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Clinical Med I > Derm - Dermatitis - Exam 1 > Flashcards

Derm - Dermatitis - Exam 1 Flashcards

1
Q

What is the primary symptoms of atopic eczema?

A

Itchy skin

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2
Q

What is the atopic triad?

A

Combination of the following:

  • Atopic dermatitis
  • Allergic rhinitis (hay fever)
  • Asthma
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3
Q

What is the clinical presentation of atopic eczema? Include appearance and location.

A
  • Ranges from ill-defined, erythematous, scaling patches to edematous papules and vesicles
  • Located on cheeks, scalp, and extensor surfaces in infants
  • Located on flexural surfaces, hands, and feet in older children/adults
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4
Q

In pediatric patients, what is an important indicator that can help you determine if the presentation is atopic eczema or another rash?

A

The diaper area will be spared

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5
Q

What are essential/required features of atopic eczema in order to make the diagnosis?

A
  • Pruritis
  • Eczema
  • Typical morphology and age-specific patterns
  • Chronic or relapsing history
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6
Q

What are important features that are observed in the majority of cases and add support to the diagnosis of atopic eczema?

A
  • Early age of onset
  • Atopy (either personal or family history)
  • IgE reactivity
  • Xerosis
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7
Q

What are complications of atopic eczema?

A
  • Excoriations
  • Lichenification (thickened, dry, irritated skin due to chronic scratching / accentuated skin lines)
  • Fissures (palms, fingers, soles) which can be very painful
  • Secondary cellulitis as skin is often highly colonized with Staph aureus
  • Eczema Herpeticum (disseminated viral infection - typically primary infection of HSV1)
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8
Q

What is Pityriasis Alba?

A

Inflammation that when it subsides/resolves, it causes and leaves hypopigmentation in those areas.

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9
Q

How is Eczema Herpeticum, a complication of Atopic eczema, typically treated?

A

Prompt treatment with antiviral needed (acyclovir or valacyclovir) as it is a dermatological emergency.

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10
Q

In general, what does optimal management of Atopic Eczema include?

A

Patient education which includes:
- Avoiding exacerbating factors (allergens/irritants) - - Hydrate the skin and restore skin barrier function

Pharmacologic treatment of skin inflammation:

  • Topical/oral steroids
  • Calcineruin inhibitors
  • Antihistamines for itching
  • Antibiotics
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11
Q

What should an individual avoid if diagnosed with atopic eczema?

A
  • Common triggering irritants (fragrances, bleach, wool clothing, heat, low humidity)
  • Animal dander, dust mites
  • Excessive bathing/swimming
  • Scented bath oils, lotions
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12
Q

How can an individual restore skin barrier function if diagnosed with atopic eczema?

A
  • Avoid rubbing/scratching

- Treat stress and anxiety

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13
Q

What is the gold standard in regards to moisturizers?

A

Petroleum (Vaseline)

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14
Q

How often should a moisturizer be applied in cases of atopic eczema?

A

Two times daily and immediately after bathing

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15
Q

If prescribing topical corticosteroids for atopic eczema, what potency and how often should the patient apply it for mild disease?

A

Low potency applied 1-2x daily for 2-4 weeks

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16
Q

If prescribing topical corticosteroids for atopic eczema, what potency and how often should the patient apply it for moderate disease?

A

Medium to high potency applied 1-2x daily for 2-4 weeks

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17
Q

If prescribing topical corticosteroids for atopic eczema, what potency and how often should the patient apply it for acute flares?

A

Intermediate to super high potency may be used for up to 2 weeks, then replaced with a lower potency until lesions resolve

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18
Q

Where should one generally avoid applying topical corticosteroids? Why?

A

Thinned-skin areas such as the face, neck, and skin folds.

These areas have a higher absorption rate and risk of adverse effects.

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19
Q

What specific body regions have the highest percutaneous absorption rates?

A
  • Forehead
  • Mandible
  • Genitalia
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20
Q

What are the potential adverse effects of topical corticosteroids?

A
  • Skin atrophy
  • Acneiform or rosacea-like eruptions
  • Straie (thick red lines on skin)
  • Bruising
  • Telangiectasias
  • Hypertrichosis (increased hair growth)
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21
Q

What are the two common topical calcineurin inhibitors that are prescribed?

A
  • Pimecrolimus (Elidel) cream

- Tacrolimus (Protopic) ointment

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22
Q

What are topical calcineurin inhibitors prescribed for and how often are they applied?

A
  • Prescribed for mild to moderate eczema of the face, eyelids, neck, and skin folds (thinned-skinned areas in which you avoid steroids). Applied twice daily.
  • Maintenance therapy in adults and children 2-15 years old. Applied 2-3 times per week to recurrent sites of involvement to reduce relapse.
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23
Q

What is the topical calcineurin inhibitor formulation for adults? Patients 2-15 years old?

A

Adults: 0.1% formulation

2-15 years old: 0.03% formulation

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24
Q

What are side effects of topical calcineurin inhibitors?

A
  • Burning
  • Stinging
  • Pruritis

(Note that these effects are most common during the 1st week of application and then subside)

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25
Q

What are oral antihistamines recommended for in atopic eczema?

A

Pruritis to break the itch-scratch-itch cycle

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26
Q

When would you prescribe antibiotics in atopic eczema?

A

If the complication of a secondary infection occurs

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27
Q

When would you prescribe oral steroids in atopic eczema?

A

Only in severe cases

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28
Q

What is the general population affected by Lichen Simplex Chronicus “Neurodermatitis”?

A

Females ages 30-50 years old

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29
Q

What are common areas in which you would observe Lichen Simplex Chronicus “Neurodermatitis”?

A
  • Scalp
  • Back of neck
  • Wrists
  • Forearms
  • Lower legs
  • Genitals (seen more in males)
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30
Q

What are common characteristics of Lichen Simplex Chronicus “Neurodermatitis”?

A
  • Lichenified plaque caused by excessive scratching or rubbing
  • Exaggerated skin markings, dry, leathery appearance, pigmentation
  • Pruritis often worse at night
31
Q

What are causes of Lichen Simplex Chronicus “Neurodermatitis”?

A
  • Atopic dermatitis
  • Contact dermatitis
  • Psoriasis
  • Lichen Planus
  • Fungal infection
  • Insect bite
  • Neuropathy (DM)
  • Anxiety/stress
32
Q

What are treatment options for Lichen Simplex Chronicus “Neurodermatitis”?

A
  • Stop itching/rubbing
  • High potency topical steroids
  • Moisturizers
  • Antidepressants: SSRI - Paroxetine (Paxil), Sertraline (Zoloft) or tricyclic antidepressants
  • 1st generation antihistamine, Hydroxyzine (Vistaril), or tricyclic antidepressant (Doxepin) can be used for nocturnal pruritis
33
Q

What are common characteristics of Dyshidrotic Eczema “dyshidrosis/pompholyx”?

A
  • Deep seated vesicles with tapioca-like appearance which can coalesce and rupture
  • Intensely pruritic
34
Q

Where is Dyshidrotic Eczema typically observed?

A
  • Hands (80%)
  • Sides of fingers
  • Palms and soles
35
Q

What are precipitating factors for Dyshidrotic Eczema?

A

Emotional stress and hot weather.

Also found in those with nickel allergy

36
Q

What is the duration of Dyshidrotic Eczema?

A

Episodes are usually weeks to months apart with spontaneous remission after 2-3 weeks

37
Q

What is the management for Dyshidrotic Eczema?

A
  • Reassurance
  • Wet dressings which draw fluid out of the vesicles (Burow’s soaks/Domeboro solution)
  • Topical steroids
38
Q

What is Keratosis Pilaris?

A

Disorder of keratinization causing the formation of horny plugs in hair follicles

39
Q

What are common characteristics of Keratosis pilaris?

A
  • Rough, raised papules (flesh, red or brownish)

- Usually worse in winter months

40
Q

Where is Keratosis pilaris typically observed?

A
  • Outer upper arms
  • Thighs
  • Cheeks
  • Upper back
41
Q

What is the treatment for Keratosis pilaris?

A

Individuals can try creams, exfoliating scrubs, topical retinoids, urea, salicylic acid, alpha-hydroxy acids, but there is not much one can do for it and typically improves with age.

42
Q

What is the presentation associated with Allergic Contact Dermatitis?

A
  • Dominant symptom is itch
  • Localized to skin areas that came in contact with the allergen
  • Hands, face, and eyelids are common
  • Erythematous, papular dermaitis with indistinct margins; often blisters and edema
  • Can take 1-3 days to appear after contact with allergen
43
Q

What is the presentation associated with Irritant Contact Dermatitis?

A
  • Burning, stinging pain
  • Hands are most common
  • Erythema, chapped skin, dryness, and fissuring
  • More immediate onset (minutes to hours)
44
Q

What are typical examples of Allergic Contact Dermatitis?

What are some other allergenic agents?

A
  • Poison ivy, Oak, Sumac

- Nickel, Rubber, Latex, Preservatives, Cosmetics, Neomycin

45
Q

What is a common Irritant Contact Dermatitis which involves saliva?

A

Lip licker’s dermatitis

46
Q

What is the treatment for contact dermatitis?

A
  • Topical steroids 1-2 times daily for 7-14 days
  • Discontinue exposure to allergen OR irritant
  • Decreased frequency of hand-washing if that is playing a role
  • Use mild soap
  • Wear gloves or protective clothing
  • Apply bland emollient (Vaseline, Aquaphor)
  • Consider an oral corticosteroids for Allergic Contact Dermaitis involving face or greater than 20% of body surface area
47
Q

If prescribing an oral corticosteroids for Allergic Contact Dermaitis involving the face or greater than 20% of body surface area, what could you prescribe?

A

Prednisone 0.5-1 mg/kg per day (max 60 mg/day) for 7 days

48
Q

Is a drug allergy Type I, II, III, or IV reaction?

A

Type I immune reaction mediated by IgE

49
Q

What accounts for the large majority of all adverse cutaneous drug reactions?

A

Drug-induced exanthems

50
Q

How long does it take for a drug-induced exanthem to develop?

A

Within 5-14 days of exposure

51
Q

What are the common characteristics associated with Drug-induced exanthems?

A
  • Morbilliform rash - erythematouse macules, papules (measle-like rash)
  • Involves trunk and proximal extremities
  • Mucosal involvement is absent
52
Q

What commonly causes Drug-induced exanthems?

A

Penicillins and sulfonamides

53
Q

What are common characteristics associated with urticaria “hives”?

A
  • Intensely pruritic

- Circumscribed, raised erythematous eruption with central pallor

54
Q

What is angioedema?

A

Swelling deeper in the dermis and subcutaneous tissue of the face and lips

55
Q

What can lead to airway obstruction in angioedema?

A

Tongue swelling and laryngeal edema

56
Q

When does urticaria and angioedema typically occur in a drug reaction?

A

Most commonly occurs during the first weeks of therapy, but can happen at any time, even months to years after being on the medication

57
Q

What are examples of medications that commonly cause urticaria or angioedema?

A
  • ACE inhibitors

- Antibiotics (penicillins, cephalosporins, sulfonamides)

58
Q

What is the treatment for common cutaneous drug reactions?

When do these reactions typically resolve once treatment has started?

A

Treatment:

  • Discontinue the offending drug
  • Supportive and/or symptomatic care such as systemic corticosteroids, topical steroids, or antihisamines

Resolution:
Typically within 5-14 days

59
Q

What are examples of severe cutaneous drug reactions?

A
  • Drug-induced hypersensitivity syndrome (DIHS)

- Steven-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN)

60
Q

What are common characteristics associated with Drug-induced hypersensitivity syndrome (DIHS)?

A
  • Fever (100.4-104 F)
  • Facial edema
  • Rash (morbilliform eruption)
  • Lymphadenopathy
  • Blood abnormalities
  • Visceral involvement (heart, kidney, liver)
61
Q

What are causes of Drug-induced hypersensitivity syndrome (DIHS)?

A
  • Antiepileptic agents
  • Allopurinol (used for gout)
  • Sulfonamides
62
Q

What is SJS/TEN?

A

A rare, acute, potentially life threatening mucocutaneous reaction in which there is epidermal necrosis and sloughing off of the mucous membranes and skin due to Fas/Fas ligand-induced apoptosis

63
Q

Which population is at a greatly increased risk for SJS/TEN?

A

HIV-infected individuals

64
Q

What medications are commonly implicated in SJS/TEN?

What is another cause of SJS/TEN?

A

Medications:

  • Allopurinol
  • Anticonvulsants (phenobarbital, phenytoin, carbamazepine, and lamotrigine)
  • Sulfonamides
  • NSAIDS

Other:
Mycoplasma pneumoniae

65
Q

What are the most common causes of SJS/TEN in pediatrics?

A

Medications:

  • Anticonvulsants (phenobarbital, carbamazepine, and lamotrigine)
  • Sulfonamides

Other:
Mycoplasma pneumoniae

66
Q

What is Nikolsky Sign and what disorders is it commonly associated with?

A

Nikolsky Sign is the elicitation of skin blistering as a result of gentle mechanical pressure on the skin.

Commonly associated with SJS/TEN and Pemphigus

67
Q

What is the common clinical presentation of SJS/TEN?

A
  • Fever often greater than 39C/102.2F
  • Flu-like symptoms 1-3 days before lesions develop
  • Tender erythematous skin lesions, purpuric macules –> Vesicles/bullae form –> Skin sloughing
  • Mucosal involvement
  • Erythema and edema of lips
  • Intraoral bullae –> painful friable raw surfaces and hemorrhagic crusts
  • Oral, genital, and/or ocular involvement (conjunctival itching, burning, pain, corneal ulceration, and photophobia
68
Q

What classifies SJS versus TEN?

A

SJS - skin detachment of less than 10% of total body surface area

TEN - skin detachment of greater than 30% total body surface area

69
Q

How is SJS/TEN diagnosed?

A

Clinical initially, followed by skin biopsy and cultures

70
Q

What is the treatment for SJS/TEN?

A
  • Discontinue offending medication
  • Hospital admission if extensive skin sloughing; ICU/burn unit depending on severity
  • Supportive care
  • Nutritional and fluid replacement
  • Temperature maintenance
  • Pain relief
  • Ocular management
  • Wound care/sterile handling
71
Q

What is the typical cause of death associated with SJS/TEN?

A

Septicemia (S. aureus and P. aeruginosa)

72
Q

What are the long-term complications associated with SJS/TEN?

A
  • Cutaneous
  • Mucosal
  • Ocular
  • Pulmonary
73
Q

What is drug hypersensitivity?

A

Immune-mediated response to a drug in a sensitized patient

Clinical Med I (24 decks)

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