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Clin Med III: Dermatology > Dermatitis & Eczema > Flashcards

Dermatitis & Eczema Flashcards

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1
Q

an acute, subacute and chronic, relapsing, pruritic condition that is often associated with allergic rhinitis and/or asthma

dx?

A

atopic derm

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2
Q

atopic derm is Ig-___ mediated

A

IgE

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3
Q

atopic derm is MC affects in what pt demographic?

A

Infants and children

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4
Q

atopic derm MC is found where in the body?

A
  • face, scalp, torso, and extensors
  • MC flexures
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5
Q

___ patterns of atopic dermatitis are MC in persons with darker skin phototypes

A

Follicular

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6
Q

what is the itch-scratch cycle?

A

Characterized principally by dry skin and pruritus; consequent rubbing leads to increased inflammation and lichenification and to further itching and scratching

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7
Q

atopic derm - Decrease in barrier function due to ?

A
  1. impaired filagrin production
  2. reduced ceramide levels
  3. increased trans-epidermal water loss; dehydration of skin.
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8
Q

Acute inflammation in AD is associated with a predominance of what markers/cytokine?

A

interleukin (IL) 4
IL-13 expression

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9
Q

describe the 3 categories of atopic derm

A
  1. Acute – erythema, vesicles, bullae, weeping, crusting
  2. Subacute – scaly plaques, papules, round erosions, crusts
  3. Chronic eczema – lichenification, scaling, hyper- and hypopigmentation
    - “itch that rashes”
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10
Q

atopic derm Environmental triggers:

A
  1. Heat
  2. Humidity
  3. Detergent
  4. Soaps
  5. Abrasive clothing
  6. Chemicals
  7. Smoke
  8. Stress
    - Allergy to eggs, cow’s milk, or peanuts is common
    - possible relationship between atopic dermatitis and the development of ASA-related rsp disease
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11
Q

hallmark of atopic derm

A

Intense pruritus (itching)

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12
Q

scratching can lead to ____ aka skin thickening

A

lichenification

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13
Q

atopic derm - Impaired barrier function leads to ___ and ____

A

increased water loss and cutaneous infections

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14
Q

impaired barrier function in atopic derm can lead to impetiginization of what pathogen?

A

Staphylococcus aureus

Secondary infections with HSV (eczema herpeticum), Coxsackie viruses (eczema coxsackium), or vaccinia virus (eczema vaccinatum) may transpire

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15
Q

Scaly, erythematous papules and plaques involving the flexural surfaces, particularly the antecubital fossae and popliteal fossae, face, neck, and extremities in general

dx?

A

atopic derm

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16
Q

s/s of chronic cases of atopic derm

A

Lichenification, scaling, and dyspigmentation may be seen

  • Facial findings include periorbital scaly plaques and thinning of the lateral eyebrows
  • Periorbital hyperpigmentation if darker
  • Hyperlinear palms
  • Keratosis pilaris
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17
Q

tests for atopic derm

A
  • Family and Personal history is key to diagnosis
  • Serum IgE (not necessary but can be done)
  • Culture suspected infection
  • Skin biopsy can help
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18
Q

tx for atopic derm

A
  1. avoid triggers
  2. appropriate skin care - gentle cleansers, fragance free
  3. low-strength steroid
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19
Q

SE of steroid in atopic derm

A
  1. Atrophy
  2. Hypopigmentation
  3. Striae
    - Ointment without preservatives
    - Damp skin or under occlusive dressing
    - AVOID soap except in the body folds
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20
Q

medium potency meds for localied topic derm

A
  1. Triamcinolone cream or ointment – BID
  2. Mometasone cream or ointment – BID
  3. Fluocinolone cream or ointment – BID
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21
Q

low potency meds for atopic derm

A

desonide

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22
Q

3 nonsteroidal tx for localized atopic derm?
who is this not recommended for?

A
  1. Tacrolimus ointment BID
  2. Pimecrolimus cream BID
  3. Crisaborole ointment BID

not recommended in <2 years old

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23
Q

systemic tx for atopic derm

A

Dupilumab (Dupixent)

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24
Q

what med can be given for pruritis in atopic derm?

A

antihistamines

  • Diphenhydramine hydrochloride
  • Hydroxyzine
  • Cetirizine hydrochloride
  • Loratadine
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25
Q

generic term applied to acute or chronic inflammatory reactions to substances that come in contact with the skin.

A

contact derm

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26
Q

occurs after a single exposure to the offending agent that is toxic to the skin. It is confined to the area of exposure and is therefore always sharply marginated and never spreads
Well demarcated suggestive of an “outside job” or external contact
can also present as a systemic contact reaction with widespread lesions
Ingested or implanted device

dx?

A

Irritant contact dermatitis- (ICD)

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27
Q
  • caused by an antigen (allergen) that elicits a type IV (cell-mediated or delayed) hypersensitivity reaction. immunologic reaction that tends to involve the surrounding skin (spreading phenomenon) and may spread beyond affected sites
  • Repeat exposures
  • 24-48 hours post exposure
  • topical agents, ingested, implanted devices, airborne

dx?

A

Allergic contact dermatitis- (ACD)

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28
Q

s/s of acute contact derm

A

Erythema, vesicles, and bullae

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29
Q

s/s of chronic contact derm

A

Scaling, lichenification, fissures, and cracks
Geometric shapes with well-demarcated borders may be seen

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30
Q

airborne contact derm affects what parts of the body?

A
  • face (particularly the upper eyelids)
  • neck (including the submandibular region)
  • upper chest
  • forearms
  • hands (esp palmar surfaces)
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31
Q

how does cumulative contact derm occur? examples of certain agents?

A

after repeated exposure

  • Soaps, detergents, waterless hand cleaners
  • Acids and alkalis 3: hydrofluoric acid, cement, chromic acid, phosphorus, ethylene oxide, phenol, metal salts
  • Industrial solvents: coal tar solvents, petroleum, chlorinated hydrocarbons, alcohol solvents, ethylene glycol, ether, turpentine, ethyl ether, acetone, carbon dioxide, DMSO, dioxane, styrene
  • Plants: Euphorbiaceae (spurges, crotons, poinsettias, manchineel tree), Ranunculaceae (buttercup), Cruciferae (black mustard), Urticaceae (nettles), Solanaceae (pepper, capsaicin), Opuntia (prickly pear)
  • Others: fiberglass, wool, rough synthetic clothing, fire-retardant fabrics, “NCR” paper
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32
Q

Occupational ACD should be considered, particularly in ?

A
  • health care professionals, machinists, and construction workers
  • Consider allergy adhesive, wound dressings, and/or antimicrobial tx in pts with chronic wounds including stomas
  • Implanted devices: Pacemakers, orthopedic implants, and endovascular stents
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33
Q

best tests for contact derm

A
  1. H&P
  2. patch testing to verify the allergen (if necessary)
    - Allergy referral
    - (+) test does not always equate to a diagnosis; clinical correlation is key
    - Skin prick tests: used to dx type I hypersensitivity reactions and not used for testing for contact dermatitis
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34
Q

hapten specific T cell-mediated inflammation
Due to a reexposure to a substance that a patient has been sensitized.
Allergens are found in jewelry, personal care products, topical medications, plants, house remedies, and chemicals the individual may come in contact with at work.

A

Allergic contact dermatitis

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35
Q

process of the development of lesions in Allergic contact dermatitis

A

Erythema — > papules — > vesicles — > erosions — » crusts — » scaling

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36
Q

management for contact derm

A

Review of medications

  • OTC/RX/Homeopathic
  • Hot water
  • Humidifier
  • Antihistamines (Hydroxyzine vs Benadryl)
  • Animals
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37
Q

tx for contact derm

A
  • Avoid offending agents
  • Topical steroids (max 2 weeks on, 2 weeks off, repeat cycle)
  • Oral steroids
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38
Q

low potency tx for contact derm

A
  • Hydrocortisone 1% cream, ointment
  • Hydrocortisone 2.5% cream, ointment
  • Desonide ointment twice daily
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39
Q

medium potency tx for contact derm

A
  • Triamcinolone cream, ointment – Apply every 12 hours
  • Mometasone cream, ointment – Apply every 12 hours
  • Fluocinolone cream, ointment – Apply every 12 hours
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40
Q

hgih potency tx for contact derm

A
  • Clobetasol cream, ointment – Apply every 12 hours
  • Halobetasol cream, ointment – Apply every 12 hours
  • Betamethasone dipropionate cream, ointment – Apply every 12 hours
  • Fluocinonide cream, ointment – Apply every 12 hours
  • Desoximetasone cream, ointment – Apply every 12 hour
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41
Q

alt therapy intervention for severe contact derm

A

phototherapy - PUVA

Psoralen, ultra, violet, a solar spectrum 320-400 um in wavelength

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42
Q
  • Generalized term used to describe a rash in the buttocks
  • Causes cutaneous candidiasis, ICD, and miliaria
  • miliaria = blocked sweat ducts
  • Combo of wet, dark, friction, urine, feces and microorganisms
  • MC in infants
  • 3 weeks old 2 years in age
A

diaper derm

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43
Q
  • Fussiness
  • Crying during diaper changes
  • Diarrhea typically multiple
  • Shiny erythema with dull margins
  • +/- papules/vesicles/erosions: Candidiasis can be present
  • Miliaria: Multiple papulovesicular lesions/pruritus

dx?

A

diaper derm

44
Q

mangement for diaper derm

A
  1. Discuss proper diaper changes (frequency/wipes) - Disposable; Avoid tight fitting
  2. Keep area dry; allow air flowl After bathing use blow drier
  3. Barrier creams - Zinc oxide / petroleum jelly
  4. Candidiasis
    - Nystatin x 2 weeks
    - Clotrimazole x 2 weeks
    - Econazole x 2 weeks
45
Q

Dermatitis characterized by pruritic, coin-shaped, scaly plaques
frequent bathing, low humidity, irritating and drying soaps, skin trauma, interferon therapy for hepatitis C, and exposure to irritating fabrics such as wool

A

nummular eczema

46
Q

predisposing factor to developing nummular eczema on the legs?
Signs and symptoms associated with classic atopic dermatitis
MC in who?

A

venous stasis
Men - 50-65 y

47
Q
  • Round or coin-shaped erythematous scaly plaques; PIH, often with minute fissures, round erosions, or crusts located within
  • Erythema may be less prominent in patients with darker skin phototypes
  • Plaques may begin as papules or vesicles, which then coalesce
  • Trunk and extremities MC
  • May involve the hands and feet, but not the face and scalp

dx?

A

nummular eczema

48
Q

best tests for nummular eczema

A

Culture if bacteria suspected
Skin scraping if fungus suspected
Biopsy if necessary

49
Q

tx for nummular eczema

A

same as AD

50
Q

Common inflammatory papulosquamous condition
Affects the sebum-rich areas of the body
Face, scalp, neck, upper chest, and back
Pityrosporum (Malassezia) yeast, a common skin flora

A

seb derm

51
Q

Simple dandruff fulminant rash
Dryness, pruritus, erythema, fine greasy scaling
Scalp, eyebrows, glabella, nasolabial folds, the beard area, upper chest, external ear canal, posterior ears, eyelid margins (blepharitis), and intertriginous areas
Anogenital involvement has also been reported
Stress can exacerbate
Crusted plaques are seen
Lighter skin yellow to red to pink
Darker skin hypo or hyperpigmentation
Asx or may complain of pruritus or burning in affected areas

dx?
MC affects who?
best tests?

A
  • seb derm
  • immunocomp - HIV, parkinsons
  • Clinical dx, bx, KOH if fungal
52
Q

management for seb derm

A
  1. No cure
  2. Waxes and wanes
    - Shampoos - Salicylic Acid, Selenium Sulfide, Tar shampoos, Pyrithone Zinc
    Ketoconazole 2% shampoo (TOC), Vanicream Zbar
    - Steroids - Clobetasol, Betamethasone, Fluocinolone Scalp Oil; Face hydrocortisone / desonide
53
Q

Inflammatory skin condition occurring on lower extremities
Cause chronic venous insufficiency
Symptoms - Pruritus, Heaviness, Edema

dx?

A

stasis derm

54
Q

Reddish-brown discoloration
Erythematous
Scaling
Patches
Weeping
Crusting - MC area medial ankle; Hyperpigmentation late; Lichenification; Loss of hair shiny skin

dx?

A

stasis derm

55
Q

management for stasis derm

A
  • Treat underlying VI
  • Weeping lesions = wet compresses = Clean water and burrows
  • Topical steroids - Triamcinolone, Clobetasol
56
Q

Lichenified plaques excessive rubbing and scratching
Predisposing factors: Chronic skin conditions, Emotional stress, Habit forming scratching (ANXIETY)

dx?

A

lichen simplex chronicus

56
Q

complications of stasis derm

A
  1. Cellulitis
  2. Non healing wounds (wound clinic referral)

Consult vascular

57
Q

MC chronic skin condition that predisposes for lichen simplex chronicus

A

AD

58
Q
  1. Thick
  2. Plaques
  3. Lichenified - Small papules; Hyperpigmentation; Excoriations
  4. MC areas: Scalp, ankles, lower legs, upper thighs, forearms, vulva, pubis, anal region, scrotum, groin

dx?

A

lichen simplex chronicus

59
Q

tx course in lichen simplex chronicus

A
  1. Chronic pts typically aren’t happy
  2. Stop the itch scratch cycle
    - Antihistamines?
    - avoid scratching - Nails/pressure; Occlusive dressings/gloves
    - Topical steroids - TAC
    - ILK
    - Emollients
60
Q
  1. Erythematous papular and pustular eruption involving the nasolabial folds, the upper and lower cutaneous lip, and the chin
  2. lip margin and the immediate circumoral area are typically spared
    - Periorbital involvement, predominantly the lower and lateral eyelids, may occur
  3. Fine scaling may be seen
  4. eruption may be asx, but burning or itch may be encountered
  5. MC women 18-40

dx?
best tests?

A
  1. perioral derm
  2. clinically, bx may help
61
Q

If the perioral dermatitis was triggered by the use of mid- or high-potency topical steroids, then use _____ because the disorder will flare if corticosteroids are discontinued abruptly

A

low-potency to taper

Patients must be warned that they will likely flare before they improve after the topical steroid is stopped

62
Q

therapy regimen for perioral derm

A
  • DC topical steroids (taper)
  • Topical pimecrolimus 1%
  • Topical and oral abx may also be used - avoid use of gels, solutions, or lotions on the eyelid as inadvertent intraocular application may occur
63
Q

medication options for perioral derm (6)

A
  1. erythromycin
  2. metronidazole
  3. pimecrolimus
  4. azelaic acid
  5. clindamycin
  6. Oral abx: Doxy if necessary
64
Q
  • Common on the hands and feet
  • Pruritic vesicular rash; Classic “tapioca like vesicles”
  • Typically history of AD
  • MC between 20-40 years old
  • Itching, Burning, Pain

dx?
tests?
tx?

A
  • dyshidrotic eczema
  • C&S if unsure if there is infection or not
  • Patch testing (not always necessary)
  • Biopsy – diagnostic
  • topical steroids under occulsion x 2 wks; severe: high dose PO prednisone, PUVA
65
Q

pt ed for dyshidrotic eczema

A

Avoid allergens/irritants like excessive hand washing

66
Q

5 medications for dermatitis & eczema

A
  1. Emollients
  2. Topical Steroids
  3. Immunomodulators: pimecrolimus (Elidel)
  4. selenium sulfide
  5. pyrithione zinc
67
Q

benefits of emollients

A

Non-cosmetic moisturizers
increases skin moisture, flexibility and prevents cracking/fissures
use unscented & without anti-aging ingredients

68
Q

application of emollients

A
  1. apply immediately after bathing and frequently throughout the day (3x/d)
  2. apply in direction of hair growth
  3. avoid excessive rubbing
  4. continue use after flare up is controlled
69
Q

which emollient is the best option for most dermatoses
mixture of fat and water
cooling effect on skin
moderate moisturizing effect

A

cream

70
Q

which emollient has more water, less fat than cream
less effective at moisturising skin
useful for hair covered areas

A

lotion

70
Q

which emollient is greasy; avoid on weeping eczema
preferable for dry/thickened skin

A

ointment

70
Q

indications for topical corticosteroids

A
  1. atopic/seborrheic, contact dermatitis
  2. lichen simplex
  3. pruritus ani
  4. nummular eczema
  5. stasis dermatitis
  6. psoriasis
70
Q

MOA of topical corticosteroids

A

decreases immune response by 4 different processes:

  1. stabilizes leukocyte/macrophage/histamine activity
  2. constriction of the capillaries and reduced capillary wall permeability - improving and preventing edema formation
  3. decreases activation of complement cascade
  4. reduces fibroblast proliferation and collagen deposition which leads to reduced scar formation
71
Q

CI of topical corticosteroids

A
  1. underlying bacterial infections
  2. hypersensitivity
  3. ophthalmic use
72
Q

cautions with chronic use of topical corticosteroids

A
  1. chronic use may inhibit growth in children
  2. chronic use induced Cushing syndrome, Kaposi sarcoma
73
Q

classification of potency of topical corticosteroids

A

Class I-VII
I-highest
VII- lowest

74
Q

SE of topical corticosteroids

A
  1. skin atrophy
  2. striae
  3. easy bruising
  4. telangiectasias
  5. change in skin pigmentation
  6. corticoid rosacea
  7. steroid acne
  8. adrenal suppression
  9. glaucoma (periorbital use)
75
Q

SE of topical corticosteroids are more likely to happen with:

A
  1. continuous long term use
  2. high potency steroids/vehicles
  3. facial, intertriginous, genital dermatoses
76
Q

pros vs cons of corticosteroid ointment

A
  • semi-occlusive
  • petroleum based
  • most potent topical steroid vehicle
  • benefits: superior lubrication, prevention of moisture loss, increase active ingredient absorption
  • disadvantage: greasy, avoid hairy areas
77
Q

benefit of corticosteroid cream

A
  • semisolid emulsions of oil in 20-50% water
  • less potent (than ointment) vehicle
  • benefits - cosmetic absorption
78
Q

benefit of corticosteroid lotion

A
  • powder in water- requires shaking of container prior to use
  • least potent vehicle
  • benefits: minimal residue, cooling/soothing to skin, covers large area, good for thick hair bearing areas
79
Q

benefit of corticosteroid gels

A
  • mixture of oil in water with alcohol base
  • drying effect with minimal residue
  • great for scalp dermatitis or acne
  • no residue
80
Q

benefit of corticosteroid powders

A
  • absorb excess moisture
  • protect skin-skin chafing
  • covers large area
81
Q

benefits of corticosteroid foam

A
  • gaseous bubbles in matris of liquid film
  • easy to spread, w/o residue
  • more expensive
82
Q

benefit of corticosteroid solution

A
  • low viscosity
  • powder in water/alcohol
  • alcohol = drying effect
83
Q

potency classification table of topical corticosteroids

A
84
Q

Maximum Duration of corticosteroid tx based on classification

A
  • Class I - < 3wk
  • Class II-IV - < 6-8 wk
  • Class V-VII - chronic intermittent therapy - face, intertriginous, genital limit to 1-2 wk intervals of therapy
85
Q

what is Tachyphylaxis
tx/prevention?

A
  • a progressive decrease in clinical response to same dose
  • results from repetitive use of same drug
  • prevention/treatment: drug free intervals (“holidays”); switch to alternative agent
86
Q

pimecrolimus (Elidel) and tacrolimus (Protopic) are what drug class

A

immunomodulators - calcineurin inhibitor

87
Q

what meds inhibit T-lymphocyte activation via calcineurin inhibition
prevents release of inflammatory cytokines/mediators

A

pimecrolimus (Elidel) and tacrolimus (Protopic)

88
Q

indications for pimecrolimus (Elidel) and tacrolimus (Protopic)

A

atopic dermatitis
Off-label - intertriginous and facial psoriasis, oral lichen planus; Vitiligo

89
Q

which meds have a BBW for
rare case of lymphoma and skin malignancy

A

pimecrolimus (Elidel) and tacrolimus (Protopic)

avoid long term use; limit to areas of AD only , with minimal application to achieve control

90
Q

CI of pimecrolimus (Elidel) and tacrolimus (Protopic)

A

hypersensitivity
< 2 y/o

91
Q

cautions with pimecrolimus (Elidel) and tacrolimus (Protopic)

A
  1. do not use with occlusive dressing
  2. reassess if no improvement in 6 wks
  3. Pregnancy cat. C
92
Q

SE of pimecrolimus/tacrolimus

A
  1. burning sensation (MC) - resolves with continued use
  2. HA
  3. URI symptoms, fever
93
Q

pros and cons of pimecrolimus/tacrolimus

A

Pros: no skin atrophy/striae; safe for use on face/eyelids
Cons: more expensive; BBW - tumorigenicity

94
Q

An ingredient found in Head and Shoulders, Selsun
MOA not fully known; reduction in corneocyte production

what med?

A

selenium sulfide

95
Q

indications for selenium sulfide

A

seborrheic dermatitis
tinea versicolor

96
Q

CI of selenium sulfide

A
  1. hypersensitivity
  2. oral, ophthalmic, anal or intravaginal use
97
Q

dosing for seb dern with selenium sulfide

A

apply to affected area for 2-3 minutes, rinse thoroughly, repeat 2x/wk initially; maintenance therapy once q 1-2 wks

98
Q

dosing of selenium sulfide for tinea vesicolor

A

shampoo/lotion: apply to affected area , lather, leave for 10 minutes, rinse thoroughly; apply QD x 7 days
foam: rub into affected area q12 hr x 7 days

99
Q

Se of selenium sulfide

A

transient burning, stinging

100
Q

An ingredient found in Head and Shoulders, Selsun, T/Gel
binds to hair/skin- reduces cell turnover

what med?

A

pyrithione zinc

101
Q

indications of pyrithione zinc

A

seb derm

102
Q

SE of pyrithione zinc

A
  1. transient stinging/burning
  2. desquamation
103
Q

what is the triad of atopic derm?

A
  1. eczema
  2. asthma
  3. hay fever

Clin Med III: Dermatology (13 decks)

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