Eczema and dermatitis Flashcards
Dermatitis features
Pruritic papaulovesicular which has acute acute (erythema, vesiculation, weeping ,edema) and chronic (thickening, lichenification, scaling) features
Chronic histologic features of Eczema
hyperkeratosis, irregular acanthosis of epidermis, thickening of collagen bundles in papaillary dermis(scar)
Acanthosis:
Epidermal thickening or widening
Exocytosis
edema and serous exudate between epidermal cells
Subcorneal pustule
(neutrophils and bacteria) => secondary
impetignization; not always present
eczema will have similar chronic
histologic features:
- Hyperkeratosis
- Irregular acanthosis of epidermis
- Thickening of collagen bundles in papillary dermis (scar)
End stage of any eczema
LSC
Reaction to a chemical in a potent concentration in a sufficient length of time. No allergic mechanisms
Irrititant Contact Dermatitis
provoking substantces in ICD
Acids/alkalis, metallic elements salts, essential oils, detergent,organic solvent, excessive water exposuire
ACD is what tyoe if hypersensitivity
Delayed type hypersensitivity
(Type IV) - mediated by Tlymphocytes
(memory); may
persist forever
plant dermatitis and metal dermatitis
PD: linera configuration…. MD: nickel and <18K gold
Locations of eczema
nipple (bilateral in the young with family hx), ear,eyelid, diaper,hand,mucous membrane
medicine that causes photocontact dermatitis
clindamycin, tetracycline,doxycycline
2 types of photocontact dermatitis
Phototoxic(ICD) and photoallergic(ACD)
Sx and symtons of CD
- Always has pruritus (acute,subacute,chronic)
Patch test
Applications of specific allergens directly to skin
other name for ATopic Dermatitis
Besnier’s prurigo
Endogenous Dermatitis
• Atopic dermatitis • Seborrheic Dermatitis • Nummular Dermatitis • Dishydrotic Eczema • Static Dermatitis
usually found in the chronic stage and always generalize. Increased IgE-mediated immune response in early stages which develop to defective T-Cells in later stages
Atopic Dermatitis
Genetic predisposition in AD
Filaggrin gene for filament aggregatigng protein, atopic skin becomes like a sieve, increased IgE mediatied response
Essential elements of AD (PEC)
Pruritus, Chronicity,, characteristic Eczema
3 stages if AD and their involvement
Infantile= Extensors, Childhood = Flexural, Adult = antecubitals, popliteals
Associated conditions of AD
KEratosis Pilaris (this autosomal dominant), Pityriasis Alba (reddish patch becming hypopigmented through time)
How to determine pityriasis versicolor
Fingernail test, KOH
test for leprosy for kids
Let them play outside,if not sweaty, positive
Seborrheic dermatitis also known as
Seborrhea
Yellowish or grayish, sharply marginated macules covered with greasy scales
seborrhea
Coalesce to form irregular patches, found in greater sebaceous areas
SD
Factors of SD
STress, HPN,diabetes, Dyslipedemia, HIV, Infection, Weather cahnges, ROH
Dyshidrosis, cheiropopomoyx,phompholyx features
Recalcitrant, deep-seated vesicular eruptions on the palms and soles( Dyshidrotic = palmar,planter)
DDX for Dyshidrotic dermatitis
Tinea,(different tx since DD is steroids)
Accompanied by Hemosiderin and lipdermatosclerosis
STasis dermatitis
PAthophysio of Stasis Dermatitis
V.insuffciency => Pooling of
blood => Varicosities => Varicose
edema => Static dermatitis
• Poor nutrition (deoxygenated blood) which leads to dryness, itchiness and edema
Unclassified dermatitis and 1 feature
Astetotic Eczema (crazy paving), neurodermatitis(single fixed lichenified plaque, Prurigo nodularis( one finger used instead of five)
DDX of Eczema: Fungal infection
has a clear center, advancing border with papules
and pruritus is not present all the time
interdigital webs
Tinea Pedis
psoriasis
with Auspitz’s sign, silvery scales but sometimes shows
as red papules so harder to differentiate from eczema
Zinc deficiency
Acrodermatitis enteropathica
Histiocytosis X
bad case of seborrhea, it can present like a cradle
cap, should be spotted early. When you see a baby in the ward with
petecchial lesions on the soles and hands with hepatomegaly, think
HX
Management
Dressings, Dessicants, topical steroids,Oral antihistamines,systemic steroids, immunomodulators,• Ancillary
o Antibiotics
o Emollients – use for dry skin (atopic dermatitis and eczema craquele or asteatotic eczema)
patient info
• Ancillary
o Antibiotics
o Emollients – use for dry skin (atopic dermatitis and eczema craquele or asteatotic eczema)
• Try to identify contactants, educate patients to avoid them and stop
scratching; otherwise, useless treatment
