DD-Inflammatory Skin Disorders Flashcards
to refer to spongiotic dermatitis, s nonspecific reaction pattern seen on skin biopsy
Dermatitis
Common skin disease which may begin at any age, however a majority begin before age 5.
Prevalence: 7-17.2% in children
Atopic Dermatitis
Atopic Dermatitis
Diagnostic Criteria
Itchy skin +Plus 3 OF:
History of involvement of skin creases (or face if pt < 10 yrs)
Personal history of asthma or hay fever (or FH of atopic disease if pt < 4 yrs)
History of dry skin within the last year
Visible flexural eczema (or face if pt < 4 yrs)
Onset under 2 years of age
The _____ mutation is asc. w/ Atopic Dermatitis leading to worsened Staphlyococcus aureus as a superantigen
Filaggrin
Atopic Dermatitis Infantile (Birth – 2 years)
Eruption is characterized by:
erythematous papules
redness
scaling and areas of lichenification
Xerosis means
Dry Skin
Number one skin disease globally
eczema
A general term that describes inflammation of the skin
Dermatitis
Non-immunologically mediated reaction resulting from a direct cytotoxic effect. Can be first exposure or many. No test for this
Irritant Contact Dermatitis
Allergic Contact Dermatitis Requires contact exposure of an allergen, immune response and development of _______
“memory” T cells
What is contact allergy?
Delayed type hypersensitivity reaction
Requires contact exposure of an allergen, immune response and development of “memory” T cells
Allergic Contact Dermatitis
Allergic Contact Dermatitis tends to be
itchy
Allergic Contact Dermatitis effects
the epidermis
Cellulitis affects the
dermis
Cellulitis feels
painful
Langerhans cells present allergen to
T cells
Elicitation of ACD caused by inflammatory cytokines including TNFa and_____.
IL-1
Contact dermatitis is determined by
patch testing
__________ present allergen to T cells
Langerhans cells
Elicitation of ACD caused by inflammatory cytokines including ______ and IL-1.
TNFa
When do you patch test?
Patients with suggestive history Patients with resistant dermatitis Chronic dermatitis Occupationally related dermatitis Atopic eczema - flaring Stasis dermatitis Photo or airborne distribution
Top Contact Allergen
Nickel
Female
Younger age
12.9% nickel positivity in Denver children < 5 yr
30.4% nickel positivity (UCH Age < 18 years)
Ear piercing
14.8% with ears pierced: 1.8% without
Risk Factors for Nickel sensitivity
Unscented products may have a masking fragrance, therefore patients with fragrance allergy should use only _________ products.
fragrance-free
Patients with suggestive history Patients with resistant dermatitis Chronic dermatitis Occupationally related dermatitis Atopic eczema - flaring Stasis dermatitis Photo or airborne distribution these are all?
reasons to do a patch test
Risk Factors for Nickel sensitivity
Female
Younger age
12.9% nickel positivity in Denver children < 5 yr
30.4% nickel positivity (UCH Age < 18 years)
Ear piercing
14.8% with ears pierced: 1.8% without
Nickel sensitivity is ____ in the US and ______ in Europe
raising in the US and declining in Europe
Europe regulates nickel
Quaternium-15
most frequently causes ACD in the United States.
It is a fragrance
Bacitracin and Neomycin are in _____
neosporin
causing ACD- delayed hyper sensitivity
Drug Eruptions are another type of
acd delayed hyper sensitivity
Usually begins 7-14 days after starting a new medication
Starts sooner in cases of receiving an “old” medication (i.e. inadvertent re-challenge)
Drug Eruptions acd delayed hyper sensitivity
Exanthematous Eruptions/drug rashes are usually ____ in kids and ____ in adults
virus in kids and meds in adults
Often also called ‘drug rash’ or ‘maculopapular eruption’ by non-dermatologists, this is the most common form of cutaneous drug eruption
Exanthematous Eruptions
Stasis Dermatitis is always on
the lower legs
Often seen in association with other signs of venous insufficiency of the lower extremities
Stasis Dermatitis
Thick, scaly plaques with “lichenification” that result from chronic rubbing and scratching
Topical steroids are first line therapy
Antihistamines can be used for itching
Patients need to be counseled to break the itch-scratch cycle
Lichen Simplex Chronicus
Common in patients with a history of leg swelling, varicose veins or a history of blood clots
Primarily found on the medial lower leg just above the ankle
Red in color with yellow fibrinous base
Borders irregularly shaped
They may be purulent if infected
Venous Stasis Ulcers
Most often occurs on legs, but can appear on arms and trunk
More common in men age 50+
often from over use of soap
Also called Discoid Eczema
Nummular Dermatitis
Stasis Dermatitis will present with
itching
Cellulitis is usually not ____ and will spread
bilateral
Round patches may be red, scaly and become crusty
Tends to be stubborn
Moisturization, minimize soap and topical corticosteroids are first line therapy
Nummular Dermatitis
Cellulitis has
pain
swelling
increasing warmth
Seborrheic Dermatitis in neomates
Flaky,white to yellowish oily scale on scalp
Can become confluent with a thick scale covering most of the scalp
Facial involvement is usually symmetric over the medial eyebrows, nasolabial folds and ears
Occurs in areas rich in sebaceous glands (scalp, face, ears, chest).
Characterized by flaky, “greasy” scales
Seborrheic Dermatitis in adults
Seborrheic Dermatitis occures in areas rich in
sebicious glands
occurs near hair
Seborrheic dermatitis is thought to be due to a combination of an over production of skin oil and irritation from a _____ called Malassezia furfur.
yeast
Chronic Plaque Disease
Guttate
Erythroderma
Pustular Psoriasis
Psoriasis
Clinical Subtypes
Psoriasis has a thick ____ scale
silvery
A condition in which skin cells build up and form scales and itchy, dry patches. Takes a gentic predisposition and environmental trigger
Psoriasis
Psoriasis
Clinical Subtypes
Chronic Plaque Disease
Guttate
Erythroderma
Pustular Psoriasis
Persistent low grade inflammation favors the development of insulin resistance, obesity and metabolic syndrome
Psoriasis and Comorbidities
Metabolic syndrome patients have accelerated atherosclerosis due to inflammation
Psoriasis and Comorbidities
cardiovascular disease
obesity
mi
Psoriasis is treated with
anti inflammatory ir immunosuppresents
**Stasis derm occurs on
lower legs
**Seborrheic dermatitis occurs on
scalp
**Atopic dermatitis occurs on
Flexor surfaces
**Psoriasis affects
Extensor surfaces, may include arthritis
Stasis dermatitis**
– lower extremity edema
Seborrheic dermatitis Etiology**
– Malassezia furfur
Atopic dermatitis Etiology**
– Filaggrin
Irritant dermatitis Etiology**
– Common irritants
Allergic contact dermatitis Etiology**
– Common allergens
Associated with Asthma and Allergic rhinitis**
Atopic dermatitis
Delayed type hypersensitivity reaction (Type IV); Diagnosis confirmed with patch testing**
Allergic contact dermatitis
May be associated with increased risk of cardiovascular disease**
Psoriasis