Lecture 4 - Dermatology 1 Flashcards
Its dermatitis if you are….
itching
endogenous dermatitis
Atopic
Seborrheic
Discoid
Varicose
Endogenous eczema of palms/soles
Asteatoic
Exogenous dermatitis
Primary irritant contact dermatitis
Allergic contact dermatitis
Atopic dermatitis info
AKA excema
Prelude to atopic diathesis
Inflammation & Pruritus**
~8% pts develop symptoms before 5yrs old
Precipitating factors Atopic Dermatitis
Dry weather
Hot weather
Bathing
Stress
Infections
Genetics
Signs & symptoms of Atopic Dermatitis
Inflammation and pruritus
Early age of onset
Excematous skin lesions
Dry, Flaky skin
IgE reactivity
Chronic or releasing courses
Desired outcomes for Atopic Dermatitis
- provide symptomatic relief and control AD
- id/elim trigger of aeroallergens
- ID/minimize factors for exacerbations, including stressors
- prevent flare-ups
- minimize/prevent ADE from meds
- Treat any secondary skin infection if present
non-pharm TXM Atopic Dermatitis
Moisturizer
Keep finger nails filed short
Use cotton
Limit scratching
ID and renovate irritants/allergens
Humidity should be kept at/above 50% and temp should be cool
Non-pharm bathing & clothes info
Bathing lukewarm water, between 15/20min….can ad emulsifying oil and apply moisturizer after bathing
Double rinse clothing and use mild detergents
skin hydration info
lotions aren’t ideal due to high water/low oil and draw water out
Which moisturizers do you want to use
active ingredients are mineral oil, petrolatum and urea
use scent free
Occlusiveness of treatments
Ointments > Creams > Lotions
Topical Steroid info
ultrahigh and high potency topical steroids should be reserved for severe cases
matched to severity and site of disease
after stuff clears can move to lower potency steroids such as HCort 2.5%
Dont wanna use on thin skin
Topical Calcineurin inhibitors
Tacrolimus
Pimecrolimus
TCI uses
very useful in reducing pruritus
equal to medium-dose potency steroids
** can be used anywhere **
Tacrolimus vs Pimecrolimus
Pimecrolimus useful in pts who cant tolerate stinging of Pimecrolimus, also more favorable lipophilic characteristics
Taco 0.03% = > 2yrs old, 0.1% > 16yrs old
Pimecrolimus 1% > 2yrs old
why are TCI not 1st line?
Concerns over possible risk of cancers
Dont use in children in weakened or compromised immune symptoms
Eucrisa
Crisaborole
> 2yrs older Atopic dermatitis
SE: application site pain, reactions, hypersensitivity
use after Topical Steroids & TCI before trying due to $$$
Phototherapy info
may worsen AD in pts who get flare from sunlight
Relapse frequently occurs
recommended if disease not controlled by TCI or topical corticosteroids
Systemic Therapy for AD
Most agents not well studied or approved
Biologic response modifiers not currently approved for AD
Cyclosporine considered effective for severe AD
How long is cyclosporine typically used for?
1 year, no improvements after that
Dupilumab (Dupixent) info
FDA approved for moderate/severe atopic dermatitis in adults not adequately controlled by topical prescription therapies
Favored to other immunosuppressants
MOA: monoclonal antibody binds IL-4
Limited by cost $$$, given SubQ every other week
should all patients use non-pharm therapy?
yes
Options for Milld AD
- Low potency TCS once daily for 2-4weeks and reassess
- Continue or switch to TCI or crisaborole for 2-4 weeks if no response
- Medium-high potency TCS on affected areas QD/BID for 2-4 weeks (low-med or TCI for sensitive areas)
- consider phototherapy/dupilumab if no response
Optons for Moderate-Severe AD
- Medium to high potency TCS on affected areas QD/BID for 2-4 weeks….low/med or TCI for sensitive areas
- Consider phototherapy/dupilumab
Maintenance and prevention of relapse AD
After remission….
intermittent therapy w/ moderate to high potency topical steroids, applied QD to previously affected skin for 2 consecutive days per week for up to 16 weeks
Emollients applied liberally multiple times per day
preventing relapse in infants/young children w/ moderate-> severe atopic dermatitis who have frequent flares….
proactive intermittent therapy w/ low potency topical corticosteroids
applied once daily to previously affected skin areas for 2 consecutive days per week X 16 weeks
Allergic contact dermatitis is…..
an inflammatory reaction caused by exposure to an allergan
common substances to cause ACD
Urushiol
Metals = nickel, cobalt, chromium
Topical anesthetics
Fragrances
Latex
Neomycin/bacitracin
ACD prevention
avoid allergens
cover up and use barrier products when working with allergens
eradicate poison ivy/oak/sumac from home
Post-exposure ACD non-pharm treatments
wash area and remove and wash any clothing that was exposed
cold/tepid, soap-less shower
trim fingernails and limit scratching
cold compress
oatmeal bath
Urushiol cleansers
Tech outdoor
Zanfel cream
Others = goop grease remover, dish soap
Pharm treatments to reduce pruritus
calamine lotion
aluminum acetate
oatmeal bath or compresses
Mild-moderate ACD treatment inc face or flexural
medium/low potency topical steroids QD/BID X 1-2 weeks
alternative: topical calcineurin inhibitors BID until resolution
ACD involving < 20% BSA no face/flexural areas
High potency topical steroids QD/BID X 2-4 weeks or until resolution
alternative: topical calcineurin inhibitors Bid until resolution
When to use oral corticosteroids for ACD
involves > 20% BSA
< 20% BSA and is disabling OR has not responded to treatment
Chronic ACD unresponsive to topical or oral corticosteroids may respond to phototherapy
Irritant contact dermatitis is….
an inflammatory reaction caused by exposure to an irritant…..
non-allergic and non-immunologic**
ICD non-pharm prevention
avoid irritants
use barrier products
cover up
non-pharm treatment ICD post-exposure
trim fingernails
oatmeal bath
cold, soap-less shower
wash area and remove any clothes
Pharm ICD treatment
really not necessary
can do topical steroid, oral steroids in severe cases, and NSAIDs for pain
exclusions for ACD/ICD
< 2yrs old
last more than 2 weeks
BSA > 25%
numerous bull present
extreme itching, irritation
swelling of eyelids/extremiteis
involvement,emt of genitalis, eyes or mucus membranes
pts with low tolerance of itching/pain
