Cf Paediatrics Chapter 44 Atopic Dermatitis (Eczema)

Front 1

1. Emollient?

Back 1

a. A cream or lotion that restores water and lipids to the epidermis.
b. Those containing urea or lactic acid are more lubricating and may be more effective.
c. Creams lubricate better than lotions.

Front 2

2. Flexural areas?

Back 2

a. Areas of repeated flexion and extension, which often perspire on exertion (antecubital fossae, neck, wrists, and ankles).

Front 3

3. Lichenification

Back 3

a. Epidermal thickening, w/normal skin lines resembling a washboard.

Front 4

4. Atopic dermatitis?

Back 4

a. Typically pruritic, recurrent, and flexural in older children and symmetrical in adults.
b. Aetiology is unknown but thought to be related to immune factors.
c. 70% of atopic pts have a family hx of asthma, hay fever, or eczema.

Front 5

5. Atopy?

Back 5

a. The term atopy was coined to describe a group of pts who had a personal or family hx of hay fever, asthma, dry skin, and eczema.

Front 6

6. Three phases of Atopic Dermatitis!?!?

Back 6

1. Infant phase (birth to 2 yrs)
2. Childhood (2-12 yrs)
3. Adults (>12 yrs)
b. Infants are rarely born w/atopic dermatitis, but typically develop the first signs of inflammation during the third month of life.

Front 7

7. Presentation of Atopic dermatitis (eczema) in infant?

Back 7

a. A common scenario is a baby who, during the winter months, develops dry, red, scaling cheeks w/o perioral or paranasal involvement.
b. Chin is often involved
c. Diaper area is usually spared.
d. The infant is uncomfortable because of pruritus and is often restless during sleep.

Front 8

8. Prognosis of atopic dermatitis in infant?

Back 8

a. Inflammation in flexural areas.
b. Perspiration stimulates burning and itching, initiating an itch-scratch cycle.
c. Initial papules rapidly coalesce into plaques that ultimately become lichenified when scratched.
d. The exudative lesions typical of the infant phase are not common in the childhood phase.

Front 9

10. Adult phase of atopic dermatitis?

Back 9

a. Begins near the onset of puberty.
b. Flexural inflammation ensues, often accompanied by hand dermatitis, inflammation around the eyes, and lichenification of the anogenital area.

Front 10

11. PE for atopic dermatitis?

Back 10

a. H&P
b. Includes temperature measurement to ID possible infection
c. Skin is evaluated for locations and nature

Front 11

12. Lab studies for atopic dermatitis?

Back 11

a. Not particularly helpful in diagnosing atopic dermatitis
b. Serum IgE is often elevated.
c. Culture of the skin is performed if superinfection is suspected.

Front 12

13. Seborrheic dermatitis (cradle cap) [part of the differential diagnosis for atopic dermatitis]?

Back 12

a. Usually begins on the scalp in the first few months of life and may involve the ears, nose, eyebrows, and eyelids.
b. The chronic, symmetrical eruption, characterized by overproduction of sebum, affects the scalp, forehead, retroauricular region, auditory meatus, eyebrows, cheeks, and nasolabial folds.

Front 13

14. How do you distinguish Seborrheic dermatitis (cradle cap) from atopic dermatitis?

Back 13

a. The greasy brown scales of seborrheic dermatitis are in contrast to the erythematous, weeping, crusted lesions of infantile atopic dermatitis

Front 14

15. Tx of Seborrheic dermatitis?

Back 14

a. Softening the scales w/any type of oil, avoiding scrubbing, and daily shampooing w/a mild shampoo.
b. Low to medium potency topical steroids or ketoconazole (Nizoral) shampoo maybe helpful.

Front 15

1. Other considerations in the differential of atopic dermatitis?

Back 15

a. Scabies 
b. Irritant dermatitis (perioral fruit juice dermatitis)
c. Allergic contact dermatitis (poison ivy)
d. Eczematoid dermatitis (infectious lesion near a draining ear).

Front 16

17. Tx goals of atopic dermatitis?

Back 16

a. Preserving and restoring the skin barrier by using emollients
b. Eliminating inflammation and infection w/meds
c. Reducing scratching through antipruritic use
d. Controlling exacerbating factors.
e. Some recommend limiting bathing to brief baths or showers of moderate temperature w/mild and preferably non-soap cleansers (Cetaphil).

Front 17

18. What should be avoided w/atopic dermatitis?

Back 17

a. Drying soaps (ivory).

Front 18

19. Tx options for atopic dermatitis?

Back 18

a. Lubricants (Eucerin) are applied immediately after bathing and air- or pat-drying.
b. Some products contain urea (Nutraplus) or lactic acid (Lac-Hydrin).
c. They have special hydrating qualities and may be more effective than other moisturizers.
d. Topical corticosteroids used to control inflammation vary in potency.
e. Percentage is not an indication of potency.

Front 19

20. Lower potency steroids (glucocorticoid groups VI and VII)?

Back 19

a. Can be used for longer periods to treat chronic symptoms involving the trunk and extremities.
b. Lower-potency steroids are generally used for infants and can be added to moisturizers to cover larger areas of affected skin.

Front 20

21. Only FDA-approved topical steroid for infants as young as 3 months?

Back 20

a. Fluticasone.

Front 21

23. Note: Lotions and creams may sting shortly after application due to bases or specific ingredients, such as lactic acid. If itching and stinging continue w/each application, another product should be selected.

Back 21

23. Note: Lotions and creams may sting shortly after application due to bases or specific ingredients, such as lactic acid. If itching and stinging continue w/each application, another product should be selected.

Front 22

24. Higher-potency steroids (glucocorticoid group I and II) indications?

Back 22

a. Used only for short periods and on lichenified areas.
b. The face and skin are avoided.

Front 23

25. What type of steroid preparations are preferably?

Back 23

a. Ointment preparations bc they result in better penetration of the steroid, thus reducing the incidence of irritant and hypersensitivity reactions.
b. Administration of agents is usually 2x daily unless the chosen agent requires only once-daily application.
c. Lubrication is continued after steroids are d/c.

Front 24

26. 2 Nonsteroidal, immunomodulator topicals approved for tx of atopic dermatitis?

Back 24

1. Tacrolimus (Protopic)
2. Pimecrolimus (Elidel)

b. They are approved for use in children 2 yrs and older.
c. They are recommended for short-term and long-term therapy, on a twice-daily basis, in pts not adequately responsive to, or intolerant of, conventional therapy.

Front 25

27. Role or oral antihistamines?

Back 25

a. Used to reduce itching.
b. Bc sx of atopic dermatitis are often worse at night, sedating oral antihistamines (hydroxyzine and diphenhydramine) may offer an advantage

Front 26

28. What is avoided in the treatment of atopic dermatitis?

Back 26

a. Topical antihistamines (Caladryl), bc of the potential for skin irritation or toxicity due to absorption.

Front 27

29. Topical abx for 2° skin infection?

Back 27

a. Mupirocin (Bactroban) may be used for limited areas of infection or in the nose to reduce chronic staph aureus carriage.
b. Oral abx are indicated for more extensive infection.

Front 28

30. Pityriasis rosea?

Back 28

a. Preceded by a “herald patch”, an annular, scaly, erythematous lesion.
b. The lesions are salmon-coloured and in a Christmas tree formation, following the lines of the skin.
c. Cause is unknown.
d. The rash usually lasts up to 6 wks and then resolves.
e. It can be confused w/nummular eczema and tinea versicolour.
f. In the sexually active adolescent, syphilis should also be considered.