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Dermatitis (Exam 1) Flashcards

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1
Q

Forms of contact dermatitis

A

irritant
allergic

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2
Q

in contract dermatitis, lesions are found

A

only in the area of exposure

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3
Q

irritant contact dermatitis

A

non-immune modulated irritation of the skin by a substance
can be acute or chronic

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4
Q

acute irritant contact dermatitis

A

irritant exposure to oxidizing agents, strong acids, detergents or solvents
effect in minutes to hours

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5
Q

chronic irritant contact dermatitis

A

continuous skin exposure to liquids
prolonged wearing of slices
hand washing/disinfectant

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6
Q

difference in appearance of acute and chronic irritant contact dermatitis

A

acute - erythema
chronic - cracks/skin fissures

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7
Q

allergic contact dermatitis

A

delayed hypersensitivity reaction
foreign substance comes into contact with the skin
immune modulated

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8
Q

examples of allergic contact dermatitis

A

poison ivy
nickel
fragrance exposure

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9
Q

what is the dominant feature of allergic contact dermatitis

A

pruritis

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10
Q

chronic allergic contact dermatitis symptoms

A

dry, scaly and thicker
lichenification and fissuring

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11
Q

what type of hypersensitivity reaction is contact dermatitis?

what about eczema?

A

type IV

type I (also type IV)

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12
Q

goals of therapy for contact dermatitis

A

restoration of normal epidermal barrier
treatment of inflammation of skin
control of itching

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13
Q

the mainstay of therapy in dermatitis are

A

topical corticosteroids

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14
Q

when prescribing topical corticosteroids, the ____________ potent topical agent that is effective for the patient should be used for the _______________________

A

least

shortest possible time

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15
Q

topical corticosteroids are classified according to

A

potency

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16
Q

which type of corticosteroids are more potent?

why?

A

fluorinated steroids (groups 1-3)

they penetrate the skin better than non fluorinated steroids

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17
Q

why are fluorinated steroids not used mostly first?

A

more local complications
may be associated with systemic absorption and side effects

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18
Q

the choice of steroid based on potency is determined by the ________________ to be treated.

low potency agents treats __________

Higher potency agents treats __________

A

area of skin

thinner stratum corneum (face, scrotum, skin folds)

palms and soles, crusting and thickened conditions

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19
Q

________________ are the most potent and most lubricating and have ____________ properties

A

ointments and gels

occlusive

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20
Q

what type of formulation in most desirable?

A

lotions and creams - less greasy

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21
Q

what formulations are useful for treating the scalp

A

foam sprays and solutions

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22
Q

correct usage of topical corticosteroids

A

use sparingly to affected areas 2-4 times a day
tolerance is common
repository effect (1 or 2 applications/day may be as effective as 3 or more)

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23
Q

what type of topical corticosteroids are preferred in children?

A

low potency

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24
Q

super high potency topical corticosteroids should generally not exceed

A

2 consecutive weeks due to increased risk of immunosuppression

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25
topical corticosteroids should not be _______________ because a __________ effect may occur
abruptly discontinued rebound
26
topical corticosteroids should not be applied to
wet or weeping lesions
27
adverse effects of topical corticosteroids
local tissue atrophy, skin degeneration and striae thinning of the epidermis risk of suppression of HPA axis development of cushingoid features
28
first line for irritant contact dermatitis
mild to moderate potent topical steroid oral antihistamine as needed
29
second line for irritant contact dermatitis
more potent topical corticosteroid for up to 14 days
30
first line for allergy contact dermatitis
moderate potent topical steroids oral antihistamine as needed
31
second line for allergy contact dermatitis
systemic corticosteroids, taper to no medication by 2 weeks
32
atopic dermatitis
chronic disorder due to defective skin barrier similar presentation to allergic contact dermatitis but more widespread
33
pathogenesis of atopic dermatitis
IgE dysregulation defects in the cutaneous cell mediated immune response genetic factors
34
cytokines that cause inflammation in atopic dermatitis
IL4 and IL13
35
atopic dermatitis severity scale we need to know is
United Kingdom National Institute for Health and Care Excellence
36
mild atopic dermatitis
areas of dry skin infrequent itching little impact on everyday activities sleep and psychological well being
37
moderate atopic dermatitis
areas of dry skin frequent itching and redness moderate impact on everyday activities frequently disturbed sleep
38
severe atopic dermatitis
widespread areas of dry skin (incessant itching, redness, bleeding, oozing, etc) severe limitation of everyday activities nighyly loss of sleep
39
goals of therapy for atopic dermatitis
restoration of normal epidermal barrier treatment of inflammation of skin control of itching remission
40
first line treatment for mild-moderate atopic dermatitis
emollients/moisturizers, education
41
when acute control of pruritis and inflammation is needed in mild-moderate atopic dermatitis
low potency topical corticosteroid
42
second line treatment for mild-moderate atopic dermatitis
switch to topical calcineurin inhibitors or crisaborole
43
third line treatment for mild-moderate atopic dermatitis
medium-high potency topical corticosteroid low potency topical corticosteroid or topical calcineurin inhibitors on areas of increased risk of atrophy
44
maintenance therapy for mild to moderate atopic dermatitis
topical calineurin inhibitors (2 consecutive days/week) or crisaborole include intermittent topical corticosteroids prn
45
adjunctive therapy for mild to moderate atopic dermatitis
avoidance of trigger factors antihistamine as needed
46
newer options that can be used as maintenance for mild to moderate atopic dermatitis
topical roflumilast tapinarof ruxolitinib
47
examples of emollients/moisturizers
eucerin lubriderm lac-hydrin vaseline
48
the thicker the preparation,
the more effective the product
49
Eucrisa (crisaborole)
topical phosphodiesterase 4 inhibitor mild-moderate atopic dermatitis can be used in infants 3 months and older
50
examples of topical immunosuppressants
Protopic (tacrolimus) Elidel (pimecrolimus)
51
topical immunosuppressants
inhibit calcineurin which normally initiates T cell activation acute or maintenance ages 2 and up
52
adverse effects of topical immunosuppressants
stinging, itching, burning (common) flu like symptoms muscle pain swollen glands skin infections
53
Vtama(Tapinarof)
topical immunosuppressant modulation of T helper cytokines alternative to topical steroids/ineffective treatments adults
54
Zoryve (roflumilast)
inhibits PDE4 topical immunosuppressant alternative to topical steroids/ineffective treatments ages 6 and up
55
Opzelura (Ruxollitinib)
topical immunosuppressant JAK inhibitor inhibits cytokines IL4 and 13 ages 12 and up
56
when using Opzelura (Ruxollitinib), when signs and symptoms resolve
discontinue use
57
Opzelura is approved for
short term treatment only
58
First line treatment for moderate/severe atopic dermatitis
Dupixent (dupilumab) inhibits IL4 and 13 ages 6 months and up
59
alternate treatments to the first line treatment for moderate/severe atopic dermatitis in adults
tralokinumab (Adbry) Lebrikizumab (Ebglyss)
60
second line treatment for moderate/severe atopic dermatitis
oral JAK (janus kinase) inhibitors: Rinvoq(upadacitinib) Cibinqo (abrocitinib) phototherapy
61
can topical corticosteroids or other topical agents still be used in a person who has moderate/severe atopic dermatitis on maintenance treatment?
yes! only as needed
62
biologic agents adverse effects
conjunctivitis and keratitis eosinophilia antibody development viral infection injection site reactions
63
biologics inhibit the
binding of one or more cytokines, by either binding the cytokine or receptor causing changes that trigger inflammation
64
biologics are ____________ while JAK inhibitors are ______________
genetically engineered proteins from living organisms synthetic
65
JAK inhibitors block
enzymes which decrease inflammation from INSIDE the cells
66
are biologics or JAK inhibitors preferred when treating atopic dermatitis? why?
while JAK inhibitors provide more rapid improvement, BIOLOGICS are preferred there is potential risk for serious adverse events when using JAK inhibitors
67
when to use JAK inhibitors
control of seasonal flares eczema that does not respond to biologics
68
JAK inhibitors are considered _____________ due to their serious adverse effects
last line agents
69
phototherapy
use of UV light to slow the rapid growth of new skin cells in atopic dermatitis
70
JAK inhibitors warnings/precautions
cerebrovascular accidents MI hypotension arrhythmias hematologic toxicities severe hepatic reactions reactivation of HBV active TB
71
non targeted oral immunosuppressive agents for moderate/severe atopic dermatitis
cyclosporine (Neoral, Sandimmune) methotrexate
72
cyclosporine (Neoral, Sandimmune)
blocks calcineurin activation inhibiting T cell activation and non targeted cytokine production
73
Methotrexate
inhibits folic acid reductase resulting in the inhibition of cellular DNA replication leads to suppression of inflammation
74
methotrexate is often combined with
folic acid
75
methotrexate is contraindicated in
pregnancy (X)
76
treatments for scalp seborrhea
topical corticosteroids in conjunction with a shampoo: either selenium sulfide (Selsun) or ketoconazole (Nizoral) salicylic acid coal tar products
77
treatments for diaper rash
occlusive agents (zinc oxide, petrolatum) low potency topical corticosteroid
78
if secondary Candida infection is present in diaper dermatitis, the treatment should include
anti fungal agents (nystatin, clotrimazole, miconazole, ketoconazole)
79
super high potency topical corticosteroids (group 1)
betamethasone dipropionate augmented clobetasol propionate fluocinonide halobetasol propionate
80
high potency topical corticosteroids (group 2)
halcinonide
81
medium potency topical corticosteroids (group 4)
mometasone furoate
82
lower mid potency topical corticosteroids (group 5)
hydrocortisone butyrate hydrocortisone probutate hydrocortisone valerate
83
low potency topical corticosteroids (group 6)
alcometasone dipropionate desonide
84
least potent topical corticosteroids (group 7)
hydrocortisone (base less than 2%)

Pharmacotherapeutics (28 decks)

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