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DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.
1- Each reply should be at least 200 words.
2- One scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA style needs to be followed.
4- Each response should have reference at the end
5- Reference should be within last 5 years
DQ-1
Eczema is a common, chronic inflammatory skin condition characterized by dry, itchy skin. Individuals with eczema have a dysfunctional skin barrier which can be due to genetics where there is a mutation in the gene filaggrin (Nemeth & Evans, 2019). Filaggrin is an important component for skin cell maturity and is responsible for making the tough, flat corneocytes; however, patients with a filaggrin mutation will have an inconsistent organization of the skin cells allowing water to leak through the skin barrier which will dehydrate the skin leading to skin irritation (Nemeth & Evans, 2019). Also, patients with eczema have decreased amounts of bet-defensins in the skin which are vital peptides that fight off bacteria, viruses, and fungi. Therefore, patients with eczema are easily irritated by environmental factors and are more susceptible to infections.
First-line therapy for eczema includes hydration via over the counter skin moisturizers that are fragrance-free, ointments, anti-inflammatory medications, and antihistamines. Topical corticosteroids can be utilized for acute symptoms and should only be used a few times a week as long-term use can result in skin atrophy, striae, acne, and rebound dermatitis (Nemeth & Evans, 2019). Second-line therapy includes immunomodulators, such as pimecrolimus and tacrolimus, phototherapy, immunosuppressants, oral steroids, and alitretinoin. Pimecrolimus is a topical immunomodulator applied twice daily on the affected area and can be used as a long-term treatment. Compared to topical corticosteroids, pimecrolimus is more beneficial on sensitive and/or think skin and has positive effects on epidermal integrity (Jovanovic, 2019). However, patients may experience burning, soreness, stinging, and pruritus for the first few treatment days (Jovanovic, 2019). Adverse reactions include skin papilloma, skin infections, acne vulgaris, hypersensitivity, herpes simplex dermatitis (“Pimecrolimus,” 2019). Additionally, there are theoretical risks that pimecrolimus may be associated with skin malignancy and lymphoma, but the FDA agency indicated the safety of its use including in patients as young as 3 months old and for long-term management (Jovanovic, 2019). However, black box warning still indicates that pimecrolimus should not be used in children <2 years of age. It is also contraindicated in patients with erythroderma, skin diseases that may potentially increase systemic absorption such as Netherton’s syndrome, and in immunocompromised patients (“Pimecrolimus,” 2019). Drug interactions include CYP3A4 inhibitors as it may decrease the metabolism of pimecrolimus and immunosuppressants which may enhance adverse effects and toxicity.
References
Jovanovic, M. (2019). Safety of pimecrolimus and tacrolimus in the topical therapy of atopic dermatitis. Medicinski Pregled, 5–6, 139-142. doi:10.2298/MPNS1906139J
Nemeth, V., & Evans, J. (2019). Eczema. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538209/
Pimecrolimus. (2019). Retrieved from https://www.drugs.com/ppa/pimecrolimus.html
DQ-2
Psoriasis is a skin disease that is multi factorial in nature and involves the body’s immune response system (Kalb, 2019). Psoriasis is unique in the aspect that it has a typical red waxy scaly skin characteristic (Kalb, 2019). Psoriasis is usually apaprant at the elbows, knees, scalp, nails, and gluteal cleft (Kalb, 2019). The diagnosis of psoriasis is based on a skin biopsy to confirm the diagnosis (Kalb, 2019).
The pathology of psoriasis is characterized by systemic and local inflammation from deficits and defects in T regulatory cells and an upregulation of Th-1 and Th-17 cells, antigen-presenting cells- and cytokines (Kalb, 2019). Treatment focuses on suppressing interlukin 12, 23, and 17 to stop the inflammatory process that causes the presentation of psoriasis (Kalb, 2019). For example a treatment option is brodalumbwhich is given as a three weekly doses for induction, followed by every other week thereafter (Kalb, 2019).
Some adverse reactions of brodalumb is injection site reaction, a 1-2% chance of a cutaneous candida infection, inflammatory bowel disease exacerbation, depression, and suicidal ideation (Kalb, 2019). The depression and suicidal ideation could be a combination of self-esteem issues but could be agitated or exacerbated by brodalumb (Kalb, 2019).
Another interesting fact is that anti-IL-17 and anti-IL-23 classes have an insert warning that states that there is an infection risk from long term usage that suppresses the immune system and that there is an increased cancer risk (Kalb, 2019).
Some interactions of brodalumb include avoiding live vaccines due to the immunosuppressant nature of brodalumb and also avoiding grapefruit juice (Siliq, 2017). Brodalumb is also noted to have a narrow therapeutic index requiring monitoring of the immune system and dose adjustments as necessary (Siliq, 2017).
References:
Kalb, R. E. (2019). Overcoming Challenges in the Management of Psoriasis: Treatment Advances to Improve Standard of Care. Journal of Managed Care Medicine, 22(4), 63–66.
Siliq. (2017). MPR Monthly Prescribing Reference, 8, 3.Retrived from: https://search-ebscohost .com.lopes.idm.oclc.org/login.aspx?direct=true&db=edsgao&AN=edsgcl.510111204&site=eds-live&scope=site
DQ-3
Eczema is a chronic skin disorder that affects all ages and often begins in infancy and can resolve during puberty, but often returns after that (Woo & Osborn, 2019, pg. 958). The exact cause is unknown but patients normally have a high IgE antibody levels and have high correlation with developing asthma, allergies, or hay fever later on in life. Depending on the severity of eczema there are over-the-counter medications, prescription topical medications, phototherapy, immunosuppressants, medications, and other natural treatments for eczema.
Eczema is usually a rash that develops anywhere on the face, trunk, scalp, or extremities that causes mild to severe itching. Patches of skin become inflamed, red, cracked and rough during times of flare up and can be triggered by a variety of things. Eczema is an IgE hypersensitivity reaction and involves a complex immunologic cascade involving defects in the cell-mediated immune response, IgE dyregulation, and disruption in the epidermal barrier (Piliang & Schneider, 2019).
Treatment includes hydrating the skin, topical corticosteroids, antipruitics, emollients, phototherapy, and avoiding triggers. Patients can take vitamin D, probiotics, use oatmeal baths, lotions/creams as nonpharmacological treatments. They should take a 20 minute bath, pat the skin dry and apply emollients such as eucerin or aquaphor to the skin to lock in the moisture. Oatmeal baths help with the itching and hydrate the skin as well. Topical medications can be used such as Protopic (tacrolimus) that is a macrolide immunosuppressant that is applied to the skin twice a day. It is not indicated for children under 2 years old and should be used short term with breaks in between if needed (Protopic, 2019). It is not a first line therapy and should be used if the topical steroids fail. Long-term safety has not been established and the causal relationship has not been established for skin malignancy but has been reported. It comes in a 0.03% for pediatric and a 0.1% for adults or kids 16 and over. They need to avoid light therapy, tanning beds, and sun exposure while using it. There has not been studies with drug interactions with this but CYP3A4 inhibitors such as erythromycin, ketoconazole, fluconazole, calcium channel blockers, and cimetidine should be used with caution.
Piliang, M., & Schneider, S. (2019, July 3). Atopic Dermatitis. Retrieved February 27, 2020, from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/atopic-dermatitis/default.htm
Protopic – FDA prescribing information, side effects and uses. (2019, April 1). Retrieved February 27, 2020, from https://www.drugs.com/pro/protopic.html
Woo, T. M. & Osborn, K. (2019). Dermatological Conditions. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (pp. 957-989). Philadelphia, PA: F. A. Davis Company.