Dermatitis and Eczema

Question 1

contact dermatitis

Answer 1

acute or chronic inflammatory reaction to substance that comes in contact with the skin

Question 2

irritant contact dermatitis (ICD)

Answer 2

chemical irritant, can occur in anyone, confined to areas of exposure, certain threshold above which dermatitis occurs and below which it does not

Question 3

allergic contact dermatitis (ACD)

Answer 3

type IV hypersensitivity reaction to an allergen, spreading reaction, occurs only in sensitized individuals

Question 4

symptoms of acute ICD

Answer 4

burning, stinging, smarting (immediate - acid, chloroform, methanol), can start 1 -2 min, peak at 10 and fade after 30 min (delayed - propylene glycol)

Question 5

presentation of acute ICD

Answer 5

well-demarcated erythema - vesicles and blisters - crusting - erosions, necrosis. NO papules.

Question 6

symptoms of chronic ICD

Answer 6

stinging, smarting, burning AND itching - pain later

Question 7

presentation of chronic ICD

Answer 7

dryness, chapping, erythema - hyperkeratosis and fissuring - lichenification, ill defined borders, crusting

Question 8

treatment for acute ICD

Answer 8

remove offending agent, wet dressings with Burow’s solution q 2-3 h, topical glucocorticoids; 60mg red for 2 weeks with 10 mg taper

Question 9

treatment for chronic ICD

Answer 9

remove offending agent, betamthasone or clobetasol; topical calcineurin inhibitors not enough to suppress inflammation

Question 10

phytodermatitis - common offending agents

Answer 10

poison ivy, poison oak - oleoresins called uroshiol

Question 11

derm path: ACD

Answer 11

spongiosis, lymphocytes and eosinophils, chronic - lichenification

Question 12

Atopic dermatitis presentation

Answer 12

pruritus and itching leading to more inflammation and pruritus, lichenification: “itch scratch cycle”

Question 13

AD microbial agents

Answer 13

Staph areus exotoxins, S. pyogenes

Question 14

Skin barrier disruption of AD

Answer 14

defect in filaggrin, decreased ceramides

Question 15

other atopies associated with AD

Answer 15

allergic rhinitis, asthma

Question 16

pathophysiology of AD

Answer 16

type 1 HS reaction mediated by IgE as a result of vasoactive substances released by mast cells and basophils

Question 17

what type of AD is common in black people?

Answer 17

follicular lichenification

Question 18

pathogenesis of lichen simplex chronicus (LSC)

Answer 18

hyper excitability of lichenified skin in response to minimal external stimuli

Question 19

symptoms LSC

Answer 19

pruritus in paroxysms

Question 20

clinical presentation LSC

Answer 20

solid lichenified plaque with confluence of small papules. exoriations. dull red and later brown or black hyperpigmentation

Question 21

path LSC

Answer 21

hyperplasia of all epidermal components: hyperkeratosis, acanthosis, elongated and board rate ridges. chronic inflammatory infiltrate in the dermis

Question 22

mgmt LSC

Answer 22

occlusive bandages at night, topical glucocorticoid prep or tar prep covered by occlusive dressings for legs/arms, Unna boot: gauze roll dressing impregenated with zinc oxide paste wrapped around a large lichenified calf - left for one wee.

Question 23

Prurigo nodularis

Answer 23

associated with AD but occurs without it; starts with piercing pruritus leading to picking and scratching. Multiple, firm, dome shaped nodules with excoriations

Question 24

Tx prurigo nodularis

Answer 24

IL triamcinolone with occlusive dressings; neuron tin 300mg may be helpful

Question 25

Dyshidrotic eczema

Answer 25

vesicular type of hand and foot dermatitis; sudden onset of deep-seated pruritic clear “tapioca-like” vesicles.

Question 26

Nummular Eczema

Answer 26

pruritic coin-shaped plaques composed of papules or vesicles on an erythematous base, esp common in the winter months

Question 27

Nummular eczema tx

Answer 27

hydrate with moisturizer or cream topical GC or 2-5% crude coal tar ointment

Question 28

Autosensitization dermatitis or “id reaction”

Answer 28

generalized pruritic dermatitis directly related to primary dermatitis elsewhere. Primary releases cytokines into blood, heightening the sensitivity of distant skin areas.

Question 29

2 diseases related to increased incidence of seborrheic dermatitis

Answer 29

PD and HIV

Question 30

clinical presentations seborrheic dermatitis

Answer 30

greasy, erythema, yellow-orange scales and crusts on the scalp eyebrows, and beard

Question 31

etiology seborrheic dermatitis

Answer 31

malesszia furfur - tx with ketoconazole or selenium sulfide

Question 32

mineral deficiency that are seborrheic dermatitis-like

Answer 32

zinc (acrodermatitis enteropathica -perioral, diaper area at 6 month old), niacin, pyridoxine deficiency

Question 33

asteatotic dermatitis

Answer 33

common pruritic dermatitis occurs esp in older persons in the winter in temperate climates; dry, “cracked” superficially fissured skin with slight scaling

Question 34

mgmt asteatotic dermatitis

Answer 34

acid hot soapy baths and increasing ambient humidity to >50% with humidifiers