SM_256a: Eczema and Itchy Skin Flashcards
Eczema presentation is ____, ____, ____, ____, ____, and ____
Eczema presentation is typically symmetric, poorly defined, erythematous, patches or plaques, lichenification, and erosions
Describe age-related changes of atopic dermatitis distribution
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
___ is pathognomonic for atopic dermatitis
Flexural distribution is pathognomonic for atopic dermatitis
Early eczema histology includes ____, ____, and ____
Early eczema histology includes spongiosis, perivascular infiltrate, and eosinophils
- Spongiosis: fluid between cells
- Perivascular infiltrate: inflammation around blood vessels
- Eosinophils
Chronic eczema presentation includes ____ and ____
Chronic eczema presentation includes parakeratosis and acanthosis
- Perakeratosis: scale
- Acanthosis: thickening of the epidermis
Atopic dermatitis diagnosis mainly involves ____ but this can only narrow the diagnosis to ____
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)
Atopic dermatitis includes ____ and ____
Atopic dermatitis includes barrier and inflammation
Atopic dermatitis barrier mechanism invovlves mutations in ____
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
Atopic dermatitis inflammation mechanism is mediated by pro-inflammatory cytokines ____ and ____
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
People with atopic dermatitis are likely to have ____, ____, and ____
People with atopic dermatitis are likely to have asthma, respiratory allergies, and food allergies
Atopic dermatitis include ___, ___, ___, ___, ___, and ___
Atopic dermatitis include sleep problems, obesity (central obesity), increased BP, T2DM, HLD, and osteoporosis and boen fractures
Atopic dermatitis is associated with ___ quality of life
Atopic dermatitis is associated with poor quality of life
Barrier disruption in atopic dermatitis leads to ____
Barrier disruption in atopic dermatitis leads to transcutaneous sensitization
- Genetically predisposed: filaggrin loss-of-function mutations
- Acquired: cutaneous inflammation results in downregulation of filaggrin
Lower irritant thresholds lead to ____
Lower irritant thresholds lead to irritant contact dermatitis
Allergens cross the impaired barrier and reach antigen presenting cells (e.g. Langerhans cells), causing ____ and ____
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
Atopic dermatitis has a ____ irritant threshold
Atopic dermatitis has a low irritant threshold
(rates also higher in patients with allergic respiratory disease in the absence of dermatitis)
Eczema prevalence is greater in ____ climates
Eczema prevalence is greater in colder climates
(also influenced by small particle air pollution, hard water, bacteria / viruses / fungi, and stress)
Atopic dermatitis treatment includes ____, ____, ____, and ____
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
____ is a novel treatment for atopic dermatitis
Dupilumab is a novel treatment for atopic dermatitis
(side effects of conjunctivitis, injection-site reaction, and allergic conjunctivitis)
Contact dermatitis includes ____, ____, and ____
Contact dermatitis includes irritant contact dermatitis, allergic contact dermatitis, and systemic contact dermatitis
(irritant contact dermatitis is most common)
Irritant contact dermatitis requires ____, involves ____, and often occurs in atopic dermatitis due to ____
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
Irritant contact dermatitis common exposures include ____, ____, ____, and ____
Irritant contact dermatitis common exposures include frequent hand washing, hand sanitizers, harsh soaps, and heavily fragrant skin care products
Allergic contact dermatitis requires ____, can be caused by ____ exposures, and involves ____
Allergic contact dermatitis requires previous sensitization, can be caused by minimal exposures, and involves delayed reactions involving lymphocyte recruitment and expansion
Allergic contact dermatitis most common causes are ____ worldwide and ____ in the US
Allergic contact dermatitis most common causes are nickel worldwide and poison ivy in the US
Irritant contact dermatitis mechanisms include ____ and ____
Irritant contact dermatitis mechanisms include TNF-alpha and non-specific release of junk from damaged cells
Allergic contact dermatitis mechanism involves ____ and cytokines ____ and ____
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
Contrast allergic contact dermatitis and food/seasonal allergies
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
____ testing is used for diagnosis of allergic contact dermatitis
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
____ involves adverse skin reactions to medications and is most often caused by ____
Drug-induced eczema involves adverse skin reactions to medications and is most often caused by calcium channel blockers
