Term
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Definition
| a common medical term used to describe patients at risk of developing allergic rhinitis, asthma, and atopic dermatitis |
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Term
THE EXACT CONTRIBUTING CAUSE OF ATOPIC DERMATITIS (AD) IS UNKNOWN
A COMBINATION OF GENETIC, ENVIRONMENTAL, AND IMMUNOLOGIC MECHANISMS ARE THE MOST LIKELY PRIMARY CAUSES OF AD |
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Definition
patients with one atopic condition are at a higher risk of developing another atopic disease
patients with one or both parents that have an atopic condition are also at higher risk of developing another atopic disease
patients with AD often also have elevated levels and/or abnormalities in function of immune mediators such as IgE, eosinophils, macrophages, lymphocytes, mast cells, or Langerhans cells
AD's underlying immune mediated mechanisms occurs by both IgE and T helper cells
since different immune mediated mechanisms can contribute to this condition, a wide variety of clinical presentations and high variation in response to treatments is seen with patients having AD
immunologic and/or allergen triggers that commonly cause AD exacerbations include the following:
ALLEROALLERGENS - dust mites, cat cander, molds, ragweed pollen, grass
FOOD ALLERGENS - egg, milk, peanuts, soy, wheat
OTHER - stress, soaps/detergents, abrasive clothing, smoking, extreme temperatures, humidity
children will often "outgrow" food allergens. parents should be careful in examining food labels in determining if they contain these allergens and/or related allergens
breast fed infants have been shown to beat lower overall risk of developing allergies/atopic disease. for infants at high risk of developing AD (family history of one or more atopic conditions), parents should be counseled that exclusive breastfeeding during the first 3-6 months of life may decrease the risk of developing AD
greater air pollution, urbanization, industrialization, and higher socioeconomic status have also been correlated to increased rates of AD |
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Term
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Definition
a hallmark complaint of patients with AD
xerosis occurs ON A LARGE AREA OF THE BODY AND IS PRESENT MOST OF THE YEAR
dry skin is primarily due to keratinocytes within the epidermis are unable to hold in water
this abnormal skin barrier allows irritants (i.e. chemicals, allergens) to more easily penetrate and cause pruritus and inflammation of the skin
xerosis can become progressively worse with time, in particular if not cared for properly |
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Term
| overall treatment strategies for AD include: |
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Definition
identification and avoidance of triggers
adequate skin hydration and patency
prompt treatment of acute exacerbations |
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Term
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Definition
non medication measures should be tailored toward specific triggers of patients
skin hydration with moisturizers is an essential component of the treatment plan for AD management |
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Term
| moisturizers can be classified as: |
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Definition
OCCLUSIVE - provide an oily layer to protect skin from water loss; best moisturizer for AD
HUMECTANTS - increase water holding capacity of skin; not useful for AD
EMOLLIENTS - smooth out skin surface by filling spaces with oil droplets; least effective for AD |
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Term
| general non-pharm therapies for AD |
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Definition
identify and eliminate potential allergens
limit overall length of bathing and potentially frequency of bathing
use lukewarm water in baths/showers
avoid soaps or detergents with irritants (ex. dyes, fragrances)
avoid washcloths or irritating scrubs
air dry skin or gently pat dry
apply emollient therapy immediately after bathing
keep fingernails short and clean
consider cotton gloves to prevent scratching at night
use cotton sheets and pajamas
avoid temperature extremes
use a second rinse cycle for laundry
keep humidity at or above 50% at home |
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Term
| topical corticosteroids: MOA |
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Definition
| vasoconstrictive and anti-inflammatory effects aids in symptomatic relief and healing of skin manifestations |
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Term
| topical corticosteroids: ADRs |
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Definition
often dependent on potency or strength used, quantity applied, frequency of applications, length of therapy, and areas of application (in particular in children)
systemic ADRs such as hypothalamus pituitary axis (HPA) suppression and growth retardation rarely occur
long term ADRs:
skin atrophy
straie
hypo-pigmentation
steroid induced acne |
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Term
| topical corticosteroids: place in therapy for AD management |
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Definition
1st line agents for acute AD flares and only to be used for short term management
use for no more than 3 weeks
do not use on face, mucous membranes, eyelids, or skin folds
reserve use for lichenified (thickened lesions) or refractory exacerbations
mild to moderate potency agents can be used for chronic AD
children should be treated with low potency agents |
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Term
| topical immunomodulators (tacrolimus, pimecrolimus): MOA |
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Definition
inhibit calcineurin receptors by forming a complex with FKBP-12, calcium, clamodulin, and calcineurin
calcineurin receptors are involved in T cell activation |
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Term
| topical immunomodulators (tacrolimus, pimecrolimus): ADRs |
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Definition
burning
itching
BBW: long term safety of topical calcineurin inhibitors has not been established and rare cases of malignancy (e.g. skin and lymphoma) have been reported in patients treated with topical calcineurin inhibitors. due to these un-established risks with chronic use, these medications are often reserved as a second line therapy for persistent or refractory disease |
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Term
| topical immunomodulators (tacrolimus, pimecrolimus): place in therapy |
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Definition
second line therapy for AD
may be used for acute exacerbations for long term management of AD
reductions in disease severity and acute AD flares have been evaluated with chronic use of both medications
indications for use:
tacrolimus - 2 years of age and older, use for moderate to severe AD disease
pimecrolimus - 2 years of age and older, used for moderate to severe AD disease |
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Term
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Definition
| block effects of histamine by competing for histamine receptors (inhibit effects of H1 and/or H2 receptors) |
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Term
| antihistamines: place in therapy for AD management |
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Definition
adjunctive therapy for pruritus symptoms
sedating antihistamines (non-selective antihistamines) may be most effective in treating night itching
topical preparations have shown variable therapeutic effectiveness; not recommended for use |
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Term
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Definition
| possess anti-inflammatory and anti-pruritic properties |
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Term
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Definition
folliculitis
photosensitivity
strong odor and stains clothing |
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Term
| coal tar: place in therapy |
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Definition
used as a second line therapy option for AD
often used in combination with steroids and/or UV light therapies
avoid use on acute purulent lesions |
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Term
| potency of betamethasone dipropionate |
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Definition
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Term
| potency of clobetasol propionate |
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Definition
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Term
| potency of desoximetasone |
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Definition
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Term
| potency of triamcinolone acetonide |
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Definition
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Term
| potency of mometasone furoate |
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Definition
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Term
| potency of hydrocortisone |
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Definition
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