questions

Case Study: Atopic Dermatitis

· Only answer the bolded highlighted yellow questions to the case study.

· Answers must be bulleted

· Only use the ppt to answer the questions

· Concise, bulleted answers are highly preferred. Points will be removed for lengthy answers.

 

After reviewing the case, please provide answers to the questions that follow. Concise, bulleted answers are highly preferred. Points will be removed for lengthy answers.

 

1st Visit

 

 Background:

AT is a 6-year-old boy who presents with a pruritic rash involving predominantly his wrists, ankles, and popliteal and antecubital fossae. Figures 1 and 2 show what his rash looks like (antecubital and popliteal fossae). When he plays soccer, the rash burns, and itches intensely. He has had similar symptoms off and on since the age of 18 months when, according to the mother, he developed an itchy rash on his face and upper torso. He has mild persistent asthma which is being managed with fluticasone (by oral inhaler, 88 mcg twice daily) and albuterol (by oral inhalation, 1 to 2 puffs every 4 to 6 hours as needed for rescue). AT has no other symptoms at present and has no known drug allergies. 

 

 

1. Would antihistamine therapy be useful in the management of this patient? What is the role of oral and topical antihistamines in the management of atopic dermatitis?

 

2. What are some key points you would want to ensure the caregiver understands about the disease and its treatment? What counseling points are important for a patient started on this medication?

· Similar to treatment of atopic dermatitis

· Avoid further allergen exposure

· Self-care: for mild cases

· Alleviate pruritus: Calamine, counter-irritant lotions; hydrocortisone cream; sodium bicarbonate compresses or baths; Burow’s compresses, oatmeal baths, systemic antihistamines, topical corticosteroids

· Avoid topical anesthetics, antihistamines, antibiotics

· Moderate to severe

· Medical evaluation; draining of bullae

· Systemic corticosteroids

3. What criteria or findings would indicate the need to refer this patient to a dermatologist?

Patients should be referred to a specialist under the following conditions:

· Diagnostic uncertainty

· Poor compliance or over- or under-usage of topical steroid

· Parental concern

· Treatment failure with appropriate topical therapy regimen

· Need to use potent topical steroid every day or every other day

· Involvement of sites that are difficult to treat, e.g. face

· Frequent infections

· Poor sleep or excessive scratching

· Psychological disturbance or marked deleterious effects of the disease on the child or family