Eczema Flashcards
All eczema have the same histopathologic pattern called ________.
Spongiosis
What are the endogenous eczema?
- Atopic dermatitis
- Seborrheic dermatitis
- Nummular dermatitis
- Dyshidrotic eczema
- Stasis dermatitis
- Aztetotic dermatitis
Major features of Atopic dermatitis
- Pruritus
- Rash on face, extensor, or both
- Lichenification in flexural areas
- Personal or family history of atopic disease
- Chronically relapsing dermatitis
Infant distribution of AD
erythematous, scaly papules and plaques on the face, scalp, and ears
Childhood (2yrs - puberty) distribution of AD
Flexural dermatitis
scaly plaques appear in the antecubital and popliteal fossa
Teenager-Adult distribution of AD
Localized flexural extremities
Hands, dorsum, feet
scaly plaques
What are the physical findings associated to skin asthma
Perioral pallor
Allergic shiners ~ Hyperpigmentation around the eye
Dennie Morgan fold ~ extra fold beneath the eyelid
Palmar Hyperlinearity ~ increased palmar markings
Pityriasis alba ~ ill-defined hypopigmented patches commonly seen on the face
Keratosis pilaris
aka chicken skin; usually seen on the extensors extremities
Hertoghe sign ~ loss or thinning of the ⅓ eyebrow hair
Infra- and retro- auricular fissuring
Nipple eczema
What is the pathophysiology of atopic dermatitis
there is a mutation in the gene encoding for filaggrin (structural protein in the epidermis) that cause impaired skin barrier leading to less water holding capacity and makes the skin dry. This cause increase susceptibility to irritants and allergens.
Management for Atopic dermatitis (Skin Asthma)?
- Bathing (cool/lukewarm)
- Gentle cleanser & avoid allergens
- Use of emolients or mosturizers
- Use of anti inflammatories
- treat secondary infections if present.
What anti-inflammatories can be use?
- Topical steroids
- Topical calcineurin inhibitors
- Oral steroids
What potency of topical steroids are used in face and folds?
Low potency (i.e Hydrocortisone)
What potency of topical steroids are used for thicker lesions on the rest of the body?
Mild potency (i.e Mometasone)
What potency of topical steroids are used for thick like lichenified areas and also in the palms and soles
Potent (i.e Clobetasol)
True or False. Can topical steroids be used for maintencace of skin asthma?
False. Use only for flare ups since overuse can caues: Skin atrophy, Telangiectasia, Striae, and Localized hypertrichosis
What can be used for mild flares and as maintenance therapy?
Topical calcineurin inhibotrs (i.e. Pimecrolimus & Tacrolimus)
What is the most common agent for secondary infection in Atopic dermatitis and what are the treatments?
S. aureus
Topical antibiotics (Mupirocin or Dusidic acid)
Oral antibiotics (Cloxacillin or Cephalosporins)
What is uncontrolled eczema with weeping, crusting, pustules, and yellowish discharge
Impetiginized eczema
What is an acute worsening of eczema, patients with multiple vesicles and monomorphic punched out erosions cause by viral infections?
Eczema hepeticum
It presents as greasy, scaly plaques on the scalp, face, and body
Seborrheic dermatitis
Commonly known as ________ when it affects the scalp but can also affect the face, particularly the ______ such as glabellar area, eyebrows, eyelids, and nasolabial folds
Dandruff
Oily areas
How to differentiate Atopic dermatitis to Seborrheic dermatits?
SD affects the scalp, skin folds, and diaper area while Atopic dermatits face and extremities.
Differential diagnosis for Seborrheic dermatitis.
- Atopic dermatitis
- Psoriasis
- Langerhans cell histiocytosis
- Pediculosis capitis
- Tinea Capitis
What is the treatment for Seborrheic dermatitis
- Anti-dundruff shampoo with zinc pyrithione
- Topical antifungals cream and shampoo (miconazole & ketoconazole)
- Low potent topical steroid for severe scaling and inflammations
- Calcineurin inhibitors as alternative for topical steroids. (Tacrolimus & Pimecrolimus)
True or False. High potent topical steroids can be used for long period of time and can be given in orally.
False. High potent can cause steroid-induced acne and topical steroids should only be use interminently.
It is a coin-shaped lesion that starts as a few pruritic edematous papules that becomes crusted and scaly
Nummular dermatitis
Differential diagnoses of Nummular dermatitis
- Tinea corporis ~ has fungal element
- Allergic contact dermatitis ~ specific areas consistent with exposure to environmental allergens
- Atopic dermatitis ~ can occure concurrently
Intensely pruritic deep-seated papules and vesicles on the thenar and hypothenar surface of the hands and lateral aspects of fingers
Dyshidrotic dermatitis
Endogenous factors for Dyshidrotic dermatitis?
genetics, stress, hyperdydrosis
Management of Dyshidrotic dermatitis?
- Topical steroids (Clobetasol) ~ super potent
- Topical anti-perspirant (Aluminum chloride)
- Short course oral steroids
- Immune modulating medication (methotrexate, cyclosporin, mycophenolate mofetil, azathioprine)
- Allotretinoin ~ for resistant chronic disease
- Phototherapy ~ if not adequately controlled
Differential diagnosis of Dyshidrotic dermatitis?
- Tinea Pedis ~ there is maceration and scaling in the toe webs and soles
- Contact dermatitis ~ lacks the deep seated vesicles and more scaling and dryness
- Atopic hand dermatitis ~ affects the dorsum of the hands and patients will have other signs of atopic dermatitis.
- Herpatic whitlow ~ Presents with grouped vesicles on an erythematous base and affects only one or few fingers of one hand. Painful instead of itchy
It is an ill-defined, erythematous scaly plaque with erosions and a small, well-defined round ulceration on the ankle with yellowish crusts and appears shiny
Stasis dermatitis
What are the aggrevating factor of Stasis dermatitis?
- Heart failure
- Hypertension
Reason why Stasis dermatitis develops?
when there is stasis or stopping/slowing of the normal flow of blood and lymph in a body area, this induces capillaries and increased capillary permeability.
This leads to pericapillary fibrin cuffs and edema, leukocyte accumulation and adhesion to vascular epithelium, hemosiderin deposits, and hyperplastic venule
What is the late stage of Statis dermatitis that is Characterized by erythema, edema, and pain, mimicking cellulitis?
Lipodermatosclerosis
Differential diagnosis of Stasis dermatitis
- Cellulitis ~ usuallt unilateral
- Allergic Contact dermatitis ~ itchy while venous insufficiency is usually not
- Lichen simplex chronicus ~ does not present with edema; Well-defined, dry, very pruritic, lichenified plaque usually in the ankles
- Psoriasis ~ silvery-white scales; In contrast to stasis dermatitis, psoriasis lesions are usually not edematous, and painful
Management for Stasis dermatitis
- Address the cause of stasis
- Lifestyle modifcation (exercise, avoid prolonged standing, weight loss, leg elevation)
- Topical corticosteroids
- Wound care
- Compression stockings
Presents with dry scaling cracks, and ichthyosiform or fish-like scaling
Asteatotic dermatitis
It is called “winter itch” or Eczema craquele that is very pruritic condition of the bilateral lower extremities
Most commonly seen in the elderly
Asteatotic dermatitis
Management
- Emollients and moisturizers
- Avoid over-bathing and use of irritants
- Topical steroid ointment in more severe cases
An exogenous contact dermatitis that has delayed type (type IV) hypersensitivity
Allergic contact dermatitis
How to diagnose Allergic contact dermatitis
Patch testing
The skin reaction or injury is caused by the inherent characteristics of the irritating compound
Irritant contact dermatitis
