Dermatological Flashcards
What is atopic dermatitis?
chronic, relapsing, skin disease of unknown etiology
What is the mechanism of atopic dermatitis?
IgE mediated hypersensitivity type 1 to environmental allergens
When does atopic dermatitis begin?
infancy and can continue to adulthood
What are other names for atopic dermatitis?
allergic eczema, infantile eczema, allergic dermatitis
What are common ocular complications of atopic dermatits?
cataracts around age 20; ASC if eye rubbing and PSC if steroid induced
What are common ocular findings of atopic dermatitis?
keratoblepharoconjunctivitis, keratitis, herpes
What is keratoblepharoconjunctivitis?
buildup on the lashes with itchy/flaky skin on the lid margin
What is keratitis?
ocular finding from mechanical rubbing or secondary to blepharitis irritation the cornea
What is the prevalence of atopic dermatitis?
2-5% of children, 33% of children with FMHx of atopy or asthma (60% chance if 1 parent and 80% if 2); male=female
When is the typical onset of atopic dermatitis?
90% of cases onset <5 years of age
What is the most common ocular sign of atopic dermatitis?
keratoconjunctivitis superiorly, under UL
What are signs/symptoms of keratoconjunctivitis?
pruritus, FB sensation, superior SPK>pannus, sympblepharon, thickened lid margins, blepharitis, slight mucous discharge, Trantas dots
What are trantas dots?
superior collection of dead eosinophils
What is a Dennie Morgan fold?
prominent infraorbital fold of lower eyelid secondary to repeated episodes of swelling with atopic dermatitis; prevalence 25%
What are less frequent ocular signs of atopic dermatitis?
keratoconus, uveitis, ocular HTN, RD, herpes simplex
What are systemic signs of atopic dermatitis?
pruritus, lichenification, xerosis, keratinization, scaly/rough/red patches–> weeping lesions over time
Where are atopic dermatitis systemic signs located in an infant?
cheeks, forearms, legs, diaper area
Where are atopic dermatitis systemic signs located in an toddler?
elbows, knees, wrists and ankles once crawling and walking
Where are atopic dermatitis systemic signs located in an adult?
hands, face, neck, genitalia, legs
How do you diagnose atopic dermatitis?
clinical presentation and FMHx, IgE levels may or may not be elevated, not related to ocular manifestations, higher levels with cataract formation
What is the systemic treatment of atopic dermatitis?
removal of inciting agents, avoid itching and scratching, cold compresses/astringents for itching, oral antibiotics for secondary infections, oral antihistamines, topical steroids (or systemic), oral cyclosporin A (immunosuppressive), UVA and B exposure to dry rash
What is the ocular treatment of atopic dermatitis?
cold compresses, topical antihistamines/decongestants, topical steroids, 1% hydrocortisone cream for facial skin, artificial tears between attacks, systemic therapy, cataract surgery
What is rosacea?
facial issue of the cheeks, nose, forehead, chin and eyes
What are signs of rosacea?
rhinophyma, erythema, telangiectasia, papule, pustule, ocular rosacea
What is rhinophyma?
hypertrophy of sebaceous glands
What are signs of ocular rosacea?
blepharitis, meibomianitis, hordeolum, chalazia, keratitis, corneal vascularization and thinning, decreased VA, penetrating keratoplasty in advanced cases
Who gets systemic rosacea?
adults 30-60 years, women 2x more than men
T/F more women get ocular rosacea than men
false, equal incidence when ocular
What is the etiology of rosacea?
30% FMHx, unknown etiology, potentially H. pylori, inflammatory component and/or type IV hypersensitivity
How often does systemic rosacea become ocular?
58% ocular involvement before, during or after systemic onset
T/F ocular rosacea can have symptoms>signs
true, bilateral FB sensation, pain, burning, red eyes, styes, epiphora (signs: tear debris, oily, foamy tears, SPK inferior 2/3)
How is rosacea diagnosed?
clinical impression, facial features must exist to make ocular dx
What are differentials of rosacea?
seborrheic dermatitis, lupus, acne vulgaris
What is the treatment for systemic rosacea?
250 mg tetracycline qid x 4-6 weeks, low maintenance dose may be required; topical and/or oral metronidazole; accutane, dietary restriction of alcohol, spicy foods and hot beverages; stress reduction, laser tx
Is metronidazole antibacterial or antiinflammatory?
both
What is the treatment for ocular rosacea?
same as facial treatment, 100 mg doxycycline qday x4-6 weeks as alternative to tetracycline, lid hygiene therapy, artificial tears, topical steroids, keratoplasty, conjunctival flap, amniotic membranes, scleral lenses
What is verruca?
benign lesion, viral etiology, lobulated (looks like cauliflower)
What is a papilloma?
benign overgrowth of cells, skin-tag, smooth surface
What is a typical treatment of benign lesions?
excision, cautery, laser
What is molloscum contagiosum?
viral infection of epidermis from pox virus, flesh colored with umbilicated center
Where is molloscum contagiosum located?
face, eyelids, trunk, axillae, extremities, genitals– tend to form wherever there is hair
What increases the incidence of molloscum?
AIDS
Is molloscum contagious?
yes, active and infectious if excreted; leads to follicular conjunctivitis or toxic keratitis
What is treatment of molloscum?
self limiting 6-9 months in immunocompetent patient; can consider cryotherapy and HIV testing
What is keratoacanthoma?
benign skin tumor, derived from hair follicles on sun exposed skin; rapid growth of central crater and keratin cap
What is treatment of keratoacanthoma?
involute and resolve alone or surgical removal- both cause a scar
What is seborrheic keratosis?
greasy lesion confined to epidermis on sun-exposed skin, may occur adjacent to malignant lesions
What is actinic keratosis?
pre-malignant lesion from years of accumulated sun exposure, rough lesion
What can actinic keratosis become?
squamous cell carcinoma, 25% of the time
What is treatment for actinic keratosis?
topical retin-A, cryotherapy, biopsy
What is the most common skin/eyelid malignancy?
basal cell carcinoma; 90% occur on head and neck, lower>upper euelid
What is basal cell carcinoma?
pearly, round lesion with raised borders and bleeding; grows and expands by direct vertical invasion
How common is basal cell metastasis?
rare
What are complications of basal cell?
high degree of local destruction, orbital extension suggested by diplopia on extreme gaze, globe displacement, pain, tissue redness, chemosis
What is treatment of basal cell?
cryotherapy, surgical excision, radiation
What is squamous cell carcinoma?
lesion on sun-exposed/damaged skin; UL=LL; 60-75% occur on head and neck
How common is squamous cell metastasis?
highly metastatic, spreads through lymphatic system
What is the treatment of squamous cell?
recognize and refer promptly for biopsy
What is sebaceous gland carcinoma?
aka meibomian gland carcinoma, small/firm and painless mass, yellowish in color due to high lipid content, madarosis
Does a sebaceous gland carcinoma metastasize?
yes metastatic potential
What are differentials for sebaceous gland?
recurrent hordeolum, chalazion
What is malignant melanoma?
itchy, bleeding and painful lesion; typically red/white/blue that grows horizontally before vertically
How common and deadly is malignant melanoma?
3% of dermatologic malignancies, causes 2/3 of all fatalities related to skin cancer
What is prognostic for survival rate with malignant melanoma?
vertical thickness
What is treatment of malignant melanoma?
excision, chemo, radiation; can recur
What is erythema-multiform?
acute, inflammatory condition of skin and mucous membranes; usually self-limiting
When does erythema-multiform occur?
20-40 years
What are the 2 types of erythema-multiform?
EM minor male=female and EM major “SJS” males>females
What are systemic associations of erythema-multiform?
sulfonamides, infections, collagen vascular disease, vaccinations, pregnancy, neoplasms, radiation
What medications are associated with SJS?
sulfonamides, PCNs, salicylates, barbiturates, arsenicals, mercurials, tropicamide, proparacaine, oral acetazolamide
What is the pathophysiology of erythema-multiform?
monocyte infiltration into dermis, lymphocytes around the dermal blood vessels, subepithelial bullae form and the epidermal cells become edematous
What are signs and symptoms of erythema-multiform?
flu-like symptoms, dermal eruptions (itchy and painful bulls eye lesions)
When do dermal eruptions occur with erythema-multiform?
can occur within hours of the pro-drome
What are s/s of EM minor?
skin, extremities rash only
What are s/s of EM major?
skin and mucous membranes, trunk rash
What is the ocular involvement of EM?
lid edema, focal ulceration, conj membranes, conj and corneal scarring, iritis, symblepharon, ankyloblepharon, dry eye, decreased mucin layer
How is EM diagnosed?
clinical signs and Hx
What is EM r/o systemically?
Reiter syndrome, behcet’s, bullous pemphigoid, lupus
What is EM r/o ocularly?
sjogren, sarcoidosis, cicatricial pemphigoid, chemical burns, trauma
What is treatment of EM?
discontinue causative agent, antibiotics for secondary infections, manage dry eye, bandage CL, topical tretinoin, debride filaments, surgical intervention for symblepharon, mitomycin-C injection to prevent adhesion reformation, epilation for trichiases
What is the mortality rate of EM?
25%
What does topical tretinoin do?
as a vitamin A derivative, it enhances goblet cell regeneration and mucin production
What is cicatricial pemphigoid?
progressive bullous disease of skin and mucous membrane
What is the onset of cicatricial pemphigoid?
55-70 years old
How often does cicatricial pemphigoid have ocular involvement?
75-85% of the time
How many patients with cicatricial pemphigoid have ocular HTN or glaucoma?
1/3
What is the etiology of cicatricial pemphigoid?
type II autoimmune disorder with antibodies to basement membrane (IgM and IgG)
What topical drugs are associated with cicatricial pemphigoid?
timolol, epinephrine, dipivefrin, pilocarpine
What are systemic signs of cicatricial pemphigoid?
bullous lesions of the oral mucosa, skin lesions much less common than mucosal
What are ocular signs of cicatricial pemphigoid?
bilateral conjunctivitis, conjunctival shrinkage, symblepharon, severe dry eye, ocular surface keratinization, corneal scarring, significant VA reduction
How is cicatricial pemphigoid diagnosed?
history, signs, progression
What is the treatment of cicatricial pemphigoid?
corticosteroids, immunosuppressives to control inflammation and prevent loss of vision, dry eye treatment (including tarsorrhaphy), tx secondary infections, lid hygiene, topical steroids, penetrating keratoplasty (low success rate)
