Philippine Dermatological Society - The Filipino Atopic Dermatological Society Officers Board of Trustees ... Clobenate Clobederm Dermovate ... Neo-Synalar 10/Neo-Synalar 25

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<ul><li><p> 213</p><p>Philippine Dermatological Society </p><p>Officers &amp; Board of Trustees</p><p> PresidentVice President</p><p>SecretaryTreasurer</p><p>Board Members</p><p>Immediate Past President</p><p>Rm. 1015 Front Tower, Cathedral Heights Complex, St. Lukes Medical Center, E. Rodriguez Sr. Ave, Quezon CityEmail: pds@pacific.net.ph Website: http://www.pds.org.ph Tel/Fax No.: 727-7309 Fax No.: 932-9269 </p><p>Francisca C. Roa, MDEvangeline B. Handog MDMa. Lorna F. Frez, MDMa. Teresita Gabriel MD</p><p>Benjamin Bince, MDMarcellano Cruz MDMa. Juiet Macarayo MDArnelfa Paliza MDGeorgina Pastorfide MDCarmela Veronica Reyes MDLilian Villafuerte MD</p><p>Amelia V. Tianco, MD </p><p>CPM8th Atopic Dermatitis.indd 213 06/18/2014 4:45:33 PM</p></li><li><p>atopic Dermatitis cpm 8tH eDitioN</p><p>214 </p><p>Guidelines of Care for Atopic Dermatitis</p><p>I. Definition Atopic Dermatitis (AD) is a chronic and </p><p>recurrent inflammatory dermatologic problem marked by severe pruritus causing excoriations, erosions, lichenification and susceptibility to skin infections. The distribution of the lesions are age-related, and a family / personal history of atopy, asthma or allergic rhinoconjunctivitis is elicited. AD has no biological marker.</p><p>II.Rationale A. Scope AD is a disease causing great burden on the qual-</p><p>ity of life of the patient and family alike. This familial disease has a genetic predisposition and environmentally influenced expression.</p><p> B. issue Recognizing AD relies on good patient history </p><p>(includes family history) and a thorough physical examination especially that of the skin.</p><p>III.Diagnosticcriteria A. Clinical 1. Major Characteristics: a. Pruritus b. Typical Morphology &amp; Distribution 1) Eczematous dermatitis 2) Flexural lichenification or linearity in </p><p> adults 3) Facial &amp; extensor involvement in infants 4) Any of these patterns or combination </p><p> of patterns can appear in both adults &amp; children</p><p> c. Chronic or chronically relapsing dermatitis d. Personal or family history of atopy (asthma, allergic rhinoconjunctivitis, atopic dermatitis, contact urticaria) 2. Other Characteristics a. Xerosis b. Ichtyosis/ palmar hyperlinearity in adults c. Early age of onset d. Cutaneous colonization and/or overt </p><p> infections 1) Staphylococcus aureus 2) Herpes simplex virus 3) Warts 4) Molluscum 5) Others e. Nonspecific hand and/or foot dermatitis, </p><p> increased susceptibility to irritant contact dermatitis</p><p> f. Nipple eczema g. Cheilitis h. Recurrent conjunctivitis i. Infraorbital fold</p><p> j. Keratoconus k. Anterior subcapsular cataracts l. Orbital darkening m. Facial pallor / facial erythema n. Erythroderma o. Pityriasis alba p. Anterior neck folds q. Perifollicular accentuation r. White dermographism / delayed blanch s. Impaired cell-mediated immunity t. Other B. Diagnostic/ConfirmatoryTests 1. Uncomplicated AD with definite clinical </p><p> characteristics: none required 2. For definitive diagnosis or complicating factors a. Hematological 1) Complete blood count a) Differential count b) Total count for eosinophilia b. Immunologic Testing 1) Complement levels 2) Serum IgE c. Smears for infective agents 1) Tzanck test 2) KOH preparation d. Cultures 1) Bacterial (with antibiotic sensitivity) 2) Viral 3) Fungal e. Skin biopsy f. Patch test g. Radioallergosorbent tests may be </p><p> appropriate in special cases h. Scratch / prick / intradermal tests i. Food elimination j. Psychological evaluation: AD tends to </p><p>flare during periods of psychic stress (anxi-ety, depression, anger, embar-rassment, shame, resentment). If factors cannot be adequately evaluated and treated by the dermatologist, psycho-logical evaluation and care, including testing, may be of value and should be considered. </p><p> iV. Recommendations Goal: Management is individualized to improve </p><p>the quality of life of the patient allowing optimal productive daily activities. The aim is to hydrate the skin, reduce inflammation, prevent the itch and eruption of the lesions and relieve sleep disturbance.</p><p> 1. Prevention / Modulation of trigger factors a. Patient Comprehension and avoidance of </p><p> trigger factors 1) Skin care products that cause skin </p><p> irritation or dryness a) Soaps</p><p>Prepared by: Maria Victoria C. Dizon, MD</p><p>CPM8th Atopic Dermatitis.indd 214 06/18/2014 4:45:33 PM</p></li><li><p>cpm 8tH eDitioN atopic Dermatitis</p><p> 215</p><p> (1) Germicidal / fragrant (2) Non-moisturized (3) Shower gels / bubble baths (4) Fabric softeners (5) Harsh detergents b) Fabrics (1) Rough (2) Occlusive 2) Environment a) Excessive heat (ill-ventilated rooms, </p><p> summer months) b) Extreme cold (air-conditioned </p><p> rooms) c) Exposure to known allergens (in </p><p> gested, inhaled, contactants like herb concoctions)</p><p> 3) Emotional stress 4) Strenuous physical activities 5) Hygienic practices a) Improper bathing practices </p><p>(1) Frequency of bathing too fre-quent bathing or prolonged water exposure dries out the skin.</p><p>(2) Use of abrasives (scrub cloths, loofahs, pumice stones)</p><p> 2. Therapy a. Topical 1) Anti-inflammatory agents a) Corticosteroids: mid to high strength steroids after bathing may be used for brief periods, low strength steroids for maintenance. Certain vehicles may act as irritants, so alternative products or com- </p><p> pounded preparations may be indicated. b) Tar preparation c) Phototherapy (1) UVA (with or without psoralen) (2) UVB (3) Goeckerman and/or Ingram d) Antibiotics: for localized sites (1) Mupirocin (2) Fusidic acid e) Moisturizers / Emollients: applied </p><p> within 3 minutes from bathing. f) Immunomodulators (1) Tacrolimus (FK506) (2) Pimecrolimus (ASM 981) g) Therapeutic baths, compresses, cleansers (1) Tars (2) Emollients / moisturizing soaps (3) Colloidals (4) Skin cleansers 2) Oral / Systemic a) Antihistamines single or multiple (1) Hydroxyzine hydrochloride (2) Chlorpheneramine maleate (3) Cetirizine (4) Other b) Antibiotics c) Corticosteroids (rarely) d) Immunotherapy</p><p> (1) Cyclosporine (2) Mycophenolate mofetil (3) Methotrexate (4) Azathioprine (5) Interferon-alpha and -gamma (6) Other e) Ketotifen (a mast cell stabilizer) 3) Dietary a) Elimination diet b) Supplements c) Other 4) Hyposensitization 5) Others may include but are not limited to </p><p> the following: a) Occupational and / or psychological </p><p> counseling b) Bed rest c) Psychotherapy 6) Hospitalization when indicated</p><p>V. Supportingevidence See References. </p><p>Vi. Disclaimer Despite strict adherence to these guidelines, a </p><p>complete cure of atopic patients will not be ensured. Patient management is individualized and deciding on the management solely depends on the physician. </p><p>References:1. Absolon CM, Cottrell D, Eldridge SM, Glover MT. </p><p>Psychological disturbance in atopic eczema: the extent of the problem in school-aged children. Br J Dermatol 1997; 137: 241-45.</p><p>2. Coleman R, Trembath R, Harper JI. Genetic studies of atopy and atopic dermatitis. Br J Dermatol 1997; 136. 1-5.</p><p>3. Dorner W, Baylock KW, et al. Guidelines of care for atopic dermatitis. J Am Acad Dermatol 1992; 26: 485- 8.</p><p>4. Eichenfield LF, Lucky AW, Boguniewicz M, et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol 2002; 46: 495-504.</p><p>5. Hanifin JM, Chan S. Biochemical and immunologic mechanisms in atopic dermatitis: new targets for emerging therapies. J Am Acad Dermatol 1999; 41: 72-7.</p><p>6. Harper JI, Ahmed I, Barclay G, et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol 2000; 142: 52-8.</p><p>7. Krafchik BR. Diagnosis and management of atopic dermatitis. Dermatol Ther 1997: 2;18-28.</p><p>8. Leent EJM, Grber M, Thurston M, et al. Effectiveness of the ascomycin macrolactam SDZ ASM 981 in the topical treatment of atopic dermatitis. Arch Dermatol 1998; 134: 805-9. :127</p><p>10. Leung DYM, Soter NA. Cellular and immunologic mechanisms in atopic dermatitis. J Am Acad Dermatol 2001; 44: S1-12.</p><p>11. Neuber K, Schwartz L, Itschert G, Tom Dieck A. Treatment of atopic eczema with oral mycophenolate mofetil. Br. J Dermatol 2000: 143: 385-391.</p><p>12. Paller AS, Eichenfield LF, Leung DYM, et al. A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 2001; 44: S47-57.</p><p>13. Ramsay CA, Savole JM, Gilbert M, et al. The treatment of atopic dermatitis with topical fusidic acid and hydrocortisone acetate. J Eur Acad Dermatol Venerol 1995; 7: S15-S22.</p><p>14. Ricci G, Patrizi A, Specchia F, et al. Effect of house dust mite avoidance measures in children with atopic dermatitis. Br J Dermatol 2000; 143: 379-384.</p><p>15. Ruzicka T, Assmann T, Homey B. Tacrolimus: The drug for the turn of the millenium? Arch Dermatol 1999; 135: 574-580.</p><p>16. Tofte SJ, Hanifin JM. Current management and therapy of atopic dermatitis. J Am Acad Dermatol 2001; 44: S13-6.</p><p>CPM8th Atopic Dermatitis.indd 215 06/18/2014 4:45:33 PM</p></li><li><p>atopic Dermatitis cpm 8tH eDitioN</p><p>216 </p><p>Drugs Mentioned in the Treatment GuidelineThis index lists drugs/drug classifications mentioned in the treatment guideline. Prescribing information of these drugs can be found in PPD reference systems.</p><p>TopicalCorticosteroidsBetamethasone Betnovate Betnovate Scalp Diprolene Diprosone Steroderm Valezone Bethamethasone/ Clioquinol Betnovate-C Diproform Betamethasone/ Clotrimazole Clotrasone Betamethasone/ Fusidic acid FucicortBetamethasone/ Gentamicin DiprogentaBetamethasone/ Gentamicin/ </p><p>Clotrimazole Triderm Betamethasone/ Gentamicin/ </p><p>Tolnaftate/ Clioquinol Quadriderm </p><p>Quadrotopic Cream Betamethasone/ Neomycin Sulfate Betnovate-N Betamethasone/ Salicylic acid Diprosalic Clobetasol Clobenate Clobederm Dermovate Dermovate Scalp Clobetasol/ Neomycin/ Nystatin </p><p>Clobederm-N Dermovate NN Desonide Desowen </p><p>Sterax Dexamethasone/ Neomycin </p><p>sulfate Decilone Cream SteraxDiflucortolone Nerisona/ Nerisona ForteFluocinolone Aplosyn/Aplosyn HP Synalar/Synalar HP Syntopic Fluocinolone/ Clioquinol </p><p>Aplosyn CFluocinolone/ Neomycin sulfate </p><p>Aplosyn N Neo-Synalar 10/Neo-Synalar 25 </p><p>Fluocinonide Lidemol Lidex </p><p>Fluocinonide/ Neomycin sulfate/ Gramcidin/ Nystatin</p><p> Lidex NGN Fluticasone </p><p>Cutivate Fluocortolone Ultralan Hydrocortisone Cortizan Efficort Lacticare-HC Lotion Hydrocortisone/ Miconazole </p><p>nitrate Daktacort Hydrocortisone/ Oxytetracycline </p><p>Terra-Cortril TopicalMometasone furoate </p><p>Elica Elocon</p><p>Methylprednisolone aceponate Advantan Triamcinolone acetonide Kenacort A 0.1% </p><p>TopicalAntibioticsGentamicin sulfate Bactiderm Ointment Garamycin 0.1% Cream/ </p><p> OintmentMupirocin BactrobanNitrofurazone Drugmaker's Biotech </p><p> Nitrofurazone FuracinFusidate Na Fucidin Intertulle/Ointment/ </p><p> Cream Fusoderm 2% OintmentKeratoplastics PolytarTopicalImmunomodulatorPimecrolimus ElidelTacrolimus ProtopicEmollients,Demulcents&amp;Protectants</p><p> Cetaphil Dermablend Cleansing milk Johnson's Baby Double </p><p> Protection Powder Johnson's Baby Lotion </p><p> Rich &amp; Creamy Johnson's Baby Oil w/ Aloe </p><p> Vera and Vitamin E Johnson's Baby Sorbolene </p><p> Cream Wash Johnson's Baby Top to Toe </p><p> Wash Lactacyd Liquid Lacticare Nutraderm Nutraplus Oilatum Bar/ Gel/ Plus PhysiogelPetroleum jelly </p><p>Apollo Petroleum Jelly Zinc oxide/ Benzoic acid/ </p><p>Salicylic acid/ Sulfur Bioderm Ointment</p><p>Zinc oxide/ Calamine Calmoseptine OintmentZinc oxide/ Econazole nitrate Pevaryl HP </p><p>AntihistaminesChlorphenamine maleate Antamin Barominic Chlor-trimeton Clormetamine Drugmaker's Biotech </p><p> Chlorphenamine Hargenan Synestal UL ChlorphenamineChlorphenoxamine </p><p>hydrochloride SystralCetirizine </p><p>Virlix Zinex ZyrtecClemastine Tavegyl TavistDesloratadine </p><p>Aerius Diphenhydramine </p><p>Alertuss Am-Europharma Diphenhydramine</p><p>CPM8th Atopic Dermatitis.indd 216 06/18/2014 4:45:34 PM</p></li><li><p>cpm 8tH eDitioN atopic Dermatitis</p><p> 217</p><p> Benadryl Dramelin Drugmaker's Biotech Diphenhydramine </p><p> Hizon Diphenhydramine Inj Pharex Diphenhydramine </p><p>Hydroxyzine Iterax </p><p>Levocetirizine Xyzal</p><p>Loratadine Claritin Loradex </p><p>OralAntibiotics Amoxicillin </p><p>Aldemox Amoxil Amusa Athenalyn Axmel Bacihexal</p><p> Cartrimox Cilfam </p><p>Clearamox Daisamox DLI Amoxicillin Drugmaker's Biotech Amoxicillin Eleomox Emilex</p><p> Glamox Globamox Globapen</p><p> Harvimox Himox </p><p> IHC-Amoxicillin Littmox Macropage</p><p> Medimoxil Megamox </p><p> Montecil Moxillin Multicare Amoxcillin</p><p> Novamox Oramox/Oramox Forte </p><p>Pediamox Pharex Amoxicillin </p><p> Pharmamox Polymox</p><p> Promox RiteMED Amoxicillin</p><p> Semoxillin Servimox </p><p>Shinamox Sumoxil Teramoxyl Zymoxyl </p><p>Amoxicillin/ clavulanic acid Amoclav Augmentin</p><p> Natravox Ampicillin </p><p>Ampicin Ampin Amplivacil Apamicin Bactimed DLI-Ampicillin Drugmaker's Biotech Ampicillin Excillin</p><p> Genaxcin Pensyn Pentrexyl </p><p> Polypen Saloxin </p><p>Shinapen Azithromycin Zithromax Bacampicillin PenglobeCefaclor Ceclor/Ceclor BID/ Ceclor CD Ceclobid Clorotir Pharex Cefaclor RiteMED Cefaclor XelentCefadroxil Drozid Duracef Cefalexin Asaflex Biogenerics Cefalexin Bloflex Cefalexin-Vamsler Cefalin Capsule/ Drops/ </p><p> Suspension Ceporex Cidoxine Cromlex Difagen Drugmaker's Biotech Cefalexin </p><p>Eliphorin Exel Fensid Fevenil Genflex Gesenal Harvexyl Keflex Lefex Lexum Lyceplix Medoxine Oneflex Oranil </p><p> Pectril Pharex Cefalexin RiteMED Cefalexin</p><p> Servispor VCP Cefalexin </p><p>Xinflex Zeporin Cefatrizine ZanitrinCefdinir Omnicef Cefprozil Procef Cefradine Sedinef Velodyne VelosefCefuroxime Kefox Lifurox Profurex RiteMED Cefuroxime Romicef Shincef Zegen Zinacef ZinnatCiprofloxacin Ciloxan Ciprobay Cipromet Cirok Iprolan Pharex Ciprofloxacin Xipro Zyflox ZalvosClarithromycin Klaricid/ Klaricid OD OnexidClindamycin Biogenerics Clindamycin Clindal Dalacin C HCl/Dalacin C </p><p> Palmitate/Dalacin C Phosphate </p><p> Inprosyn-HPCloxacillin Biogenerics Cloxacillin </p><p>Cloxigen Drugmaker's Biotech Cloxacillin </p><p>Encloxil IHC-Cloxacillin Interclox Myrex Cloxacillin </p><p>Oxaclen Patriflex Pharex Cloxacillin Prostaphlin-A</p><p>CPM8th Atopic Dermatitis.indd 217 06/18/2014 4:45:34 PM</p></li><li><p>atopic Dermatitis cpm 8tH eDitioN</p><p>218 </p><p> Ritemed Cloxacillin Cotrimoxazole Bacidal Bactille Forte Bactille-TS Bactrim </p><p>Bacxal Biogenerics Cotrimoxazole Cotrexel</p><p> Cotribase Cotrimoxazole-Vamsler DLI-Cotrimoxazole Doctrimox Drugmaker's Biotech Cotrimoxazole</p><p> Fedimed Genoxzole/Genoxzole Forte </p><p>Genzaprim/ Genzaprim Forte </p><p> Globamox Globec/Globec Forte Gutrisul Intrafort Kathrex Lagatrim Forte Macromed Microbid/Mi...</p></li></ul>