Podcast
Questions and Answers
What topical therapy is not mentioned in the content for atopic dermatitis?
What topical therapy is not mentioned in the content for atopic dermatitis?
- Tapinarof cream
- Corticosteroid (correct)
- Coal tar
- Phototherapy
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 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?
- Lanacort topical ointment
- Diphenhydramine topical gel
- Urea topical lotion
- Cortaid topical cream (correct)
What would be a good alternative to corticosteroids for IG?
What would be a good alternative to corticosteroids for IG?
- Apremilast
- Tapinarof cream
- Crisaborole ointment (correct)
- Probiotics
How long would a 60-gram tube of cream last if applied BID, covering an area of ~2 hand-prints behind each knee?
How long would a 60-gram tube of cream last if applied BID, covering an area of ~2 hand-prints behind each knee?
What is NOT a systemic therapy option for atopic dermatitis?
What is NOT a systemic therapy option for atopic dermatitis?
What would you recommend if IG had a past medical history of HIV?
What would you recommend if IG had a past medical history of HIV?
What could be added to help IG sleep at night?
What could be added to help IG sleep at night?
What is an alternative to topical corticosteroids?
What is an alternative to topical corticosteroids?
What would you recommend for IG if she preferred a non-steroid option?
What would you recommend for IG if she preferred a non-steroid option?
What is NOT a comprehensive treatment option for atopic dermatitis?
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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