Lecture 4 - Dermatology 1

Question 1

Its dermatitis if you are….

Answer 1

itching

Question 2

endogenous dermatitis

Answer 2

Atopic
Seborrheic
Discoid
Varicose
Endogenous eczema of palms/soles
Asteatoic

Question 3

Exogenous dermatitis

Answer 3

Primary irritant contact dermatitis
Allergic contact dermatitis

Question 4

Atopic dermatitis info

Answer 4

AKA excema
Prelude to atopic diathesis
Inflammation & Pruritus**
~8% pts develop symptoms before 5yrs old

Question 5

Precipitating factors Atopic Dermatitis

Answer 5

Dry weather
Hot weather
Bathing
Stress
Infections
Genetics

Question 6

Signs & symptoms of Atopic Dermatitis

Answer 6

Inflammation and pruritus
Early age of onset
Excematous skin lesions
Dry, Flaky skin
IgE reactivity
Chronic or releasing courses

Question 7

Desired outcomes for Atopic Dermatitis

Answer 7

1. provide symptomatic relief and control AD
2. id/elim trigger of aeroallergens
3. ID/minimize factors for exacerbations, including stressors
4. prevent flare-ups
5. minimize/prevent ADE from meds
6. Treat any secondary skin infection if present

Question 8

non-pharm TXM Atopic Dermatitis

Answer 8

Moisturizer
Keep finger nails filed short
Use cotton
Limit scratching
ID and renovate irritants/allergens
Humidity should be kept at/above 50% and temp should be cool

Question 9

Non-pharm bathing & clothes info

Answer 9

Bathing lukewarm water, between 15/20min….can ad emulsifying oil and apply moisturizer after bathing

Double rinse clothing and use mild detergents

Question 10

skin hydration info

Answer 10

lotions aren’t ideal due to high water/low oil and draw water out

Question 11

Which moisturizers do you want to use

Answer 11

active ingredients are mineral oil, petrolatum and urea
use scent free

Question 12

Occlusiveness of treatments

Answer 12

Ointments > Creams > Lotions

Question 13

Topical Steroid info

Answer 13

ultrahigh and high potency topical steroids should be reserved for severe cases

matched to severity and site of disease

after stuff clears can move to lower potency steroids such as HCort 2.5%

Dont wanna use on thin skin

Question 14

Topical Calcineurin inhibitors

Answer 14

Tacrolimus
Pimecrolimus

Question 15

TCI uses

Answer 15

very useful in reducing pruritus
equal to medium-dose potency steroids
** can be used anywhere **

Question 16

Tacrolimus vs Pimecrolimus

Answer 16

Pimecrolimus useful in pts who cant tolerate stinging of Pimecrolimus, also more favorable lipophilic characteristics

Taco 0.03% = > 2yrs old, 0.1% > 16yrs old
Pimecrolimus 1% > 2yrs old

Question 17

why are TCI not 1st line?

Answer 17

Concerns over possible risk of cancers

Dont use in children in weakened or compromised immune symptoms

Question 18

Eucrisa

Answer 18

Crisaborole

> 2yrs older Atopic dermatitis

SE: application site pain, reactions, hypersensitivity

use after Topical Steroids & TCI before trying due to $$$

Question 19

Phototherapy info

Answer 19

may worsen AD in pts who get flare from sunlight
Relapse frequently occurs

recommended if disease not controlled by TCI or topical corticosteroids

Question 20

Systemic Therapy for AD

Answer 20

Most agents not well studied or approved

Biologic response modifiers not currently approved for AD

Cyclosporine considered effective for severe AD

Question 21

How long is cyclosporine typically used for?

Answer 21

1 year, no improvements after that

Question 22

Dupilumab (Dupixent) info

Answer 22

FDA approved for moderate/severe atopic dermatitis in adults not adequately controlled by topical prescription therapies

Favored to other immunosuppressants

MOA: monoclonal antibody binds IL-4

Limited by cost $$$, given SubQ every other week

Question 23

should all patients use non-pharm therapy?

Answer 23

yes

Question 24

Options for Milld AD

Answer 24

1. Low potency TCS once daily for 2-4weeks and reassess
2. Continue or switch to TCI or crisaborole for 2-4 weeks if no response
3. Medium-high potency TCS on affected areas QD/BID for 2-4 weeks (low-med or TCI for sensitive areas)
4. consider phototherapy/dupilumab if no response

Question 25

Optons for Moderate-Severe AD

Answer 25

1. Medium to high potency TCS on affected areas QD/BID for 2-4 weeks....low/med or TCI for sensitive areas 2. Consider phototherapy/dupilumab

Question 26

Maintenance and prevention of relapse AD

Answer 26

After remission.... intermittent therapy w/ moderate to high potency topical steroids, applied QD to previously affected skin for 2 consecutive days per week for up to 16 weeks Emollients applied liberally multiple times per day

Question 27

preventing relapse in infants/young children w/ moderate-> severe atopic dermatitis who have frequent flares....

Answer 27

proactive intermittent therapy w/ low potency topical corticosteroids applied once daily to previously affected skin areas for 2 consecutive days per week X 16 weeks

Question 28

Allergic contact dermatitis is.....

Answer 28

an inflammatory reaction caused by exposure to an allergan

Question 29

common substances to cause ACD

Answer 29

Urushiol Metals = nickel, cobalt, chromium Topical anesthetics Fragrances Latex Neomycin/bacitracin

Question 30

ACD prevention

Answer 30

avoid allergens cover up and use barrier products when working with allergens eradicate poison ivy/oak/sumac from home

Question 31

Post-exposure ACD non-pharm treatments

Answer 31

wash area and remove and wash any clothing that was exposed cold/tepid, soap-less shower trim fingernails and limit scratching cold compress oatmeal bath

Question 32

Urushiol cleansers

Answer 32

Tech outdoor Zanfel cream Others = goop grease remover, dish soap

Question 33

Pharm treatments to reduce pruritus

Answer 33

calamine lotion aluminum acetate oatmeal bath or compresses

Question 34

Mild-moderate ACD treatment inc face or flexural

Answer 34

medium/low potency topical steroids QD/BID X 1-2 weeks alternative: topical calcineurin inhibitors BID until resolution

Question 35

ACD involving < 20% BSA no face/flexural areas

Answer 35

High potency topical steroids QD/BID X 2-4 weeks or until resolution alternative: topical calcineurin inhibitors Bid until resolution

Question 36

When to use oral corticosteroids for ACD

Answer 36

involves > 20% BSA < 20% BSA and is disabling OR has not responded to treatment Chronic ACD unresponsive to topical or oral corticosteroids may respond to phototherapy

Question 37

Irritant contact dermatitis is....

Answer 37

an inflammatory reaction caused by exposure to an irritant..... non-allergic and non-immunologic****

Question 38

ICD non-pharm prevention

Answer 38

avoid irritants use barrier products cover up

Question 39

non-pharm treatment ICD post-exposure

Answer 39

trim fingernails oatmeal bath cold, soap-less shower wash area and remove any clothes

Question 40

Pharm ICD treatment

Answer 40

really not necessary can do topical steroid, oral steroids in severe cases, and NSAIDs for pain

Question 41

exclusions for ACD/ICD

Answer 41

< 2yrs old last more than 2 weeks BSA > 25% numerous bull present extreme itching, irritation swelling of eyelids/extremiteis involvement,emt of genitalis, eyes or mucus membranes pts with low tolerance of itching/pain