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Questions and Answers
What topical therapy is not mentioned in the content for atopic dermatitis?
What would you recommend for IG, a 24-year-old female with a past medical history of asthma and seasonal allergies, who has dry, itchy skin on the back of her knees?
What would be a good alternative to corticosteroids for IG?
How long would a 60-gram tube of cream last if applied BID, covering an area of ~2 hand-prints behind each knee?
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What is NOT a systemic therapy option for atopic dermatitis?
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What would you recommend if IG had a past medical history of HIV?
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What could be added to help IG sleep at night?
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What is an alternative to topical corticosteroids?
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What would you recommend for IG if she preferred a non-steroid option?
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What is NOT a comprehensive treatment option for atopic dermatitis?
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Study Notes
Atopic Dermatitis (AD) Treatment
- Appropriate care candidate: Yes, if < 2 years old, involvement of large area of body (>5% BSA), and presence of triggers
- Effective therapy: Eliminate triggers, skin hydration, and appropriate pharmacotherapy
Goals of Treatment
- Relieve itch and rash
- Prevent flare-ups
- Improve quality of life
Non-Pharmacologic Interventions
- Avoid triggers (e.g., clothing, detergents, fabric softeners)
- Bathe with non-soap cleansers, lukewarm water, and apply moisturizer immediately after
- Wear cotton clothing, use mild detergent, and avoid alcohol-containing products
- Keep fingernails short and avoid scratching
Emollients and Moisturizers
- Lotions, creams, and ointments containing water, mineral oil, petrolatum, lanolin, or ceramide
- Apply topically, TID-QID, maybe more often if on hands
- Maximize hydration by applying immediately after bathing while skin is still damp
Topical Corticosteroids
- Hydrocortisone: suppresses cytokines associated with inflammation and itchiness
- Strengths available OTC: 0.5% and 1%
- Administration: Apply sparingly to affected area, BID (up to 4 times daily), for 7 days (self-care use)
- Local side effects are uncommon due to low potency
Systemic Therapy
- Apremilast (Otezla): limited role for AD
- Systemic corticosteroids, cyclosporine, interferon, azathioprine, methotrexate, mycophenolate mofetil, and nemolizumab
Case Study
- IG, a 24-year-old female with AD, asthma, and seasonal allergies
- Recommended OTC: Urea topical lotion
- Recommended Rx: Aclometasone ointment or Crisaborole ointment
- How to apply: Apply topically, BID, to affected area
- Treatment expectations: Relieve itch and rash, improve quality of life
- Key counseling points: Avoid triggers, use moisturizer, and avoid scratching
Fingertip Method
- Use to determine the days' supply of a prescription for a cream or an ointment
- Example: If the affected area is ~2 hand-prints behind each knee, and applied BID, a 60-gram tube will last approximately 10-14 days
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