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Gen Med: Dermatology > Eczema/Dermatitis > Flashcards

Eczema/Dermatitis Flashcards

1
Q

What are the types of eczema/dermatitis?

A
  1. Atopic Dermatitis
  2. Contact Dermatitis
  3. Stasis Dermatitis and Ulcerations
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2
Q

Define dermatitis

A

literally means “inflammation of the skin”

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3
Q

Define eczema

A

Greek for “a boiling out”

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4
Q

What are the three stages of eczema/dermatitis?

A
  1. Acute
  2. subacute
  3. Chronic
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5
Q

25% of all new derm pts have what?

A

A form of dermatitis

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6
Q

What are the characteristics of acute dermatitis? What is an ex?

A

Pruritis, erythema, edema, vesicles

Acute Contact Dermatitis)

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7
Q

What are the characteristics of subacute dermatitis? What is an ex?

A

Pruritis, erythema, scale, crust

(Atopic Dermatitis)

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8
Q

What are the characteristics of chronic dermatitis? What is an ex?

A

Pruritis, scale, lichenification

(LSC)

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9
Q

define stasis dermatitis

A
  1. Subacute and Chronic

A. Eczematous Dermatitis of the lower legs

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10
Q

What is stasis dermatitis asst w/?

A
  1. venous insufficiency

2. varicose and dilated veins

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11
Q

What is common history for stasis dermatitis?

A
  1. Often prior hx of DVT’s, Surgery or Trauma to leg
  2. PMHx/FamHx of Varicosities
  3. Heavyness, Aching of leg
  4. Legs are swollen at end of day
  5. Worse w/ prolonged standing
  6. Dermatitis and itching prolonged
  7. +/- Secondary Infections
  8. +/- Ulcerations with slight trauma
  9. Asymptomatic to mildly achey (severe pain think infection or arterial disease!)
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12
Q

How does stasis dermatitis present?

A
  1. Varied in size
  2. Subacute to Chr Eczematous changes with dry/xerotic skin, brown hyperpigmentation (hemosiderosis) and Erythema
  3. Patch
  4. Scale, Excoriatons, Fissures
    A. +/- Ulcerations, Ivory white scar
  5. Symmetrical or Asymmetrical
  6. Distributed to Lower Extr
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13
Q

How is stasis dermatitis diagnosed?

A

Venous Doppler to r/o DVT’s

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14
Q

What is the treatment for acute wet dermatitis?

A

Dry it with H2O or Burrows compresses

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15
Q

What is the treatment for chronic dry dermatitis?

A

Wet it with heavy Lubrication

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16
Q

What is the treatment for medium TCS dermatitis?

A

Triamcinolone 0.1% oint

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17
Q

How is venous insufficiency treated?

A
  1. Elevate legs & Active exercise
  2. Compr Stock’s (20-30mmHg)
  3. Surgical Consult
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18
Q

What is the treatment for venous ulcers?

A 
1. Treat Venous Insuff.
A. Unna Boots
2. Treat Surrounding Eczema
3. Keep Ulcer Clean 
A. Debridement of crust/exudate
B. Saline compresses 
4. Polysporin to base
5. Cover with Telfa Dressing
6. MVI (Vit C/E and Zinc aid in healing)
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19
Q

Define contact dermatitis?

A

Cutaneous infl from interaction of skin and an external agent (allergen vs. irritant)

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20
Q

What are the 2 types of contact dermatitis? What is there prevalence and etiology?

A
  1. Allergic contact dermatitis
    A. Immunologic, 20%
  2. Irritant Contact dermatitis
    A. Nonimmunologic, 80%
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21
Q

What is the pathophys of irritant contact derm?

A
  1. Irritants produce direct toxic injury to skin
  2. Any substance under right circumstances can become and irritant (Substance, Patient, Environmental factors to be considered)
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22
Q

What are the 2 subtypes of irritant contact derm?

A
  1. Acute Toxic- single exp., acute derm
  2. Chronic Insult- mult exp., chr derm
    A. DIAPER DERMATITIS!
23
Q

What is the pathophys of allergic contact derm?

A
  1. ACD is a delayed type IV cell mediated hypersensitivity rxn
  2. Sensitization occurs in about 5-21 days
  3. Re-exposure causes delayed rxn in 48-72hrs
  4. Small amount may be all that is needed to trigger rxn
24
Q

What are the 2 subtypes of allergic contact derm?

A
  1. Acute ACD – can go generalized

2. Chronic ACD – mimics ICD

25
Q

What are the characteristics of acute irritant contact derm?

A
  1. Acute Toxic Eruption subtype
  2. From single exposure to strong toxic irritant (acid/alkali)
  3. Acute Dermatitis
  4. Occurs w/in min to hrs after exp.
  5. Sharp borders
  6. Healing occurs soon after exp.
26
Q

What are the characteristics of chronic irritant contact derm?

A
  1. Due to mult exposures over time (wk, mo, yrs)
  2. Low level irritants (water, soaps, preservatives)
  3. Subacute to Chronic dermatitis
27
Q

How is irritant contact dermatitis diagnosed?

A

Clinically

28
Q

How is irritant contact dermatitis treated?

A
  1. HC 1% is all that is needed (+/- Acid Mantle Base)

2. If fails or persists, add antifungal/yeast (Nystatin)

29
Q

How is irritant contact dermatitis like diaper rash prevented?

A
  1. Air, Barrier, Cleansing, Diaper, Education
    A = Diaper Free times (can be messy!) (+/- Zeasorb AF powder if yeast concern)
    B = Vaseline or Aquaphor (+/- Zinc Oxide Pastes)
    C = Frag free/Alcohol free for wipes and Cetaphil Gentle Cleanser for baths
    D = Super-absorbant the best for Dipaers, but still need to change frequently!
    E = Take the time to Educate all care givers
30
Q

What are the characteristics of acute allergic contact derm?

A
  1. Spreads beyond area of contact, Becomes generalized
  2. Acute dermatitis presentation
  3. Classic example is Rhus dermatitis
31
Q

What are the characteristics of chronic allergic contact derm?

A
  1. Allergic type dermatitis from repeated exposure

2. Mimics ICD but is immunologically mediatied

32
Q

What is Irritant contact diagnosis based on?

A

Based on contact history and characteristic distributions noted on physical exam

33
Q

What is allergic contact diagnosis based on?

A

is Based on Patch Testing

34
Q

why is Distribution of dermatitis important?

A

a vital clue in finding the causative agent

35
Q

What is the treatment for acute atopic derm?

A

Wet to Dry compresses

36
Q

What is the treatment for subacute to chronic atopic derm?

A
  1. TCS of appropriate strength for pt’s age and affected area BID
  2. Newer Topical Immune Modulators (TIMs) helpful for long term control because they are steroid free (Protopic and Elidil, safe for 2yo and older)
37
Q

When are antihistamines used for atopic dermatitis?

A

Antihistimines QHS for their sedating effects

Remember AD not caused by histamine release like Allergies/Asthma

38
Q

What treatment is used for severe cases of atopic dermatitis?

A
  1. TCS under occlusion (incr penetration 100-fold!) – Two Pajama Tx
  2. Short course of systemic steroids (tapered PO or injected IM)
  3. Phototherapy with UVB or PUVA
  4. Immunomodulating therapies such as cyclosporin or azathioprine
39
Q

true/false: atopic dermatitis can be cured?

A

AD cannot be cured but AD can be controlled

40
Q

What lifestyle changes can be used to control atopic dermatitis?

A
  1. Avoid provoking irritants (sweating, scented products, wools)
  2. Gentle unfrag. cleansers to dirty areas only in luke warm Baths
  3. Moisturize skin often A. (Ointments > Creams > Lotions)
  4. Use frag free products only!
  5. Apply immediately after bathing and often throughout day
  6. Wear cotton clothing often, avoid wool/synthetics
  7. Humidifiers in home for winter months
  8. Reduce Stress!!!
    Tar preps - vasoconstrictive, astrigent, disinfectant, antipruritic
41
Q

What is necessary to make a diagnosis of atopic dermatitis?

A
  1. Pruritis
  2. Typical Morphology & Distribution of lesions for age
  3. Chronic or Chronically relapsing course
  4. PMHx of FamHx of Atopy (Allergies, Asthma, AD)

Need three of the above 4

42
Q

When is Atopic dermatitis usually seen?

A
  1. AD may present at any age
  2. 60% experience their first outbreak by their 1st Birthday
  3. 90% by their 5th B-day
43
Q

What are the 4 clinical stages of atopic dermatitis

A
  1. INFANTILE PHASE
  2. CHILDHOOD PHASE
  3. ADOLESCENT PHASE
  4. ADULT PHASE
44
Q

Describe the infantile stage of atopic dermatitis

A
  1. 2mo to 2yrs
  2. Intense itching
  3. Acute to Subacute
  4. Distributed to cheeks, forehead and scalp with less involvement of trunk and extremities
  5. Diaper areas spared
  6. AD clears in 50% of pts before age 3yo
45
Q

Describe the childhood stage of atopic dermatitis

A
  1. 3 – 11 yrs old
  2. Subacute to Chronic
  3. Distributed to wrists, ankles, back of thighs, buttocks, flexural areas, and extensor surfaces
  4. 2/3 of pt’s clear by age 6yo
46
Q

Describe the adolescent stage of atopic dermatitis

A
  1. 12 – 20 yrs old
  2. Subacute to Chronic
  3. Distributed to face, neck, upper arms, back and flexures
47
Q

Describe the adult stage of atopic dermatitis

A
  1. > 20yo
  2. Subacute and Chronic
  3. Distributed to hands, face and neck.
  4. Only 10% of infantile or childhood cases of AD persist into Adulthood.
48
Q

Define Xerosis

A

Abnl dryness of the skin due to decr ability to retain H2O

49
Q

Define keratosis pilaris

A

Follicular horny plugs to upper arms and thighs

50
Q

What sxs are sen in atopic dermatitis?

A
  1. Xerosis
  2. Keratosis Pilaris
  3. Hyperlinearity to palms/soles
  4. Allergic Shiners/Nasal Crease
  5. Dennie-Morgan lines
  6. Pityriasis Alba
  7. Vascular abnormalities
51
Q

Define Dennie-Morgan lines

A

Infraorbital line in below the lower eyelid due to edema

52
Q

Define Pityriasis Alba

A

common skin condition mostly occurring in children and usually seen as dry, fine-scaled, pale patches on the face

53
Q

What factors provoke atopic dermatitis?

A
  1. Excessive washing w/o lubrication is MC irritant
  2. Airborne irritant particles such as tobacco smoke, animal dander, molds, dust mites
  3. Heat and Perspiration – 96%
  4. Wool/Synthetics – 91%
  5. Emotional Stress – 81%
  6. Certain Foods – 49%
  7. URI’s – 36%
  8. Dust Mites – 35%

Gen Med: Dermatology (10 decks)

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