Dermatology/ Dermatitis and Eczema

Question 1

What is the clinical significance of the atopic triad of asthma, allergic rhinitis, and eczema? I

Answer 1

The presence of one of these disorders is believed to result in a genetic predisposition to other atopic disorders either in the same patient or in the patient’s family members

Question 2

In atopic dermatitis, a rash appears and subsequently becomes itchy. True or false?

Answer 2

False.

Atopic dermatitis is the “itch that rashes.”

Symptoms appear before rash is present.

Question 3

Presentaion of Eczema in Infants

Answer 3

Pruritic erythematous papules and vesicles that ooze and crust on the cheeks, forehead, and scalp (spares the diaper area)

Question 4

Presentation of Eczema in Children

Answer 4

Children Lichenified scaly patches and plaques that ooze and crust on the wrists, ankles, buttocks/posterior thighs, and the antecubital and popliteal fossae

Question 5

Presentation of eczema in Adolsecents

Answer 5

Adolescents Scaling plaques on the face, neck, upper arms, back, and flexural creases

Question 6

Presentation of eczema in Adults

Answer 6

Adults Scaling plaques on the hands, face, and neck

Question 7

Describe some additional physical findings associated with atopic dermatitis.

Answer 7

• Xerosis (dry skin)
• infraorbital skin folds (Dennie-Morgan lines)
• bluish discoloration of the periorbital skin
• hyperlinear palm and sole creases
• keratosis pilaris (follicular accentuation on the posterolateral arms and anterior thighs)

Question 8

Name some common food allergens that have been associated with atopy.

Answer 8

Milk, egg whites, wheat, soy, peanuts

Question 9

Name some common exacerbating factors of atopic dermatitis.

Answer 9

• excessive bathing
• xerosis
• environments with low humidity
• emotional stress

Question 10

What is the treatment approach for atopic dermatitis?

Answer 10

• eliminate exacerbating factors
• treat noninflamed lesions with emollients
• reserve topical corticosteroids and topical calcineurin inhibitors for inflamed lesions

Question 11

When considering treating atopic dermatitis with emollients, what is the optimal vehicle for the topical therapy?

Answer 11

• ointments (petroleum jelly) with zero water content followed by thick creams (eucerin, cetaphil) with low water content

Question 12

Which areas of the body should not be treated with potent topical corticosteroids?

Answer 12

• Thin skin of the face and skin folds can have irreversible skin atrophy with steroids.

Question 13

A patient complains of red, papulopustules around the mouth and nasolabial folds that are mildly pruritic and sometimes painful. They have not improved with a trial of corticosteroids for contact dermatitis. What diagnosis do you suspect?

Answer 13

Perioral dermatitis

Question 14

How should you treat Perioral dermatitis?

Answer 14

Stop topical steroids and start antibiotics (tetracycline, minocycline or doxycycline) for 2-6 weeks

Question 15

Name the two types of contact dermatitis.

Answer 15

1. Irritant
2. Allergic

Question 16

What type of hypersensitivity reaction is allergic contact dermatitis?

Answer 16

Type IV, T-cell mediated

Question 17

Is allergic contact dermatitis always confined to the site of exposure?

Answer 17

No. It can be generalized.

Question 18

What is the most common cause of allergic contact dermatitis in the United States?

Answer 18

Poison ivy

Question 19

Which topical antibiotic is a common cause of contact dermatitis?

Answer 19

Neomycin-containing topical antibiotics

Question 20

How is allergic contact urticaria diagnosed?

Answer 20

Prick test: a small amount of allergen is injected subcutaneously and is positive if a wheal develops within 15-20 minutes

Question 21

Red, scaly plaques on the nasolabial folds, eyebrows, ears, or scalp suggest what diagnosis?

Answer 21

Seborrheic dermatitis

Question 22

What is the treatment of Seborrheic dermatitis?

Answer 22

• Shampoos with selenium sulfide or zinc pyrithione, or prescription shampoo with 2% ketoconazole for the scalp
• topical steroid cream or lotion
• tar shampoo
• pimecrolimus 1% cream

Question 23

In infants, Seborrheic dermatitis is referred to as what condition?

Answer 23

Cradle cap