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Dermatology - Atopic Dermatitis Flashcards

1
Q

Atopic dermatitis, also known as allergic inhalant dermatitis, has a ______ predisposition.

A

familial (hereditary)

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2
Q

What are the major pathologic mechanisms associated with atopic dermatitis?

A

type I hypersensitivity and disruption/damage to the epidermal barrier

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3
Q

What is type I hypersensitivity mediated by?

A

IgE and subclasses of IgG

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4
Q

How does an animal become sensitized to an allergen?

A

An initial exposure to the antigen is required, then later exposure will lead to a reaction

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5
Q

What specific molecule plays a big role in pruritus due to atopic dermatitis?

A

interleukin-31

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6
Q

On a cellular level, what has been found in atopic patients?

A

they have been shown to have a cellular defect that allows increased adherence of bacteria to keratinocytes leading to increased bacterial infections

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7
Q

What allergens are known to cause atopic dermatitis?

A

pollens, molds, house dust mites, epidermals (wool, feathers, horse, human), insects, and many others (like tobacco)

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8
Q

What allergens typically appear in the spring?

A

trees and molds

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9
Q

What allergens typically appear in the summer?

A

grasses, and some weeds

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10
Q

What allergens typically appear in the fall?

A

weeds and molds

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11
Q

What allergens typically appear in the winter?

A

indoor allergens (dust mites, molds)

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12
Q

What allergens are typically year-round?

A

indoor allergens and combinations of the seasonal ones

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13
Q

At what age does atopic dermatitis typicall present?

A

9 months - 3 years of age

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14
Q

What is the hallmark of atopy?

A

pruritus

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15
Q

What are some signs of pruritus?

A

licking the feet, rubbing the fase, perineal pruritus, and generalized scratching

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16
Q

How do atopic lesions initally present?

A

mild: erythema, papules, and mild alopecia

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17
Q

What lesions are associated with chronic atopy?

A

lichenification, hyperpigmentation, and generalized alopecia

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18
Q

What areas are typically effected with atopy?

A

thin-skinned regions, such as the feet and between the toes, around the eyes, and in the axilla and inguinal regions

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19
Q

What is a common manifestation of atopy?

A

otitis externa

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20
Q

How may cats with allergic disease present?

A

they may have miliary dermatitis or other ‘reaction patterns of cats’ and generalized pruritus

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21
Q

What often perpetuates atopic dermatitis?

A

secondary infections

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22
Q

What secondary infections are commonly associated with atopic dermatitis?

A

superficial pyoderma and Malassezia dermatitis

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23
Q

What are secondary infections frequently the cause of?

A

apparent’ treatment failure of atopics: so-called ‘prednisone resistance’

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24
Q

Aside from secondary manifestations, otitis externa, and pruritus, what are some other clinical manifestations of allergy?

A

chronic anal sac inflammation and pruritus, acral lick dermatitis, and interdigital dermatitis

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25
What are some diagnostic tools to diagnosing atopic dermatitis?
history, physical findings, dermatologic data base, allergy tests
26
What are the indications for allergy tests?
To confirm the diagnosis and to provide informtation for alternative therapy
27
What is intradermal skin testing?
Injection of known amounts of allergens intradermally and comparing the reaction to a positive (histamine) and negative control (saline)
28
What can be used for chemical restraint during intradermal skin testing?
only injalants, xylazine, dexdomitor, and some narcotis (no phenothiazines)
29
What is the technique for intraderma skin testing?
1. Injections are made in the lateral thoracolumbar area after gentle clipping 2. No skin preparation 3. Area can be marked with a felt-tipped pen 4. Injection of 0.05 ml of antigen intradermally with a 25-gauge needle
30
When do you read the results from intradermal skin testing?
Reactions are read at 0, 15, and 30 minutes
31
How do you prepare a patient for intradermal allergy testing?
No antihistamines 1-2 weeks prior, no oral glucocorticoids for a minimum of 4 weeks, no injectable glucocorticoids for 1-3 months, no otic, topical, or opthalmic glucocorticoids for 2+ weeks prior, and no fatty acid supplements and/or off diets with high concentrations of fatty acids for 2 weeks prior
32
What is measured in intradermal allergy tests?
the degree of each reaction - erythema and wheal
33
What is a considered a positive result?
a reaction that is greater than 2+ on the scale of 0-4+
34
What is a 4+ on the scale?
histamine reaction
35
What does a positive result mean?
animal is allergic to antigen, allergen is irritative to the skin, and dermohraphia
36
What does a negative result mean?
animal is not allergic to the antigen, poor technique, drug inhibition, insufficient antigen as in mixed preparations, or an out-dated antigen
37
What techniques are used in serologic allergy tests?
radio-allergosorbent test (RAST) or ELISA techniques to measure allergen specific IgE levels in serum
38
False positives are common with what serologic allergy test?
RAST
39
With allergy testing, what must you ask yourself?
Do the test results fit the patients clinical features? And Do they make sense in correlation with severity of clinical signs, seasonality, and response to therapy?
40
What is the most important step to do first when treating atopic dermatitis?
control of perpetuating factors
41
What are the types of therapies for atopic dermatitis?
topical therapies, antihistamines, fatty acid supplements, glucocorticoids, cyclosporine, Oclacitnib, IL-31 Monoclonal andibody therapy, and/or hyposensitization
42
What is topical therapy indicated for?
to control the signs of allergies, especially pruritus
43
What are some topical therapies for atopic dermatitis?
colloidal oatmeal, colloidal oatmeal + others, topical glucocorticoids
44
How much relief does colloidal oatmeal allow for?
about 24-36 hours of relief from pruritus
45
What can colloidal oatmeal be combined with?
Diphenhydramine HCL, Pramoxine, and hydrocoritzone
46
Are topical glucocorticoids effective?
typically no, due to the generalized nature of the condition
47
Which topical glucocorticoid may be effective as an intermittent adjunctive therapy of atopic animals?
Hydrocortisone shampoo
48
What is the risk with overjudicious use of topical glucocorticoids?
it may cause iatrogenic hyperadrenocorticism and H-P-A supression leading to comedones, cutaneous atrophy at site of application, and calcinosis cutis
49
How often are antihistamines helpful?
in 15-30% of atopic animals - will reduce pruritus by 10-90%
50
What adverse effects are associated with antihistamines?
sedation, trembling, panting, or occasional excitement
51
What is the goal of using fatty acid supplements for atopic dermatitis therapy?
It is intended to promote production of non-inflammatory prostaglandins in lieu of those inducing inflamation - they are thought to modulate the arachidonic acid pathways, leading to production of prostaglandins and leukotrienes that competitively inhibit receptors
52
What percentage of patients have shown clinical improvement with fatty acid supplements?
15-30%
53
When are fatty acid supplements thought to be the most useful?
as adjunctive therapy when used in combination with either antihistamines or glucocorticoids
54
What type of glucocorticoids should be used for atopic dermatitis therapy?
only short acting oral glucocorticoids - prednisone, prednisolone, and methylprenisolon - long acting ones should not be used
55
What is the recommended protocol for using glucocorticoids?
give once daily initially to control clinical signs (1.1 mg/kg), then the dose is reduced and switched to alternate-day administration (1.1 mg/kg)
56
What is the recommended maintenance dosage for glucocorticoids?
0.5 - 1.1 mg/kg
57
What are the main side effects of glucocorticoid use?
polydipsia/polyuria, polyphagia, and panting
58
What is the generic name of cyclosporine that is used to treat atopic dermatitis?
Atopica and Atopica for cats
59
What is the goal of cyclosporine?
To control pruritus by regulating cellular mechanisms, thus repress activation of immune cell types known to be involved in atopic disease
60
What is the recommended dosage and protocol for use of cyclosporine?
5 mg/kg daily for induction 3-6 weeks, then either every other day or every day at 2.5 mg/kg
61
What is the success rate of using cyclosporine?
65-75%
62
What adverse effects are associated with cyclosporine?
vomiting, diarrhea, papillomatosis, and gingival hyperplasia
63
What are the disadvantages to using cyclosporine?
high cost of treatment, considered contraindicated in patients with neoplasia
64
What is the brand name of Oclacitinib?
Apoquel
65
How does apoquel work?
It is an IL-31 inhibitor, classified as a Janus-kinase-1 inhibitor
66
What remedies has Apoquel been shown to do?
reduce pruritus in animal models of atopy, in canine patients with atopic dermatitis, and in dogs with flea allergy dermatitis
67
Does Apoquel work quickly?
Yes, but it requires twice daily therapy for induction with once daily treatment for maintenance because it has a short duration of action
68
In what percentage patients is Apoquel effective?
in 70% of patients
69
What dogs should not get apoquel?
dogs under the age of 1
70
What adverse effects are associated with the use of Apoquel?
GI disturbances, weight gain, tendency to develop benign cutaneous masses
71
What drug is used for IL-31 monoclonal antibody therapy?
Cytopoint
72
How often is Cytopoint given and what does it do?
Once montly via injection and it is intended to bind to IL-31 before it can reach JAK-STAT receptors
73
What is the duration of action of Cytopoint?
The average is approximately 30 days, but can be longer in some patients
74
What is the advantage of using Cytopoint?
the advantage is that this therapy eliminates the daily fluctuations in drug concentrations that lead to variable effectiveness day to day
75
When is hyposensitization indicated?
if symptomatic therapy alone is ineffective, when the patient has unacceptable side-effects to symptomatic therapy, when the client chooses to treat the cause
76
What does hyposensitization appear to keep under control bettar than drugs that work by suppressing itch ?
it appears to be more effective at keeping perpetuating conditions under control than drugs that work by suppressing itch
77
What is the mechanism of action of hyposensitization?
Formation of IgG against the antigen to prevent cross-bridging of IgE bound to mast cells
78
How does hyposensitization work?
Antigen is induced in increasing doses to reduce sensitivity over time
79
What is the success rate of hyposensitization?
60-80%
80
How are antigens/allergens administered during hyposensitization?
typically subcutaneously, but can be given sublingually
81
What adverse reactions are associated with hyposensitization?
pruritus, wheals, urticaria, erythema, and anaphylaxis
82
What is the number 1 reason for atopic dermatitis 'relapses'?
Malassezia dermatitis (not treated properly)
83
What are some other reasons for relapse?
inadequate doses, poor owner and patient compliance
84
When are you most likely to chose glucocorticoids for treatment?
When you need a rapid response, need anti-inflammatory effects, if it is needed seasonally or short-term, and if cost is a factor
85
When are you less likely to chose glucocorticoids for treatment?
concurrent health issues, patient cannot tolerate (historically), if you plan to allergy test
86
When are you more likely to chose cyclosporine?
Small dog (cause of cost), and some anti-inflammatory effect is desired and GCs aren't an option
87
When are you less likely to chose cyclosporine?
concurrent infections, diabetes mellitus, cost is a factor
88
When are you more likely to chose Oclacitinib (Apoquel)?
need rapid response, prior to allergy testing, while waiting for immunotherapy, cost is somewhat a factor
89
When are you less likely to chose Oclacitinib (Apoquel)?
long term use, does not provide 24 hours of relief
90
When are you more likely to use Lokivetmab (Cytopoint)?
client compliance is an issue, convenience factor, adverse effects to other options
91
When are you less likely to use Lokivetmab (Cytopoint)?
clients are not mobile, large dogs (cost)
92
When are you more likely to chose immunotherapy?
younger dog, infectious/otitis are main manifestation, owners prefer to treat the disease vs masking symptoms
93
When are you less likely to chose immunotherapy?
Client compliance/ability to administer treatment, owners want/expect short term gratification

Small Animal Medicine (100 decks)

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