Eczema and Dermatitis Flashcards by Jonathan Paul Ladera

Pruritic papulovesicular process associated with

Acute: Erythema, vesiculation, weeping, edema

Chronic: Thickening, lichenification, scaling

Eczema

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Irregular epidermal thickening and/or widening of rete ridges

Acanthosis

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Edema and serous exudate between epidermal cells; appear as increased intercellular space

Spongiosis

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Lymphocytic/mononuclear infiltrate in superficial dermis and epidermis; your eczema is impetiginized (pustule; your biopsy has an infection)

Exocytosis

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made up of neutrophils and bacteria _> secondary impetiginization; not always present

Subcorneal pustule

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Chronic histologic feature of eczema

Hyperkeratosis
irregular acanthosis of the epidermis
thickening of the secondary layer of collagen bundles

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Lichenification

NOT thickening but the accentuation of your skin lines brought about by scratching

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Classifcation of Eczema

Exogenous
Endogenous
Unclassified

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Examples of Exogenous Eczema

Irritant contact Dermatitis

Allergic Contact Dermatitis

Photodermatitis

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Examples of Endogenous Eczema

Atopic dermatitis
Seborrheic Dermatitis
Nummular Dermatitis
Vesicular Palmoplantar Eczema

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Examples of Unclassified Eczema

Asteatotic Eczema
Neurodermatitis or LSC
Prurigo Nodularis
Disseminated Eczema

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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

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Acute Lesions of ICD

Eythema, vesicles, eroisoons, crusts, and scaling

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Chronic Lesions of ICD

papules, plaques, fissures, scaling and crusts

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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

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2 phases of ACD

Sensitization phase

Elicitation Phase

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Sensitization Phase

1st contact with allergen (Occurs within a few weeks to months after but no visible skin changes yet)

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Elicitation Phase

Subsequent contact. Presentation of dermatitis

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Clinical Presentation of ACD

intensely pruritic rash particularly popular erythematous dermatitis with indistinct margins, distributed in areas of exposure.

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ACD

may not be bilateral or nodular all the time but is often patchy

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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

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Approach in Management for ACD

Frequency Approach

Topographical Approach

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Plant dermatitis

Linear streaks

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Metal dermatitis

gold jewelry less than 18k, usually because of NICKEL and cobalt

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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