Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pedia > atopic dermatitis > Flashcards

atopic dermatitis Flashcards

1
Q

the most common chronic
relapsing skin disease seen in infancy and childhood

A

Atopic dermatitis (AD), or eczema,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

It affects ____ of children worldwide and frequently occurs in families with other atopic diseases, such as asthma, allergic rhinitis, and food allergy.

A

10-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Infants with AD are predisposed to development of allergic rhinitis and/or asthma later in childhood, a process called

A

“the atopic march.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

AD is a complex genetic disorder that results in

A

a defective skin barrier,
reduced skin innate immune responses
exaggerated T-cell responses to environmental allergens
microbes that lead to chronic skin inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute AD skin lesions are characterized by

A

spongiosis,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

spongiosis,

A

marked intercellular edema, of the epidermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

dendritic antigenpresenting cells in the epidermis, such as Langerhans cells, exhibit surface-bound

A

immunoglobulin (Ig) E molecules.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

These antigenpresenting
cells play an important role in cutaneous allergen presentation to

A

T-helper type 2 (Th2) cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

There is a marked___ macrophages in
acute AD lesions.

A

perivenular T-cell infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

are found in normal numbers but in different
stages of degranulation.

A

Mast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

chronic, lichenified AD is characterized
by a

A

hyperplastic epidermis with hyperkeratosis, and minimal spongiosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

There are predominantly IgE-bearing Langerhans cells in the

A

epidermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

There are predominantly macrophages in the

A

dermal mononuclear cell infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

____numbers are increased, contributing to skin
inflammation.

A

Mast cell and eosinophil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Two forms of AD

A

Atopic eczema, Nonatopic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Two forms of AD

A

Atopic eczema, Nonatopic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

is associated
with IgE-mediated sensitization

A

atopic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

is associated
with IgE-mediated sensitization

A

atopic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

aropic eczema occurs in ___ of px with atopic dermatitis

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

is not associated with IgE-mediated sensitization and is seen in 20-30%
of patients with AD

A

non atopic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

non atopic eczema is not associated with IgE-mediated sensitization and is seen in___
of patients with AD

A

20-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Both forms of AD are associated with

A

eosinophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In atopic eczema, circulating T cells expressing the skin homing receptor _____produce increased
levels of Th2 cytokines, including interleukin (IL)-4 and IL-13, which induce isotype switching to IgE synthesis

A

cutaneous lymphocyte-associated antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In atopic eczema, circulating ____expressing the skin homing receptor cutaneous lymphocyte-associated antigen produce increased levels of Th2 cytokines, including interleukin (IL)-4 and IL-13, which
induce isotype switching to IgE synthesis

A

t cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

In atopic eczema, circulating T cells expressing the skin homing receptor cutaneous lymphocyte-associated antigen produce increased levels of ____________, which
induce isotype switching to IgE synthesis

A

Th2 cytokines (interleukin (IL)-4 and IL-13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In atopic eczema, circulating T cells expressing the skin homing receptor cutaneous lymphocyte-associated antigen produce increased levels of Th2 cytokines, including interleukin (IL)-4 and IL-13, which induce isotype switching to ____

A

IgE synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

plays an important role in eosinophil development and survival.

A

IL -5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nonatopic eczema is associated with lower ___production than is atopic eczema.

A

IL-4 and IL-13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Compared with the skin of healthy subjects, both unaffected skin and acute skin lesions of patients with AD have an decreased number of cells expressing IL-4 and IL-13

A

increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

___ have significantly fewer cells that express IL-4 and IL-13

A

Chronic AD skin lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

increased numbers of cells that express IL-5, granulocyte-macrophage colony-stimulating factor, IL-12, and interferon (IFN)-γ than acute AD lesions

A

Chronic AD skin lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Chronic AD is characterized by a

A

shift from a Th2-dominant to a Th1-dominant profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The infiltration of ____ correlates with severity of AD, blocks keratinocyte differentiation, and
induces epidermal hyperplasia.

A

IL-22–expressing T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

The infiltration of IL-22–expressing T cells
correlates with severity of AD, blocks keratinocyte differentiation, and induces

A

epidermal hyperplasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

The infiltration of IL-22–expressing T cells
correlates with severity of AD, ____________, and
induces epidermal hyperplasia.

A

blocks keratinocyte differentiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The development of AD skin lesions is orchestrated by local tissue expression of proinflammatory

A

cytokines and chemokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

play a central role in defining the nature of the inflammatory infiltrate in AD.

A

cytokines and chemokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

The chemotactic protein, _____, is highly upregulated in AD and preferentially attracts cutaneous lymphocyte-associated antigen positive T cells to the skin

A

CCL27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

are increased in AD skin lesions, resulting in chemotaxis of eosinophils, macrophages, and Th2 lymphocytes expressing their receptor (CCR3).

A

C-C chemokines,
RANTES (regulated regulated on activation, normal T-cell expressed and secreted),
monocyte chemotactic protein-4,
eotaxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Other C-C chemokines, RANTES (regulated regulated
on activation, normal T-cell expressed and secreted), monocyte chemotactic protein-4, and eotaxin are increased in AD skin lesions, resulting in

A

chemotaxis of eosinophils, macrophages
Th2 lymphocytes expressing their receptor (CCR3).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

In healthy people, the___acts as a protective barrier against external irritants, moisture loss, and infection.

A

skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Proper function of the skin depends on

A

adequate moisture
lipid content
functional immune responses
structural integrity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

is a hallmark of AD.

A

Severely dry skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Severely dry skin results from compromise of the epidermal barrier, which leads to

A

excess transepidermal water loss
allergen penetration
microbial colonization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

, a structural protein in the epidermis,
and its breakdown products are critical to skin barrier function

A

Filaggrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Genetic mutations in the filaggrin gene family have been identified in up to ___ of patients with severe AD.

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Cytokines found in allergic inflammation, such as __________can also reduce filaggrin expression

A

IL-4
IL-13
IL-22
IL-25
tumor necrosis factor (TNF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

AD patients thereby have increased risk of bacterial, viral, and fungal infection related to impairment of adaptive immunity, including a loss of barrier function and impaired generation of antimicrobial peptides

A

AD patients thereby have increased risk of bacterial, viral, and fungal infection related to impairment of innate immunity, including a loss of barrier function and
impaired generation of antimicrobial peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

AD patients thereby have increased risk of bacterial, viral, and fungal infection related to impairment of innate immunity, including ______

A

a loss of barrier function
impaired generation of antimicrobial peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

AD typically begins in

A

infancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Approximately___ of patients experience
symptoms in the 1st yr of life,

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Approximately 50% of patients experience
symptoms in the

A

‘Ist yr of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

additional 30% are diagnosed
between

A

1 and 5 yr of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

an additional ___ are diagnosed
between 1 and 5 yr of age

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

are the cardinal features of AD

A

Intense pruritus, especially at night,
and cutaneous reactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

cause increased skin inflammation that contributes to
the development of more pronounced eczematous skin lesions.

A

Scratching and excoriation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Foods , aeroallergen, infection, reduced humidity, excessive
sweating, and irritants can lessen pruritus and scratching

A

Exacerbate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Foods
(

A

cow milk, egg, peanut, tree nuts, wheat, fish, shellfish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Aeroallergens

A

pollen, grass, animal dander, dust mites), infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Infection (

A

staphylococcus,
herpes simplex, molluscum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Irritants

A

wool, acrylic, soaps, toiletries, fragrances,
detergents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Acute AD skin lesions are

A

intensely pruritic with erythematous
papules (Figs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

manifests as erythematous,
excoriated, scaling papules

A

Subacute dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Chronic AD is characterized by

A

Iichenification, and fibrotic papuleS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Thickening of the skin with
accentuated surface markings,

A

Lichenification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

All 5 types of skin reactions may coexist in the same individual.

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Most patients with AD have ___ irrespective of their stage of
illness.

A

dry, lackluster skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Skin reaction pattern and distribution do not vary with the patient’s age and disease activity

A

Vary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

AD is generally more acute in ____

A

Infancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

AD is generally more acute in infancy and
involves the

A

face, scalp, and extensor surfaces of the extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

The
diaper area is usually affected

A

Spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Older children and children with chronic
AD have lichenification and localization of the rash to the

A

flexural folds
of the extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

AD often goes into _____as the patient grows
older, leaving an adolescent or adult with skin prone to itching and inflammation when exposed to exogenous irritants

A

Remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

There are no specific laboratory tests to diagnose AD

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Many patients
have peripheral blood

A

eosinophilia and increased serum IgE levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

can identify the allergens

A

JSerum IgE measurement or prick skin testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Serum IgE measurement or prick skin testing can identify the allergens -to which patients are desensitized.

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

AD is diagnosed on the basis of 3 major features:

A

pruritus, an eczematous
dermatitis that fits into a typical presentation, and a chronic or
chronically relapsing course (

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Associated features, such as ___
, are variably present

A

a family history of asthma, hay fever, elevated IgE, and immediate skin
test reactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

should be considered for
infants presenting in the 1st yr of life with diarrhea, failure to thrive,
generalized scaling rash, and recurrent cutaneous and/or systemic
infection

A

Severe combined immunodeficiency
Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

) should be excluded in any
infant with AD and failure to thrive

A

Histiocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

X-linked recessive disorder associated with thrombocytopenia,
immune defects, and recurrent severe bacterial infections,

A

Wiskott-Aldrich syndrom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

is characterized by a rash almost indistinguishable from that in
AD.

A

Wiskott-Aldrich syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

characterized by markedly elevated serum IgE values, recurrent deep-seated
bacterial infections, chronic dermatitis, and refractory dermatophytosis.

A

One of the hyper-IgE syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Many of these patients have disease as a result of

A

autosomal dominant
STAT3 mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

All patients with hyper-IgE
syndrome present with increased susceptibility to viral infections and
an autosomal recessive pattern of disease inheritance.

A

Some

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

some patients with hyper-IgE
syndrome
may have a –

A

Dock 8 (Dedicator of cytokinesis 8) mutation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

This diagnosis
should be considered in __ with severe eczema, food
allergy, and disseminated skin viral infections.

A

young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Adolescents who present with an eczematous dermatitis but no
history of childhood eczema, respiratory allergy, or atopic family
history may have

A

allergic contact dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

A____ may be the problem in any patient whose AD does
Not respond to appropriate therapy.

A

contact allergen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Sensitizing chemicals, such as
____ can be irritants for patients with AD and are
commonly found as vehicles in therapeutic topical agents

A

parabens and lanolin,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

has been reported in patients with chronic
dermatitis on topical corticosteroid therapy

A

Topical glucocorticoid allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Has nalso been reported with HIV infection as well as with a variety of infestations such as scabies.

A

Eczematous dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Eczematous dermatitis has
also been reported with HIV infection as well as with a variety of
infestations such as

A

Scabies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Other conditions that can be confused
with AD include .

A

psoriasis, ichthyoses, and seborrheic dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

The treatment of AD requires a systematic, multifaceted approach that incorporates

A

skin hydration,
Topical anti-inflammatory therapy,
Identification and elimination of flare factors
systemic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Cutaneous hydration is done because patients with AD have impaired skin barrier function from
reduced lipid levels, they present with diffuse, abnormally dry skin, or

A

xerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

are first-line therapy

A

Moisturizers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Lukewarm soaking baths for
____ followed by the application of an occlusive emollient to
retain moisture provide symptomatic relief

A

15-20 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Lukewarm soaking baths for
15-20 min followed by the ___to
retain moisture provide symptomatic relief

A

application of an occlusive emollien

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

___
of varying degrees of viscosity can be used according to the patient’s
preference.

A

Hydrophilic ointments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

are sometimes not well tolerated
because of interference with the function of the eccrine sweat ducts
and may induce the development of folliculitis1

A

Occlusive ointments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

“therapeutic moisturizers/barrier creams” are available,
containing components such as ___ intended to improve skin barrier function.

A

ceramides and filaggrin acid
metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Hydration by baths or wet dressings promotes ___
of topical glucocorticoids

A

transepidermal . penetration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

may also serve as effective
barriers against persistent scratching, in turn promoting healing of
excoriated lesions.

A

Dressings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

are recommended for use on severely
affected or chronically involved areas of dermatitis refractory to skin
care.

A

Wet dressings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

It is critical that wet dressing therapy be followed by ___
application to avoid potential drying and fissuring from the
therapy

A

Topicàl emollient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

It is critical that wet dressing therapy be followed by topical emollient application to avoid

A

potential drying and fissuring from the therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Wet dressing therapy can be complicated by ___and should be closely monitored by a physician.

A

Maceration and 2nd infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

are the cornerstone of antiinflammatory treatment
for acute exacerbations of AD.

A

Topical corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Patients should be carefully
instructed on their use of topical glucocorticoids in order to avoid
potential adverse effects.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

There are 10 classes of topical glucocorticoids,
ranked according to their potency as determined by vasoconstrictor
assays

A

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

should not be used on the face or
intertriginous areas and should be used only for very short periods on
the trunk and extremities

A

ultrahigh-potency glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

can be used
for longer periods to treat chronic AD involving the trunk and extremities

A

Mid-potency glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Long-term control can be maintained with ___ to areas that have healed
but are prone to relapse, once control of AD is achieved after a daily
regimen of topical corticosteroids

A

twice-weekly applications
of topical fluticasone or mometasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Compared with creams, ___
have a greater potential to occlude the epidermis, resulting in enhanced
systemic absorption

A

ointments

116
Q

Systemic Adverse effects of topical glucocorticoids are

A

suppression of the hypothalamic–pituitary–
adrenal axis.

117
Q

Local adverse effects include the

A

development of striae
and skin atrophy.

118
Q

Systemic adverse effects are related to the

A

potency of the topical corticosteroid, site of application, occlusiveness of the preparation, percentage of the body surface area covered, and length of use

119
Q

The potential for adrenal suppression from potent topical corticosteroids
is greatest in

A

infants and young children with severe AD requiring
intensive therapy

120
Q

The____are effective in reducing
AD skin inflammation

A

nonsteroidal topical calcineurin inhibitors

121
Q

is indicated
for mild to moderate AD.

A

Pimecrolimus cream 1% (Elidel)

122
Q

is indicated for moderate to severe AD.

A

Tacrolimus ointment 0.1% and 0.03% (Protopic)

123
Q

Pimecrolimus and tacrolimus are approved for
short-term or intermittent long-term treatment of AD in patients

A

≥2 yr whose disease is unresponsive
who are intolerant of other conventional therapies whom these therapies are inadvisable owing
to potential risks.

124
Q

Topical calcineurin inhibitors may be better than
topical corticosteroids in the treatment of patients whose AD is

A

poorly responsive to topical steroid
patients with steroid phobia
patients with face and neck dermatitis

125
Q

ineffective, lowpotency topical corticosteroids are usually used because of fears of steroid-induced skin atrophy.

A

patients with face and neck dermatitis,

126
Q

have antipruritic and antiinflammatory effects
on the skin

A

Coal tar preparations

127
Q

antiinflammatory effects are usually not as
pronounced as those of topical glucocorticoids or calcineurin inhibitors.

A

Coal tar preparations

128
Q

Tar preparations are useful in

A

reducing the potency of topical glucocorticoids required in long-term maintenance therapy of AD

129
Q

Tar shampoos can be particularly beneficial for

A

scalp dermatitis

130
Q

Adverse effects associated with tar preparations include

A

skin irritation, folliculitis, and photosensitivity.

131
Q

act primarily by blocking the histamine H1
receptors in the dermis, thereby reducing histamine-induced pruritus.

A

Systemic antihistamines

132
Q

Systemic antihistamines act primarily by ___
receptors in the dermis, thereby reducing histamine-induced pruritus.

A

blocking the histamine H1

133
Q

Systemic antihistamines act primarily by blocking the histamine H1
receptors in the dermis, thereby

A

reducing histamine-induced pruritus.

134
Q

is only one of many mediators that induce pruritus of the
skin

A

Histamine

135
Q

Because pruritus is usually worse at night,____may offer an advantage with
their soporific side effects when used at bedtime

A

sedating antihistamines
(hydroxyzine, diphenhydramine)

136
Q

Because pruritus is usually worse at night, sedating antihistamines (hydroxyzine, diphenhydramine) may offer an advantage with their

A

soporific side effects when used at bedtime

137
Q

has both tricyclic antidepressant and H1- and H2-receptor blocking
effects.

A

Doxepin hydrochloride

138
Q

Doxepin hydrochloride
has both

A

tricyclic antidepressant and H1- and H2-receptor blocking
effects.

139
Q

Short-term use of a sedative to allow adequate rest may be
appropriate in cases of

A

severe nocturnal pruritus.

140
Q

may be useful in the small subset of patients with AD and concomitant urticaria.

A

newer nonsedating antihistamine

141
Q

Systemic corticosteroids are rarely indicated in the treatment of chronic
AD

A

Systemic corticosteroids

142
Q

The dramatic clinical improvement that may occur with systemic
corticosteroids is frequently associated with

A

a severe rebound flare of AD after therapy discontinuation

143
Q

may be appropriate for an acute exacerbation of AD while other treatment
measures are being instituted in parallel.

A

Short courses of oral corticosteroids

144
Q

If a short course of oral corticosteroids is given, it is important to ____ prevent rebound
flaring of AD.

A

taper the dosage
begin intensified skin care with topical corticosteroids
frequent bathing
application of emollients

145
Q

is a potent immunosuppressive drug that acts primarily on T cells by suppressing cytokine gene transcription.

A

Cyclosporine

146
Q

Cyclosporine forms a complex with an intracellular protein, ____

A

cyclophilin

147
Q

cyclophilin inhibits

A

calcineurin

148
Q

phosphatase required for activation of NFAT (nuclear factor of activated T cells

A

calcineurin

149
Q

a transcription
factor necessary for cytokine gene transcription

A

NFAT (nuclear factor of activated T cells),

150
Q

Cyclosporine ___ for short term

A

(5 mg/ kg/day)

151
Q

cyclosporin ___ long-term

A

1 yr

152
Q

cyclosporin 1 yr long-term use has been beneficial for

A

children with severe, refractory AD

153
Q

cyclosporing possible adverse effects include

A

renal impairment and hypertension.

154
Q

is a purine biosynthesis inhibitor used as an
immunosuppressant in organ transplantation that has been used for
treatment of refractory AD.

A

Mycophenolate mofetil

155
Q

Aside from immunosuppression, _____have been
reported with mycophenolate mofetil use.

A

herpes simplex retinitis and dose-related bone marrow suppression

155
Q

Aside from immunosuppression, _____have been
reported with mycophenolate mofetil use.

A

herpes simplex retinitis and dose-related bone marrow suppression

156
Q

Mycophenolate mofetil should be discontinued if the disease does not respond within

A

4-8 wk.

157
Q

is an antimetabolite with
potent inhibitory effects on inflammatory cytokine synthesis and cell
chemotaxis.

A

Methotrexate

158
Q

Methotrexate has been used for patients with

A

recalcitrant AD.

159
Q

In AD, dosing is more frequent than the weekly dosing used for psoriasis

A

Methotrexate

160
Q

is a purine analog with antiinflammatory and antiproliferative effects that has been used for severe AD

A

Azathioprine

161
Q

is a significant adverse effect of methotrexate

A

Myelosuppression

162
Q

levels may identify individuals at risk for myelosuppression of methotrexate

A

thiopurine methyl transferase

163
Q

is often beneficial to patients with AD as long as
sunburn and excessive sweating are avoided.

A

Natural sunlight

164
Q

Many phototherapy modalities are effective for AD, including

A

ultraviolet A-1
ultraviolet B
narrow-band ultraviolet B
psoralen plus ultraviolet A.

165
Q

is generally reserved for patients in whom standard treatments fail.

A

Phototherapy

166
Q

are usually required for phototherapy to be effective

A

Maintenance treatments

167
Q

Short-term adverse effects with phototherapy include

A

erythema, skin pain, pruritus, and pigmentation

168
Q

Long-term adverse effects include

A

predisposition to cutaneous malignancies

169
Q

Unproven Therapies

A

ifn -y
omalizumab
allergen immunotherapy
probiotics
chinese herbal medications
vitamin D

170
Q

is known to suppress Th2-cell function.

A

IFN-γ

171
Q

Reduction in clinical severity of AD correlated with the ability of IFN-γ to decrease total circulating

A

eosinophil counts. .

172
Q

are commonly observed side effects during the treatment course of ifn -y

A

Influenza-like symptoms

173
Q

Treatment of patients who have severe AD and elevated serum IgE values with monoclonal anti-IgE may be considered in those with

A

allergen-induced flares of AD

174
Q

used in patients with AD sensitized to dust mite allergen showed improvement in severity of skin disease, as well as reduction in topical steroid use.

A

specific immunotherapy

175
Q

of the probiotic Lactobacillus rhamnosus
strain GG has been shown to reduce the incidence of AD in at-risk children during the first 2 yr of life.

A

Perinatal administration

176
Q

Perinatal administration of the probiotic ___
strain GG has been shown to reduce the incidence of AD in at-risk children during the first 2 yr of life.

A

Lactobacillus rhamnosus

177
Q

Perinatal administration of the probiotic Lactobacillus rhamnosus strain GG has been shown to reduce the incidence of AD in at-risk children during the

A

first 2 yr of life.

178
Q

The treatment response has been
found to be more pronounced in patients with

A

positive skin prick test results and elevated IgE values

179
Q

The beneficial response of_____ is often temporary, and effectiveness may wear off despite continued
treatment.

A

Chinese herbal therapy

180
Q

The possibility of_____ remains a concern of chinese herbal therapy

A

hepatic toxicity, cardiac side effects, or idiosyncratic reactions

181
Q

The specific ingredients of the herbs also remain to be elucidated, and some preparations have
been found to be contaminated with

A

corticosteroids.

181
Q

The specific ingredients of the herbs also remain to be elucidated, and some preparations have
been found to be contaminated with

A

corticosteroids.

182
Q

often accompanies severe AD.

A

vitamin D

183
Q

enhances skin barrier function, reduces corticosteroid requirements to control inflammation and augments skin antimicrobial function

A

Vitamin D

184
Q

can enhance antimicrobial peptide expression in the skin and reduce severity of skin
disease especially in patients with low baseline vitamin D, for example, during the wintertime when exacerbation of AD often occurs

A

vitamin D

185
Q

Patients with AD have a low threshold response to irritants that trigger their

A

itch-scratch cycle.

186
Q

Patients with AD have a low threshold response to ___that trigger their itch-scratch cycle.

A

irritants

187
Q

common triggers of AD

A

Soaps or detergents
chemicals
smoke
abrasive clothing
exposure to extremes of temperature
humidity

188
Q

Patients with AD should use soaps with

A

minimal defatting properties and a neutral pH.

189
Q

New clothing should be laundered
before wearing to decrease levels of

A

formaldehyde and other chemicals

190
Q

Residual laundry detergent in clothing may trigger the

A

itchscratch cycle;

191
Q

facilitates removal of the detergent.

A

using a liquid rather than powder detergent and adding a second rinse cycle

192
Q

Every attempt should be made to allow children with AD to be as normally active as possible.

A

true

193
Q

A sport such as ____ may be better tolerated than others that involve intense perspiration, physical
contact, or heavy clothing and equipment

A

swimming

194
Q

Rinsing off___immediately and lubricating the skin after swimming are important.

A

chlorine

195
Q

Although ultraviolet light may be beneficial to some patients with AD, ____ should be used to avoid sunburn.

A

high sun protection factor sunscreens

196
Q

is comorbid in approximately 40% of infants and young children with moderate to severe AD

A

Food allergy

197
Q

Food allergy is comorbid in approximately___of infants and young children with moderate to severe AD

A

40%

198
Q

Undiagnosed food allergies in patients with AD may induce____in some patients and urticarial reactions, wheezing, or nasal congestion in others.

A

eczematous dermatitis

199
Q

Undiagnosed food allergies in patients with AD may induce eczematous dermatitis in some patients and ____ in others.

A

urticarial reactions, wheezing, or nasal congestion

200
Q

Increased severity of AD symptoms and younger age
correlate directly with the presence of

A

food allergy

201
Q

Removal of food allergens from the diet leads to significant clinical improvement but requires a great deal of education, because most common allergens
such as _____ contaminate many foods and are difficult to avoid.

A

(egg, milk, peanut, wheat, soy)

202
Q

Removal of food allergens from the diet leads to significant clinical improvement but requires a great deal of education, because most common allergens
such as _____ contaminate many foods and are difficult to avoid.

A

(egg, milk, peanut, wheat, soy)

203
Q

Potential allergens can be identified by a

A

careful history
performing selective skin prick tests
in vitro blood testing for allergen specific IgE.

204
Q

have a high predictive value for excluding suspected allergens

A

Negative skin and blood test results for allergen-specific IgE

205
Q

Positive results of skin or blood tests using foods often do not correlate with clinical symptoms and should be confirmed with

A

controlled food challenges and elimination diets.

206
Q

Extensive elimination diets, which can be nutritionally deficient, are often required

A

rarely

207
Q

Even with multiple positive skin test results, the majority of patients react to fewer than ___ foods under controlled challenge conditions.

A

3 foods

208
Q

In older children, AD flares can occur after intranasal or epicutaneous exposure to aeroallergens such as

A

fungi, animal dander, grass, and ragweed pollen.

209
Q

Avoiding aeroallergens, particularly___, can
result in clinical improvement of AD

A

dust mites

210
Q

Avoidance measures for dust mite–allergic patients include

A

using dust mite–proof encasings on pillows, mattresses, and box springs
washing bedding in hot water weekly
removing bedroom carpeting; and decreasing indoor humidity levels with air conditioning.

211
Q

are usually beneficialfor patients who are not colonized with a resistant S. aureus strain;

A

Erythromycin and azithromycin

212
Q

a is recommended for macrolide-resistant S. aureus

A

first-generation cephalosporin (cephalexin)

213
Q

is useful in the treatment of localized impetiginous lesions, with systemic antibiotics for widespread infections.

A

Topical mupirocin

214
Q

___ contributes to skin colonization with S. aureus; this fact indicates the importance of combining effective anti-inflammatory therapy with antibiotics for treating moderate to severe AD to avoid the need for repeated
courses of antibiotics, which can lead to the emergence of antibioticresistant strains of S. aureus.

A

Cytokine-mediated skin inflammation

215
Q

Dilute bleach baths twice weekly may be also considered to reduce S. aureus colonization.

A

(1 2 cup of bleach in 40 gallons of water)

216
Q

In one randomized trial the group who received
the bleach baths plus _____had significantly
decreased severity of AD at 1 and 3 mo compared with placebo.

A

intranasal mupirocin (5 days/mo)

217
Q

can provoke recurrent dermatitis and
may be misdiagnosed as S. aureus infection.

A

Herpes simplex virus (HSV)

218
Q

The presence of____, and infected skin lesions that fail to respond to oral antibiotics suggests HSV infection,

A

punched out erosions, vesicle

219
Q

HSV infection can be diagnosed by a

A

Giemsa-stained Tzanck smear of cells scraped from the vesicle base
viral polymerase chain reaction or culture

220
Q

should be temporarily discontinued if HSV infection is suspected

A

Topical corticosteroids

221
Q

Persons with AD are also susceptible to _____ which is
similar in appearance to eczema herpeticum and historically follows smallpox (vaccinia virus) vaccination

A

eczema vaccinatum,

222
Q

are additional viral infections affecting children with AD.

A

Cutaneous warts and molluscum
contagiosum

223
Q

infections also can contribute to exacerbation of AD.

A

Dermatophyte

224
Q

Patients with AD have been found to have a greater susceptibility to_____fungal infections than nonatopic control subjects.

A

Trichophyton rubrum

225
Q

There has been particular interest in the role of ____
(formerly known as Pityrosporum ovale) in AD because it is a lipophilic yeast commonly present in the seborrheic areas of the skin

A

Malassezia furfur

226
Q

____ against M. furfur have been found in patients with head and neck dermatitis.

A

IgE antibodies

227
Q

may develop in patients with extensive skin involvement.

A

Exfoliative dermatitis

228
Q

exfoliative dermatitis is associated with generalized

A

redness, scaling, weeping, crusting, systemic toxicity, lymphadenopathy, and fever,

229
Q

exfoliative dermatitis is usually caused by

A

superinfection (e.g., with toxin-producing S. aureus or HSV infection) or inappropriate therapy.

230
Q

In some cases, the withdrawal of systemic glucocorticoids used to control severe AD precipitates

A

exfoliative
erythroderma.

231
Q

may result in visual impairment from corneal scarring

A

Eyelid dermatitis and chronic blepharitis

232
Q

is usually bilateral and can have disabling symptoms that include itching, burning, tearing, and copious mucoid discharge.

A

Atopic keratoconjunctivitis

233
Q

is associated with papillary hypertrophy or cobblestoning of the upper
eyelid conjunctiva.

A

Vernal conjunctivitis

234
Q

Vernal conjunctivitis typically occurs in younger patients and has a marked seasonal incidence with

A

spring exacerbations

235
Q

is a conical deformity of the cornea believed to result from chronic rubbing of the eyes in patients with AD

A

Keratoconus

236
Q

may be a primary manifestation of AD or from extensive use of systemic and topical
glucocorticoids, particularly around the eyes.

A

Cataracts

237
Q

AD generally tends to be mild and persistent in young children, particularly if they have null mutations in their filaggrin genes

A

more severe

238
Q

Periods of remission occur more frequently when patients are young

A

grow older

239
Q

Spontaneous resolution of AD has been reported to occur after____

A

age 5 yr

240
Q

Spontaneous resolution of AD has been reported to occur after age 5 yr in ___of patients affected during infancy, particularly for mild
disease

A

40-60%

241
Q

Earlier studies suggested that approximately ___ of children outgrow their AD by adolescence

A

84%

242
Q

later studies reported that AD resolves in approximately 20% of children monitored from infancy
until adolescence and becomes less severe in

A

65%.

243
Q

Of those adolescents treated for mild dermatitis, ___may experience a relapse of disease as adults,

A

> 50%

244
Q

relapse of disease as adults frequently manifests as

A

hand dermatitis, especially if
daily activities require repeated hand wetting

245
Q

Predictive factors of a poor prognosis for AD include

A

widespread AD in childhood
filaggrin gene null mutations
concomitant allergic rhinitis and asthma
family history of AD in parents or siblings
early age at onset of AD
being an only child, and very high serum IgE levels

246
Q

Breastfeeding or a feeding with a hypoallergenic hydrolyzed formula is not beneficial.

A

beneficial

247
Q

Breastfeeding or a feeding with a hypoallergenic hydrolyzed formula is not beneficial.

A

beneficial

248
Q

may also reduce the incidence or severity of AD, but this approach is unproven

A

Probiotics and prebiotics

249
Q

If an infant with AD is diagnosed with food allergy, the breast feeding mother may not need to eliminate the implicated food allergen from her diet.

A

need to eliminate

250
Q

is the mainstay for prevention
of flares as well as for the long-term treatment of AD.

A

Identification and elimination of triggering factors

251
Q

applied to the whole body for the first few months
of life may enhance the cutaneous barrier and reduce the risk of eczema.

A

Emollient therapy

252
Q

MAJOR FEATURES of AD

A

Pruritus
Facial and extensor eczema in infants and children
Flexural eczema in adolescents
Chronic or relapsing dermatitis
Personal or family history of atopic disease

253
Q

ASSOCIATED FEATURES of AD

A

Xerosis
Cutaneous infections (Staphylococcus aureus, group A
streptococcus, herpes simplex, coxsackievirus, vaccinia,
molluscum, warts)
Nonspecific dermatitis of the hands or feet
Ichthyosis, palmar hyperlinearity, keratosis pilaris
Nipple eczema
White dermatographism and delayed blanch response
Anterior subcapsular cataracts, keratoconus
Elevated serum immunoglobulin E levels
Positive results of immediate-type allergy skin tests
Early age at onset
Dennie lines (Dennie-Morgan infraorbital folds)
Facial erythema or pallor
Course influenced by environmental and/or emotional factors

254
Q

Cutaneous infections

A

Staphylococcus aureus,
group A streptococcus
herpes simplex
coxsackievirus
vaccinia
molluscum
warts

255
Q

Dennie lines

A

Dennie-Morgan infraorbital folds

256
Q

CONGENITAL DISORDERS

A

Netherton syndrome
Familial keratosis pilaris

257
Q

CHRONIC DERMATOSES

A

Seborrheic dermatitis
Contact dermatitis (allergic or irritant)
Nummular eczema
Psoriasis
Ichthyoses

258
Q

INFECTIONS AND INFESTATIONS

A

Scabies
HIV-associated dermatitis
Dermatophytosis
Insect bites
Onchocerciasis

259
Q

MALIGNANCIES

A

Cutaneous T-cell lymphoma (mycosis fungoides/Sézary syndrome)
Letterer-Siwe disease (Langerhans cell histiocytosis)

260
Q

Letterer-Siwe disease

A

(Langerhans cell histiocytosis)

261
Q

AUTOIMMUNE DISORDERS

A

Dermatitis herpetiformis
Pemphigus foliaceus
Graft-versus-host disease
Dermatomyositis

262
Q

IMMUNODEFICIENCIES

A

Wiskott-Aldrich syndrome
Severe combined immunodeficiency syndrome
Hyperimmunoglobulin E syndromes (autosomal dominant and
recessive types)
Immunodysregulation polyendocrinopathy enteropathy X-linked
(IPEX) syndrome

263
Q

METABOLIC DISORDERS

A

Zinc deficiency
Pyridoxine (vitamin B6) and niacin
Multiple carboxylase deficiency
Phenylketonuria

264
Q

List of Aggravating Factors and Counselling for AD Patients

Clothing:

A

avoid skin contact with irritating fibers (wool, large-fiber textiles)
do not use tight and too warm clothing to avoid excessive sweating
New nonirritating clothing designed for AD children is being evaluated

265
Q

List of Aggravating Factors and Counselling for AD Patients
Tobacco:

A

avoid exposure

266
Q

List of Aggravating Factors and Counselling for AD Patients

temperature:

A

Cool temperature in bedroom and avoid too many bed covers
Increase emollient use with cold weather

267
Q

List of Aggravating Factors and Counselling for AD Patients

Infections

A

Avoid exposure to herpes sores
urgent visit if flare of unusual aspect

268
Q

List of Aggravating Factors and Counselling for AD Patients

vaccines

A

normal schedule in noninvolved skin, including egg-allergic patients (

269
Q

List of Aggravating Factors and Counselling for AD Patients

Sun exposure:

A

no specific restriction. Usually helpful because of improvement of epidermal barrier. Encourage summer holidays in altitude or
at beach resorts

270
Q

List of Aggravating Factors and Counselling for AD Patients

Physical exercise, sports:

A

no restriction. If sweating induces flares of AD, progressive adaptation to exercise. Shower and emollients after
swimming pool

271
Q

List of Aggravating Factors and Counselling for AD Patients

Food allergens

A

Maintain breast feeding until 4 mo if possible
Otherwise normal diet, unless an allergy work-up has proven the need to exclude a specific food

272
Q

List of Aggravating Factors and Counselling for AD Patients

Indoor aeroallergens

A

House dust mites
Use adequate ventilation of housing; keep the rooms well aerated even in winter
Avoid wall-to-wall carpeting
Remove dust with a wet sponge
Vacuum floors and upholstery with an adequately filtered cleaner once a week
Avoid soft toys in bed (cradle), except washable ones
Wash bed sheets at a temperature higher than 55° every 10 days
Use bed and pillow encasings made of Gore-Tex or similar material

273
Q

List of Aggravating Factors and Counselling for AD Patients

Furred pets:

A

advise to avoid. If allergy is demonstrated, be firm on avoidance measures, such as pet removal

274
Q

List of Aggravating Factors and Counselling for AD Patients
Pollen:

A

close windows during peak pollen season on warm and dry weather and restrict, if possible, stays outdoors. Windows may be open at
night and early in the morning or during rainy weather. Avoid exposure to risk situations (lawn mowing). Use pollen filters in car. Clothes and
pets can vectorize aeroallergens, including pollen

275
Q

Categorization of Physical Severity of Atopic Eczema

Normal skin, with no evidence of atopic eczema

A

clear

276
Q

Categorization of Physical Severity of Atopic Eczema

Widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing,
cracking, and alteration of pigmentation)

A

severe

277
Q

Categorization of Physical Severity of Atopic Eczema
Areas of dry skin, infrequent itching (with or without small areas of redness)

A

mild

278
Q

Categorization of Physical Severity of Atopic Eczema

Areas of dry skin, frequent itching, redness (with or without excoriation and localized skin thickening)

A

moderate

279
Q

Selected Topical Corticosteroid
Preparations

group 2

A

Mometasone furoate (Elocon) 0.1% ointment
Halcinonide (Halog) 0.1% cream
Fluocinonide (Lidex) 0.05% ointment/cream
Desoximetasone (Topicort) 0.25% ointment/cream
Betamethasone dipropionate (Diprolene) 0.05% cream

280
Q

Selected Topical Corticosteroid
Preparations

group 1

A

Clobetasol propionate (Temovate) 0.05% ointment/cream
Betamethasone dipropionate (Diprolene) 0.05% ointment/lotion/gel
Fluocinonide (Vanos) 0.1% cream

281
Q

Selected Topical Corticosteroid
Preparations

group 3

A

Fluticasone propionate (Cutivate) 0.005% ointment
Halcinonide (Halog) 0.1% ointment
Betamethasone valerate (Valisone) 0.1% ointment

282
Q

Selected Topical Corticosteroid
Preparations

group 4

A

Mometasone furoate (Elocon) 0.1% cream
Triamcinolone acetonide (Kenalog) 0.1% ointment/cream
Fluocinolone acetonide (Synalar) 0.025% ointment

283
Q

Selected Topical Corticosteroid
Preparations

group 5

A

Fluocinolone acetonide (Synalar) 0.025% cream
Hydrocortisone valerate (Westcort) 0.2% ointment

284
Q

Selected Topical Corticosteroid
Preparations

group 6

A

Desonide (DesOwen) 05% ointment/cream/lotion
Alclometasone dipropionate (Aclovate) 0.05% ointment/cream

285
Q

Selected Topical Corticosteroid
Preparations

A

pedia (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions