Dermatitis Flashcards
What is contact dermatitis?
Inflammatory skin condition
Characterized by inflammation, redness, itching, burning, stinging, and vesicle and pustule formation on skin areas exposed
What are the subcategories of dermatitis?
Irritant contact dermatitis: occurs when the skin undergoes mechanical or chemical trauma on exposure to an irritating substance (around 80% of contact dermatitis cases)
Allergic contact dermatitis: occurs when skin is exposed to an allergen (required a primary exposure)
What are the types of reactions of contact dermatitis?
Acute reactions: red, edematous papillose in early phase, which become vesicles and bullae that ooze if the reaction is severe enough
Chronic reactions: primary lesions are minimal and secondary changes such as dryness, lichenification (toughening of the skin, giving a leather appearance), pigment changes, hyperkeratosis or thickening, excoriation and fissuring predominate
Itching is the primary symptom in both acute and chronic
What are the signs and symptoms of irritant contact dermatitis?
Mild irritants produce erythema, vesiculation and oozing while strong irritants produce blistering, erosions and ulcers
What are the signs and symptoms of allergic contact dermatitis?
Mild form similar to irritant exposure. A typical allergic reaction consists of grouped or linear tense vesicles and blisters.
Severe = edema, espeically in face and periorbital and genital areas
What are the types of irritants for contact dermatitis?
Plants (poison ivy, sunflowers, marigolds) Foods (kiwis, bananas, peanuts) Chemicals (fertilizers, weed killers) Cosmetics Latex Metals
What is poison ivy?
Perennial Consists of 3 leaflets Edges may be smooth or toothed Leaves vary in size (8-55 mm long) Reddish in the spring Green in the summer Orange/red in autumn The allergen is urushiol
What are risks/aggravating factors for contact dermatitis?
Gender (women are more frequently exposed due to cosmetic use)
Area on the body (different types of irritants; chrome, silver, gold, nickel jewellery)
Seasonal
Occupational (irritation through contact with chemicals; exposure of foods and plants)
UV light (phototoxic reactions when taking medications)
When should contact dermatitis be referred?
Dermatitis spreads to distant sites or becomes generalized to more than 30% of the BSA
Acute and non responsive with a few days
Edema persists or increases within a few days/swelling of the body or extremities/swollen eyes or eyelids swollen shut
Discomfort in genitalia from itching, redness, swelling or irritation
Involvement and/or itching of mucous membranes of the mouth, eyes, nose or anus
Chronic and non responsive within 7 to 10 days
Interferes with quality of
Child under 2 years of age
Presence of numerous bullae
Extreme or low tolerance to itching, irritation, or severe vesicle or bullae formation
What is atopic dermatitis?
Genetic based, chronic relapsing skin disorder
Usually begins in infants or early childhood and may last into adulthood
Most common dermatological condition in children
Exact cause is unknown
Aka eczema
Describe the pathophysiology of atopic dermatitis?
Chronic inflammatory skin disease associated with cutaneous and mucous membranes hyper-reactivity toward environmental triggers that are innocuous to normal, non-atopic individuals
80-85% have high levels of total IgE which leads to an eczema-type reaction
In infants, may be a prelude to the development of other atopic disorders later in life
Genetic impairment of epidermal barrier proposed cause of atopic dermatitis
What is “the triad”?
When someone has atopic dermatitis, allergic rhinitis and asthma
What are the signs and symptoms of atopic dermatitis?
Pruritus is the main symptom
No primary skin lesion
Skin is typically dry and lesions are scaly - though they may be vesicular, weeping and oozing in the acute stage
Pruritus may be focal or generalized. May be more intense in the evening and at night
What is the diagnostic criteria for atopic dermatitis (keep in mind that pharmacists cannot diagnose atopic dermatitis)?
Pruritus must be present, plus at least three of the following:
Onset before 2 years
History of skin crease involvement
History of generally dry skin
Personal history of other atopic disease (or history of any atopic disease in first degree relative in children over 4 years of age)
Visible flexural dermatitis (or dermatitis of cheeks/forehead and other out limbs in children over 4 years of age)
What are risk factors for atopic dermatitis?
Genetics Environmental allergens Climate Sweating Physiologic stress Dietary influences Irritants Infections Itch-scratch cycle
When should atopic dermatitis be referred?
If dermatitis is acute or vesicular. Severe condition with intense pruritus
If moderate to severe defined as: large area of the body, remains unresponsive, skin appears to be infected (pus, fever, inflammation, warm), child under 2 years of age, interferes with activities of daily life or sleep patterns
How should dermatitis be assessed?
Signs and symptoms (atopic or contact dermatitis?)
Location and size of area (face, hands, flexural areas (elbows, knees) or area that was in contact with the irritant; covers large area of the body or specific smaller areas that were exposed to the irritants)
Risk or aggravating factors (family history, rapid temperature changes or sensitization to a specific irritant)
Appearance of lesions (red, raised blisters, dry thickened skin or red blisters, dry area)
What has been tried?
Past history?
Describe a patient assessment of dermatitis
Gather information: ask questions regarding the signs and symptoms (onset, progression, timeframe, locations and description of the lesions, presenting symptoms, and if previous occurrence)
Determine urgency: severity, area and extent of skin involvement; signs of a systemic/generalized reaction or condition
Medication history
Differential diagnosis
What are the goals of treatment of dermatitis?
Eliminate trigger factors or contact exposure to irritants and allergens
Provide symptomatic relief while decreasing skin lesions
Implement preventative measures focusing on decreasing the number of episodic flares, lengthening symptom-free periods and prevention of excoriations
Develop coping strategies the expectations for patients/caregivers
