Eczema and Dermatitis Flashcards
Pruritic papulovesicular process associated with
Acute: Erythema, vesiculation, weeping, edema
Chronic: Thickening, lichenification, scaling
Eczema
Irregular epidermal thickening and/or widening of rete ridges
Acanthosis
Edema and serous exudate between epidermal cells; appear as increased intercellular space
Spongiosis
Lymphocytic/mononuclear infiltrate in superficial dermis and epidermis; your eczema is impetiginized (pustule; your biopsy has an infection)
Exocytosis
made up of neutrophils and bacteria _> secondary impetiginization; not always present
Subcorneal pustule
Chronic histologic feature of eczema
Hyperkeratosis
irregular acanthosis of the epidermis
thickening of the secondary layer of collagen bundles
Lichenification
NOT thickening but the accentuation of your skin lines brought about by scratching
Classifcation of Eczema
Exogenous
Endogenous
Unclassified
Examples of Exogenous Eczema
Irritant contact Dermatitis
Allergic Contact Dermatitis
Photodermatitis
Examples of Endogenous Eczema
Atopic dermatitis
Seborrheic Dermatitis
Nummular Dermatitis
Vesicular Palmoplantar Eczema
Examples of Unclassified Eczema
Asteatotic Eczema
Neurodermatitis or LSC
Prurigo Nodularis
Disseminated Eczema
Irritant contact dermatitis results from exposure to substances that cause physical, mechanical, or chemical irritation of the skin
Irritant Contact Dermatitis
- No allergic Mechanism involved
- 80% of all contact dermatitis cases
Acute Lesions of ICD
Eythema, vesicles, eroisoons, crusts, and scaling
Chronic Lesions of ICD
papules, plaques, fissures, scaling and crusts
Occurs when a particular substance elicits a TYPE 4 hypersensitivity reaction;
Pt. have normal cell mediated immunity
Allergic Contact Dermatitis
-20% of all contact dermatitis
2 phases of ACD
Sensitization phase
Elicitation Phase
Sensitization Phase
1st contact with allergen (Occurs within a few weeks to months after but no visible skin changes yet)
Elicitation Phase
Subsequent contact. Presentation of dermatitis
Clinical Presentation of ACD
intensely pruritic rash particularly popular erythematous dermatitis with indistinct margins, distributed in areas of exposure.
ACD
may not be bilateral or nodular all the time but is often patchy
Considerations in diagnosis (ACD)
Not always bilateral
Very often patchy, eczematous manifestations
Can and does affect palms and soless
Some parts of the skin are more sensitive than other parts
Approach in Management for ACD
Frequency Approach
Topographical Approach
Plant dermatitis
Linear streaks
Metal dermatitis
gold jewelry less than 18k, usually because of NICKEL and cobalt
Clothing Dermatitis
ask about fabric conditioner, bleach, soap
Footwear dermatitis
rubber slippers
Cosmetic dermatitis
Preservatives in cosmetics
Topical medication dermatitis
NEOMYCIN
Occupational Medication dermatitis
Factory workers, chemical exposures
Perfume or atomizer dermatitis
Berloque Dermatitis - diffuse pattern of lesion
Non-Eczematous Variants
Purpuric ACD
Lichenoid ACD
Lymphomatoid ACD
Ectopic ACD/airborne ACD
Ectopic ACD/airborne ACD
Autotransfer
heterotransfer
Nipple Eczema
important to differentiate from Paget’s disease
Eyelid dermatitis
most commonly caused not by make-up by ail lacquer and hand sanitizers -> when the patient scratches eyes
Diaper dermatitis
differentiate from candidiasis; there is sparing of skin folds in dermatitis; candidiasis starts with interginous areas
Eruption caused by sensitization due to sun-activated irritant/allergen
Must consist of the chemical and the sun; if one is lacking, it is not photodermatitis
Photocontact Dermatitis
Photocontact
counterpart of irritant CD
Photoallergic
counterpart of allergic CD
Avoid exposure to the sun when using this antibiotics
tetracycline and clindamycin
Main symptom of contact dermatitis
Pruritus
Acute Ssx of CD
Erythema, edema, papules, vesicles, occasional bullae
Subacute Ssx of CD
usually dry; dull erythema, minimal eduma, vesiculation, crusting
Chronic (LSC) Ssx of CD
Dry, lichenified, scaly patches, occasionally fissures. May also be acneiform with hyperpigmentation and purpura
The application of specific allergens directly to the skin under controlled conditions, causing a local allergic reaction in a susceptible person
Patch test (Type 4 delayed hypersensitivity reaction)
Also know as Besnier’s prurigo or neurodermatitis disseminata
Atopic dermatitis
Gene encoding for filament aggregating protein involved in establishing epidermal baerrier. Atopic skin becomes like a sieve where allergens enter
Filaggrin
Stages and Typical Morphology/distribution
Infantile: Extensor areas
Childhood: Flexural areas
Adolescent/adult: Flexural
Senile>60 (senile atopic dermatitis)
AD Diagnostic Features
Major (3 out of 4 present)
Pruritus
Chronicity
Personal or family history of atopy
Typical Morphology and distribution of skin lesions
Closely associated with skin asthma but not skin asthma (chicken skin)
Keratosis Pilaris
Irregularly shaped white patches. With higher sun exposure, it becomes lighter
Pityriasis alba
Dry scaly, cracked, glazed/shiny and fissured tender, reddish plantar surface of the forefoot
Juvenile Plantar Dermatitis
Yellowish or grayish, sharply emarginated macules covered with greasy scales (Scaly, oily plaques)
Seborrheic Dermatitis
-areas of greater sebaceous activity
Also known as discoid eczema
Nummular dermatitis
Conin-shaped, discrete, eythematous, edematous, papulovesicular plaques and patches. Most commonly found in the legs as wells as the back of the hands and fingers (extremities and extensors)
Nummular dermatitis
Also known as dyshidrosis, cheiropompholyx, pompholyx
Vesicular Palmoplantar Eczema
Refers to an intensely pruritic, chronic, and recurrent, vesicular dermatitis of unknown etiology that typically involves the palms and soles and lateral aspects of the fingers
Vesicular Palmoplantar Eczema
Recalcitrant, deep seated vesicular eruptions, palms, and soles
Vesicular Palmoplantar Eczema
-acral areas: lateral sides of fingers, palms, and spares the webs (palms and soles)
Common inflamatory dermatosis of the lower extremities occuring in patients with chronic venous insufficiency, often in association with varicose veins, dependent chronic edema, hyperpigmentation, lipdermatosclerosis, and ulcerations
Static Dermatitis
- accompanied by hemosiderin deposition (dark spots) and lipodermatosclerosis
- associated with chronic venous insufficiency
Dry skin with redness, scaling, fine crackling or fine superficial fissures. Common among the elderly
Asteatotic Eczema
Also known as Lichen simplex chronicus
neurodermatitis
Chronic skin disorder affecting primarily older adults and is characterized by multiple, firm, pruritic nodules localized to the extensor surface of the extremities
Prurigo nodularis
-hard nodules on proximal limbs
Autosensitization, generalized eczema, id reaction.
has secondary lesions Distant from the primary site (toxin travels systemically)
Disseminated eczema
- Usually symmetric and associated with allergic contact dermatitis and static dermatitis
acute infection of the upper dermis and superficial lymphatics which presents with a skin rash
Erusipelas
A disorder of keratinization characterized by generalized scaling
Ichthyosis
Niacin deficiency characterized by photosensitive pigmented dermatitis
Pellagra
Management if Eczema
First: IDENTIFY THE CAUSE
Dressings
Topical steroids: (hydrocortisone) doctors must be know when to use ointment
Oral histamines
Immunomodulators
Ancillary
