Dermatitis (PHARM)

Question 1

The two types of dermatitis

Answer 1

1. Atopic dermatitis (eczema) Type I, IgE
2. Contact dermatitis

Question 2

The two types of contact dermatitis

Answer 2

1. Allergic contact dermatitis Type IV
2. Irritant contact dermatitis

Question 3

Allergic contact dermatitis

Answer 3

an allergic reaction to an allergen touching the skin, takes couple of days to see, common to poison ivy, nickel, latex

Question 4

Irritant contact dermatitis

Answer 4

NOT an allergic reaction, damage to water protein matrix of outer layer of skin due to reaction of skin to detergents and chemical

Question 5

Definition of atopic dermatitis

Answer 5

-Inheritable chronic inflammatory pruritic and generalized dry skin disease
-More common in children can persist
-Elevated IgE
-Personal family of Type I allergies
-Red patches, scale, excoriations, lichenifications

Question 6

Pathophysiology of atopic dermatitis

Answer 6

-Immune response
-Disruption of water and skin lipids in stratum corner leads to itching
-Systemic Th2 helper response
-Cytokine release and inflammation
-Eosinophilia
-Increase IgE levels
-Dermal fibrosis, epidermal hyperplasia, lichenification

Question 7

Signs and Symptoms of AD

Answer 7

-Acute: pruritis, erythema, vesicles, exudate and crusts
-Chronic: skin thickening, lichenification, scaling
-AD is characterized by exacerbation and remissions

Question 7

AD distribution in the body

Answer 7

-Infants: cheeks, neck, scalp, extensor of elbows and knees (outside)
-2-Adolescence: flexural (inside), hands, neck, around eyes
-Adult: neck, front of ankles, hand dermatitis

Question 8

Managements of AD

Answer 8

-Luke warm baths 5-10 mins
-Lubrication, occlusives
-Topical corticosteroids
-Calcineurin inhibitors
-Coal Tar
-Antihistamines sedating ones to help with sleep
-Oral prednisone
-Immunosuppressants

Question 9

What are the three main effects of topical corticosteroids?

Answer 9

1. anti-inflammatory
2. antipruritic
3. vasoconstrictive
   -Strength of the topical corticosteroid is inherent to the molecule (type) and not the concentration

Question 10

Potency of topical corticosteroids types

Answer 10

-Type I super high
-Type II high
-Type III-V medium
-Type VI-VII Low

Question 11

The reason for selection of the type of topical steroid

Answer 11

-Location of application: super high can be used on scalp, palms, soles, thick plaques

-Medium/high can be applied limited period on flexural surfaces, trunk

-Low: facial, eyelids, genitals, folds

Question 12

Side effects of topical corticosteroids

Answer 12

-Skin atrophy
-Tachyphylaxis (tolerance, takes several months)
-Hypertrichosis (localized hair growth)
-Infection (staph aureus or herpes simplex)
-Telangiectasia (prominent blood vessels)
-Striae
-Acneiform eruption
-Hypopigmentation
-HPA suppression-rare (kids<2 years with severe AD)
-Growth suppression (measure height and weight)
-Osteoporosis in adults in long term potent usage
-Glaucoma
-HTN
-Hyperglycemia

Question 13

Prescribing topical corticosteroids, what is the measurement?

Answer 13

-1 finger tip FTU=0.5 gram
-FTU for body area involved X 0.5g/FTU X # of applications/day X days of treatment

Question 14

The treatment durations for different potencies of topical corticosteroids

Answer 14

-Super high potency <4 weeks
-High/medium <4-6 weeks
-Low 1-2 weeks to avoid skin atrophy

Question 15

Calcineurin inhibitors mechanism of action?

Answer 15

-Calcineurin is an enzyme involved in release of cytokines, inhibition of this enzyme decreases T lymphocyte activation
-Provides specific anti-inflammatory
-As effective as mid potency steroids
-Use when steroids are not working
-Twice daily application is needed

Question 16

Side effects of calcineurin

Answer 16

-Short term safety is good no skin atrophy
-Long term safety concerns of lymphoma and skin cancer
-Systemic absorption-> HTN, renal toxicity

Question 17

Contraindications of calcineurin?

Answer 17

-Elidel cream NOT for Children < 3 months of age or immunocompromised
-Protopic NOT for children <2 years of age or immunocompromised