Dermatitis

Question 1

Incidence

Answer 1

10% at anytime

40% will have eczema in their lives

Question 2

Common Features Phases

Answer 2

-All have common features: - pruritus + spectrum of clinical presentation

1) Acute Phase:
- vesicles + Bullae appear on the skin (if inflmm is severe)

2) Subacute Phase:
- skin becomes: Erythematous/Dry/Edematous/Crusted (sec infxn)

3) Chronic Phase:
- thickened/lichenified

All = Polymorphic inflmm process involving Epidermis/Dermis

Question 3

Classification of Dermatitis

Answer 3

ENDOGENOUS: ASDA, HV

1) Atopic
2) Discoid
3) Hand
4) Seborrheic
5) Venous (Gravitational)
6) Asteatoic

EXOGENOUS:

1) Contact - allergic
2) Contact - Irritant
3) Photosensitive
4) Lichen Simplex/ Nodula

Question 4

Discoid Eczema

Answer 4

• Well Demarcated Scaly Patches (esp on the Limbs)
• Not really Chronic (Acute/Subacute)
• Adults: atopic/non-atopic

*can be confused with Psoriasis

Question 5

Hand Eczema

Answer 5

confined to Hands + Feets

• Itchy Vesicles on Palm + alongside Finger (Pompholyx)
• Diffuse Erythematous scaling + Hyperkeratosis of Palms
• Scaling most marked at fingers

Freq in Non-Atopic

Etiology:

• contact of Irritants (detergents/chemicals)
• Fungal infection

Dx:
-PAtch Testing –> for specific allergic/contact Eczema

Question 6

Seborrhoeic Eczema

Answer 6

-Due to Pityrosporum Ovale (malassezia in hyphal form) –> Cutaneous inflmm to the fungus

• Affects area with lots of Seborrheic Glands
• Scalp
• Face
• Pre-sternal Area
• Body Folds

DANDRUFF
CRADLE CAP:
- on scalp of newborns (yellow, greasy, thick crust on scalp)

YOUNG ADULT Males:

• erythema scaling over nose/eyebows/eyes - extend to scalp
• also affect: Glans of Penis/Axillae/Groin

ELDERLY:
-more severe and covers larger part of the body

Question 7

Treatment of Seborrhoiec Eczema

Answer 7

• Mild Steroind (1% Hydrocortisone)
• • Topical Antifungal Cream (Miconazole)

For Scalp:

• Ketoconazole Shampoo
• Arachis Oil

Question 8

Venous Eczema

Answer 8

-Lower Legs (esp Ankles) –> dueto Chronic Venous HT

Cause:
- endothelial Hyperplasia + Extravasation of RBC + Leukocytes –> lead to inflmm

His:
- tend to affect elderly (females)
- history often reveals:
 > past venous thrombosis
 > surgery for Varicose veins

Question 9

Tx of Venous Eczema

Answer 9

• Mod Potent Topical Steroids
• Emoillients
• Support Stockings
• Leg elevation

Question 10

Asteatotic Eczema (Winter/Senile Eczema)

Answer 10

look:

• dry, plate like cracking of skin
• with red erthythematous parts

who:
- elderly people (lower leg/back of hand)

Cause:

• lots of soap
• loss of stratum corneum lipids (w/age)
• assoc with Myexedema/Diuretics

Question 11

Contact Eczema

Answer 11

-variety of environmental agents –> have unusual/localized distribution

1) Allergic Contact:
- repeated exposure to a chemical substance –> type 4 HSR
- causative agents:
>nickel
>chromate
> latexlatex
> perfus
> Plant
- patch test

2) Irritant:
- in any individual –> repeated exposure to irritants (detergents/bleach)

TX: same as for atopic eczema

Question 12

Photosensitive Eczema

Answer 12

-Rare (middle-aged/elderly males)

Distribution: Face/Neck/Hands

May spread to areas not otuched by sunlight

Tx:

• avoid sun
• high factor sunblock
• topic steroids
• oral prednison + Azathiprine

Question 13

Lichen Simplex (neurodermatitis)

Answer 13

• cutaenous resp to Scatching/Rubbing (in absense to underlying dermatosis)
• Thickened, scaly, hyperpigmented areas of lichenification with intense pruritus (tender on rubbing)