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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
Q

patch test or allergic contant dermatits

A

?

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26
Q

Risk Factors for Nickel Sensitivity

A

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)

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27
Q

Classic example of nickel allergic contact dermatitis

A
  • in periumbilical area in an 11 yo, from button on pants (use duct tape as a physical barrier to prevent)
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28
Q

Prevalence of positive patch tests for nickel

A

?

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29
Q

Prevention of nickle ACD

A

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

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30
Q

Regulation of nickel - affects

A

= 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

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31
Q

ACD

A

?

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32
Q

ACD

A

?

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33
Q

ACD

A

?

34
Q

Fragrance as allergens

A
  • > 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
Q

Fragrance - laws

A
  • 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
Q

Formaldehyde Releasing Preservatives

A

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
Q

?

A

?

38
Q

?

A

?

39
Q

?

A

?

40
Q

Bacitracin and Neomycin

A
  • Neomycin & bacitracin allergies often occur together (co-sensitization)
  • Wide spread use has led to increase sensitization
41
Q

Co-sensitization defn.

A

= allergy to 2 allergens which are not structurally related, but are frequently used concomitantly

42
Q

Stasis Dermatitis - associations

A

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
Q

Stasis Dermatitis - Complicating Factors

A
  • Dryness
  • Itching
  • Allergic contact dermatitis due to use of topical preparations (i.e. topical antibiotics)
  • Irritant Dermatitis due to wound exudates
44
Q

Stasis Dermatitis - treatment

A
  • Compression
  • Elevation
  • Exercise calf muscles
  • Vascular surgery
  • Topical steroids
  • Avoid allergens
45
Q

Lichen Simplex Chronicus defn.

A

= Thick, scaly plaques with “lichenification” that result from chronic rubbing and scratching

46
Q

Lichen Simplex Chronicus - treatment

A
  • Topical steroids are first line therapy
  • Antihistamines can be used for itching
  • Pts need to be counseled to break the itch-scratch cycle
47
Q

Venous Stasis Ulcers - seen commonly w/…

A
  • Common in pts w/Hx of leg swelling, varicose veins or blood clots
48
Q

Venous Stasis Ulcers - appearance / location

A
  • 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
Q

Nummular Dermatitis - aka, main demographic

A
  • aka Discoid Eczema

- More common in men age 50+

50
Q

Nummular Dermatitis - location / appearance

A
  • Most often occurs on legs, but can appear on arms and trunk
  • Patches may be red, scaly & become crusty
  • Tends to be stubborn
51
Q

Nummular Dermatitis - treatment

A

First line therapies:

  • Moisturization
  • Minimization of soap
  • Topical corticosteroids
52
Q

Cellulitis vs. Erysipelas vs. Dermatitis - Morphology

A

Cellulitis

  • warm, tender, erythematous
  • patches or plaques

Erysipelas

  • warm, tender, erythematous
  • sharply demarcated, raised plaque

Dermatitis

  • erythematous papules
  • thin plaques w/scale
53
Q

Cellulitis vs. Erysipelas vs. Dermatitis - Location of Inflammation

A

Cellulitis
- dermis & subQ tissue

Erysipelas
- dermis & minimal subQ tissue

Dermatitis
- epidermis & dermis

54
Q

Cradle Cap (Seborrheic dermatitis)

A

= 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
Q

Seborrheic Dermatitis - appearance / location

A
  • 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
Q

Seborrheic Dermatitis - Pathogenesis

A

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
Q

Seborrheic Dermatitis

A

“Dandruff”
= Commonly involves scalp
- more diffuse lesions w/ finer scale than psoriasis

58
Q

Psoriasis

A
  • Affects up to 2% of population
  • Positive FHx in 36% of psoriasis pts
  • Impacts quality of life
59
Q

Histology of Psoriasis

A

Shows

  • hyperproliferation of the epidermis
  • elongation of the rete ridges
  • neutrophils
  • dilated capillary loops in dermal papillae
60
Q

Psoriasis - Clinical Subtypes

A
  • Chronic Plaque Disease
  • Guttate
  • Erythroderma
  • Pustular Psoriasis
61
Q

Psoriasis - Chronic Plaque Disease

A

?

62
Q

Guttate Psoriasis associated with Strep Throat

A

?

63
Q

Psoriasis - Palmar/Plantar

A

?

64
Q

Psoriatic Arthritis

A

Occurs in 5-20% patients

65
Q

Psoriasis Affects Quality of Life

A
  • Impacts public perceptions
  • Negatively impacts interactions at home & work
  • Interferes with sleep, sexual activity, walking
    and using hands
66
Q

Psoriasis and Comorbidities

A

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
Q

Psoriasis - Treatment of Localized Disease

A
  • Calcipotriol (Vit D3 analog)
  • Corticosteroids
  • Topical Retinoids
  • Phototherapy
  • UVB/NBUVB
  • PUVA
68
Q

Psoriasis - Treatment of Widespread Disease (+/- Psoriatic Arthritis)

A
  • Methotrexate
  • Cyclosporin
  • Systemic Retinoids
  • Biologics
  • – Anti-T lymphocyte
  • – Anti-TNF alpha
69
Q

Stasis dermatitis location

A

lower legs

70
Q

Seborrheic dermatitis location

A

scalp

71
Q

Atopic dermatitis location

A

flexor surfaces

72
Q

Psoriasis location

A

extensor surfaces

may include arthritis

73
Q

Stasis dermatitis etiology

A

lower extremity edema

74
Q

Seborrheic dermatitis etiology

A

Malassezia furfur (yeast)

75
Q

Atopic dermatitis etiology

A

Filaggrin

76
Q

Irritant dermatitis etiology

A

common irritants

77
Q

Allergic contact dermatitis etiology

A

common allergens

78
Q

Atopic dermatitis - Misc. Facts to Know

A

Associated with Asthma and Allergic rhinitis

79
Q

Allergic contact dermatitis - Misc. Facts to Know

A
  • Delayed type hypersensitivity reaction (Type IV)

- Dx confirmed with patch testing

80
Q

Psoriasis - - Misc. Facts to Know

A

May be associated with increased risk

of cardiovascular disease

Unit 3 D&D (18 decks)

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