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CDM 3 Exam 2 > Lecture 4 - Dermatology 1 > Flashcards

Lecture 4 - Dermatology 1 Flashcards

1
Q

Its dermatitis if you are….

A

itching

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2
Q

endogenous dermatitis

A

Atopic
Seborrheic
Discoid
Varicose
Endogenous eczema of palms/soles
Asteatoic

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3
Q

Exogenous dermatitis

A

Primary irritant contact dermatitis
Allergic contact dermatitis

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4
Q

Atopic dermatitis info

A

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

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5
Q

Precipitating factors Atopic Dermatitis

A

Dry weather
Hot weather
Bathing
Stress
Infections
Genetics

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6
Q

Signs & symptoms of Atopic Dermatitis

A

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

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7
Q

Desired outcomes for Atopic Dermatitis

A
  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
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8
Q

non-pharm TXM Atopic Dermatitis

A

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

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9
Q

Non-pharm bathing & clothes info

A

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

Double rinse clothing and use mild detergents

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10
Q

skin hydration info

A

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

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11
Q

Which moisturizers do you want to use

A

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

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12
Q

Occlusiveness of treatments

A

Ointments > Creams > Lotions

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13
Q

Topical Steroid info

A

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

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14
Q

Topical Calcineurin inhibitors

A

Tacrolimus
Pimecrolimus

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15
Q

TCI uses

A

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

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16
Q

Tacrolimus vs Pimecrolimus

A

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

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17
Q

why are TCI not 1st line?

A

Concerns over possible risk of cancers

Dont use in children in weakened or compromised immune symptoms

18
Q

Eucrisa

A

Crisaborole

> 2yrs older Atopic dermatitis

SE: application site pain, reactions, hypersensitivity

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

19
Q

Phototherapy info

A

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

recommended if disease not controlled by TCI or topical corticosteroids

20
Q

Systemic Therapy for AD

A

Most agents not well studied or approved

Biologic response modifiers not currently approved for AD

Cyclosporine considered effective for severe AD

21
Q

How long is cyclosporine typically used for?

A

1 year, no improvements after that

22
Q

Dupilumab (Dupixent) info

A

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

23
Q

should all patients use non-pharm therapy?

A

yes

24
Q

Options for Milld AD

A
  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
25
Q

Optons for Moderate-Severe AD

A
  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
26
Q

Maintenance and prevention of relapse AD

A

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

27
Q

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

A

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

28
Q

Allergic contact dermatitis is…..

A

an inflammatory reaction caused by exposure to an allergan

29
Q

common substances to cause ACD

A

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

30
Q

ACD prevention

A

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

31
Q

Post-exposure ACD non-pharm treatments

A

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

32
Q

Urushiol cleansers

A

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

33
Q

Pharm treatments to reduce pruritus

A

calamine lotion
aluminum acetate
oatmeal bath or compresses

34
Q

Mild-moderate ACD treatment inc face or flexural

A

medium/low potency topical steroids QD/BID X 1-2 weeks

alternative: topical calcineurin inhibitors BID until resolution

35
Q

ACD involving < 20% BSA no face/flexural areas

A

High potency topical steroids QD/BID X 2-4 weeks or until resolution

alternative: topical calcineurin inhibitors Bid until resolution

36
Q

When to use oral corticosteroids for ACD

A

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

37
Q

Irritant contact dermatitis is….

A

an inflammatory reaction caused by exposure to an irritant…..

non-allergic and non-immunologic**

38
Q

ICD non-pharm prevention

A

avoid irritants
use barrier products
cover up

39
Q

non-pharm treatment ICD post-exposure

A

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

40
Q

Pharm ICD treatment

A

really not necessary

can do topical steroid, oral steroids in severe cases, and NSAIDs for pain

41
Q

exclusions for ACD/ICD

A

< 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

CDM 3 Exam 2 (11 decks)

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