Eczema Flashcards
Risk Factors for Eczema
- Family history of atopy (AR, eczema, asthma)
- Genetic (Filaggrin gene deficiency)
- Less exposure to endotoxins (“Hygiene hypothesis”)
Possible triggers of Eczema
- Allergens (dust, pet dander, etc.)
- Low humidity
- Emotional Stress
- Excessive sweating
- Solvents, detergent, soaps, etc.
- Excessive bathing/bathing with hard water
Least potent (Group 7) steroids
- Betamethasone valerate 0.025% cream
- Hydrocortisone 1% cream
Low potency (Group 6) steroids
- Desonide cream/lotion (Desowen 0.05)
- Bethamethasone valerate lotion (Betnovate scalp lotion 0.1)
Lower-mid potency (Group 5) steroids
- Triamcinolone acetonide cream 0.1%
- Betamethasone dipropionate lotion
- Fluticasone propionate cream
- Desonide ointment (Desowen)
- Betamethasone valerate cream (Dermasone)
Medium potency (Group 4)
- Mometasone furoate cream/lotion (Elomet, Vizomet)
High potency (Group 3)
-Betamethasone dipropionate cream (Beprosone)
- Betamethasone valerate ointment (Dermasone)
- Mometasone furoate ointment (Elomet 0.1%)
High potency (Group 2)
Betamethasone dipropionate ointment (Beprosone 0.05%)
Ultra high potency (Group 1)
Clobetasol propionate (Dermovate)
Tacrolimus 0.1% and 0.03% indicated age and frequency of application?
Tacrolimus 0.1% >= 16yo, apply BD
Tacrolimus 0.03% >= 2yo, apply BD
but off-label use in children <2yo may be allowed
Pimecrolimus 1% indicated age and frequency?
> = 3 months old, apply BD
Side effects of Topical Calcineurin Inhibitors and FDA black box warning?
Transient burning, redness and itch.
Association with lymphoma and skin cancer (animal studies) but no studies to demonstrate increased cancer.
Frequency of proactive treatment?
Can use twice a week, spaced apart by 3-4 days.
Use on areas with stubborn eczema (depends on patient)
Instructions for normal saline/PP compress & PP soak?
- Fill basin with NS / one part of PP to 8 parts of water
- Soak disposable towel/gauze in bowl until wet
- Apply onto affected area and leave on for 2 mins
- Repeat with another set of towel/gauze for 3 cycles
- Perform soaking 2 times a day for 5 days or until lesion recovers.
- For PP soak, also use one part of PP to 8 parts of water.
- Soak affected body part for 10 minutes
- Rinse affected limb with water
- Perform soak 2 times a day for 5 days
Dupilumab: Class? Indicated age? Onset?
IL-4 inhibitor.
FDA approved age >= 6 months (mod to severe AD)
HSA approved age >6yo (mod to severe AD)
Onset in 2-4 weeks, within 16 weeks.
Dupilumab: Dose?
6m - 6y (no loading dose):
5 - <15kg = 200mg q4w
15 - <30kg = 300mg q4w
6 - <18years:
15 - <30kg = 600mg once, then 300mg q4w
30 - <60kg = 600mg once, then 300mg q3w* (KKH off-label use, licensed dose is 400mg once, then 200mg q2w)
>=60kg = 600mg once, then 300mg q2w
> = 18yo: 600mg once, then 300mg q2w
Dupilumab: SE and Monitoring?
Side effects:
- Injection-site reactions
- Keratoconjunctivitis, keratitis (mild-mod, use eye lubricants)
Monitoring:
- Baseline FBC, LFT, renal panel
- Arthralgia, ocular side effects (consider eye exam)
- Discontinue if no improvement after 16 weeks
Systemic therapies for AD
Ciclosporin, Azathioprine, Methotrexate, Mycophenolate mofetil
How long can Ciclosporin be used and why?
Can only be used for 1 year due to risk of adverse effects with long term use = Hypertension (dose-dependent, longer duration of use)
Other AEs = Infection, Nephrotoxicity, Risk of skin cancer and lymphoma
Monitoring parameters for systemic therapies of eczema
Ciclosporin: SCr, LFTs, BP
Azathioprine: CBC, LFTs, S&S of infection and malignancy
MTX: CBC, LFTs, S&S of infection
MMF: CBC, renal, liver function
