Derm III Flashcards
Another name for Dermatitis?
Family of what kind of disease?
Eczema, Atopic dermatitis
Superficial, pruritic, erythematous skin lesions that can be red, blistering, oozing, scaly or thickened skin
Atopic
- life-long tendency to allergic conditions, such as asthma & allergic rhinitis
- extra sensitive to skin irritation
What can trigger eczema?
Anything
Describe Atopic dermatitis
-chronic relapsing, type 1 IgE mediated hypersensitivity reaction
What percent of the population has Atopic Dermatitis?
5 - 10%
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?
- Atopic Dermatitis
- IgE mediated reaction: Mast cells & Basophils of dermis release histamine and other vasoactive amines
If you are examining an infant w/ Atopic Dermatitis, how might the distribution differ than an adult?
- Infants: both Flexor and Extensor involvement, Cheeks, chest, neck
- Adults: mainly Flexor involvement, Neck, Eyelids, Face, Dorsum of hands & feet
What disease is characterized by “the itch that rashes”? What are other likely findings?
-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
Histology of Atopic Dermatitis
- varies w/ stage of lesion
- hyperkeratosis, acanthosis, and excoriation –> spongotic
- Staph colonization may occur
- Eosinophil deposition
When does Infantile Atopic Dermatitis usually present? Describe the lesions
- 60% of cases in first year of life, usually after 2 months
- Can be generalized & bilateral/symmetric - scaly, red, occasionally oozing plaques
When determining between Atopic Dermatitis and Psoriasis, what are some considerations?
- 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
If a pt has Dennie-Morgan lines, what should you suspect?
Atopic dermatitis
Differential dx for Atopic Dermatitis
- Contact dermatitis (unilateral vs bilateral, potential exposure)
- Scabies (distribution & hx)
- Psoriasis
Managing Atopic Dermatitis
- 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)
If you are prescribing your patient a Topical Corticosteroid, what are some counceling points?
- 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
If your pt w/ Atopic Dermatitis has developed a secondary bacterial Staph infxn, what should you do?
- PO abx
- Cephalexin (Keflex) 500 mg qid x 10 days
What are general management strategies for Atopic Dermatitis?
- Avoid triggers (extreme cold/head/soaps)
- Use moisturizing soap - Cetaphil
- Emollients
Pt presents w/ coin-shaped pruritic patches & plaques on his legs. Patches display central clearing. Hx of Atopic Dermatitis –> what test could you order?
Nummular Eczema
- KOH to rule out fungus (mimics Tinea corporis)
- Tinea corpois would be + KOH
Management of Nummular Eczema
-Acute: Intermediate potency Topical Steroid (Triamcinolone cream); if Severe, High potency (Clobetasol ointment)
+/- occlusion
-Long-term: Less potent Topical Steroids
What is “Wet Eczema”
Dyshydrosis
-vesicle formation resulting from inflammation & foci of intracellular edema (spongiosis) which becomes loculated in the skin of the palm and soles
Pt presents w/ pruritic, small vesicles on her hands and feet, Pt is a florist and frequently washes her hands; management?
- 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
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?
Allergic Contact Dermatitis
-Type IV Delayed HS reaction after exposure to Poison Ivy
What are some things that may cause Allergic Contact Dermatitis?
Differential Diagnosis?
- Poison Ivy, Nickel (can cause chronic reactions - jewelry, buttons), Chemicals
- Herpes Zoster: usually painful & unilateral following dermatome
Management for Allergic Contact Dermatitis
- remove offending agent
- cool shower
- Burrow’s solution
- Potent or Super potent Topical Steroid
- Severe –> systemic steroids
What causes Irritant Contact Dermatitis
- direct toxic reaction to rubbing, friction, maceration, or exposure to chemical/thermal agent
ex. alkali, acids, soaps, detergents, feces/urine
How do you diagnose Irritant Contact Dermatits
-history & R/O Allergic Contact Dermatitis
What is Diaper Dermatitis? How does it develop? Management?
- 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
When evaluating a pt w/ diaper dermatitis, what presentation do you suspect? What would be a concerning finding?
- Eryethema, scale papules & plaques that spares the creases
- Neglect –> ulceration & erosion
- Beefy Red –> C. albican (tx w/ Topical Ketoconazole + Nystatin powder)
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?
Perioral Dermatitis
- Topical ABX for their anti-inflammatory benefit: Metronidazole or Erythromycin
- If severe, PO mino/tetra/doxycycline
- CI: Topical Steroids –> worsens rash
What should you counsel a pt w/ Perioral Dermatitis to avoid?
Cosmetics, Topical steroids
What causes Stasis Dermatitis
Incompetent valves –> Decreased venous return –> Increased hydrostatic pressure –> Edema –> Tissue hypoxia
Who is most likely to develop Stasis Dermatitis?
-Women w/ genetic predisposition to varicosities
Course of Stasis Dermatitis
Erythematous Scale develops erythemia, edema, erosions, crusts, & secondary infections –> Chronic changes: non-inflammatory, thickened skin w/ a “Woody” appearance –> can ulcerate
Management of Stasis Dermatitis
- Compression socks
- Burrow’s solution
- Moderate Topical Steroid (Desonide, Triamcinolone cream)
- Secondary infections - Cephalexin (Keflex)
What dermatitis is thought to be caused by P. Ovale (yeast)? Where does it manifest?
- Seborrheic Dermatitis
- Areas w/ the greatest concentration of sebaceous glands: Face (t-zone), Scalp, Body folds
Presentation of Seborrheic Dermatitis
Pruritic, yellowish-gray, scaly macules w/ greasy look
-Infants: Cradle cap
-Adults:
Scalp - Dandruff
Face - Erythema, & Scaling
Management of Seborrheic Dermatitis
- Scalp: Zinc shampoo, Ketoconazole shampoo (5-10 min for absorption)
- Face, Intertriginous areas: Low potency topical steroids (Desonide, Valisone cream)
What is Neurodermatitis? Presentation?
Lichen Simplex Chronicus
- Chronic, solitary, pruritic eczematous eruption caused by repetitive rubbing & scratching
- Focal lichenified plaque or multiple plaques –> post-inflammatory hyper/hypo-pigmentation
Distribution of Lichen Simplex Chronicus
Nape of neck, vulvae, scrotum, groin, wrists, extensor forearms, ankles, pretibial areas
DX & Differential dx for Lichen Simplex Chronicus
- HPE
- Groin: Tinea cruris & Candidiasis
- Inguinal crease or Perianal: Inverse Psoriasis
Tx for Lichen Simplex Chronicus
- Behavioral
- Intermediate potency Topical Steroid (Triamcinolone cream) +/- Occlusion
- Oral Antihistamines
- Tacrolimus, Pimecrolimus (protopic, elidel)
