Treatment Landscape for Atopic Dermatitis Flashcards
What are the treatment Goals for Atopic Dermatitis?
To restore Skin Barrier function, hydrate skin, reduce inflammation, manage exacerbating factors, and control symptoms.
Define Atopic Dermatitis.
A chronic, intensely itchy, inflammatory skin disorder with a relapsing course that is characterized by recurrent symptomatic flares interspersed with periods of disease improvement.
————–methods of treating atopic dermatitis include daily skin care regimens and the avoidance of any triggers that may worsen the disease.
nonpharmacologic
What are the goals of daily skin care?
to improve cutaneous hydration and attempt to restore normal moister function of the skin.
The use of moisturizers in atopic dermatitis is beneficial because?
The can reduce cutaneous dryness, transepidermal water loss and reduce inflammation. Thereby lessoning the signs and symptoms of itching, redness, cracking and lichenification.
What does TCS stand for?
Topical Corticosteroid
What are the recommendations for the use of TCS’s?
TCS’s are recommended as first line therapy in patients with atopic dermatitis whose disease is not well-controlled with good skin care regimen.
What is an immunomodulator?
an agent that modifies an immune response.
What is the mechanism of action in TCS’s?
precise MOA in Atopic dermatitis is unknown, immunomodulators produce effects in the skin through vasoconstriction, anti- inflammatory, immunosuppressive, and antiproliferative properties.
—– cells inhibit the proliferation of various cell types in the skin.
T
One way TCS’s may exert antiproliforative effects is through the induction of ————–.
Lipocortins.
Lipocortins are…
inhibitory proteins that block the production of inflammatory mediators in the skin.
What are the 7 potency classes of TCS’s?
Very High (I) High(II) (III) Medium(IV) Lower-medium(V) low(VI) Lowest(VII)
Available TCS vehicle include
Ointments, Creams, Gels, Lotions, Solutions, Aerosols, tapes, and foams.
What risk factors may increase potential side effects of TCS’s?
Higher potency agents prolonged use increased amount of product application to areas of thin skin older age use of occlusion
What are the potential local side effects of TCSs?
Atrophic striae ( stretch marks)
Telangiectasias
Hypopigmentation
Folliculitis
What is Tachyphlaxis?
a progressive decrease in the clinical response to a drug when it is used on a repetitive basis.
What is a systemic side effect of that can occur with the use of Very high and high potency TCSs?
HPA-axis suppression, where adrenal insufficiency may occur.
Very high potency TCS agents should be used on…
areas of thickened skin, such as the palms, soles, or linchenified lesions.
Medium to high potency TCSs should be used on…
the trunk and extremities.
low to medium TCSs should be used on…
large surface areas that need to be treated.
low potency TCSs should be used on…
intertriginous regions, face and genitalia
What Is a TCI
Topical Calcineurin inhibitor, non steroidal anti-inflammatory medications
Name two medications that are TCS’s
Elidel and Protopic.
Elidel is indicated for…
second line therapy for the short term and noncontinuous chronic treatment of mild to moderate atopic dermatitis in nonimmunocompromised adults and children age 2 and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable.
Protopic is indicated for…
both .03% and .1% for adults and only .03% for children aged 2-15 years as second line therapy for short term and noncontinuous chronic treatment of Moderate to severe atopic dermatitis in nonimmunocompromised adults and children who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable.
What is the MOA for TCIs
MOA in Atopic Dermatitis is unknow but it is presumed that both tacrolimus and pimecrolimus excert their effects by modulating T-cell activation.
TCI’s are know to have effects on other cells, such as —–cells and ——————–( such as Langerhans cells and inflammatory dendritic epidermal cells)
Mast, epidermal dendritic antigen-presenting cells.
Both TCIs have boxed warning that state…
Long term safety of topical Calcineurin inhibitors have not been established and that continuous long term use should be avoided.
avoid use on premalignant skin conditions
avoid use in patients with and increased potential for systemic absorption
avoid use in patients with active cutaneous bacterial or viral infections.
avoid or minimalize natural sunlight exposure
Pregnancy category C.
What are common side effects of TCI’s?
Stinging, burning, or irritation at application site.
In the study done by Triangle insights group,LLC results show that TCSs were perceived as being—————-in terms of safety and efficacy. Mid potency and high potency TCSs were viewed as being ——————–. Low potency TCSs were perceived as being——————–.
less favorable
more efficacious but less safe
more safe but less efficasious
What are the systemic therapies currently being used in the treatment of Atopic Dermatitis?
Systemic antimicrobials, systemic antihistamines and systemic immunomodulating agents.
