Lecture 33 Dermatitis Flashcards
What is atopic dermatitis (causes)?
inflammatory disorder of skin with an onset in early childhood - some children will outgrow it but proportion of pt will have persistent disease into adulthood
Heredity: ex. decreased ceramide levels in epidermis which impair water-holding capacity and barrier fxn
around 70% of pt with this have + FHx of atopic disease
What is the clinical presentation of atopic dermatitis?
ill-defined patches of erythema/inflammation, scale and excoriations
in skin of colour its less erythematous, violaceous-greyish hue and hypo or hyperpigmentation instead may be main indicators
thickened skin with increased skin markings often in response to chronic rubbing (Lichenification)
significant pruritis and generalized dry skin
What are scoring systems for atopic dermatitis, and a summary of what they assess?
Eczema Area and Severity index (EASI): measures extent (area) and severity - score for body region and extent affected, severity score of affected regions (intensity of redness, thickness/swelling, scratching, lichenification)
minimum score is 0 and max is 72
SCORing this (SCORAD): based on area, intensity, subjective sx (itch), max score 20 = bad
Summary: they assess body region and how much affected (BSA) ⇒ head, neck, upper and lower limbs, trunk/back, genitals
sx of inflammation, thickness of plaques, intensity of itch, intensity of lichenification, dryness, oozing/crusting
Calcineurin inhibitors for atopic dermatitis (MOA, dose, AE)
Drugs: tacrolimus ointment (0.03 or 0.1%) - 0.03% for >2 years, 0.1% for >16
pimecrolimus cream (1%) use in > 3 months
MOA: inhibit this dependent T-cell activation, block secretion of inflammatory cytokines, effects on dendritic and mast cell activation
Dose: used BID, indicated for patients who failed to respond adequately to other topical tx or when those aren’t advisable
Crisaborole for atopic dermatitis (MOA, dose/use, AE)
MOA: inhibits PDE4, new pathway implicated in pathogenesis of inflammatory skin disorders such as this and psoriasis
Dose/Use: indicated for pt with mild-moderate and over age of 2
dispensed as 60 g ointment, applied BID, not to be used on mucous membranes
AE: possible local skin irritation
Roflumilast for atopic dermatitis (MOA, dose/use, AE)
MOA: inhibits PDE4, new pathway implicated in pathogenesis of inflammatory skin disorders such as this and psoriasis
Dose/Use: indicated in plaque psoriasis in pt >12 and seborrheic dermatitis in pt >9, available in 0.3% cream and 0.3% foam forms, applied QD
AE: mild weight loss, diarrhea , H/A
Oral/injectable corticosteroids for atopic dermatitis (MOA, use, AE, monitor)
MOA: suppress expression of inflammatory genes, including: cytokines, chemokines, adhesion molecules, inflammatory enzymes, receptors and proteins
Use: short-term tx of acute flare in pt with severe this, used only in short courses as bridge to steroid-sparing immunosuppressants
AE: glucose intolerance, Cushing’s, glaucoma, myopathy, HTN, infections, cataracts, osteonecrosis
Monitor: BP, eye exam, adrenal axis suppression testing, bone density evaluation
Cyclosporine for tx of psoriasis and atopic dermatitis (MOA, Dose, indication, AE, contra)
MOA: inhibit calcineurin, decreases T-cell proliferation
Dose: by weight
Indication: moderate-severe this, good/rapid clearance in acute flares, allows time to switch to other agents
AE: renal failure, HTN, tremor, H/A, paresthesia, hypertrichosis, gingival hyperplasia, myalgia, lethargy, hyperkalemia, hyperlipidemia
requires blood monitoring periodically
not used very much chronically due to limit of 1-2 year tx MAX
Contra: do not admin live vaccines
Dupilumab (Dupixent) for atopic dermatitis (MOA, dose/use, AE)
MOA: inhibits pro-inflammatory cytokines of IL-4 and IL-13
Dose/Use: usual dose is 600 mg SC at week 0 followed by 300 mg SC Q2W, dose is different for those under <60kg, no formal pre or post work-up/lab work is needed
AE: injection site rxn, allergic conjunctivitis, blepharitis, H/A, oral herpes, gastritis, arthralgia
contra in pregnancy
Tralokinumab (Adtralza) for atopic dermatitis (MOA, dose/use, AE)
MOA: inhibits pro-inflammatory cytokines of IL-13
Dose/Use: usual 600 mg SC week 0 followed by 300 mg SC Q2W, used in >12 years
no formal pre or post work-up/labs needed
AE: injection site rxn, allergic conjunctivitis, blepharitis, H/A, increased URTIs
contra in pregnancy
Lebrikizumab (Ebglyss) for atopic dermatitis (MOA, Dose/use, AE)
MOA: inhibits pro-inflammatory cytokines of IL-13
Dose/Use: for use in >12 with moderate-severe this
initial dose of 500 mg SC week 0 and week 2 then 250 mg SC Q2W until week 16
no formal pre or post work-up/labs needed
AE: injection site rxn, allergic conjunctivitis, dry eyes, herpes zoster
contra in pregnancy
Upadicitinib and abrocitinib for atopic dermatitis (MOA, dose/use, AE, monitor)
MOA: works through inhibiting Janus kinase pathway
Dose/Use: 15-30 mg QD for first one and 100-200 mg QD for second, use in >12 years
AE: H/A, URTI, nausea, acne, increased risk of infections, thromboembolic events, MACE, lymphomas
not in pregnancy
Monitor: formal work-up prior to start with - TB test, CXR, HBV, HCV, HIV, CBCdiff, LFT, RFT
at 12 weeks - repeat CBCdiff, RFT, LFT and check lipids
