slightly scaly patches on the cheeks

typically found in younger kids (w/darker skin), often presenting in spring & summer when the normal skin begins to tan

34
Q

PITYRIASIS ALBA: tx

A

reassure pts/parents that it generally fades w/time

use of sunscreens minimizes tanning->limits contrast btwn diseased & normal skin

if moisture & sunscreen do not improve skin lesions, consider low strength topical steroids

35
Q

a larger % of children w/AD will develop what

A

Asthma & Allergic Rhinitis

atopic triad

36
Q

pathogenesis of AD (4)

A 
multifactorial:
genetics
skin barrier dysfunction
impaired immune response
environment

Q5 Dermatology (14 decks)

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