Childhood Atopic Dermatitis Flashcards by Wendy Pitts

Atopic dermatitis:
Definition
Prevalence

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)

How well did you know this?

Not at all

Perfectly

atopic dermatitis: typical ages

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

How well did you know this?

Not at all

Perfectly

Primary sx of atopic dermatitis

pruritis (itch): the “itch that rashes”

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

How well did you know this?

Not at all

Perfectly

Atopic dz: course

periods of remission & exacerbation

How well did you know this?

Not at all

Perfectly

Atopic Dermatitis: clinical findings (general)

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

How well did you know this?

Not at all

Perfectly

Atopic Dermatitis distribution in infants & toddlers

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

How well did you know this?

Not at all

Perfectly

Atopic dermatitis distribution: older children & adolescents

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

How well did you know this?

Not at all

Perfectly

Atopic dermatitis distribution: adults

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

How well did you know this?

Not at all

Perfectly

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

50-80% of children will have another atopic disease

How well did you know this?

Not at all

Perfectly

Atopic Triad

consists of?

Asthma
Atopic dermatitis
Allergic rhinitis

How well did you know this?

Not at all

Perfectly

Typical AD for infants & toddlers

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

How well did you know this?

Not at all

Perfectly

typical atopic dermatitis for older children

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

How well did you know this?

Not at all

Perfectly

relationship between atopic dermatitis & eczema?

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

How well did you know this?

Not at all

Perfectly

Atopic dermatitis: pathogenesis

cause is multifactorial & not completely understood

thought to play varying roles:

genetics
skin barrier dysfunction
impaired immune response
environment

How well did you know this?

Not at all

Perfectly

Atopic dermatitis treatment: overall strategy

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

gentle skin care
identify & avoid triggers & irritants

How well did you know this?

Not at all

Perfectly

Atopic dermatitis: skin care recommendations

gentle skin care:

tepid baths without washcloths or brushes
mild soaps
pat dry
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

Atopic dermatitis: 1st line treatment of acute inflammation

and potential SEs

topical corticosteroids
ointments preferred over creams

face: low potency
body & extremities: medium pot

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

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

use stronger steroid for short periods & milder steroid for maintenance

2nd line therapy for atopic dermatitis

when are the indicated

topical calcineurin inhibitors

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

Atopic dermatitis: tx of pruritis

antihistamines help break the itch/scratch cycle

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

Atopic dermatitis: treatment of coexisting skin infections

systemic antibiotics

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

patients have recurrent skin infections
patients have extensive and/or sever disease
symptoms are poorly controlled with topical steroids

Super high potency topical steroids:
class(es)
example agent(s)

Clobetasol 0.05%

High potency topical steroid
class(es)
example agent(s)

Fluocinonide 0.05%

``` Medium potency topical steroid class(es) example agent(s) ```

III-IV Triamcinolone ointment 0.1% Triamcinolone cream 0.1% Triamcinolone lotion 0.1%

``` Low potency topical steroid class(es) example agent(s) ```

VI-VII Fluocinolone 0.01% Desonide 0.05% Hydrocortisone 1%

Topical Steroid Dosing in Kids

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

Key to success when using topical steroids in kids

parent education & written instructions "action plans" provide easy to follow tx recommedations & guidance

relationship between allergens & atopic dermatitis

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

Topical antibiotics in atopic dermatitis

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

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

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

Patients with AD are susceptible to what? | how do you treat that?

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

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

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

PITYRIASIS ALBA: tx

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

a larger % of children w/AD will develop what

Asthma & Allergic Rhinitis | atopic triad

pathogenesis of AD (4)

``` multifactorial: genetics skin barrier dysfunction impaired immune response environment ```