Eczema Flashcards
What is the most common skin condition in kids?
eczema
What is the best way to describe eczema?
skin is highly sensitive/overreactive due to skin barrier being broken down which causes epidermal water loss–>drying
What are the stages of eczema?
acute: stimuli has made its impact causing blistering and inflammation, lasts 7 days
sub-acute: stimuli is gone, dry/scaly skin
chronic: fluctuations, dry/scaly skin mixed with flare ups
What is the clinical presentation of eczema?
initially seen in young children
blistering–>dry skin–>scaling
scratch-itch-scratch
on the face in infants, with age on hands, elbows, wrists, back of knees
True or false: eczema tends to fade as people move towards adulthood
true
What are some characteristics of mild, moderate, and severe eczema?
mild: areas of dry skin, infrequent itching, w or wo areas of redness
moderate: areas of dry skin, frequent itching, w or wo broken skin or localized thickening
severe: widespread areas of dry skin, incessant itching, redness w or wo skin thickening, bleeding, oozing, cracking
What are the five major clinical features associated with AD?
pruritis
chronic relapsing
age-specific distribution
family history
onset before 2yrs
Why do we view AD/eczema as a chronic relapsing inflammatory condition?
patients have acute flares followed by periods of relative clearing
What is the allergic march? What is it most linked to?
eczema–>asthma–>allergic rhinitis
80% due to genetics
What is contact dermatitis?
dermatitis via the contact of something
ex: drooling, chemicals, etc
What does eczema tend to look like in dark skin?
tends to look darker brown, purple, or ashen grey
What triggers can worsen eczema?
low humidity (winter)
irritants (wool, sweat, etc)
allergens (dust mites, food)
What is the clothing fiber of choice for eczema patients?
cotton
What are some treatments for eczema?
avoid triggers (irritants, soaps, sanitizers)
wear cotton gloves (babies at night) or disposable gloves (for avoiding detergents when washing dishes)
correct fiber choice for clothing
Rank the following from best to worse for eczema: synthetic, cotton, wool
cotton>wool>synthetic What
What are some measures to counteract dry skin in eczema sufferers?
less hot baths/showers (strips lipids off skin)
exposure to cold weather (hard to do)
humidifier in winter
cream use as much as possible and after showers/baths
True or false: lotions will suffice for eczema
false
if you can pump it out, then its too weak for eczema
What are the best moisturizers?
the ones that feel greasy because they contain more oil (ointments and creams)
What is critical to eczema care?
frequent and consistent use of moisturizers
What components of the skin are low in eczematous skin?
ceramide and proteins
Why are “ceramide therapies” probably not much better than simpler products for eczema patients?
there are many sub-types of ceramide and its a tall order for the moisturizer to have the ceramide hit the exact spots that it has to
What are the worst kind of soaps for eczema patients?
scented with colourants added
“the portal to hell”-Jeff Taylor
True or false: we should stick to the traditional companies such as Neutrogena or Polysporin when choosing an eczema product compared to the companies like Flexitol
true
What are the recommendations around bathing and eczema?
warm, plain water, once daily
moisturize immediately following bathing
gentle cleansers may be used on areas that need cleaning
mild synthetic detergent without fragrance should be used to clean soiled areas
True or false: there is plenty of evidence to support bleach baths to rid the skin of staph auerus
false
Which bacteria can cause AD in the majority of patients?
staph aureus
What is the treatment for weeping lesions (acute flare)?
dabbing with plain water for 20 min QID for 2-3d
OR wrap a dressing soaked in warm water around the aa before bedtime and sleep with it overnight
OR steroids
What should never be used for eczema?
calamine
it will make things worse because it is an astringent
What is the mainstay of therapy for eczema?
topical steroids (Rx level)
True or false: topical steroids cannot be used for weeping lesions (acute flares)
false
How long do flareups/weeping lesions last?
7 days
What type of steroid formulations are used during the acute stage? What about the chronic stage?
acute: lotion or creams (lighter stuff)
chronic: ointments (we are trying more to capture water loss)
Does a product get more potent or less potent when shifting from a cream to ointment?
more potent
What level of potency for corticosteroids can most eczema patients be treated with?
low to moderate potency (4-7)
What are some side effects of long term topical steroid use?
skin atrophy
straie
telangiectasia (spider veins)
Which agents does the three week rule apply to?
super high potent steroids (the 1s and 2s)
What is a strategy that can be used to reduce the risk of side effects of topical steroids?
drug holiday
ex: a week off between treatment
What are more potent steroids benefical for? What about lower potency agents?
high potency: severe diseases and thicker areas of skin such as bottom of feet
low potency: large surface areas (face or thin skin areas) and children
How long can high and medium potency steroids be used?
12 weeks
What is the mainstay in the treatment of AD?
topical corticosteroids
What is the ideal condition for the absorption of topical steroids?
hydrated skin (2-3 minutes after a shower)
Which class of steroids should be effective for mild AD in kids? What if the kid has severe AD?
6 or 7 level potency should be effective for mild AD in kids
moderate potency can be prescribed for 1 week for severe cases and then tapered down to a lower potency
True or false: the risk of adverse effects from steroids outweighs treatment of AD
false
undertreatment of AD outweighs the risks of side effects from steroids
What do the “rough and red” and “smooth and skin-tone” rules mean?
rough and red=apply steroid
smooth and skin tone=time to stop treatment
Are topical steroids safe in kids? What potency?
yes
low to mid potency
What is commonly not mentioned about steroids to patients?
changing strengths
if using a potent steroid and the skin starts clearing up, then consider switching to a lower potency steroid
How do you determine the potency of steroid needed for eczema?
match steroid to derm severity
-mild for mild
-moderate for moderate
-potent for severe
When do systemic side effects become a concern for steroids?
potent agent
months of use
using high amounts
What is the typical dosing for steroids?
OD or BID
What is a common reason that patients get no benefits from steroids?
undertreatment!!!!!!!!!
Describe calcineurin inhibitors.
2nd line agent (try steroid first)
promoted as steroid free therapy for kids older than 2
no skin atrophy
useful for think skin areas (face)
What are the examples of calcineurin inhibitors? What severity of eczema are they used for?
pimecrolimus (Elidel): mild-moderate cases
tacrolimus (Protopic): moderate-severe cases
What are some situations where calcineurin inhibitors may be preferable over steroids?
sensitive areas
steroid-induced atrophy
recalcitrance to steroids
long-term uninterrupted topical steroid use
Explain the prevent rather than react acutely treatment option.
use steroid daily until lesions clear, then 2x a week to prevent
OR
pimecrolimus daily until lesions clear then 2x a week to prevent
-for moderate-severe cases
-must know where lesions occur
-STILL USE MOISTURIZERS
What do PDE4 inhibitors do? What is an example?
inhibits PDE4 enzyme (regulator of inflammation) in the skin to treat AD
nonsteroid topical option!!!
ex: crisaborole
What are JAK creams?
a topical steroid that inhibits JAK (enzyme involved in inflammation of skin) for treatment of mild-moderate AD
True or false: probiotics are helpful in the treatment of eczema
false
they show promise in the prevention of eczema
What is the consensus around probiotics and eczema?
they show promise in prevention, no use during a flare up
it helped when incorporated in moms diet
has potential for kids
If a mom wants to start giving her kid a probiotic to prevent eczema, would Culturelle or Align be good options?
no
dont use the GI probiotics
Which stage of eczema is itchy?
all three stages (acute, subacute, chronic)
What are the main treatments for eczema?
topical steroids
dry skin creams
Are moisturizers with menthol a good treatment for eczema?
probably not the best option because the chemical can be an irritant
Which products will you find coal tar remedies in? Which skin condition uses coal tar?
shampoos are common to find coal tar in, skin products are uncommon
psoriasis cause of fast skin turnover, coal tar would probably irritate eczema
Which antihistamine is the best for eczema?
none!!!
