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Unit 3 D&D > DD 03-05-14 09-10am Inflammatory Skin Disorders - Dunnick > Flashcards

DD 03-05-14 09-10am Inflammatory Skin Disorders - Dunnick Flashcards

1
Q

Dermatitis defn.

A

= Inflammation of the skin
= commonly used by dermatologists to refer to spongiotic dermatitis, a nonspecific reaction pattern
seen on skin biopsy

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2
Q

Atopic Dermatitis - epidemiology (age, prevalence)

A

Common skin disease which may begin at any age, however a majority begin before age 5.

Prevalence: 7-17.2% in children

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3
Q

Atopic Diathesis

A

= aka what predisposes one to atopic dermatitis

  • Asthma
  • Allergic rhinitis
  • Atopic dermatitis
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4
Q

Atopic Dermatitis - Diagnostic Criteria

A

Must have: Itchy skin, plus…
3 more of the following:
- Hx of skin crease involvement (or face if < 10 yrs)
- Personal Hx of asthma or hay fever (or FHx of atopic disease if pt < 4 yrs)
- Hx of dry skin w/in last year
- Visible flexural eczema (or face if pt < 4 yrs)
- Onset under 2 years of age

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5
Q

Atopic Dermatitis - Pathogenesis

A
  • Barrier disrupted skin
  • Filaggrin mutation
  • Staphlyococcus aureus (acts as a superantigen)
  • Elevated IgE
  • Eosinophilia
  • TH2 type cytokine (IL-4, IL-5, IL-10) immune response produced
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6
Q

Atopic Dermatitis - Infantile manifestations

A

From birth to 2yrs

Dry, red scaly areas confined to the cheeks
—> Becomes flushed with exposure to cold

Some have more generalized eruption, characterized by:

  • erythematous papules
  • redness
  • scaling
  • areas of lichenification
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7
Q

Atopic Dermatitis - Childhood manifestations

A

From 2-12 yo

Characteristic involvement of flexural skin:

  • Antecubital fossa
  • Popliteal fossa
  • Neck
  • Wrists
  • Ankles
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8
Q

Atopic Dermatitis - Adult manifestations

A

From 12 yo to adult

Eyelid dermatitis
Hand dermatitis

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9
Q

Atopic Dermatitis - Associated Features

A
  • Dry Skin (Xerosis)
  • Keratosis Pilaris
  • Ichthyosis vulgaris
  • Hyperlinearity of the palms
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10
Q

Eczema

A

?

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11
Q

Eczema

A

?

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12
Q

Eczema

A

?

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13
Q

Eczema

A

?

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14
Q

Eczema

A

?

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15
Q

Irritant Contact Dermatitis - basics

A

= Non-immunologically mediated rxn resulting from direct cytotoxic effect
- Either from a single or repeated exposure to the
irritant
- No specific “test” for irritant dermatitis
= Most common type of contact dermatitis

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16
Q

Irritant Contact Dermatitis - types of irritants

A

Strong vs. Weak Irritants

Strong irritants:

  • damage skin directly even in small amounts contacting skin for a short time
  • i.e. strong acids & bases
  • generally carry warning labels & often suggest skin protection such as gloves be used

Weak irritants:

  • “harmless” by themselves
  • frequent, repeated contact may damage skin
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17
Q

Examples of Weak Irritants

A
  • Soap and water
  • Skin products (even “baby” and “hypoallergenic”)
  • Perfumes
  • Wool
  • Raw Foods (meat, fruits, or vegetables held while
    preparing foods)
  • Body Secretions (feces, urine, saliva, sweat)
  • Friction
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18
Q

Allergic Contact Dermatitis

A
  • Requires contact exposure of an allergen,
    immune response & development of “memory” T cells
  • Type IV, delayed-type hypersensitivity rxn usually starts 24-48 hours after allergen exposure, but it can be delayed longer
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19
Q

What is contact allergy?

A

Delayed type hypersensitivity reaction

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20
Q

Allergens

A

= small chemical molecules (haptens)
= usually < 500 Daltons
- Small size allows penetration through skin
- presented by Langerhans cells to T cells
- mostly weak allergens that require repeat exposures prior to sensitization

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21
Q

Elicitation of ACD by allergens

A

Caused by inflammatory cytokines including TNFα and IL-1

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22
Q

What is a patch test?

A

?

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23
Q

When do you patch test?

A 
= gold standard test for diagnosing ACD
Use with...
- Pts w/ suggestive Hx
- Pts w/ resistant dermatitis
- Chronic dermatitis
- Occupationally-related dermatitis
- Atopic eczema - flaring
- Stasis dermatitis
- Photo or airborne distribution
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24
Q

patch test or allergic contant dermatits

A

?

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25
patch test or allergic contant dermatits
?
26
Risk Factors for Nickel Sensitivity
Female sex (RR 3.74 women to men) Younger age (RR 3.23 Age 30 or less) - 12.9% nickel positivity in Denver children < 5 yr (54% boys & 45% girls) - 30.4% nickel positivity (UCH Age < 18 years) Ear piercing - 14.8% with ears pierced: 1.8% without (567 Danish patients nickel positivity)
27
Classic example of nickel allergic contact dermatitis
- in periumbilical area in an 11 yo, from button on pants (use duct tape as a physical barrier to prevent)
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Prevalence of positive patch tests for nickel
?
29
Prevention of nickle ACD
1994 European Union Nickel Directive ---> Limits amount to no more than 0.05% nickel content in posts used for body piercings. ---> Limits amount released from objects in direct & prolonged contact w/ skin to no more than 0.5 mg nickel/cm2/week ---> Mandates that these objects, such as jewelry, watches, buttons, & zippers, shall maintain this requirement for 2 years of normal use
30
Regulation of nickel - affects
= has successfully lowered rates of nickel sensitization in Europe - In Germany, nickel allergy in women under age 30 decreased from 36.7% (in 1992) to 25.8% (in 2001) - In Denmark, nickel sensitivity in children under age 18 fell from 24.8% to 9.2% from 1985–1986 to 1997–1998
31
ACD
?
32
ACD
?
33
ACD
?
34
Fragrance as allergens
- > 2,800 fragrance ingredients - > 100 of these are known contact allergens - Botanicals are also used as fragrance & can cause contact allergy - Unscented products may have a masking fragrance, therefore pts w/ fragrance allergy should use only fragrance-free products
35
Fragrance - laws
- Companies are reluctant to disclose fragrance components - EU requires labeling of 26 fragrance allergens on products if concentration >100 ppm for a rinse-off product & > 10 ppm for a leave-on product - FDA bans ~10 chemicals used in fragrances & does not actively regulate this industry
36
Formaldehyde Releasing Preservatives
Formaldehyde - 8.4% Prevalence, 71.5% Prevalence Quaternium-15 - preservative that most frequently causes ACD in the US - 9.3% Prevalence, 88.4% Relevance 2-Bromo-2-nitropropane-1, 3-diol Diazolidinyl urea DMDM Hydantoin Imidazolidinyl urea
37
?
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38
?
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?
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40
Bacitracin and Neomycin
- Neomycin & bacitracin allergies often occur together (co-sensitization) - Wide spread use has led to increase sensitization
41
Co-sensitization defn.
= allergy to 2 allergens which are not structurally related, but are frequently used concomitantly
42
Stasis Dermatitis - associations
Often seen in association with other signs of venous insufficiency of the lower extremities: - Varicose veins - Chronic lower extremity edema - Venous stasis ulcers - Lipodermatosclerosis
43
Stasis Dermatitis - Complicating Factors
- Dryness - Itching - Allergic contact dermatitis due to use of topical preparations (i.e. topical antibiotics) - Irritant Dermatitis due to wound exudates
44
Stasis Dermatitis - treatment
- Compression - Elevation - Exercise calf muscles - Vascular surgery - Topical steroids - Avoid allergens
45
Lichen Simplex Chronicus defn.
= Thick, scaly plaques with “lichenification” that result from chronic rubbing and scratching
46
Lichen Simplex Chronicus - treatment
- Topical steroids are first line therapy - Antihistamines can be used for itching - Pts need to be counseled to break the itch-scratch cycle
47
Venous Stasis Ulcers - seen commonly w/...
- Common in pts w/Hx of leg swelling, varicose veins or blood clots
48
Venous Stasis Ulcers - appearance / location
- Primarily found on medial lower leg just above the ankle - Red in color with yellow fibrinous base - Borders irregularly shaped - May be purulent if infected
49
Nummular Dermatitis - aka, main demographic
- aka Discoid Eczema | - More common in men age 50+
50
Nummular Dermatitis - location / appearance
- Most often occurs on legs, but can appear on arms and trunk - Patches may be red, scaly & become crusty - Tends to be stubborn
51
Nummular Dermatitis - treatment
First line therapies: - Moisturization - Minimization of soap - Topical corticosteroids
52
Cellulitis vs. Erysipelas vs. Dermatitis - Morphology
Cellulitis - warm, tender, erythematous - patches or plaques Erysipelas - warm, tender, erythematous - sharply demarcated, raised plaque Dermatitis - erythematous papules - thin plaques w/scale
53
Cellulitis vs. Erysipelas vs. Dermatitis - Location of Inflammation
Cellulitis - dermis & subQ tissue Erysipelas - dermis & minimal subQ tissue Dermatitis - epidermis & dermis
54
Cradle Cap (Seborrheic dermatitis)
= Flaky, white to yellowish oily scale on scalp - Can become confluent w/ thick scale covering most of scalp - Begins 1 wk after birth & may persist for several months
55
Seborrheic Dermatitis - appearance / location
- Facial involvement is usually symmetric over medial eyebrows, nasolabial folds & ears - Occurs in areas rich in sebaceous glands (scalp, face, ears, chest) - Characterized by flaky, “greasy” scales
56
Seborrheic Dermatitis - Pathogenesis
Thought to be due to combo of... - overproduction of skin - irritation from yeast (Malassezia furfur) Linked to: - Neurologic conditions, including Parkinson's disease, head injury, and stroke - HIV
57
Seborrheic Dermatitis
“Dandruff” = Commonly involves scalp - more diffuse lesions w/ finer scale than psoriasis
58
Psoriasis
- Affects up to 2% of population - Positive FHx in 36% of psoriasis pts - Impacts quality of life
59
Histology of Psoriasis
Shows - hyperproliferation of the epidermis - elongation of the rete ridges - neutrophils - dilated capillary loops in dermal papillae
60
Psoriasis - Clinical Subtypes
- Chronic Plaque Disease - Guttate - Erythroderma - Pustular Psoriasis
61
Psoriasis - Chronic Plaque Disease
?
62
Guttate Psoriasis associated with Strep Throat
?
63
Psoriasis - Palmar/Plantar
?
64
Psoriatic Arthritis
Occurs in 5-20% patients
65
Psoriasis Affects Quality of Life
- Impacts public perceptions - Negatively impacts interactions at home & work - Interferes with sleep, sexual activity, walking and using hands
66
Psoriasis and Comorbidities
Persistent low grade inflammation favors development of: - insulin resistance - obesity - metabolic syndrome Metabolic syndrome pts have accelerated atherosclerosis due to inflammation Psoriasis is an independent risk factor for Cardiovascular Disease Pts in their 40s with... - severe psoriasis double their risk for MI - mild psoriasis RR increases by 20%
67
Psoriasis - Treatment of Localized Disease
- Calcipotriol (Vit D3 analog) - Corticosteroids - Topical Retinoids - Phototherapy - UVB/NBUVB - PUVA
68
Psoriasis - Treatment of Widespread Disease (+/- Psoriatic Arthritis)
- Methotrexate - Cyclosporin - Systemic Retinoids - Biologics - -- Anti-T lymphocyte - -- Anti-TNF alpha
69
Stasis dermatitis location
lower legs
70
Seborrheic dermatitis location
scalp
71
Atopic dermatitis location
flexor surfaces
72
Psoriasis location
extensor surfaces | may include arthritis
73
Stasis dermatitis etiology
lower extremity edema
74
Seborrheic dermatitis etiology
Malassezia furfur (yeast)
75
Atopic dermatitis etiology
Filaggrin
76
Irritant dermatitis etiology
common irritants
77
Allergic contact dermatitis etiology
common allergens
78
Atopic dermatitis - Misc. Facts to Know
Associated with Asthma and Allergic rhinitis
79
Allergic contact dermatitis - Misc. Facts to Know
- Delayed type hypersensitivity reaction (Type IV) | - Dx confirmed with patch testing
80
Psoriasis - - Misc. Facts to Know
May be associated with increased risk | of cardiovascular disease

Unit 3 D&D (18 decks)

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