Treatment Landscape for Atopic Dermatitis

Question 1

What are the treatment Goals for Atopic Dermatitis?

Answer 1

To restore Skin Barrier function, hydrate skin, reduce inflammation, manage exacerbating factors, and control symptoms.

Question 2

Define Atopic Dermatitis.

Answer 2

A chronic, intensely itchy, inflammatory skin disorder with a relapsing course that is characterized by recurrent symptomatic flares interspersed with periods of disease improvement.

Question 3

————–methods of treating atopic dermatitis include daily skin care regimens and the avoidance of any triggers that may worsen the disease.

Answer 3

nonpharmacologic

Question 4

What are the goals of daily skin care?

Answer 4

to improve cutaneous hydration and attempt to restore normal moister function of the skin.

Question 5

The use of moisturizers in atopic dermatitis is beneficial because?

Answer 5

The can reduce cutaneous dryness, transepidermal water loss and reduce inflammation. Thereby lessoning the signs and symptoms of itching, redness, cracking and lichenification.

Question 6

What does TCS stand for?

Answer 6

Topical Corticosteroid

Question 7

What are the recommendations for the use of TCS’s?

Answer 7

TCS’s are recommended as first line therapy in patients with atopic dermatitis whose disease is not well-controlled with good skin care regimen.

Question 8

What is an immunomodulator?

Answer 8

an agent that modifies an immune response.

Question 9

What is the mechanism of action in TCS’s?

Answer 9

precise MOA in Atopic dermatitis is unknown, immunomodulators produce effects in the skin through vasoconstriction, anti- inflammatory, immunosuppressive, and antiproliferative properties.

Question 10

—– cells inhibit the proliferation of various cell types in the skin.

Answer 10

T

Question 11

One way TCS’s may exert antiproliforative effects is through the induction of ————–.

Answer 11

Lipocortins.

Question 12

Lipocortins are…

Answer 12

inhibitory proteins that block the production of inflammatory mediators in the skin.

Question 13

What are the 7 potency classes of TCS’s?

Answer 13

Very High (I)
High(II) 
(III) 
Medium(IV)
Lower-medium(V)
low(VI)
Lowest(VII)

Question 14

Available TCS vehicle include

Answer 14

Ointments, Creams, Gels, Lotions, Solutions, Aerosols, tapes, and foams.

Question 15

What risk factors may increase potential side effects of TCS’s?

Answer 15

Higher potency agents
prolonged use
increased amount of product
application to areas of thin skin
older age 
use of occlusion

Question 16

What are the potential local side effects of TCSs?

Answer 16

Atrophic striae ( stretch marks)
Telangiectasias
Hypopigmentation
Folliculitis

Question 17

What is Tachyphlaxis?

Answer 17

a progressive decrease in the clinical response to a drug when it is used on a repetitive basis.

Question 18

What is a systemic side effect of that can occur with the use of Very high and high potency TCSs?

Answer 18

HPA-axis suppression, where adrenal insufficiency may occur.

Question 19

Very high potency TCS agents should be used on…

Answer 19

areas of thickened skin, such as the palms, soles, or linchenified lesions.

Question 20

Medium to high potency TCSs should be used on…

Answer 20

the trunk and extremities.

Question 21

low to medium TCSs should be used on…

Answer 21

large surface areas that need to be treated.

Question 22

low potency TCSs should be used on…

Answer 22

intertriginous regions, face and genitalia

Question 23

What Is a TCI

Answer 23

Topical Calcineurin inhibitor, non steroidal anti-inflammatory medications

Question 24

Name two medications that are TCS’s

Answer 24

Elidel and Protopic.

Question 25

Elidel is indicated for…

Answer 25

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.

Question 26

Protopic is indicated for…

Answer 26

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.

Question 27

What is the MOA for TCIs

Answer 27

MOA in Atopic Dermatitis is unknow but it is presumed that both tacrolimus and pimecrolimus excert their effects by modulating T-cell activation.

Question 28

TCI’s are know to have effects on other cells, such as —–cells and ——————–( such as Langerhans cells and inflammatory dendritic epidermal cells)

Answer 28

Mast, epidermal dendritic antigen-presenting cells.

Question 29

Both TCIs have boxed warning that state…

Answer 29

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.

Question 30

What are common side effects of TCI’s?

Answer 30

Stinging, burning, or irritation at application site.

Question 31

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——————–.

Answer 31

less favorable
more efficacious but less safe
more safe but less efficasious

Question 32

What are the systemic therapies currently being used in the treatment of Atopic Dermatitis?

Answer 32

Systemic antimicrobials, systemic antihistamines and systemic immunomodulating agents.