DERMA Flashcards
Which treatment is appropriate in order to avoid overuse of topical corticosteroids and minimize likelihood of flares in atopic dermatitis?
EMOLLIENTS
A 31/M, known to have asthma and allergic rhinitis, complains of difficulty sleeping due to pruritus of eczema. Which drug can benefit the patient?
Diphenhydramine
May be used as prophylactic treatment for AD
Tacrolimus Ointment
Systemic therapies used for wide spread and nonresponsive AD are
1. Cyclosporine 3-5 mg/kg/day (first line for refractory AD) 2. Mycophenolate mofetil 2 g/day 3. Methotrexate 10-22.5 mg/week 4. Azathioprine 1.5-2.5 mg/kg/day
What are the most common causes of irritant contact dermatitis?
either “wet,” such as detergents, organic solvents, soaps, weak acids and alkalis,
or
“dry,” such as low humidity air, heat, powders and dusts
Mainstay of diagnosis in allergic contact dermatitis. It has a sensitivity and specificity of 70-80%. Reproduces allergic contact dermatitis in an individual sensitized to a particular allergen.
Patch testing
The optimum timing of readings is day ___. An additional reading at day 6 or 7 will pick up a ~10% more positives that were negative at days 2 and 4.
2 and 4
A patient with chronic spontaneous urticaria reports persistent symptoms despite treatment with Cetirizine 10 mg tablet OD for the last 2 weeks. What should you do next?
Continue Cetirizine 10 mg tablet OD for another 2 weeks
- Which antihistamine is a standard treatment of acute spontaneous urticaria?
Loratidine
Cutaneous expression of the atopic state (family hx of asthma, allergic rhinitis or eczema)
Dermatitis
Characteristic defect in atopic dermatitis
Impaired epidermal barrier
Mutation of this protein in the stratum corneum is responsible for Impaired epidermal barrier in atopic dermatitis
FILAGGRIN
Clinical criteria for the diagnosis of atopic dermatitis
- Pruritus and scratching
- Course marked by exacerbations and remissions
- Lesions typical of eczamatous dermatitis
- Personal or family history of atopy (Asthma, AR, FOOD ALLEGIES, OR ECZEMA)
- Clinical course lasting longer than 6 weeks
- Lichenification of skin
- Presence of dry skin
Cutaneous stigma of AD
Perioral pallor
Extra fold of skin beneath lower eyelid ( DENNIE MORGAN FOLDS)
Increased palmar skin markings
Increased of cutaneous infections (esp STATUS AUREUS)
Macrolide immunosuppressants derived from soil fungi for AD
Tacrolimus ointment
Pimecrolimus cream
Preferred systemic antibiotics for secondary infections that exacerbates AD
DICLOXACILLIN (penicillinase resistance penicillines)
Cephalosporins (CEPHALEXIN)
Preferred systemic antibiotics for secondary infections that exacerbates AD if Dealing MRSA 7-10days
TMP SMX
Minocycline
Doxycycline
Clindamycin
May represent the end stage of a variety of pruritus and eczematous disorders.
Well circumscribed plaques with lichenified skin due to chronic scratching.
Lichen simplex chronicus
Common areas involved in Lichen simplex chronicus
Posterior nuchal region
Dorsum of the feet or ankles
Treatment of Lichen simplex chronicus
Break cycle of chronic itching by HIGH potency GC
IF RECALCITRANT: GC under occlusion or intralesion injection of GC
Contact dermatitis caused by an inherent characteristic of a compound
And prior exposure is NOT NECESSARY
Irritant contact dermatitis
Delayed type hypersensitivity mediated by memory T lymphocytes in the skin, occurring 12- 72H upon exposure, prior exposure is NECESSARY
Allergic contact dermatitis
Most common type of ICD
Chronic low grade irritant dermatitis
MC in hands
Control of pruritus Is essential for treatment of AD with
Antihistamine:
Diphenhydramine
Hydroxyzine
Doxepin
A variant of hand eczema that appears as multiple , intensely pruritic, small pa pulse and vesicles occurring on thenar and hypothenar eminences and sides of fingers
Dyshidrotic eczema
For hand eczema, examine for Dermatophyte infection by
KOH Preparation and Culture
Circular or OVAL “COINLIKE” lesion, frequently in Middle aged men, usually located at the TRUNK, Extensor surfaces of extremities (pretibial areas of dorsum of the hands)
NUMMULAR ECZEMA
Also known as WINTER ITCH , mc develops on Lower legs of elderly during dry times of the year. Mild inflammatory variant of dermatitis
XEROTIC ECZEMA
OR
ASTEOTIC ECZEMA
Caused by venous incompetence of the LOWER EXTREMITIES + chronic edema, most commonly affecting MEDIAL ASPECT of the ankle over a distended vein and may proceed to chronic dermal fibrosis recognized as BRAWNY edema of the skin
Statis dermatitis
Treatment for Statis dermatitis
- Elevation of legs
- Use of compression stocking with gradient >30-40mmhg
- Emollients
- Mid potency Topical GC
- Avoid irritants
(+)blister and mucosal or epidermal detachment resulting form FULL THICKNESS epidermal necrosis in the absence of substantial dermal inflammation
SJS/TEN
Blister developing on TARGET LESIONS, dusky orpurpuric macular in which MUCOSAL involvement is significant, and total body surface area blistering and eventual detachment is <10%
Rare confluence
SJS
total body surface area blistering and eventual detachment is 10-30%
SJS/TEN OVERLAP
total body surface area blistering and eventual detachment is >30%
+confluence erythema
TOXIC EPIDERMAL NECROLYSIS
Most common drugs associated with SJS AND TEN
Allopurinol Sulfonamide NSAID - OXICAM AROMATIC ANTICONVULSANT (phenytoin, carbamazepine, phenobarbitone) Lamotrigine (anticonvulsant) NEVIRAPINE
Pustular eruptions + high spiking fever + leukocytosis - innumerable pinpoint pustules overlying a diffuse edematous erythema
20% oral lesions
AGEP
Acute generalized exanthematous pustulosis
Adverse drug reaction for type I
IgE mediated
Urticaria
Anaphylaxis
Angioedema
Adverse drug reaction for type II
IgG mediated
DRUG INDUCED Hemolysis
THROMBOCYTOPENIA
Adverse drug reaction for type III
Immune complex
Vasculitis
Serum sickness
Drug induced lupus
Adverse drug reaction for type IVA
T cell mediated MACROPHAGE inflammation:
Tuberculin skin test
Contact dermatitis
Adverse drug reaction for type IVB
T cell mediated EOSINOPHILS inflammation:
MORBILLIFORM ERUPTIONS
DRUG INDUCED HYPERSENSITIVITY REACTION (DIHS)
Adverse drug reaction for type IVC
T cell mediated CYTOTOXIC inflammation:
MORBILLIFORM ERUPTIONS
SJS/TEN
Adverse drug reaction for type IVD
T cell mediated NEUTROPHIL inflammation:
AGEP acute generalized exanthematous pustulosis
(+)mucositis in 30%,
Diffuse, red morbilliform eruption with facial involvement, facial and acral swelling. (Fever, LAD, hepatitis, nephritis, carditis, eosinophilia, atypical lymphocytosis)
Dress or DIHS
Urticarial serpiginous or polycystic dash, purpuric eruption along the sides of the feet and hands is characteristic
Serum sickness or serum sickness reactions
Seen with urticaria or swelling of the face with respiratory distress and cardiovascular collapse
ANGIOEDEMA
Associated with red man syndrome, a histamine related AnaPhylactoid reaction characterized by FLUSHING, DIFFUSE MACULOPAPULAR ERUPTION AND HYPOTENSION
Vancomycin
Commonly implicated in vasculitis
B lactams