el chaar - peds atopic derm/eczema Flashcards
TRUE OR FALSE
atopic dermatitis is:
an immune response
chronic
an inflammatory disease
TRUE
true or false
atopic dermatitis is systemic
true
at what location/age is atopic dermatitis most prevalant?
more prevalent in peds than adults
higher prevalence in high income, industrialized countries
____% of peds with atopic dermatitis go into remission by their adolescent years
50%
name some characteristics/symptoms of AD
itchy lesions/rash
disrrupted barrier
immune system disregulation, inflammation
plaque formation
WAXES AND WANES - comes and goes
pathogenesis of AD:
interplay between what 3 types of factors?
genetic, immune, and environmental
what is another word for atopic dermatitis
eczema
explain the pathogenesis of atopic dermatitis
there is a defect in proteins supporting the epidermal barrier and natural moisturization of the skin
the result is greater water loss through the epidermis, and greater ellergen entry into the skin - resulting in immune disregulation and microbial colonization —- SKIN INFECTION
name a protein that has a defect in AD patients
keratin
explain the immune cells involved in AD
T helper cells are formed from the trigger of mechanical injury
inflammatory cytokines are then formed that downregulate fillagrin and antimicrobial peptides – recruit eosinophils - dirsupt barrier
what is the function of fillagrin?
what downregulates it?
fillagrin promotes moisturization and maintains ksin integrity
down regulated by the production of cytokines formed by T helper cells
once cytokines are activated, what else is activated?
what is the result?
JAK kinase pathways
result is inflammation
what enzyme is overactive in atopic dermatitis patients and we have therapy that inhibits it?
PDE4
explain how inhibiting PDE4 reduces inflammation in AD patients
PDE4 converts cAMP to AMP
when there is too much PDE4, there is not enough cAMP. low cAMP levels lead to inflammatory cytokine and chemokine production
in helping a patient who presents with AD, what is a very important consideration to find out first
the history of the patient – did they use something new that causes the irritation??
what is the most important and prevalent complication in AD patients and why
infectious complications – greater susceptibility to skin infections bc decreased antimicrobial peptides and broken skin barrier
name some infections that are the result of AD complications
streptococcus and staph aureus
herpes simplex virus-1 (eczema herpeticum)
molluscum contagium
fungi
what is the most prominent infection that occurs as a result of AD
MRSA
methicillin resistant staph auerus
aside from infectious complications, name 4 other complications of AD
cataracts
sleep disturbances (bc itching at night)
low QOL
inc risk of asthma and allergic rhinitis later in life
as mentioned, a complicaiton of AD is that there is an increased risk of developing asthma and allergic rhinitis later in life
what is the term for this?
why?
atopic march
because of IG immune activation
the goals of therapy of AD is to ___ not ____
MANAGE not cure
AD is chronic, but it can go into remission – this is the goal
what is one of the most effective treatments for pediatric AD?
education to parents
name 3 types of drugs used for managing AD flares
topical corticosteroids
topical calcineurin inhibitors
PDE4 inhibitors
how is prevention of AD done
by avoiding triggers – find out pt history and address risk factors
how is bathing helpful in AD
to remove bacteria from the skin and improve skin hydration – moisturizers better absorbed
help maintain a functional skin barrier and reduce the frequency and severity of AD flares
explain the directions for bathing AD patients
10-15 mins ONLY ONCE daily – more than this can be drying
use lukewarm water and MILD detergent w/o fragrance
pat skin dry – apply drug and then moisturizer to seal
what are bleach baths used for in AD
remove bacteria from the skin
mainly for patients at risk for recurrent infections
rank the following according to effectiveness as moisturizers:
lotions
ointments
creams
ointments most effective – allows moisture to stay in skin
then creams
then lotions
give a scenario in which creams would actually be preferred over ointments
patient preference.
ointmenets are very greasy and can be unappealing
what dosage form is emulsions of water in lipid
creams
what moisturizer dosage form is used in hairy areas?
solutions and gels
what is an issue with using gel moisturizers
they may burn bc of the alcohol content
what is an issue with using lotions as moisturizers
may cause MORE dryness, and requires frequent application
TRUE OR FALSE
powders are not effective moisturizers
true
what is an issue with using creams
may contain preservatives and stabilizers – may burn or sting
lotions are _____ based
water
which contains higher water content - lotions or creams
lotions
how often should moisturizers be used in AD patients
EVERY DAY*****
TRUE OR FALSE
AD patients use moisturizers as needed
FALSE - MUST USE EVERY DAY
TRUE OR FALSE
moisturizers must be applied every day and to the entire body - not just area affected
TRUE
True or false
Rx moisturizers tend to be more effective than OTC
FALSE - both equal efficacy
what class of drugs are preferred for pruritis
1st generation antihistamines
usually avoided in allergy patients - bust used for AD
(diphenhydramine, hydroxyzine, cyproheptadine)
are 2nd gen antihistamines like cetirizine/fexofenadine/loratidine used for pruritis in AD?
NO - NOT GOOD AT MANAGING ITCH
preferred over 1st gen for allergies, but not this
are topical antihistamines used for controlling itch in AD patients?
NO
can develop contact dermatitis from irritants
if 1st gen antihistamines do not provide itch relief, what is recommended?
doxepin or melatonin to induce sleep
when does itching in AD tend to be the worst
at night
which are preferred and why - bleach baths or burrow’s solution
bleach baths preferred
burrow’s solution can have drying effects
how often are bleach baths recommended
2x a week
explain how bleach baths are done
very diluted
soak 5-10 mins with fresh water
PAT DRY - do not rub
_____ decreases the frequency of infection against MRSA
bleach bath
what are the adverse effects of bleach baths
none
there is NO increase in resistant staph strains
vitamin ___ has immunomodulating properties
D
since vitamin D has immunomodulating properties, how can it be used in AD patients
if supplemented or if serum levels are normal, there is improved antimicrobial protection against AD
what is the MECHANISM in which vitamin D supplementation/normal serum levels improves antimicrobial protection against AD
increase in cathelicidin expression — normal deficient in AD patients and results in bacterial colonization
what 2 antimicrobial peptides are deficient in AD patients
cathelicidn and B-defensin
recap: what is used to treat FLARES in AD patients
corticosteroids
topical calcineurin inhibitors
PDE4 inhibitors
what is first line of treatment for eczema flares
topical CS
name 3 ways in which CS are beneficial in AD flares
-reduce inflammation and severity/duration of flares
reduced bacterial colonization
improves sleep bc not itching as much
true or false
cs’s have immunosuppressive and vasoconstrictive effects
true
how many classes of corticosteroids are there?
what does a high class vs low classs mean?
7
lower the class = more potent
true or false
class 1 steroids are of LOWER POTENTCY than class 7
FALSE - much higher potency
which is more potent
class 6 or class 5 CS
class 5
the classes of topical CS are based on ____
vasoconstriction
what is the unit of measurement for applying topical CS
“fingertip unit”
lower potency CS are generally preferred for which areas of the body
the face/neck/genitalia
true or false
similar to moisturizers, ointments are generally the preferred dosage form for topical corticosteroids
true
unless pt preference is otherwise
which is applied first – the drug or the emollient (moisturizer)
drug, then emollient to seal
how many times a day are topical corticosteroids used? where are they applied and for how long?
BID
THIN layer to the affected areas ONLY
continue until smooth is no longer red or itchy and for THREE DAYS AFTER*****
when may a high potency CS be considered
liquenified skin
how long does the duration of CS GENERALLY take
7-14 days, but all depends on the response
what happens if the AD does not respond to the topical CS prescribed?
an alternate diagnosis may be considered
