Dermatitis

Question 1

What is eczema herpeticum?

Answer 1

complication of atopic dermatitis/eczema.

disseminated viral infection characterised by fever and clusters of itchy blisters or punched-out erosions.

Question 2

What is the cause of eczema herpeticum?

Answer 2

Most cases of eczema herpeticum are due to Herpes simplex type 1 or 2. usually arises during a first episode of infection with Herpes simplex (primary herpes).

more commonly seen in infants and children with atopic dermatitis.

better called Kaposi varicelliform eruption when a breakdown of the skin barrier is not due to eczema.

Question 3

Common site for eczema herpeticum?

Answer 3

most often seen on face and neck

Question 4

Eczema herpeticum classical appearance

Answer 4

clusters of itchy and painful blisters.
Monomorphic
Blood stained
Filled with pus
Umbilication
Sores formation
White scars may persist

Question 5

patient with known atopic dermatitis presents with an acute eruption of painful, monomorphic clustered vesicles associated with fever and malaise. What is the diagnosis?

Answer 5

Eczema herpeticum

Question 6

What is the treatment of eczema herpeticum?

Answer 6

dermatological emergencies

Oral aciclovir 400–800 mg 5 times daily, or, if available, valaciclovir 1 g twice daily, for 10–14 days or until lesions heal

Question 7

Tide water mark dermatitis

Question 8

What is Hertoghe’s sign

Answer 8

Also known as Queen Anne’s sign

thinning or loss of the outer third of the eyebrows,

Question 9

Hertoghe Sign is a classical sign of which diseases?

Answer 9

hypothyroidism or atopic dermatitis

can also be detected in lepromatous leprosy

Question 10

What is atopic dermatitis?

Answer 10

also called atopic eczema

the most common inflammatory skin disease worldwide,

presents as generalised
skin dryness, itch, and rash.

Question 11

Approximately ……………. percent of children affected develop
it before the age of 6 years.

Answer 11

Eighty percent

20 percent starts in infancy.

Footnote: prevalence
in young adults up to 26 years of age is still 5–15%.

Question 12

clinical features of atopic dermatitis?

Answer 12

erythematous scaly papules with crusting

Question 13

Which areas are most commonly affected by atopic dermatitis?

Answer 13

1.INFANT– face and extensors
2. Children— back of the knees and the front of elbows ( flexures)

2. Adults: hand and feet

Question 14

What type of reaction is atopy?

Answer 14

Immediate onset allergic reaction

Type I hypersensitivity reaction

Question 16

Rash on exposure to sun, after exercise, when getting angry or eating spicy food? What is the likely diagnosis?

Answer 16

Cholinergic Urticaria

Question 17

Types of Urticaria

Answer 17

1. Symptomatic dermographism
2. Cold Urticaria
3. Cholinergic urticaria
4. Contact urticaria
5. Delayed pressure urticaria
6. Solar urticaria
7. Heat Urticaria
8. Vibratory urticaria
9. Aquagenic urticaria

Question 18

How do you diagnose cholinergic urticaria?

Answer 18

Pilocarpine Stimulation test

A pilocarpine stimulation test, also known as a sweat chloride test, is a procedure that uses pilocarpine to stimulate sweat glands and measure the amount of chloride in sweat. It’s the standard test for diagnosing cystic fibrosis (CF).

Question 19

Classical appearance for cholinergic urticaria

Answer 19

A number of small (1–4 mm) punctate wheals, often surrounded by a larger erythematous flare
Wheals are itchy or burn
They may coalesce to form larger swellings.

Question 20

What causes cholinergic urticaria?

Answer 20

Any stimulus that can cause excessive sweating can precipitate this inducible urticaria.

Footnote:
Exercise (most common trigger)
High temperature exposure, eg, hot water baths
Spicy food ingestion
Emotional stress.

Question 20

Unique characteristic of cholinergic urticaria

Answer 20

Transient, starting within minutes of the trigger stimulus and resolving within 90 minutes after stopping the initiating activity.

It almost never occurs on the palms, soles, or axillae.

Question 21

What is the treatment for cholinergic urticaria?

Answer 21

oral H1 second-generation antihistamines.

cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine

Question 22

What is dyshidrotic eczema? or Pompholyx?

Answer 22

an itchy, chronic, recurrent, often symmetric eruption on the palms of hands, fingers, and soles of the feet

foot note:
also known as acute and recurrent vesicular hand dermatitis, acute palmoplantar eczema, vesicular endogenous eczema, or cheiropompholyx(hands); pedopompholyx ( foot)

Question 23

clinical features of dyshidrotic eczema?

Answer 23

Small, deep-seated, fluid-filled blisters (vesicles) on the sides of the fingers, hands, and feet.

The vesicles are small (1–2mm), often symmetrical, with no associated erythema, and they do not occur elsewhere on the body. Vesicles may coalesce into larger blisters.

It is extremely itchy.

The vesicles commonly resolve after 2–3 weeks with scaling.

Question 24

What is the treatment for dyshidrotic eczema?

Answer 24

1. Potassium permanganate soaks
2. Topical treatments:
   Topical steroids (usually potent or ultrapotent)
   Pimecrolimus and tacrolimus
   Bexarotene gel
   Regular use of emollients and moisturisers
   Iontophoresis or botulinum toxin when used for hyperhidrosis
   Topical antifungal medication if indicated for documented fungal infection.

Phototherapy:
Topical psoralens and ultraviolet light A (tPUVA).

Systemic treatments:
Antihistamines
A short course of oral corticosteroids for immediate relief
Oral antibiotics or antifungal agents if indicated for secondary skin infection

Question 25

Most common metal responsible for contact dermatitis

Answer 25

Nickel

Question 26

What are the types of contact dermatitis?

Answer 26

Irritant contact dermatitis

Allergic contact dermatitis

Question 27

What type of hypersensitivity reaction is allergic contact dermatitis?

Answer 27

Type IV

Question 28

Most common site for irritant contact dermatitis

Answer 28

Hands and forearms

Question 29

Most common allergens causing allergic contact dermatitis

Answer 29

Pollen esp by Parthenium ( congress grass) and Metals

Question 30

How is contact dermatitis diagnosed?

Answer 30

Patch Test

Foot note: reading is done after 48-72hrs ( 2 days) to see the signs of delayed hypersensitivity: 1st reading

2nd reading taken at 96 hrs( 4 days)

two types: open ( outer arm skin and uncovered) and closed ( applied to back and occluded)

Question 31

What is urticaria pigmentosa?

Answer 31

Maculopapular cutaneous mastocytosis

Due to abnormal collections of mast cells in the skin causing brown patches and freckles.

It is the most common type of cutaneous mastocytosis.

Question 32

What is Noonan syndrome?