Dermatitis

Question 1

Irritatant Contact Dermatitis Definition

Answer 1

Skin reactivity caused by exposure to any toxic agent
Point of contact
May spread beyond point of contact

Question 2

Allergic Contact Dermatitis Definition

Answer 2

Skin reactivity caused by an antigen that causes an immune response

T cell activation

Initial Sensitization: skin response 5-7 days after exposure

Secondary Sensitization: Skin response 6-18 hours after exposure

Question 3

Atopic Dermatitis: Exzema Definition

Answer 3

Increased production of Immunoglobulin E,
Adaptive and innate immune response
Genetic Factors
Deficiency in Filaggrin
Risk for secondary exposure to Staphylococcus Aureus

Question 4

Symptomatic Management - First Line

Answer 4

Cool compresses,
baths,
colloidal oatmeal,
compresses of Burrow solution

Question 5

Topical Corticosteroids

Answer 5

Least potent, shortest amount of time

Initiate with intermediate potency for short duration

Max: 2 weeks adults, 1 week children

SE: skin thinning, hypopigmentation,

Question 6

Types of Steroids and Potency

Answer 6

Question 7

Topical Calcineurin Inhibitors

Answer 7

Tacrolimus - moderate to severe
Pimecrolimus - mild to moderate

MOA: Act on T cell by preventing cytokine transcription

Apply: BID for flare, 2-3 / wk prophy

Use: moderate to severe atopic, not responsive to steroids

Question 8

Systemic Corticosteroids

Answer 8

MOA: suppress the influx of inflammatory cells and the inflammatory process

Dose Taper: 1 mg/kg decreased by 5 mg every 2 days for 2-3 weeks

Education: take same time every morning
Continue for full 2 weeks to minimize rebound

Use: Severe widespread dermatitis, not responsive to TCS

SE’s: adrenal suppression, osteoporosis

Question 9

Order of Tx for Contact Dermatitis

Answer 9

First Line: Avoid triggers, Symptom management, TCS, Oral antihistamine

Second Line: Increased potency of TCS

Third Line: OCS

Question 10

Order of Tx for Atopic Dermatitis

Answer 10

First Line: Non-Pharmacologic, TCS

Second Line: TCI, Crisaborole (PDE-4 inhibitor), Phototherapy

Third Line: Oral systemic therapy

Question 11

Picture: Order of Tx Atopic Dermatitis

Answer 11

Question 12

Picture: Order of Tx Allergic and Instant Contact Dermatitis

Answer 12

Question 13

Special Population Dermatitis Considerations

Answer 13

Pediatric: Topical corticosteroids for only 7 days in children <6 yrs and at the lowest potency

Geriatric: Topical corticosteroids can cause atrophy of the skin in older people