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Dermatitis Flashcards

1
Q

what is dermatitis

A

polymorphic inflammatory reaction; involves the epidermis and dermis

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2
Q

what are the primary lesions of acute dermatitis

A
  • erythematous macules, papules, vesicles; pruritus

- may conjoin to form patches

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3
Q

what are secondary lesions of scute dermatitis

A

may occur related to infection and excoriation

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4
Q

what is chronic dermatitis

A

pruritus, xerosis, hyperkeratosis, lichenification, fissuring

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5
Q

what are the three different types of dermatitis

A
  1. seborrheic dermatitis (SD)
  2. atopic dermatitis (AD)
  3. contact dermatitis (irritant/allergic)
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6
Q

what is seborrheic dermatitis

A

redness and scaling of the skin

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7
Q

what is the infantile form of seborrheic dermatitis

A

cradle cap, typically with in the first 3 months of life

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8
Q

what are some risk factors assoicated with SD

A
  • immunosuppression: HIV/AIDs, premature birth
  • alcoholism
  • endocrine disorders associated with obesity
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9
Q

what is SD caused by

A

Malassezia species (yeast), which is the cause for inflammatory response

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10
Q

How does SD appear

A

pink to red erythematous patches and plaques with a grey/white or yellow/red, greasy scale

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11
Q

what does SD on scalp occur with

A

dandruff

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12
Q

what are some exacerbating factors of SD

A
  • low humidity
  • cold temp
  • stress
  • medications: lithium (mood), buspirone (anxiety)
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13
Q

what can improve symptoms of SD

A

UV lighting

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14
Q

where are some areas that SD is located on the human body

A

face, scalp, eats, upper trunk, intertriginous areas (areas with high concentration of sebaceous glands)

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15
Q

how should cradle cap be treated

A
  • body oil
  • vegetable oil
  • then leave ALONE
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16
Q

what are some pharmacological treatments you can use on an infant that has cradle cap

A
  • low potency topical steroids: hydrocortisone 1% cream or lotion
  • antifungals: ketoconazole 2% cream/lotion or 1-2% shampoo
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17
Q

which of the following is more potent hydrocortisone cream or ointment

18
Q

what is the common age for adults getting SD

19
Q

is SD more common in males or females

20
Q

If a patent has acute scalp SD how should they be treated?

A
  • OTC shampoo containing selenium sulfide, zinc pyrithione, coal tar, salicylic acid
  • rx: ketoconazole 2% shampoo, cream, lotion, or foam
  • rx: ciclopirox shampoo, cream, gel
21
Q

If a patient has acute SD on face, ears, and trunk how should this be treated

A
  • antifungals: mainstay of therapy
    ketoconazole 2% shampoo, cream, lotion or foam (mainstay)
    Ciclopirox shampoo, cream, gel (side effects may be more tolerable)
  • topical steroids
    low potency for short duration
  • topical calcineurin inhibitors ( rare to use)
    pimecrolimus 1% cream
    tacrolimus 0.1% ointment
22
Q

How should you maintain chronic prevention of SD

A
  • ketoconazole 2% shampoo/gel/foam (decrease frequency)

- low potency steroids (hydrocortisone 1-2.5%)

23
Q

what is the MOA of ketoconazole

A
  • inhibits fungal P450 system to alter cell wall permeability
  • inhibits androgen synthesis
24
Q

How should ketoconazole be administered

A
  • twice weekly x 4-8 weeks; at least 3 days between applications (shampoo)
  • twice daily x 4 weeks (cream; foam)
  • daily x 2 weeks (gel)
25
what are some side effects associated with ketoconazole cream/gel
contact dermatitis, headache, burning/irritation, paresthesia (all are relatively uncommon)
26
what are some side effects of ketoconazole shampoo
hair loss, scalp/skin irritation, abnormal hair texture, dry skin, itching (all are relatively uncommon)
27
what are some side effects of ketoconazole foam
burning (10%), application site reaction (6%), contact sensitization, dryness, erythema
28
what is atopic dermatitis
eczema
29
In what patient population does atopic dermatitis occur in
patients in urban areas and in smaller families
30
what is the onset of AD
~ 90% occur before age 5
31
what is the pathophysiology of AD
defective epidermal barrier allows greater access of allergens to the skin
32
What does type 1 IgE-mediated include
- atopic dermatitis/eczema - allergic rhinitis - asthma
33
what are some predisposing factors with AD
- genetics - weather heat is likely to cause perspiration which may increase pruritus cold, dry weather can exacerbate xerosis and dermatitis - S. aureus may increase AD symptoms - emotional stress - exposure to aeroallergens - food (controversial)
34
how does AD present as in acute AD
- pruritus - erythematous papules or plaques - may also occur with excoriations and scales - may also ooze or have crusting - may be accompanied by secondary infections
35
what is the appearance of chronic AD
erythematous plaques; may have lichenification
36
what are other common signs/symptoms of AD
- Dennie-morgan folds (lines or folds under lower eyelid) - allergic shiners ( darkening of eyelid or under eye) - hyperlinearity of palms/soles
37
where can AD be located on the body
face, scalp, bends or flexures in the extremities (wrists, dorsa of hands/feet)
38
How is AD diagnosed
``` must have: - pruritus - eczema: skin swelling may also have: - early age of onset - atophy (personal or family history of IgE reactivity) ```
39
What are the non-pharm treatments of AD
- avoid rubbing or scratching lesions - keep nails trimmed - ELIMINATNG risk factors and exposure to triggers - take lukewarm (not hot) baths - keep temp cool and household humid - phototherapy: may be used as adjunct - use of skin moisturizers - apply emollients: keep skin hydrated (mainstay of therapy and may reduce the need for steroids)
40
what are the pharmacological treatment options for AD
- topical corticosteroids - topical calcineurin inhibitors - crisaborole ointment - biologic agents

Skin Midterm (4 decks)

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