Ch 7 Eczema Flashcards
Pathogenesis
- Activation of keratinocyte leading to release of IL-1 and IL-8
- IFNY increases local infiltrate
- Hyperproliferation ensues with acanthosis
Histology
- Epidermal disruption and spongiosis
- Acanthosis maybe para
- Dilation and infiltration of lymphs
Appearance
- Itch
- No sharp margin
- Scale
- Epithelial disription with weeping and crusting
Contact Locations
- Eyes, Ears, Anal/wounds (Graviational stasis), Hands
- Assymetry and clears
Exogenous
-Lanolin, Abx
Tx
- Acute: steroids and wet dressing
- Subacute: Steroids, Abx
- Chronic: Steroids, Tacro/Picro, Abx
- Flares: Cyclosporin, AZT (TMPT), MM
Irritant Vs Allergic
Allergic is type 4
Atopic is type 1
Irritant is neither and doesn’t get patch tested
Allergens are generally haptens
Metals
Chrome: Builders and Cement
Nickle
Cobalt: Seen simliiar to nickel
Cosmetics
Fragrance Lanolin Balsam of peru PPD: hair dressers Coelestyl Alcohol
Preservatives
Formaldehyde
Quat 15
Parabens
Choldoresol: antiseptic
Meds
Neomycin
Rubber
Mercapto
Vulcanization
Plants
Primin
Resins
Colophony
Epoxy
Paratert
Atopic Genes and Pathogenesis
Fillagrin -Most commonly from mother -IL-4/IL-13 -SPINK5 TH2 predominant
Patterns through life
- Infant: Weepy and Face
- Child: Lichenification wrists/ankles
- Adult: Same with white dermatographism
Diagnosis of Atopic
Itchy skin + 3 of
- History of itchy skin at sites
- Presence of eczema at sites
- Personal Allergy/Asthma
- Atopy by age 2
- Chornic dry skin for 1+yr
Prick
Will show elevated IgE which is supportive but not diagnostic
Tx
Steroids and emolients are mainstay Ointments>Creams Abx UV Cyclosporin AZT (TPMT), MM
Other Types
- Seborrheic
- Nummular
- Pompholyx
- Graviational
- Asteatotic
- Diaper
- Lichen Simplex
- Juvenile Plantar
Seborrheic
- Armpits, Ears, Hair, Chest
- Ketocolanazole
Nummular
- Be sure to appropriately differentiate with itch and ill defined borders
- Usually males and usually limbs
- Recur at previous sites
- Topical steroid and antibiotic
Pompholyx
- Larger bullae on hand
- Related to heat and emotion
- Can recur
- May lead to lymphangitis and infection
- Could be due to tinea id reaction
Stasis
- Need to repair edema first
- Site of contact allergy commonly (Neomycin)
Asteatotic
- Fissuring in elderly with chronically chapped skin
- May be caused by malnutirtion or hypo thyroidism
Lichen Simplex
-Thickened and fissured epidermis
Hands and genitals
-Must break itch scratch cycle
Juvenile Plantar
Fisurred and desquamating skin
Caused by socks
Diaper
Spares folds
Can lead to candidal super infection
