Term
| Where is infantile eczema typically located? |
|
Definition
On the scalp,
cheeks, and forehead. Eventually extend to trunk and extensor surfaces of extremities. |
|
|
Term
| Where is childhood eczema typically located? |
|
Definition
- Flexural surfaces, in the antecubital and popliteal fossa.
- Peri-oral region
- Wrists/ankles
- Neck
|
|
|
Term
| Where is adolescent/adult eczema typically located? |
|
Definition
- Face (periorbital and perioral regions)
- Dorsal feet
- Hands
- Upper back
|
|
|
Term
| What are the essential features in the diagnosis of AD? |
|
Definition
1. Pruritus
2. Chronic, relapsing eczematous dermatitis
3. Age-specific distribution |
|
|
Term
| What are the core differential diagnoses for atopic dermatitis that should be ruled out? |
|
Definition
Scabies
Psoriasis
Ichthyoses
Seborrheic dermatitis
Contact dermatitis (irritant or allergic)
Cutaneous T-cell lymphoma
Photosensitivity dermatoses
Immunodeficiency diseases
Erythroderma of other causes |
|
|
Term
| Clinically, what kind of things can help you determine atopic dermatitis severity? |
|
Definition
-Body surface area affected
-Degree of erythema
-Number of papules
-Presence or absence of edema
-Presence of absence of excoriations
-Presence of absence of lichenification
-Intensity of pruritus
-Disease persistence
-Intensity of flares
-Effect on quality of life |
|
|
Term
| If a patient with atopic dermatitis is with poor response to therapy, unusual infections, and/or failure to thrive, what should you consider? |
|
Definition
Nutritional and Metabolic disorders (acrodermatitis enteropathica, biotin deficiency, celiac disease, etc)
Primary Immunodeficiency Disorders (Agammaglobulinemia, Hyper IgE syndrome, Wiskott-Aldrich syndrome, etc)
Other (Ataxia-telangiectasia, Langerhans cell histiocytosis, etc) |
|
|
Term
| What is the most common pathogen implicated in bacterial superinfections of atopic dermatitis? Second most common? |
|
Definition
1. Staphylococcus aureus
2. Group A Streptococcus |
|
|
Term
| What are the cutaneous findings of a Staphyloccocus aureus cutaneous superinfection? |
|
Definition
| Honey-colored crusting, weeping, and pyoderma |
|
|
Term
| What are the most common viral superinfections in atopic dermatitis? |
|
Definition
HSV
Molluscum contagiosum
Coxsackie virus |
|
|
Term
| Name this superinfection: grouped vesicles in a “cluster of grapes” appearance overlying diffuse eczematous papules and plaques. Patients can manifest with severe pruritus, pain, and systemic illness, often requiring hospitalization |
|
Definition
|
|
Term
| What are the basic management strategies for atopic dermatitis? |
|
Definition
-Bathing in lukewarm water
-The use of mild or non-soap cleansers
-Application of emollients after bathing to retard evaporation of water
-Applying emollients generously at least twice daily to boost cutaneous hydration |
|
|
Term
| _______ was superior to ______ in several studies in decreasing S aureus colonization and atopic dermatitis severity. |
|
Definition
| Coconut oil was superior to olive oil in several head-to-head studies in decreasing S aureus colonization and AD severity. |
|
|
Term
| What is the first-line treatment for acute flares of atopic dermatitis? |
|
Definition
|
|
Term
| How many classes of topical steroids are there? What are the classes defined by? |
|
Definition
7 classes exist
Defined by potency
7- least potent
1- most potent |
|
|
Term
| Which areas of the body are very penetrable and should be treated with lower-potency topical steroids? |
|
Definition
| Facial and intertriginous areas |
|
|
Term
| What should providers be using to determine the correct amount of topical steroids that should be prescribed? |
|
Definition
|
|
Term
| What is wet wrap therapy (WWT), and why does it work? |
|
Definition
1. The WWT involves the application of topical steroids or emollients followed by 2 successive layers of cotton pajamas, gauze, or tubular bandages (first layer wetted with warm water; second layer dry).
2. The occlusive properties of WWT enhance penetration of the topical agent(s), improving treatment success |
|
|
Term
| What should you consider if a patient's skin worsens with topical steroids? What should you do? |
|
Definition
1. Allergic sensitization to specific components in topical formulations, including preservatives, vehicle, or active ingredients
2. Refer to allergy for patch testing |
|
|
Term
| What are the most common adverse effects of topical steroids? |
|
Definition
skin atrophy
telangiectasias
acneiform lesions
hypertrichosis
Corticophobia is common among parents and can affect treatment adherence, but in fact, adverse effects of topical steroids are actually quite rare. |
|
|
Term
What is TCI therapy?
When is it useful?
Who is it approved for? |
|
Definition
1. Topical calcineurin inhibitor (aka, non-steroidal)
2. Second line therapy for moderate to severe atopic dermatitis who have failed to respond adequately to other topical prescription treatments for atopic dermatitis. It has fewer cutaneous risks and may be more suitable for thin-skinned areas, such as the face and intertriginous regions
3. FDA approved for children older than 2 years (however, dermatology does prescribe it younger, on case-by-case basis) |
|
|
Term
| What can you consider in patients whose atopic dermatitis flares frequently? |
|
Definition
Proactive maintenance therapy (use regularly scheduled topical application of anti-inflammatory medications to frequently flaring skin areas)
Topical steroids: once to twice weekly (medium potency; excluding face and intertriginous regions) and/or once to twice daily (low potency; including face and intertriginous regions)
Topical calcineurin inhibitors: application 2 to 3 times weekly, or once to twice daily in recalcitrant cases.
|
|
|
Term
| What are the most common food allergens in patients with atopic dermatitis? |
|
Definition
| egg, milk, peanut, soy, and wheat |
|
|
Term
| What are the incidence rates of food allergy in pediatric patients with atopic dermatitis? |
|
Definition
mild-to-moderate AD: 15%
moderate-to-severe disease AD: 30%-40% |
|
|
Term
| When should a child with atopic dermatitis undergo food allergy testing? |
|
Definition
1) the child has persistent atopic dermatitis in spite of optimized management and topical therapy
and/or
2) the child has reliable history of an immediate reaction after ingesting specific foods. |
|
|
Term
What did the LEAP trial show?
What are the food allergy testing recommendations as a result of the LEAP trial? |
|
Definition
1. Children with severe eczema and/or egg allergy were shown to have a decreased rate of development of peanut allergy with early peanut consumption, beginning at 4 to 11 months of age and continuing until 5 years of age.
2. Children with severe AD in the first year of life should be evaluated with specific IgE to peanut, with early feeding with a negative serum test result and referral to allergy for skin prick testing for positive specific IgE peanut blood test results, or direct referral before serum screening, for skin prick evaluation for determination of the safety of early peanut feeding. |
|
|
