Angie Amoson by xV43uA2v


  Atopic Dermatitis

             Angie Amoson
What is Eczema?
• Atopic eczema is a chronic, relapsing,
  inflammatory skin condition associated with
  epidermal barrier dysfunction

• Significant genetic and environmental influences

• Hygiene hypothesis
  – Urban and industrialized areas
  – Higher socioeconomic status
  – Smaller family size
Who is at risk?
Who is at risk?
• Anyone at any age

• High prevalence in the US, UK, and Australia

• 70% of cases start in children under five years of
  – Asthma develops in 30% of children with eczema

• 10% of cases seen in the hospital setting start in
  – Most adult cases are recurrences from childhood
Genetic or Environmental?
• Several genes have been identified that may
  contribute to the disease

• The disease is heritable

• Environment plays a huge role
  –   Allergies
  –   Staphylococcus aureus infections
  –   Exposure to microbes at infancy
  –   Excessive heat
  –   Exposure to irritants that disrupt the skin barrier
What are the symptoms?
• Itchy rash

• Weeping rash

• Lichenification (skin

• May appear to be
  extremely dry,
  “cracking” skin
How is it diagnosed?
• Eczema is very difficult to diagnose because of
  its “variable morphology”

• Several factors influence the diagnosis of
  –   Sleep disturbances
  –   Asthma
  –   Family history
  –   Number and location if sites

• Severe? or moderate? or mild?
How is it diagnosed?
• Diagnosis is based on
  features presented at
  the time

• Skin-prick or
  tests can be preformed
  to identify food and
  environmental allergens
What is the pharmaceutical
•   Emollients
•   Other Topical Agents
•   Oral Antihistamines
•   Topical Doxepin
•   Antibiotic Agents
•   Topical Corticosteroids
•   Immunosupressive Agents
•   Topical Calcineurin Inhibitors
Topical Corticosteroids
• Considered the first-line treatment
• Very weak or moderate strength preparations are used
  on the face or in genital areas
• Stronger preparations can be used on other areas of the
• Usually used for 3-7 days when outbreaks occur
• Main concern is irreversible skin thinning
• Examples
   – Traimcinolone acetonide and retonic acid
   – Fluticasone propionate
   – Fusidic acid and hydrocortisone cream
Immunosupressive Agents
• Reserved for patients that do not respond to any
  other treatments

• Examples
  –   Prednisone
  –   Cyclosporin
  –   Azathioprine
  –   High dose Immunoglobin (Ig)
Topical Calcineurin Inhibitors
   Topical Immunomodulators
• Do not cause skin thinning like topical

• Studies show that the use of topical calcineurin
  inhibitors with topical corticosteroids could
  reduce the frequency of outbreaks

• Considered second-line agents
Elidel (Pimecrolimus)
• May be used for eczema on the head and neck or any
  other area

• Topical (cream)

• Dosage (1%)
   – Apply twice a day to the infected area

• Cost
   – 30g tube = $71- $79

• Should not be administered for more
  than 6 weeks at a time
Protopic (Tacrolimus)
• Topical (ointment)

• Dosage (0.03% or 0.1%)
   – Adults  0.03% or 0.1% twice daily
   – Children  0.03% twice daily

• Cost
   – 10g tube of 0.1% = $104.85
   – 10g tube of 0.03% = $94.85
Elidel and Protopic
• Side effects
   – Burning at application site
   – Cold-like symptoms
   – Rarely skin and viral infections

• Drug interactions
   – Erythromycin, itraconazole, ketoconazole, fluconazole, calcium
     channels blockers, cimetidine

• Warnings
   – The long-term safety has not been established.
Non-pharmaceutical treatments
• UV light
  – Easy use and low cost

  – Time consuming, moderate
    efficacy, and only used when
    other methods have failed

  – Can potential cause cancer
Non-pharmaceutical treatments
• Behavior changes
  – Avoiding food that trigger reactions
  – More helpful in kids than adults
   What other effects does the
   disease have on the patient?
• Psychological

• Financial

• Time consuming

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