ECZEMA/DERMATITIS Flashcards
erythematous, pruritic skin reaction caused by
contact with exogenous agents.
Contact dermatitis
Most causes of occupational contact dermatitis are from
irritants
encountered in the workplace.
what are the
most common causes of allergic (cell-mediated) contact dermatitis in the
United States.
Poison ivy, poison sumac, and poison oak (Toxicodendron genus)
what is the most common cause of metal dermatitis and a common cause
of allergic contact dermatitis
Nickel
Irritant Dermatitis Presentation
(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.
Irritant Dermatitis Prevention
(a) Avoidance of or decreased exposure to cutaneous irritants is critical
for recovery of an effective skin barrier.
(b) PPE (i.e., goggles, shields, and gloves, etc.)
(c) Occupational ICD persisting with PPE may require a change of job
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.
(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.
(e) Careful history should include date of dermatitis onset, possible
relationship to work, type and specifics of contact to work
exposures and type of skin care products used.
Allergic Contact Dermatitis (ACD)
ACD Prevention
1) Identification and avoidance of the allergenic substance is
essential to recovery.
2) Topical treatment using topical corticosteroid. Discontinue
all moisturizers, lotions and topical products.
ACD Treatment
(a) Identify and remove the etiologic agent.
(b) Topical class I–II glucocorticoid preparations. In severe cases,
systemic glucocorticoids may be indicated.
(c) Educate patient, detailing potential sources of exposure.
Differential Diagnosis
Irritant Dermatitis
(a) Allergic Contact Dermatitis Atopic dermatitis
(b) Cellulitis
(c) Rosacea
Differential Diagnosis
Allergic contact dermatitis
(a) Irritant Contact Dermatitis
(b) Atopic dermatitis
(c) Cellulitis
(d) Rosacea
Labs/Studies/Imaging
(1) KOH to exclude tinea infection.
(2) If you suspect ACD:
(a) Patch testing
(b) Patch tests should be delayed until the dermatitis has subsided for
at least 2 weeks
Complications
(1) Anaphylaxis
(2) Secondary infection
(a) Chronic, superficial, recurrent inflammatory rash affecting sebumrich, hairy regions of the body, especially the scalp, eyebrows, and
face
(b) Predominance: adolescence, and adulthood, male > female
(c) Prevalence: 3-5%
(a) Skin surface yeasts Malassezia may be a contributing factor.
(b) Flares are common with stress/illness.
(c) Parallels increased sebaceous gland activity
(d) Positive family history; no genetic marker is identified to date.
(e) 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.
(f) Red, greasy, scaling rash in most locations consisting of patches
and plaques with indistinct margins.
(g) Red, smooth, glazed appearance in skin folds.
(h) Minimal pruritus
(i) Chronic waxing and waning course
(j) Bilateral and symmetric
(k) Most commonly located in hairy skin areas: Scalp and scalp
margins, eyebrows and eyelid margins, nasolabial folds, ears and
retroauricular folds.
Seborrheic Dermatitis (Dandruff)
