ECZEMA/DERMATITIS Flashcards
What does the term DERMATOSIS mean?
refers to any disease of the skin (congenital, inflammatory, neoplastic etc)
What does ECZEMA mean?
from the Greek word ‘ekzein’ meaning ‘to boil out’
*a reference to the tiny vesicles (bubbles) that are often seen in the EARLY ACUTE STAGES of the disorder, but less often in its later chronic stages.
What does DERMATITIS mean?
means inflammation (infective, chemical, physical or immunological) of the skin * It is therefore a broader term than eczema which is just one of several possible types of skin inflammation.
What are the 2 broad divisions of dermatitis?
Endogenous
Exogenous
Endogenous dermatitis is otherwise known as?
Constitutional dermatitis
What does Endogenous/Constitutional Dermatitis mean?
The lesion is caused by an insult from within!
Endogenous dermatitis is further classified based on what?
etiology
age
morphology
site
Mention 5 examples of constitutional dermatitis?
atopic seborrhoiec discoid pompholyx gravitational asteatotic neurodermatitis juvenile plantar dermatosis
What does Exogenous Dermatitis mean?
It is caused by external factors contacting the skin.
Mention 4 examples of exogenous dermatitis?
Irritant contact dermatitis
Allergic contact dermatitis
Photoallergic dermatitis
Phototoxic dermatitis
What does the term atopy mean?
A genetic predisposition to form excessive IgE which leads to a generalized and prolonged hypersensitivity to common environmental antigens such as pollen.
What is atopic dermatitis?
- It is a constitutional disease modified by environmental factors.
- It is defined as eczematous eruption that is pruritic, recurrent, flexural, symmetrical and often associated with a personal or family history of asthma, hay fever, allergic rhinoconjunctivitis or eczema(i.e. positive history of atopic diathesis).
What % of ptx with atopic dermatitis actually have positive hx of atopy?
70%
Atopic dermatitis Constitutes 30-50% of all dermatological consultations worldwide (T/F)?
Very false!
It’s 3-5%
Atopic dermatitis constitutes About 18% of dermatological consultations in Nigeria (T/F)?
True!
Atopic dermatitis is a dx of unknown etiology (T/F)?
True!
infections and environmental factors have no role in the etiology of atopic dermatitis (T/F)?
False!
They do
Outline the immunological abnormalities associated with atopic dermatitis?
*Mainly excessive formation of IgE increased proportion of B cells with surface-bound IgE hyperstimulatory APCs high TH2 : TH1 ratio eosinophilia
How does The “hygiene hypothesis” explain the etiology of atopic dermatitis?
ROLE OF INFECTIONS: The “hygiene hypothesis” suggests that lack of exposure to infections in early life increses the susceptibility to immune responses in later life that favour atopy.
Classify atopic dermatitis based on age?
Infantile atopic dermatitis(<2years)
Childhood atopic dermatitis(>2years to <12years)
Adult atopic dermatitis(>12years)
What is the cardinal feature of atopic dermatitis?
Itching!
What are the clinical features of atopic dermatitis?
ACUTE FEATURES
- Itching
- widespread dryness /roughness of skin
CHRONIC FEATURES crusting scaling lichenification excoriation postinflammatory hyper- and /or hypopigmentation
A 2y/o boy presents acutely with symmetrical ill-defined erythematous , dry or oozing papules/vesicles on the face particularly the cheeks, what is the most likely diagnosis?
Atopic dermatitis!
Extracranial involvement is absent in atopic dermatitis (T/F)?
False
Extracranial involvement varies from none to extensive.
Acute features of atopic dermatitis may coexist with chronic features in what setting?
In the setting of acute exacerbation of chronic eczema
When does atopic dermatitis appear in infants?
about 3rd-6th month
Where does atopic dermatitis usually appear in infants?
on the face, spreading to the scalp, upper trunk and extensor surface of the extremities.
Infantile dermatitis may disappear or become less severe when?
at age 2-3years.
In most patient the atopic dermatitis recurs when?
in late childhood
adolescence
early adult life
Recurring atopic dermatitis lesions tend to appear in what body areas?
lesions tend to localize in FLEXURAL AREAS(neck, antecubital spaces, popliteal fossa).
Atopic dermatitis Lesions continue to wax and wane for years (T/F)?
Very true!
Atopic dermatitis usually abates when?
Early or late teens
A ptx presents with lichenified patches on the antecubital and popliteal fossa and cheilitis.
What could be the cause of these lesions?
These are signs of recurrent chronic atopic dermatitis which may have abated!
What group of individuals are prone to recurrence of atopic dermatitis as chronic hand or foot eczema or even eczema of the neck ?
women of child bearing age
What group of individuals are prone to recurrence of atopic dermatitis as chronic hand or foot eczema or even eczema of the neck ?
women of child bearing age
Mention 5 provocating factors of atopic dermatitis?
heat humidity sweating(promoted by wool or synthetic fabric e.g. nylon and polyester) scratching psychological stress superimposed bacterial infection
Outline 5 complications of atopic dermatitis
Infections Ocular(vernal conjunctivitis) Contact dermatitis Hyperpigmentation w or w/o cheilitis IgE mediated urticaria Growth retardation Psychological stress
What accounts for the infections seen in atopic dermatitis?
- viral(eczema herpeticum, Kaposi’s varicelliform eruptions)
- bacterial
- fungal
Outline 5 signs of vernal conjunctivitis seen in atopic dermatitis?
scratching eczematization swelling periorbital hyperpigmentation brownish discoloration of the conjuctiva Lower eyelid often shows a double fold(Dennie- Morgan fold)
Hypopigmentation is a recognized complication of atopic dermatitis? (T/F)?
False
It’s hyperpigmentation!
What substances should patients with atopic dermatitis avoid?
Detergents shampoo nickel highly chemicalized jobs various injections penicillin chloroquine horse sera
Why can patients with atopic dermatitis develop growth retardation?
may be attributable to the disease or effect of prolonged steroid therapy!
Outline the criteria for making a diagnosis of atopic dermatitis?
MAJOR FEATURES (Must have 3 or more)
- Pruritus (always required)
- Typical morphology and distribution.
- Chronic or Chronically relapsing course
- Personal or family history of atopy (asthma, allergic rhinoconjuctivitis, atopic dermatitis)
MINOR FEATURES (must have 3 or more)
- Xerosis (rough skin surface with fine scaling involving at least 20% of body surface)
- Icthyosis vulgaris (dryness of skin, with small flaky scales)
- Palmar hyperlinearity
- Positive skin prick test (wheal not less than 3mm with an area greter than 50% of the histamine control)
- Elevated total serum IgE
- Onset before the age of 5 years
- Hand eczema
- Nipple eczema
- Cheilitis
- Dennie-Morgan infraorbital folds
Mention 5 differentials of atopic dermatitis?
Seborrhoeic dermatitis Allergic contact dermatitis Irritant contact dermatitis Psoriasis Scabies Tinea corporis
How would you investigate and suspected case of atopic dermatitis?
- RADIOALLERGOSORBENT TEST (RAST) : this measures total and specific IgE antibodies.
- SKIN PRICK TEST can be done. But more useful in the investigation of asthma and hay fever. However, its use in atopic dermatitis is controversial.
Outline the goal and principles of MGT of atopic dermatitis?
GOAL : To control symptoms, not cure the disease
PRINCIPLES
Suppressing the urge to scratch
Suppressing inflammation
Prevention and prompt treatment of infections
Avoiding exacerbating factors
Avoiding complications of tratment
Correcting misconceptions and managing the psychosocial impact of the disease
How would you counsel a ptx on how to suppress itching in atopic dermatitis?
Rub rather than scratch
Cutting the nails
Lukewarm water for bath
Avoid vigorous towelling
Maintaining skin hydration (by applying emollients after bath)
Oral antihistamines (especially for their sedative effect) may be helpful
How would you treat the inflammation associated with atopic dermatitis?
*1% hydrocortisone cream
SEVERE CASES
fluorinated corticosteroid ointments (Betnovate/betamethasone valerate, Dermovate/clobetasol propionate, Locacorten/flumethasone+clioquinol)
WITH LICHENIFICATION
Ichthamol and 1-10% coal tar solution in appropriate cream or ointment
UNRESPONSIVE DERMATITIS
high-potency topical steroids (betamethasone dipropionate, fluocinonide) for a maximum of 2 weeks, tapered to lower strength preparations (triamcinolone)
CHRONIC UNBEARABLE UNRELENTING DERMATITIS
a course of oral systemic corticosteroid (prednisolone) may be necessary
Counsel a patient with atopic dermatitis on steroid wet wrap dressings ?
After a bath
Apply a corticosteroid cream (0.025% beclometasone diproprionate, 1 or 2.5% hydrocortisone cream for children and 0.025 or 0.1% triamcinolone cream for adults)
Cover with two layers of tubular dressing; the inner already soaked in warm water, the other being applied dry.
Cotton clothes can be used to cover these.
Leave on for an hour
Repeat 2/3 times daily
What other therapeutic agents can be used to treat atopic dermatitis?
PHOTOTHERAPY : UVA and UVB (alone or in combination), PUVA
IFN-¥ : Inhibits IL-4 induced IgE synthesis
SYSTEMIC IMMUNOSUPPRESSANTS :
cyclosporine, azathioprine
TOPICAL MACROLIDES (topical tacrolimus) : inhibit cytokine transcription in immune and inflammatory cells.
Seborrhoeic eczema classically affects what body areas?
the scalp central face nasolabial folds eye brows central chest inter scapular area armpit umbilicus groin
What organism is responsible for Seborrhoeic eczema?
Pityrosporum ovale(Malassezia furfur)
Genetic predisposition plays no role in Seborrhoeic dermatitis (T/F)?
False
there seems to be some levels of genetic predispositon.