Eczema and Dermatitis

Question 1

True/False
the terms Dermatitis and eczema can be used interchangeably

Answer 1

True

Question 2

ID vs AD
Non-immunologic reaction to substance or action producing direct damage to skin by chemical abrasion or physical irritation.

Answer 2

ID

Question 3

ID vs AD
Due to a delayed immunologic response (type IV hypersensitivity) to a cutaneous or systemic exposure to an allergen to which the patient has been previously sensitized.

Answer 3

AD

Question 4

What a re the most common causes of allergic contact dermatitis

Answer 4

Poison ivy, poison sumac, and poison oak
-Nickel is the most common cause of metal dermatitis

Question 5

What dx / Tx
(a) The hands are most often affected. Both dorsal and palmar surfaces can be affected.
(b) Erythema, dryness, painful cracking or fissuring and scaling are typical. Vesicles may be present.
(c) Tenderness and burning are common and predominate the itching.
(d) May show juicy papules and/or vesicles on an erythematous patchy background with weeping and edema.
(e) Persistent, chronic irritant dermatitis is characterized by lichenification, patches of erythema, fissures, excoriations and scaling.
(f) Open skin may burn on contact with topical products.

Answer 5

Irritant Dermatitis
Treatment
(a) Early diagnosis, treatment and preventative measures can prevent the development of a chronic irritant dermatitis.
(b) Medium or high-potency topical steroid ointment applied BID for several weeks can be helpful in reducing erythema, itching, swelling and tenderness.
(c) Antihistamines (except for their sedative effect) are ineffective in contact dermatitis.
(d) Frequent application of a bland emollient to affected skin is essential.

Question 6

What Dx / Tx
(a) Characterized by vesicles, edema, redness and extreme pruritus. Strong allergens such as poison ivy produce bullae.
(b) Distribution first confined to the area of direct exposure. May spread beyond areas of direct contact if exposure is chronic.
(c) Itch and swelling are key components of the history. Itch predominates the burning sensation.
(d) The hands, forearms and face are the most common sites. May also affect limited skin sites such as the eyelids, dorsal aspect of the hands, lips, tops of the feet and genitalia.

Answer 6

ACD
Treatment:
(a) Identify and remove the etiologic agent.
(b) Apply wet dressings with Burrow’s solution every 2-3 hrs.
(c) Topical class I–II glucocorticoid preparations. In severe cases, systemic glucocorticoids may be indicated.
(d) Educate patient, detailing potential sources of exposure.

Question 7

Irritant Dermatitis ddx

Answer 7

(a) Allergic Contact Dermatitis/Atopic dermatitis
(b) Cellulitis
(c) Rosacea

Question 8

Allergic contact dermatitis ddx

Answer 8

(a) Irritant Contact Dermatitis
(b) Atopic dermatitis
(c) Cellulitis
(d) Rosacea

Question 9

If you suspect ACD what lab is useful.

Answer 9

(a) Patch testing

Question 10

true/false
Patch tests for ACD should not be delayed until the dermatitis has subsided

Answer 10

false
delayed for at least 2 weeks

Question 11

Complications of contact Derm

Answer 11

(1) Anaphylaxis
(2) Secondary infection

Question 12

What Dx/Tx
(a) Flares are common with stress/illness.
(b) Parallels increased sebaceous gland activity
(c) Positive family history; no genetic marker is identified to date.
(d) Intermittent active phases with burning, scaling, and itching, alternating with inactive periods; activity is increased in winter and early spring, with remissions commonly occurring in summer.
(e) Red, greasy, scaling rash in most locations consisting of patches and plaques with indistinct margins.
(f) Red, smooth, glazed appearance in skin folds.
(g) Minimal pruritus
(h) Chronic waxing and waning course
(i) Bilateral and symmetric
(j) Most commonly located in hairy skin areas: scalp and scalp margins, eyebrows and eyelid margins, nasolabial folds, ears and retroauricular folds.

Answer 12

Seborrheic Dermatitis (Dandruff)
tx
(a) Adults tend to have chronic and recurrent disease; patients should know that the aim of treatment is control rather than cure.
(b) Can be treated with shampoos containing:
-1) Zinc pyrithione (Head & Shoulders)
-2) Selenium Sulfide (Selsun Blue)
-3) Ketoconazole (Nizoral)
-4) Salicylic Acid (T/Sal)
-5) Coal tar (T/Gel)
(c) Daily facial washing with antidandruff shampoo or soaps diluted with water is also effective.

Question 13

Seborrheic Dermatitis (Dandruff) Differential Diagnosis

Answer 13

(a) Tinea of the face
(b) Cutaneous Lupus
(c) Rosacea
(d) Psoriasis

Question 14

What labs are indicated for Seborrheic Dermatitis (Dandruff)

Answer 14

KOH and fungal culture are indicated