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45 Cards in this Set
- Front
- Back
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What is the colloquial term for atopic dermatitis?
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Ezcema
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What is the triad of AD?
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Atopic dermatitis
Asthma Allergic rhinitis |
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When does atopic dermatitis onset?
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Early infancy
Childhood |
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Where is there a higher prevalence of AD?
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Industrialized countries
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What are the clinical features of AD?
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Dryness
Intense ITCHING!!! Rash that occurs after the rash. |
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What does acute AD look like?
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more intensely Itchy
Red Excoriations Weeping Crusting (drying up of the moisting) SPARING OF THE NOSE!!!!! |
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Where do you find acute AD in infants?
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Face
Scalp Extensors |
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What does chronic atopic dermatitis look like?
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Thickened plaques
Lichenification due to rubbing and scratching (linear marks on the skin) Allergic shiners Dennie morgan folds |
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If an older kid or adult has dermatitis, where on the body is it found?
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Flexures of extremities
Chronic hand dermatitis |
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What kinds of bacterial infections are you more vulnerable to if you've got atopic dermatitis?
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S. aureus
You can get impetigo within the lesions |
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What kinds of viral infections are you more vulnerable to if you have AD?
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HSV
Vaccinia Molluscum Warts |
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What can occur in kids with AD and vaccinia? What is the cause
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Eczema vacciniatum
Small, punched out lesions all over the place; you've got to admit and put them on antivirals DON'T LET PEOPLE WHO COME INTO CONTACT WITH THEM GET A SMALLPOX VACCINE!!! |
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What mutations occur in AD?
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Filaggrin
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What factors play a role in AD?
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Altered lipid content
Increased protease activity Altered innate immunity Altered adaptive immunity Food allergies |
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What is the function of filaggrin?
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Helps make corneocytes flat and compact. After this it's broken down into AAs that promote water coming into the area.
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What's the effect of having a flaggrin mutation?
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You can have more antigens coming in...more activation of the lymphocytes...more problems!
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What mutation is present in ichthyosis vulgaris?
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Filaggrin
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What are some findings on people with FLG mutation?
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Atopic dermatitis + ichythosis vulgaris
PALMAR HYPERLINEARITY Early onset disease |
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What is the effect of FLG on the respiratory tract? Why?
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Increased risk of asthma
You get a systemic sensitization that causes asthmatic reactions |
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What's the association with the number of FLG copies and skin dryness?
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Less repeats, drier skin
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What is the effect of AD on lipid content?
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Decreases it, especially ceramide.
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What is the effect of altered lipids in AD?
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More water loss!
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What are the effects of decreased lipids on treatmnetfor AD?
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Soaps are bad!
-Alkaline pH emulsifies the surface lipids Synthetic detergents are great! |
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What are some of the different moisturizes used in AD?
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Occlusives to trap the water
Humectants to draw water into the strateum corneum |
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Why are the flexors favored in AD?
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Thinner barrier than other places: flexures, eyelids, face.
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What is the purpose of desquamation?
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Keeps the wall of the epidermis at a constant thickness
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What are the agents that perform desquamation?
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Stratum corneum chymotryptic enzyme
Stratum corneum tryptic enzyme |
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What are agents that regulate the desquaminating enzymes?
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Protease inhibitors
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What is the effect of AD on desquamation?
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Increased!
More stratu corneum chymotriptic enzymes. |
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What is the effect of soap on the barrier?
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Increases the pH, so the strateum corneum chymotryptic enzyme is more effective.
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What happens to the skin microbiome during a flare of AD?
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Decreased variety and increased staph!`
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What are the key cytokines in AD?
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Th2!
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What IL stimulates Th2 production?
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IL-4
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What do Th2s make?
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IL-4
IL-5 IL-10 |
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What do you see in Th2 inflammation?
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Increased IgE
Increased eosinophis Increased mast cells |
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What are the activities of mast cells in Th2 inflammation?
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Histamine production
IL-4, IL-13 production-->IgE Induction of mast cell chymase |
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What proteases are produced by S. aureus and dust mites?
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stratum corneum chymotriptic enzyme
stratum corneum tryptic enzyme |
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What is the relationship between food allergies and AD?
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35% have allergies
Most reactions are to: EGG!!! Milk Wheat Soy Nuts Most of the problems are in kids. |
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What's the test for allergies?
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Skin prick test
High NPV, low PPV |
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Do food allergies in pediatric AD persisit?
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No.
They go away (esp. if it's egg, soy, and wheat) by age 16 |
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What's the key goal in the treatment of atopic dermatitis?
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Improve the barrier!
Repair the damage; prevent breakdown Eliminate exacerbating factors |
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What are ways that you can improve the barrier in people with AD?
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Bathe!
-after bathing, use a moisturizer -DON'T USE SOAP!!! MOISTURIZE, MOISTURIZE!!! |
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What are ways that you can repair the damage in AD?
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Topical steroids to the skin
Antihistamines DON'T GIVE SYSTEMIC STEROIDS!!! |
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What is the quantity of meds in a fingertip unit?
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.5 grams
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What are the ways that you can eliminate exacerbating factors in AD?
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Get rid of staph!
-topical, oral antibotics. -bleach baths Decrease the amount of dust mites in the environment. |
