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Intro to D&D Midterm > el chaar - peds atopic derm/eczema > Flashcards

el chaar - peds atopic derm/eczema Flashcards

1
Q

TRUE OR FALSE

atopic dermatitis is:

an immune response
chronic
an inflammatory disease

A

TRUE

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2
Q

true or false

atopic dermatitis is systemic

A

true

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3
Q

at what location/age is atopic dermatitis most prevalant?

A

more prevalent in peds than adults

higher prevalence in high income, industrialized countries

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4
Q

____% of peds with atopic dermatitis go into remission by their adolescent years

A

50%

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5
Q

name some characteristics/symptoms of AD

A

itchy lesions/rash
disrrupted barrier
immune system disregulation, inflammation
plaque formation

WAXES AND WANES - comes and goes

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6
Q

pathogenesis of AD:
interplay between what 3 types of factors?

A

genetic, immune, and environmental

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7
Q

what is another word for atopic dermatitis

A

eczema

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8
Q

explain the pathogenesis of atopic dermatitis

A

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

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9
Q

name a protein that has a defect in AD patients

A

keratin

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10
Q

explain the immune cells involved in AD

A

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

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11
Q

what is the function of fillagrin?
what downregulates it?

A

fillagrin promotes moisturization and maintains ksin integrity

down regulated by the production of cytokines formed by T helper cells

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12
Q

once cytokines are activated, what else is activated?
what is the result?

A

JAK kinase pathways

result is inflammation

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13
Q

what enzyme is overactive in atopic dermatitis patients and we have therapy that inhibits it?

A

PDE4

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14
Q

explain how inhibiting PDE4 reduces inflammation in AD patients

A

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

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15
Q

in helping a patient who presents with AD, what is a very important consideration to find out first

A

the history of the patient – did they use something new that causes the irritation??

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16
Q

what is the most important and prevalent complication in AD patients and why

A

infectious complications – greater susceptibility to skin infections bc decreased antimicrobial peptides and broken skin barrier

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17
Q

name some infections that are the result of AD complications

A

streptococcus and staph aureus

herpes simplex virus-1 (eczema herpeticum)
molluscum contagium
fungi

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18
Q

what is the most prominent infection that occurs as a result of AD

A

MRSA

methicillin resistant staph auerus

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19
Q

aside from infectious complications, name 4 other complications of AD

A

cataracts
sleep disturbances (bc itching at night)
low QOL
inc risk of asthma and allergic rhinitis later in life

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20
Q

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?

A

atopic march

because of IG immune activation

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21
Q

the goals of therapy of AD is to ___ not ____

A

MANAGE not cure

AD is chronic, but it can go into remission – this is the goal

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22
Q

what is one of the most effective treatments for pediatric AD?

A

education to parents

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23
Q

name 3 types of drugs used for managing AD flares

A

topical corticosteroids
topical calcineurin inhibitors
PDE4 inhibitors

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24
Q

how is prevention of AD done

A

by avoiding triggers – find out pt history and address risk factors

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25
Q

how is bathing helpful in AD

A

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

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26
Q

explain the directions for bathing AD patients

A

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

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27
Q

what are bleach baths used for in AD

A

remove bacteria from the skin
mainly for patients at risk for recurrent infections

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28
Q

rank the following according to effectiveness as moisturizers:

lotions
ointments
creams

A

ointments most effective – allows moisture to stay in skin

then creams

then lotions

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29
Q

give a scenario in which creams would actually be preferred over ointments

A

patient preference.

ointmenets are very greasy and can be unappealing

30
Q

what dosage form is emulsions of water in lipid

A

creams

31
Q

what moisturizer dosage form is used in hairy areas?

A

solutions and gels

32
Q

what is an issue with using gel moisturizers

A

they may burn bc of the alcohol content

33
Q

what is an issue with using lotions as moisturizers

A

may cause MORE dryness, and requires frequent application

34
Q

TRUE OR FALSE

powders are not effective moisturizers

A

true

35
Q

what is an issue with using creams

A

may contain preservatives and stabilizers – may burn or sting

36
Q

lotions are _____ based

A

water

37
Q

which contains higher water content - lotions or creams

A

lotions

38
Q

how often should moisturizers be used in AD patients

A

EVERY DAY*****

39
Q

TRUE OR FALSE

AD patients use moisturizers as needed

A

FALSE - MUST USE EVERY DAY

40
Q

TRUE OR FALSE

moisturizers must be applied every day and to the entire body - not just area affected

A

TRUE

41
Q

True or false

Rx moisturizers tend to be more effective than OTC

A

FALSE - both equal efficacy

42
Q

what class of drugs are preferred for pruritis

A

1st generation antihistamines
usually avoided in allergy patients - bust used for AD
(diphenhydramine, hydroxyzine, cyproheptadine)

43
Q

are 2nd gen antihistamines like cetirizine/fexofenadine/loratidine used for pruritis in AD?

A

NO - NOT GOOD AT MANAGING ITCH

preferred over 1st gen for allergies, but not this

44
Q

are topical antihistamines used for controlling itch in AD patients?

A

NO
can develop contact dermatitis from irritants

45
Q

if 1st gen antihistamines do not provide itch relief, what is recommended?

A

doxepin or melatonin to induce sleep

46
Q

when does itching in AD tend to be the worst

A

at night

47
Q

which are preferred and why - bleach baths or burrow’s solution

A

bleach baths preferred

burrow’s solution can have drying effects

48
Q

how often are bleach baths recommended

A

2x a week

49
Q

explain how bleach baths are done

A

very diluted
soak 5-10 mins with fresh water
PAT DRY - do not rub

50
Q

_____ decreases the frequency of infection against MRSA

A

bleach bath

51
Q

what are the adverse effects of bleach baths

A

none

there is NO increase in resistant staph strains

52
Q

vitamin ___ has immunomodulating properties

A

D

53
Q

since vitamin D has immunomodulating properties, how can it be used in AD patients

A

if supplemented or if serum levels are normal, there is improved antimicrobial protection against AD

54
Q

what is the MECHANISM in which vitamin D supplementation/normal serum levels improves antimicrobial protection against AD

A

increase in cathelicidin expression — normal deficient in AD patients and results in bacterial colonization

55
Q

what 2 antimicrobial peptides are deficient in AD patients

A

cathelicidn and B-defensin

56
Q

recap: what is used to treat FLARES in AD patients

A

corticosteroids
topical calcineurin inhibitors
PDE4 inhibitors

57
Q

what is first line of treatment for eczema flares

A

topical CS

58
Q

name 3 ways in which CS are beneficial in AD flares

A

-reduce inflammation and severity/duration of flares

reduced bacterial colonization

improves sleep bc not itching as much

59
Q

true or false

cs’s have immunosuppressive and vasoconstrictive effects

A

true

60
Q

how many classes of corticosteroids are there?
what does a high class vs low classs mean?

A

7
lower the class = more potent

61
Q

true or false

class 1 steroids are of LOWER POTENTCY than class 7

A

FALSE - much higher potency

62
Q

which is more potent

class 6 or class 5 CS

A

class 5

63
Q

the classes of topical CS are based on ____

A

vasoconstriction

64
Q

what is the unit of measurement for applying topical CS

A

“fingertip unit”

65
Q

lower potency CS are generally preferred for which areas of the body

A

the face/neck/genitalia

66
Q

true or false

similar to moisturizers, ointments are generally the preferred dosage form for topical corticosteroids

A

true
unless pt preference is otherwise

67
Q

which is applied first – the drug or the emollient (moisturizer)

A

drug, then emollient to seal

68
Q

how many times a day are topical corticosteroids used? where are they applied and for how long?

A

BID
THIN layer to the affected areas ONLY

continue until smooth is no longer red or itchy and for THREE DAYS AFTER*****

69
Q

when may a high potency CS be considered

A

liquenified skin

70
Q

how long does the duration of CS GENERALLY take

A

7-14 days, but all depends on the response

71
Q

what happens if the AD does not respond to the topical CS prescribed?

A

an alternate diagnosis may be considered

72
Q
A

Intro to D&D Midterm (29 decks)

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