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PHAR153 > Eczema > Flashcards

Eczema Flashcards

1
Q

What is the most common skin condition in kids?

A

eczema

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2
Q

What is the best way to describe eczema?

A

skin is highly sensitive/overreactive due to skin barrier being broken down which causes epidermal water loss–>drying

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3
Q

What are the stages of eczema?

A

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

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4
Q

What is the clinical presentation of eczema?

A

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

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5
Q

True or false: eczema tends to fade as people move towards adulthood

A

true

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6
Q

What are some characteristics of mild, moderate, and severe eczema?

A

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

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7
Q

What are the five major clinical features associated with AD?

A

pruritis
chronic relapsing
age-specific distribution
family history
onset before 2yrs

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8
Q

Why do we view AD/eczema as a chronic relapsing inflammatory condition?

A

patients have acute flares followed by periods of relative clearing

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9
Q

What is the allergic march? What is it most linked to?

A

eczema–>asthma–>allergic rhinitis
80% due to genetics

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10
Q

What is contact dermatitis?

A

dermatitis via the contact of something
ex: drooling, chemicals, etc

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11
Q

What does eczema tend to look like in dark skin?

A

tends to look darker brown, purple, or ashen grey

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12
Q

What triggers can worsen eczema?

A

low humidity (winter)
irritants (wool, sweat, etc)
allergens (dust mites, food)

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13
Q

What is the clothing fiber of choice for eczema patients?

A

cotton

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14
Q

What are some treatments for eczema?

A

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

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15
Q

Rank the following from best to worse for eczema: synthetic, cotton, wool

A

cotton>wool>synthetic What

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16
Q

What are some measures to counteract dry skin in eczema sufferers?

A

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

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17
Q

True or false: lotions will suffice for eczema

A

false
if you can pump it out, then its too weak for eczema

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18
Q

What are the best moisturizers?

A

the ones that feel greasy because they contain more oil (ointments and creams)

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19
Q

What is critical to eczema care?

A

frequent and consistent use of moisturizers

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20
Q

What components of the skin are low in eczematous skin?

A

ceramide and proteins

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21
Q

Why are “ceramide therapies” probably not much better than simpler products for eczema patients?

A

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

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22
Q

What are the worst kind of soaps for eczema patients?

A

scented with colourants added
“the portal to hell”-Jeff Taylor

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23
Q

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

A

true

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24
Q

What are the recommendations around bathing and eczema?

A

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

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25
Q

True or false: there is plenty of evidence to support bleach baths to rid the skin of staph auerus

A

false

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26
Q

Which bacteria can cause AD in the majority of patients?

A

staph aureus

27
Q

What is the treatment for weeping lesions (acute flare)?

A

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

28
Q

What should never be used for eczema?

A

calamine
it will make things worse because it is an astringent

29
Q

What is the mainstay of therapy for eczema?

A

topical steroids (Rx level)

30
Q

True or false: topical steroids cannot be used for weeping lesions (acute flares)

A

false

31
Q

How long do flareups/weeping lesions last?

A

7 days

32
Q

What type of steroid formulations are used during the acute stage? What about the chronic stage?

A

acute: lotion or creams (lighter stuff)
chronic: ointments (we are trying more to capture water loss)

33
Q

Does a product get more potent or less potent when shifting from a cream to ointment?

A

more potent

34
Q

What level of potency for corticosteroids can most eczema patients be treated with?

A

low to moderate potency (4-7)

35
Q

What are some side effects of long term topical steroid use?

A

skin atrophy
straie
telangiectasia (spider veins)

36
Q

Which agents does the three week rule apply to?

A

super high potent steroids (the 1s and 2s)

37
Q

What is a strategy that can be used to reduce the risk of side effects of topical steroids?

A

drug holiday
ex: a week off between treatment

38
Q

What are more potent steroids benefical for? What about lower potency agents?

A

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

39
Q

How long can high and medium potency steroids be used?

A

12 weeks

40
Q

What is the mainstay in the treatment of AD?

A

topical corticosteroids

41
Q

What is the ideal condition for the absorption of topical steroids?

A

hydrated skin (2-3 minutes after a shower)

42
Q

Which class of steroids should be effective for mild AD in kids? What if the kid has severe AD?

A

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

43
Q

True or false: the risk of adverse effects from steroids outweighs treatment of AD

A

false
undertreatment of AD outweighs the risks of side effects from steroids

44
Q

What do the “rough and red” and “smooth and skin-tone” rules mean?

A

rough and red=apply steroid
smooth and skin tone=time to stop treatment

45
Q

Are topical steroids safe in kids? What potency?

A

yes
low to mid potency

46
Q

What is commonly not mentioned about steroids to patients?

A

changing strengths
if using a potent steroid and the skin starts clearing up, then consider switching to a lower potency steroid

47
Q

How do you determine the potency of steroid needed for eczema?

A

match steroid to derm severity
-mild for mild
-moderate for moderate
-potent for severe

48
Q

When do systemic side effects become a concern for steroids?

A

potent agent
months of use
using high amounts

49
Q

What is the typical dosing for steroids?

A

OD or BID

50
Q

What is a common reason that patients get no benefits from steroids?

A

undertreatment!!!!!!!!!

51
Q

Describe calcineurin inhibitors.

A

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)

52
Q

What are the examples of calcineurin inhibitors? What severity of eczema are they used for?

A

pimecrolimus (Elidel): mild-moderate cases
tacrolimus (Protopic): moderate-severe cases

53
Q

What are some situations where calcineurin inhibitors may be preferable over steroids?

A

sensitive areas
steroid-induced atrophy
recalcitrance to steroids
long-term uninterrupted topical steroid use

54
Q

Explain the prevent rather than react acutely treatment option.

A

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

55
Q

What do PDE4 inhibitors do? What is an example?

A

inhibits PDE4 enzyme (regulator of inflammation) in the skin to treat AD
nonsteroid topical option!!!
ex: crisaborole

56
Q

What are JAK creams?

A

a topical steroid that inhibits JAK (enzyme involved in inflammation of skin) for treatment of mild-moderate AD

57
Q

True or false: probiotics are helpful in the treatment of eczema

A

false
they show promise in the prevention of eczema

58
Q

What is the consensus around probiotics and eczema?

A

they show promise in prevention, no use during a flare up
it helped when incorporated in moms diet
has potential for kids

59
Q

If a mom wants to start giving her kid a probiotic to prevent eczema, would Culturelle or Align be good options?

A

no
dont use the GI probiotics

60
Q

Which stage of eczema is itchy?

A

all three stages (acute, subacute, chronic)

61
Q

What are the main treatments for eczema?

A

topical steroids
dry skin creams

62
Q

Are moisturizers with menthol a good treatment for eczema?

A

probably not the best option because the chemical can be an irritant

63
Q

Which products will you find coal tar remedies in? Which skin condition uses coal tar?

A

shampoos are common to find coal tar in, skin products are uncommon
psoriasis cause of fast skin turnover, coal tar would probably irritate eczema

64
Q

Which antihistamine is the best for eczema?

A

none!!!

PHAR153 (20 decks)

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