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Clin Med I > Derm III > Flashcards

Derm III Flashcards

1
Q

Another name for Dermatitis?

Family of what kind of disease?

A

Eczema, Atopic dermatitis

Superficial, pruritic, erythematous skin lesions that can be red, blistering, oozing, scaly or thickened skin

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2
Q

Atopic

A
  • life-long tendency to allergic conditions, such as asthma & allergic rhinitis
  • extra sensitive to skin irritation
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3
Q

What can trigger eczema?

A

Anything

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4
Q

Describe Atopic dermatitis

A

-chronic relapsing, type 1 IgE mediated hypersensitivity reaction

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5
Q

What percent of the population has Atopic Dermatitis?

A

5 - 10%

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6
Q

Pt presents w/ pruritic papules & plaques on his AC, dorsum of hands, and face bilaterally. Upon PE you find flexural lichenification. Pt has a hx of asthma & allergic rhinitis. How can you explain this dz to the pt?

A
  • Atopic Dermatitis

- IgE mediated reaction: Mast cells & Basophils of dermis release histamine and other vasoactive amines

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7
Q

If you are examining an infant w/ Atopic Dermatitis, how might the distribution differ than an adult?

A
  • Infants: both Flexor and Extensor involvement, Cheeks, chest, neck
  • Adults: mainly Flexor involvement, Neck, Eyelids, Face, Dorsum of hands & feet
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8
Q

What disease is characterized by “the itch that rashes”? What are other likely findings?

A

-Atopic Dermatitis –> rash forms secondary to scratching

  • Pruritis
  • Flexural lichenification
  • Family/personal hx of asthma or allergic rhinitis
  • Papules or plaques, edema, erosion, +/- scales or crusting (d/t secondary staph infxn)
  • post-inflammatory hyper/hypo-pigmentation
  • Persistant xerosis (dry itchy skin)
  • Dennie-Morgan lines
  • Hyperlinear palm creases
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9
Q

Histology of Atopic Dermatitis

A
  • varies w/ stage of lesion
  • hyperkeratosis, acanthosis, and excoriation –> spongotic
  • Staph colonization may occur
  • Eosinophil deposition
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10
Q

When does Infantile Atopic Dermatitis usually present? Describe the lesions

A
  • 60% of cases in first year of life, usually after 2 months
  • Can be generalized & bilateral/symmetric - scaly, red, occasionally oozing plaques
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11
Q

When determining between Atopic Dermatitis and Psoriasis, what are some considerations?

A
  • Atopic Dermatitis: Intensely pruritic, Flexor surfaces, Less well demarcated, Hx of allergic rhinitis/asthma
  • Psoriasis: Less pruritic, Extensor surfaces, Well-Demarcated, Family hx, Silver scale
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12
Q

If a pt has Dennie-Morgan lines, what should you suspect?

A

Atopic dermatitis

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13
Q

Differential dx for Atopic Dermatitis

A
  • Contact dermatitis (unilateral vs bilateral, potential exposure)
  • Scabies (distribution & hx)
  • Psoriasis
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14
Q

Managing Atopic Dermatitis

A
  • Topical steroids for flares –> anti-inflammatory + anti-mitotic +/- occlusion
  • Antihistamines (H1/2) - Sedation may be beneficial, caution w/ elderly, glaucoma, prostate issues
  • Topical Immunomodulators - Tacrolimus, Pimecrolimus (good for long term)
  • Crisabole (PDE-4 inhibitor)
  • Biologics (Dupolumab - IL-4 inhibitor)
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15
Q

If you are prescribing your patient a Topical Corticosteroid, what are some counceling points?

A
  • Should see prompt improvement, watch for tachyphylaxis (cycle dosing to avoid)
  • Skin atrophy, Telangectasias
  • Acneform eruptions on face
  • Do not use long-term, or on any other areas
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16
Q

If your pt w/ Atopic Dermatitis has developed a secondary bacterial Staph infxn, what should you do?

A
  • PO abx

- Cephalexin (Keflex) 500 mg qid x 10 days

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17
Q

What are general management strategies for Atopic Dermatitis?

A
  • Avoid triggers (extreme cold/head/soaps)
  • Use moisturizing soap - Cetaphil
  • Emollients
18
Q

Pt presents w/ coin-shaped pruritic patches & plaques on his legs. Patches display central clearing. Hx of Atopic Dermatitis –> what test could you order?

A

Nummular Eczema

  • KOH to rule out fungus (mimics Tinea corporis)
  • Tinea corpois would be + KOH
19
Q

Management of Nummular Eczema

A

-Acute: Intermediate potency Topical Steroid (Triamcinolone cream); if Severe, High potency (Clobetasol ointment)
+/- occlusion

-Long-term: Less potent Topical Steroids

20
Q

What is “Wet Eczema”

A

Dyshydrosis

-vesicle formation resulting from inflammation & foci of intracellular edema (spongiosis) which becomes loculated in the skin of the palm and soles

21
Q

Pt presents w/ pruritic, small vesicles on her hands and feet, Pt is a florist and frequently washes her hands; management?

A
  • Mild cleansers (cetaphil), avoid hand sanitizers
  • Emollient barrier cream, protective gloves, avoidance of irritants
  • Burrow’s solution (antibacterial astringent)
  • Topical Corticosteroids (Mainstay) - High for acute flare, Medium +/- occlusive dressing
  • Long Term –> Tacrolimus, Pimecrolimus
22
Q

Pt presents w/ a well demarcated, linear, pruritic rash consisting of “juicy” papules & vesicles on his right ankle and calf. Pt states he was hiking in shorts. What is the pathophys of this?

A

Allergic Contact Dermatitis

-Type IV Delayed HS reaction after exposure to Poison Ivy

23
Q

What are some things that may cause Allergic Contact Dermatitis?

Differential Diagnosis?

A
  • Poison Ivy, Nickel (can cause chronic reactions - jewelry, buttons), Chemicals
  • Herpes Zoster: usually painful & unilateral following dermatome
24
Q

Management for Allergic Contact Dermatitis

A
  • remove offending agent
  • cool shower
  • Burrow’s solution
  • Potent or Super potent Topical Steroid
  • Severe –> systemic steroids
25
Q

What causes Irritant Contact Dermatitis

A
  • direct toxic reaction to rubbing, friction, maceration, or exposure to chemical/thermal agent
    ex. alkali, acids, soaps, detergents, feces/urine
26
Q

How do you diagnose Irritant Contact Dermatits

A

-history & R/O Allergic Contact Dermatitis

27
Q

What is Diaper Dermatitis? How does it develop? Management?

A
  • Irritant contact dermatitis
  • result of over-hydration of the skin, irritated by chafing, soaps, prolonged contact w/ urine/feces
  • Zinc oxide ointment + frequent diaper changes; OTC hydrocortisone
28
Q

When evaluating a pt w/ diaper dermatitis, what presentation do you suspect? What would be a concerning finding?

A
  • Eryethema, scale papules & plaques that spares the creases
  • Neglect –> ulceration & erosion
  • Beefy Red –> C. albican (tx w/ Topical Ketoconazole + Nystatin powder)
29
Q

22 year old female presents w/ clustered papulopustules on erythematous bases w/ scales around the corner of her lips and around her mouth. They appear both acne-like & dermatitis like, and are not well demarcated. How to we treat this/why? What is CI?

A

Perioral Dermatitis

  • Topical ABX for their anti-inflammatory benefit: Metronidazole or Erythromycin
  • If severe, PO mino/tetra/doxycycline
  • CI: Topical Steroids –> worsens rash
30
Q

What should you counsel a pt w/ Perioral Dermatitis to avoid?

A

Cosmetics, Topical steroids

31
Q

What causes Stasis Dermatitis

A

Incompetent valves –> Decreased venous return –> Increased hydrostatic pressure –> Edema –> Tissue hypoxia

32
Q

Who is most likely to develop Stasis Dermatitis?

A

-Women w/ genetic predisposition to varicosities

33
Q

Course of Stasis Dermatitis

A

Erythematous Scale develops erythemia, edema, erosions, crusts, & secondary infections –> Chronic changes: non-inflammatory, thickened skin w/ a “Woody” appearance –> can ulcerate

34
Q

Management of Stasis Dermatitis

A
  • Compression socks
  • Burrow’s solution
  • Moderate Topical Steroid (Desonide, Triamcinolone cream)
  • Secondary infections - Cephalexin (Keflex)
35
Q

What dermatitis is thought to be caused by P. Ovale (yeast)? Where does it manifest?

A
  • Seborrheic Dermatitis

- Areas w/ the greatest concentration of sebaceous glands: Face (t-zone), Scalp, Body folds

36
Q

Presentation of Seborrheic Dermatitis

A

Pruritic, yellowish-gray, scaly macules w/ greasy look

-Infants: Cradle cap

-Adults:
Scalp - Dandruff
Face - Erythema, & Scaling

37
Q

Management of Seborrheic Dermatitis

A
  • Scalp: Zinc shampoo, Ketoconazole shampoo (5-10 min for absorption)
  • Face, Intertriginous areas: Low potency topical steroids (Desonide, Valisone cream)
38
Q

What is Neurodermatitis? Presentation?

A

Lichen Simplex Chronicus

  • Chronic, solitary, pruritic eczematous eruption caused by repetitive rubbing & scratching
  • Focal lichenified plaque or multiple plaques –> post-inflammatory hyper/hypo-pigmentation
39
Q

Distribution of Lichen Simplex Chronicus

A

Nape of neck, vulvae, scrotum, groin, wrists, extensor forearms, ankles, pretibial areas

40
Q

DX & Differential dx for Lichen Simplex Chronicus

A
  • HPE
  • Groin: Tinea cruris & Candidiasis
  • Inguinal crease or Perianal: Inverse Psoriasis
41
Q

Tx for Lichen Simplex Chronicus

A
  • Behavioral
  • Intermediate potency Topical Steroid (Triamcinolone cream) +/- Occlusion
  • Oral Antihistamines
  • Tacrolimus, Pimecrolimus (protopic, elidel)

Clin Med I (4 decks)

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