el chaar - peds atopic derm/eczema Flashcards by amanda kastel

TRUE OR FALSE

atopic dermatitis is:

an immune response
chronic
an inflammatory disease

TRUE

How well did you know this?

Not at all

Perfectly

true or false

atopic dermatitis is systemic

true

How well did you know this?

Not at all

Perfectly

at what location/age is atopic dermatitis most prevalant?

more prevalent in peds than adults

higher prevalence in high income, industrialized countries

How well did you know this?

Not at all

Perfectly

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

50%

How well did you know this?

Not at all

Perfectly

name some characteristics/symptoms of AD

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

WAXES AND WANES - comes and goes

How well did you know this?

Not at all

Perfectly

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

genetic, immune, and environmental

How well did you know this?

Not at all

Perfectly

what is another word for atopic dermatitis

eczema

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

name a protein that has a defect in AD patients

keratin

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

JAK kinase pathways

result is inflammation

How well did you know this?

Not at all

Perfectly

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

PDE4

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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??

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

name some infections that are the result of AD complications

streptococcus and staph aureus

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

How well did you know this?

Not at all

Perfectly

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

MRSA

methicillin resistant staph auerus

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

education to parents

How well did you know this?

Not at all

Perfectly

name 3 types of drugs used for managing AD flares

topical corticosteroids
topical calcineurin inhibitors
PDE4 inhibitors

How well did you know this?

Not at all

Perfectly

how is prevention of AD done

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

How well did you know this?

Not at all

Perfectly

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

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