Dermatitis Flashcards
Definition
- Interchangeable with eczema
- Non-specific inflammatory response of the skin
- Itchy, redness, scaling, weeping
Classification
Endogenous
- Atopic
- Sebrrhoeic->Greasy scaly around nose, ears and scalp
- Discoid
- Asteatoic->cracked skin on lower limbs
- Venous
- Hand/foot
- Lichen simplex->thickened darkened skin due to chronic scratching
Exogenous
- Irritant contact
- Allergic contact
- Photoallergic
- Phototoxicity
General treatment
- Avoid environmental irritants
- Improve general skin
Daily bathing with dispersible oil added to water, lightly dry and +emolient
Soap/shampoo substitutes
Avoid scratching
Minimise overheating - Avoid allergic factors
- Topical treatments
a. Hydrocortisone 1% on face and flexures
b. Betamethason valerate 0.02-0.05%, methyprednisilone aceponate 0.1% elsewhere
c. Betamethasone dipropionate 0.05%, betamethasone valerate 0.1% for more severe - Treat infections
a. Triclosan 2% bath oil diluted
b. Mupirocin 2% ointment
c. For widespread- di/dluclozacillin 500mg PO 6 hourly for 10 days - Control itching
Antihistamines
Wet dressings
Adverse effects of topical steroids
- Loss of dermal collagen: skin atrophy, striae, fragility, easy bruising
- Telangiectasia
- Promotion of underlying infection
- Idiosyncratic reactions->allergic contact dermatitis, perioral dermatitis
Preparations in long term chronic dermatosis
Suggested preparations for long-term use of topical corticosteroids for chronic dermatoses are:
- face and flexures—hydrocortisone 1%, desonide 0.05%
- trunk—betamethasone valerate 0.02%, methylprednisolone aceponate 0.1%, triamcinolone acetonide 0.02%
- elbows/knees and palms/soles—betamethasone dipropionate 0.05%, mometasone furoate 0.1%, methylprednisolone aceponate 0.1%.
Important considerations when using steroid creams
- Select appropriate potency
- Creams for weeping, ointment for dry
- Need enough to be effective, not to cause side effects
- Use until controlled, then switch to maintenance.
- Ask to review if not relieved in expected time
- Once daily usually adequate
- Liberal application usually required initially
- Ensure enough is prescribed
- Emolient for long term maintenance.
Atopic dermatitis in OSCE
- Examination
Dermatological - Describing lesions
a. Multiple papules and vesicles on an erythematous base, over the flexor surfaces
b. These range in size from 1-6mm
c. There is some evidence of lichenification and scaling, but no evidence of secondary infection or eczema herpeticum
d. These lesions are consistent with atopic dermatitis - Differential
Other forms of eczema - Questions for patients
FHx asthma, hay fever, eczema
Associations in atopic dermatitis
- Atopic families and individuals
- Exacerbations associated with
Allergence
Infection
Heat
Stress
Distribution of atopic dermatitis: infancy, childhood, adulthood
distribution
1. infant (onset at 2-6 mo old): face, scalp, extensor surfaces
2. childhood (>18 mo): flexural surfaces, especially antecubital fossae, popliteal fossae, and neck
3. adult: hands, feet, flexures, wrists, face, forehead, eyelids, neck
Prognosis in atopic dermatitis
- Earlier the onset, the more severe
2. 1/3 patients with childhood will continue on to have adult dermatitis
Pathophysiology of dermatitis
T cell dysfunction with epidermal barrier dysfunction
Is dyshidrionic dermatitis associated with excess sweating
No, but stress may be associated
Etiologic association of seborrhoeic dermatitis
Malassezia spp Yeats
Can cause dandruff in adults
Management of Seborrhoiec dermatitis
- Face->Ketoconazole cream + mild steroid cream
- Scalp-> salicyclic acid in olive oil , ketoconazole shampoo 2%, selenium sulphide (Selsun), zinc pyrithione, steroid lotion
Management of stasis dermatitis
- Compression stocking
- Rest and elevate legs
- Moisturise
- Mid-high potency steroid for inflammation
