Derma Ramos - Eczema Flashcards
A non-contagious, pruritic, inflammatory skin disorder characterized by: erythema, papules, vesicles, crusting, scaling and lichenification
Eczema
Eczema is often regarded synonymous with
Dermatitis
Acute stage of eczema presents with
Erythema, papules, vesicles, crusting
Chronic stage of eczema presents with
Scaling and lichenification
2 classifications of eczema
Intrinsic
Extrinsic
Extrinsic eczema
Irritant contact dermatitis
Allergic contact dermatitis
Photodermatitis
Intrinsic dermatitis
Seborrheic dermatitis Nummular dermatitis Dyshidrotic eczema Atopic dermatitis Lichen simplex chronicus Stasis dermatits Xerotic eczema
Occurs when the skin is exposed acutely or chronically to chemical or physical agents that irritate the skin
Irritant contact dermatitis
Delayed or cell-mediated type hypersentivity
Allergic contact dermatitis
Irradiation by UV light results in the transformation of certain substances into allergens or irritants
Photodermatitis
Chronic, inflammatory papulosquamous skin disorder related to high load of Ptyrosporum yeast on the skin
Seborrheic dermatitis
Annular coin-shaped pruritic plaques
Nummular dermatitis
Papulovesicular dermatitis of hands and feet
Dyshidrotic eczema
A chronic and recurrent inflammatory dermatologic condition marked by severe pruritus causing excoriations, lichenification, and susceptibility to skin infections
Atopic dermatitis
A localized plaque of chronic eczematous inflammation resulting from habitual rubbing and scratching
Lichen simplex chronicus
An eczematous dermatitis of the legs associated with edema, varicosed/ dilated veins and hyperpigmentation
Stasis/ gravitational dermatitis
Eczema due to dryness of the skin
Asteatotic / xerotic eczema
Detergents
Irritant contact dermatitis
Nickel
Allergic contact dermatitis
Tetracycline
Photodermatitis
Pitysporum yeast
Seborrheic dermatitis
wool
Atopic dermatitis
Rubbing alcohol
Asteatotic/ xerotic eczema
Diagnostic criteria
Atopic dermatitis
How many major and minor features
Major features
Minor features
Non-allergenic in nature, no previous sensitization necessary
Irritant contact dermatitis
Solvents
Irritant contact dermatitis
Rubber
Allergic cd
Paraben
Allergic cd
Water
Irritant cd
Sulfa drugs
Photodermatitis
Generally begins early in life and characterized by periods of remission and exacerbation
Atopic d
Related to altered lipid composition of the stratum corneum and to other subtle changes in epidermal differentiation
Asteatotic / xerotic eczema
Alkalis
Irritant cd
Formaldehyde
Allergic cd
Benzocaine
Allergic cd
Neomycin `
Allergic cd
Citrus
Photodermatitis
Mulberry
Photodermatitis
Seborrheic dermatitis is more severe among ptx w/
Neurolgic dse and HIV infection
Nummular dermatitis is often assoc with this condition
Atopy
Sex predilection of AD
Males have an earlier onset
Females have worse prognosis
Immunologic rxns associated with this type of eczema are: hypersensitivity rxns, impaired immunoregulation of IgE and increased mast cell releasability
AD
Acids
Irritant cd
Medications
Allergic cd
And photodermatitis
Preservative chemicals
Allergic cd
Hair dye
Allergic cd
Dry or cold weather
Irritant cd Xerotic eczema (low humidity/ cold season)
Urine
Irritant cd
Fragrances
Allergic cd
And
Atopic
Rubber
Allergic cd
Henna
Allergic cd
Acrylic clothing
Atopic
Cosmetics
Atopic
Soaps
Atopic
Cleaning agents
Atopic
Alcohol containing products
Atopic
Sweating
Derma
Changes in temp
Atopic
Physical and emotional stresses
Atopic
Major features of atopic
Pruritus
Flexural lichenification or linearity in adults
Facial and extensor involvement in infant and children
Chronic or chronically relapsing dermatitis
Personal or family history of atopy (asthma, allergic rhinitis, AD)
Minor features of AD
Xerosis
Ichthyosis/ palmar hyperlinearity/ keratosis pilaris
Immediate (type I) skin test reactivity
Elevated serum IgE
Early age of onset
Tendencuy toward cutaneous infection. Impaired cell-mediated immunity
Tendency toward nonspecific hand or foot dermatitis Nipple eczema Cheilitis Recurrent conjunctivitis Dennie-Morgan infraorbital fold Keratoconus Anterior subscapular cataracts Orbital darkening Facial pallor/ facial erythema Pityriasis alba Anterior neck folds Itch when sweating Intolerance to wool and lipid solvents Perifollicular accentuation Food allergy Course influenced by environmental / emotional factors White dermatographism/ delayed blanch
Xerotic eczema worse during
Low humidity/ cold season
Caused by an allergen
Allergic cd
Atopic cd
Mild cases irritant cd
Erythema
Moderate to severe cases of irritant cd
Swelling, blistering, ulceration
Lesions develop right after exposure and are limited to the areas of skin that have been in contact with the irritant
Irritant congtact dermatitis
Lesions initially appear on the site of contact, but may later affect other sites or entire integument
Allergic cd
Irradiation by ultraviolet light results in the transformation of certain substances into allergens
Photoallergic
Irradiation by ultraviolet light results in the transformation of certain substances into irritants
Phototoxic
Citrus and mulberry
A. Phototoxic
B. Photoallergic
A. Phototoxic
Greasy and scaly confluent papules on erythematous base
Seborrheic dermatitis
Is dyshidrotic eczema is related to sweating
No
Acute cases of allergic cd
Pruritic papules and vesicles on an erythematous base
Chronic cases allergic cd
Lichenified plaques
Common sites of seborrheic dermatitis
Scalp Eyebrows Eyelashes Nasolabial folds Paranasal skin External skin canal Presternal area
Thiazides
Photodermatitis
Common sites of lichen simplex chronicus
Wrists, ankles, anogenital area (anus, vulva, scrotum), posterior neck, upper eyelids
Common sites of asteatotic or xerotic eczema
Lower legs, forearms, hands
Tx contact dermatitis
Prevention and avoidance of contact with irritant or allergen Barrier creams, non-alkaline cleansers Topical steroids Oral antihistamines Oral antibiotics Oral steroids, in severe cases
Facial seborrheic dermatitis tx
Topical antifungal creams (azoles)
Antidandruff shampoo or soap with zinc pyrithione or selenium sulfide (facial wash)
Mild steroid creams/ lotions
Topical immune modulators
Scalp lesions
Seborrheic dermatitis tx
Antifungal / antidandruff shampoosL: ketoconazole, ciclopirox, tar, salicylic cid, elenium sulfide, zinc pyrithione
Topical steroid lotion
Severe cases: oral antifungal
Nummular dermatitis
Tx
Intralesional triamcinolone acetonide
Dyshidrotic eczema tx
Topical or intralesional steroid
Oral prednisone - severe
AD
Tx
Patient education Avoidance of triggers Emollients Topical corticosteroids Topical immune modulators Antihistamines Antibiotics - secondary bacterial infection Phototherapy
Lichen simplex chronicus tx
Stress management
Oral antihistamines
Topical steroid ointment
Intralesional steroid injection
Stasis/ gravitational dermatitis tx
Leg elevation Leg compression - stockings, ext. pneumatic compression devices Wet compress for 10-20 mins BID for acute exudative inflammation (KMNO4, Burrow’s, normal saline) Topical steroids Oral antihistamines Oral antibiotics, if indicated Pentoxyfilline 400 mg BID- TID Bland emollient Sclerotherapy Vein stripping
Xerotic eczema tx
Inc water intake
Bathe only once daily with tepid water
Avoid drying agents: rubbing alcohol, harsh soaps, detergents
Limite exposure to cold temp and wind
Apply unscented emollients after bath and whenever necessary - petroleum jelly, urea- containing/ lotion, lactic acid
Apply low-potency steroid ointment
