PHAR3912 - Severe Dermatitis

what are the Dx criteria for severe dermatitis?

Inflammatory response of the skin

redness, rash, itchy

atopic (eczema) = chronic + genetic

EASI score >20

frequent flares

what factors can lead to poor control or Tx resistance to atopic dermatitis?

non-adherence

incorrect application

allergy triggers

depression

lack of education

other conditions

what are common misconceptions of topical corticosteroid use?

1. application to cracked skin - can do

2. stunts growth - no

3. skin pigment change - no eczema can decrease melanin tho

4. moisturizer only - no

5. small sparingly - no, liberally

what is topical steroid withdrawal (TSW) Sx and Tx?

rebound reaction from TCS overuse

Sx: burning, weeping, red sleeve pattern, swelling

Tx: discontinue TCS

what are the THREE modified dressings for dermatitis?

1. wet dressing: bath, pat dry, TCS, wet dressing 60 mins 5-7d

2. soak and smear: bath, no dry, TCS, no dry, 4-14d

3. occlusion: clean, TCS, plastic wrap overnight

what is the use of phototherapy in severe dermatitis?

UVB -> inhibit immune inflammation pathways

2-3/wk for months (low adherence)

conjunction with topical therapy

what oral medication is used for severe dermatitis Tx?

1. ciclosporin: short-term, by weight dose, immunosuppression risks

2. methotrexate: off-label, long term, weekly dosing, 2-3m to see effect

3. azathioprine: off-label, by weight dosing, 1-2m to see effect

4. mycophenolate mofetil: off-label, no response to ciclosporin or azathioprine

5. upadacitinib: JAK inhibitor, 1m to see effect, immunosuppression

explain dupilumab as a biological therapy for severe dermatitis (MOA, criteria,

mAb (biologic) therapy

MOA: targets immunomodulators -> inhibit IL4/13 signaling -> stops type 2 inflammation -> stops overreaction

criteria: >12 with chronic severe eczema, Tx failure

what is the pharmacists role in severe dermatitis?

eczema care plan

education + myth debunk

use of TCS

therapy escalation discussions

what is the role of adjuvant therapy in severe dermatitis management?

antihistamines, oral corticosteroids

in combination with optimal skin care + topical measures (bleach baths) + wet wraps during flares