SM_256a: Eczema and Itchy Skin

Question 1

Eczema presentation is ____, ____, ____, ____, ____, and ____

Answer 1

Eczema presentation is typically symmetric, poorly defined, erythematous, patches or plaques, lichenification, and erosions

Question 2

Describe age-related changes of atopic dermatitis distribution

Answer 2

Atopic dermatitis age-related changes of distribution

• Infany: facial and scalp dermatitis
• Toddler: extensor dermatitits
• Older children / adults: flexural distribution
• Adults: more head and neck leasons

Question 3

___ is pathognomonic for atopic dermatitis

Answer 3

Flexural distribution is pathognomonic for atopic dermatitis

Question 4

Early eczema histology includes ____, ____, and ____

Answer 4

Early eczema histology includes spongiosis, perivascular infiltrate, and eosinophils

• Spongiosis: fluid between cells
• Perivascular infiltrate: inflammation around blood vessels
• Eosinophils

Question 5

Chronic eczema presentation includes ____ and ____

Answer 5

Chronic eczema presentation includes parakeratosis and acanthosis

• Perakeratosis: scale
• Acanthosis: thickening of the epidermis

Question 6

Atopic dermatitis diagnosis mainly involves ____ but this can only narrow the diagnosis to ____

Answer 6

Atopic dermatitis diagnosis mainly involves biopsy but this can only narrow the diagnosis to the eczema family

(no biomarkers, no blood tests, food allergy testing not generally indicated)

Question 7

Atopic dermatitis includes ____ and ____

Answer 7

Atopic dermatitis includes barrier and inflammation

Question 8

Atopic dermatitis barrier mechanism invovlves mutations in ____

Answer 8

Atopic dermatitis barrier mechanism invovlves mutations in Filaggrin 1

• Filaggrin 1 is responsible for production of Filaggrin protein: major component of natural moisturizing factor and responsible for maintaining skin barrier function

Question 9

Atopic dermatitis inflammation mechanism is mediated by pro-inflammatory cytokines ____ and ____

Answer 9

Atopic dermatitis inflammation mechanism is mediated by pro-inflammatory cytokines IL-4 and IL-13

• Increased IgE, increased Th2 differentiation, decreased filaggrin, decreased antimicrobial peptides

Question 10

People with atopic dermatitis are likely to have ____, ____, and ____

Answer 10

People with atopic dermatitis are likely to have asthma, respiratory allergies, and food allergies

Question 11

Atopic dermatitis include ___, ___, ___, ___, ___, and ___

Answer 11

Atopic dermatitis include sleep problems, obesity (central obesity), increased BP, T2DM, HLD, and osteoporosis and boen fractures

Question 12

Atopic dermatitis is associated with ___ quality of life

Answer 12

Atopic dermatitis is associated with poor quality of life

Question 13

Barrier disruption in atopic dermatitis leads to ____

Answer 13

Barrier disruption in atopic dermatitis leads to transcutaneous sensitization

• Genetically predisposed: filaggrin loss-of-function mutations
• Acquired: cutaneous inflammation results in downregulation of filaggrin

Question 14

Lower irritant thresholds lead to ____

Answer 14

Lower irritant thresholds lead to irritant contact dermatitis

Question 15

Allergens cross the impaired barrier and reach antigen presenting cells (e.g. Langerhans cells), causing ____ and ____

Answer 15

Allergens cross the impaired barrier and reach antigen presenting cells (e.g. Langerhans cells), causing class switching and production of IgE and cell-mediated immune responses

• IgE: asthma, hay fever, food allergy, urticaria
• Cell-mediated immune response: allergic contact dermatitis

Question 16

Atopic dermatitis has a ____ irritant threshold

Answer 16

Atopic dermatitis has a low irritant threshold

(rates also higher in patients with allergic respiratory disease in the absence of dermatitis)

Question 17

Eczema prevalence is greater in ____ climates

Answer 17

Eczema prevalence is greater in colder climates

(also influenced by small particle air pollution, hard water, bacteria / viruses / fungi, and stress)

Question 18

Atopic dermatitis treatment includes ____, ____, ____, and ____

Answer 18

Atopic dermatitis treatment includes topical agents, systemic agents, light therapy and lasers, and dupilumab

• Topical: corticosteroids, calcineurin inhibitors
• Systemic: corticosteroids, cyclosporine, mycophenolate mofetil, tacrolimus, methotrexate, azathioprine
• Light therapy and lasters: NBUVB, excimer, and PUVA

Question 19

____ is a novel treatment for atopic dermatitis

Answer 19

Dupilumab is a novel treatment for atopic dermatitis

(side effects of conjunctivitis, injection-site reaction, and allergic conjunctivitis)

Question 20

Contact dermatitis includes ____, ____, and ____

Answer 20

Contact dermatitis includes irritant contact dermatitis, allergic contact dermatitis, and systemic contact dermatitis

(irritant contact dermatitis is most common)

Question 21

Irritant contact dermatitis requires ____, involves ____, and often occurs in atopic dermatitis due to ____

Answer 21

Irritant contact dermatitis requires no sensitization, involves infrequent exposure to strong irritants or frequent exposure to mild irritants, and often occurs in atopic dermatitis due to impaired barrier and lower irritant threshold

Question 22

Irritant contact dermatitis common exposures include ____, ____, ____, and ____

Answer 22

Irritant contact dermatitis common exposures include frequent hand washing, hand sanitizers, harsh soaps, and heavily fragrant skin care products

Question 23

Allergic contact dermatitis requires ____, can be caused by ____ exposures, and involves ____

Answer 23

Allergic contact dermatitis requires previous sensitization, can be caused by minimal exposures, and involves delayed reactions involving lymphocyte recruitment and expansion

Question 24

Allergic contact dermatitis most common causes are ____ worldwide and ____ in the US

Answer 24

Allergic contact dermatitis most common causes are nickel worldwide and poison ivy in the US

Question 25

Irritant contact dermatitis mechanisms include ____ and \_\_\_\_

Answer 25

Irritant contact dermatitis mechanisms include TNF-alpha and non-specific release of junk from damaged cells

Question 26

Allergic contact dermatitis mechanism involves ____ and cytokines ____ and \_\_\_\_

Answer 26

Allergic contact dermatitis mechanism involves allergen crossing skin barrier -\> binding to Langerhans cells (APCs) -\> specific recruitment and expansion of T cells and cytokines IL-9 and IL-17

Question 27

Contrast allergic contact dermatitis and food/seasonal allergies

Answer 27

Allergic contact dermatitis and food/seasonal allergies * Allergic contact dermatitis: delayed reaction, lymphocyte mediated, no risk of anaphylaxis * Food seasonal allergies: immediate reaction, mast cell / IgE / histamine mediated, risk of anaphylaxis

Question 28

\_\_\_\_ testing is used for diagnosis of allergic contact dermatitis

Answer 28

Patch testing is used for diagnosis of allergic contact dermatitis * Doubtful or irritant reaction: erythema alone * +: erythema and infiltration, rare papules * ++: erythema, infiltration, and multiple papules * +++: erythema, infiltration, and vesicles or spreading papules

Question 29

\_\_\_\_ involves adverse skin reactions to medications and is most often caused by \_\_\_\_

Answer 29

Drug-induced eczema involves adverse skin reactions to medications and is most often caused by calcium channel blockers