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Clin Med I Exam I > Derm 1 > Flashcards

Derm 1 Flashcards

1
Q

Atopic dermatitis pathogenesis

A

type 1 IgE mediated hypersensitivity rxn → mast cells release histamine creating itching and basophils in dermis

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2
Q

Pt with Atopic dermatitis may also have experienced what other conditions?

A

asthma or allergic rhinitis

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3
Q

What are the signs and symptoms of Atopic dermatitis?

Where does it usually present?

A
  • “itch that rashes”
  • BI-LATERAL symmetrical papules or plaques, edema, erosion w/ or w/o scales or crusting on ★ flexor surfaces ★ , neck, eyelids , face, dorms of hands and feet
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4
Q

What are the clinical features of atopic dermatitis

A

non infectious

  • pruritic (persistent xerosis)
  • flexural linchenification (not well demarcated)
  • facial and extensor surfaces in infancy
  • personal or family hx of allergic rhinitis or asthma
  • Dennie-morgan lines **
  • Hyperlinear palmar creases
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5
Q

What are itching triggers of atopic dermatitis

A

mites, foods, EtOH, cold/hot/humid, weather

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6
Q

What is the histology of atopic dermatitis

A
  • hyperkeratosis (piling up of skin cells)
  • acanthosis (epidural thickening)
  • excoriation (scraped skin)
  • staph colonization may be noted
  • eosinophil deposition
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7
Q

How often does Infantile atopic dermatitis occur ?

A

60% of cases present in 1st year of life usually after 2 months (when mothers natural antibodies of weened off)

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8
Q

Where does infantile atopic dermatitis occur and what does the lesions look like?

A
  • cheeks, chest, neck, extensor/flexor extremities

- lesions→ scaly, red occasionally oozing plaques (symmetric)

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9
Q

What can occur after a result of a flare up of atopic dermatitis? What what you see on different skin tones?

A

post inflammatory hyper/hypo pigmented changes

darker skin: hyper/hypo

lighter skin: hyper

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10
Q

What are three differential diagnosis for atopic dermatitis ?

A
  • contact dermatitis (not location and potential exposure)
  • scabies (note distribution and hx)
  • psoriasis (not location usually extensor surface than flexor , FH, less pruritic)
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11
Q

)What are the many forms of treatment for atopic dermatitis ?

A

-topical steroids
→ mainstay treatment (applied for short periods of time and stopped when healed)

-Antihistamines
→ hydroxyzine (sedating)
→ Cetrizine (less sedating)

-Topical Immunomodulators
→ Protopic/Elidel (Tacrolimus and Pimecrolimus) (non steroidal cytokineinhibitor); used as an addition/alternative to topical steroids; good for long term use

-Non steroidal
→ Crisaborle (phospodieterase 4 inhibitor)

-Biologic
→ Dupilumab( binds and inhibits IL-4; SC injection q 2 weeks)

-P.O. antibiotics
→ keflex 500mg qid x 10d (if evidence of secondary bacterial staph infection

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12
Q

Cream, ointment, foam, or gel for atopic dermatitis ?

A
  • cream→ moisturzer (use on face)
  • ointment → opaque (vaseline); occlusive
  • gel→ drying (no greasy)
  • lotion/foam→ great for scalp/hairy areas
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13
Q

What are the side effects for topical steroids?

A

-skin atrophy/ telangiectasis/tachyphylaxis (tolerance)

→ increase with potency

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14
Q

What are the signs and symptoms of Nummular Eczema?

A

COIN SHAPED pruritic patches and plaques, often occur in clusters, often seen in Atopic patients

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15
Q

What is the distribution of nummular eczema lesions?

What occurs when the lesions heal?

A
  • Lesions occur mainly on legs may be clear centrally (resembling tine corpis)
  • post inflammatory hyper-pigmentation
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16
Q

How do you diagnosize Nummular Eczema?

What are the differential diagnosis for N.E?

A

-clinical appearance and negative result of KOH

→ Tinea corporis: usually clear in the center
→ +KOH or fungal culture

17
Q

How do you treat nummular eczema acutely and long term?

A

acute: intermediate strength topical steroid (triamcinolone cream 0.1%) or severe (clobetasol ointment) +/- occlusion

long term: treatment with less potent topical steroids

18
Q

What are the signs and symptoms of Dyshydrosis?

A

-small vesicles appear on hands and feet associated with pruritus
→ like throwing hot dog on the grill and it bubbles up until the skin cracks

19
Q

What is the treatment for Dyshydrosis?

A
  • mild cleansers (cetaphil)
  • emollient barriers creams, protective gloves
  • burrows solution (antibacterial astringent)→ powder poured in water, then let it sit on skin to dry out weepy areas
  • topical steroids are the mainstay
  • Protopic and elidel for long term management
20
Q

What is contact dermatitis ?

Examples of irritant contact dermatitis and allergic contact dermatitis ?

A

Term applied to acute or chronic inflammatory rxns to substances that come in contact w/ skin

Type IV delayed hypersensitivity Rxn’s
ICD: diaper rash, alkalis, acids, soaps, detergents
ACD: poison ivy & nickel

21
Q

Signs and symptoms of ACD?

what is a differentia DX of ACD?

A
  • well demarcated linear pruritic (sometimes burning) rash at site of contact (unilateral)
  • poison ivy has a classic linear streaks of juicy papules and vesicles

Differential Dx:

  • Herpes zoster → usually painful and unilateral following dermatome
  • shingles
22
Q

Treatment of Allergic Contact Dermatitis

A
  • remove offending agen
  • cool showers
  • burrows solution
  • potent or super potent topical steroids
  • severe cases may warrant systemic steroids
23
Q

Signs and symptoms?
Diagnosis is based on?
How to manage?

….Irritant Contact Dermatitis

A

Signs and symptoms?
→ erythematous scaly, eczematous eruption not caused by allergens

Diagnosis is based on?
→ based on history and r/p allergic dermatitis

How to manage?
→ avoid offending agent of minimize contact

24
Q

Signs and symptoms of diaper dermatitis ?

How do the lesions distribute?

How do you treat it?

A
  • eyrthema, scale papules and plaques → if neglected may erode and ulcerate
  • Distribution→ lesions spares the creases ( ex: butt crack, thigh folds)
  • Treatment→ zinc oxide and frequent diaper changes OTC hydrocortisone
  • *if beefy red c. albican is suspected→ topical anti fungal (ketoconazole w/ nystatin powder )
25
Q

Perioral Dermatitis usually occurs in what population?

What is the etiology?

A
  • Typically in young women or children
  • Etiology is not fully understood maybe related to epidermal barrier dysfunction and by be induced by topical steroids, hormonal changes, cosmetics
26
Q

What is the treatment for perioral dermatitis ?

What are the signs and symptoms?

A

Topical antibiotics:
→ Metronidazole
→ Erythromycin

Severe cases may require oral minocyclin or doxycycline:
-AVOID TOPICAL STEROIDS

Si/Sx: clustered papulopustules on erythmatous bases, may have scales found around mouth (scattered; not well demarcated)

27
Q

What is Stasis Dermatitis ?

This condition is often seen in what population?

A

An eczematous eruption seen on the lower legs as a result of venous insufficiency. Often seen in women with genetic predisposition to vericosities

28
Q

What is the pathogenesis of Stasis Dermatitis ?

A

Incompetent valves → decrease venous return → ↑ hydrostatic pressure → edema (stretches the skin)→ tissue hypoxia (causes skin breakdown)

29
Q

Si/Sx’s of Stasis Dermatitis ?

Treatment?

A
  • erythematous scale→ erythema, edema, erosions, crust, 2ndary infection.
  • Chronic changes turn erythema to hyper pigmented thickened skin and woody appearence → can lead to ulcers

Treament:

  • compression stockings
  • burrows solution
  • moderate topical steroid: desonide, triamcinalone
  • 2ndary infection → keflex
30
Q

Seborrheic Dermatitis is a described as ?

What are the most common affected areas in S.D.?

A

Common chronic inflammatory dermatitis thought to be caused by yeast p. Ovale

-Characteristics distribution over areas w/ greatest concentration of sebaceous glands: scalp, face, body folds (yeast love oils)

31
Q

Si/Sx’s of Seborrheic Dermatitis?

Treatment?

A

Pruritic yellowish gray scaly macules with greasy look mostly on body folds, face, scalp

  • cradle cap =infants
  • dandruff = adults

Treatment:
- scalp: zinc shampoo, ketoconazole shampoo

-face, intertiringinous areas: low potency topical steroid (desonide or valisone cream)

32
Q

Lichen Simplex Chronicus (Neurodematitis) is described as ?

Where do these lesions occur?

A

Chronic, solitary, pruititic eczematous erupted caused by repetitive rubbing and scratching (that one spot you like to scratch out of habit because maybe it used to be itchy at one point)
-focal lichenified plaques multiple

distribution→ nape of neck, vulvae, scrotum, wrists, extensor forearms, ankles, pretibitial areas, groin

33
Q

How do you diagnose Lichen Simplex Chronicus (Neurodematitis) ?

What is the Differential dx for this condition?

A

-Diagnosis: clinical manifiesations

-Diff Dx:
→ Tinea Cruris and Candidiasis (make sure its not a yeast infection in groin)
→ Inverse psoriasis if in inguinal creases and perianal area

34
Q

What is the treatment for Lichen Simplex Chronicus (Neurodematitis) ?

A
  • Intermediate strength topical steroid ( triamcinolone cream 0.1%) prn
  • occlusion when able (wrap sarran wrap around it)
  • oral antihistamines
  • protopic
  • elidel 1%

Clin Med I Exam I (9 decks)

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