ECZEMA/DERMATITIS Flashcards
1
Q
What does the term DERMATOSIS mean?
A
refers to any disease of the skin (congenital, inflammatory, neoplastic etc)
2
Q
What does ECZEMA mean?
A
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.
3
Q
What does DERMATITIS mean?
A
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.
4
Q
What are the 2 broad divisions of dermatitis?
A
Endogenous
Exogenous
5
Q
Endogenous dermatitis is otherwise known as?
A
Constitutional dermatitis
6
Q
What does Endogenous/Constitutional Dermatitis mean?
A
The lesion is caused by an insult from within!
7
Q
Endogenous dermatitis is further classified based on what?
A
etiology
age
morphology
site
8
Q
Mention 5 examples of constitutional dermatitis?
A
atopic seborrhoiec discoid pompholyx gravitational asteatotic neurodermatitis juvenile plantar dermatosis
9
Q
What does Exogenous Dermatitis mean?
A
It is caused by external factors contacting the skin.
10
Q
Mention 4 examples of exogenous dermatitis?
A
Irritant contact dermatitis
Allergic contact dermatitis
Photoallergic dermatitis
Phototoxic dermatitis
11
Q
What does the term atopy mean?
A
A genetic predisposition to form excessive IgE which leads to a generalized and prolonged hypersensitivity to common environmental antigens such as pollen.
12
Q
What is atopic dermatitis?
A
- 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).
13
Q
What % of ptx with atopic dermatitis actually have positive hx of atopy?
A
70%
14
Q
Atopic dermatitis Constitutes 30-50% of all dermatological consultations worldwide (T/F)?
A
Very false!
It’s 3-5%
15
Q
Atopic dermatitis constitutes About 18% of dermatological consultations in Nigeria (T/F)?
A
True!
16
Q
Atopic dermatitis is a dx of unknown etiology (T/F)?
A
True!
17
Q
infections and environmental factors have no role in the etiology of atopic dermatitis (T/F)?
A
False!
They do
18
Q
Outline the immunological abnormalities associated with atopic dermatitis?
A
*Mainly excessive formation of IgE increased proportion of B cells with surface-bound IgE hyperstimulatory APCs high TH2 : TH1 ratio eosinophilia
19
Q
How does The “hygiene hypothesis” explain the etiology of atopic dermatitis?
A
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.
20
Q
Classify atopic dermatitis based on age?
A
Infantile atopic dermatitis(<2years)
Childhood atopic dermatitis(>2years to <12years)
Adult atopic dermatitis(>12years)
21
Q
What is the cardinal feature of atopic dermatitis?
A
Itching!
22
Q
What are the clinical features of atopic dermatitis?
A
ACUTE FEATURES
- Itching
- widespread dryness /roughness of skin
CHRONIC FEATURES crusting scaling lichenification excoriation postinflammatory hyper- and /or hypopigmentation
23
Q
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?
A
Atopic dermatitis!
24
Q
Extracranial involvement is absent in atopic dermatitis (T/F)?
A
False
Extracranial involvement varies from none to extensive.
25
Acute features of atopic dermatitis may coexist with chronic features in what setting?
In the setting of acute exacerbation of chronic eczema
26
When does atopic dermatitis appear in infants?
about 3rd-6th month
27
Where does atopic dermatitis usually appear in infants?
on the face, spreading to the scalp, upper trunk and extensor surface of the extremities.
28
Infantile dermatitis may disappear or become less severe when?
at age 2-3years.
29
In most patient the atopic dermatitis recurs when?
in late childhood
adolescence
early adult life
30
Recurring atopic dermatitis lesions tend to appear in what body areas?
lesions tend to localize in FLEXURAL AREAS(neck, antecubital spaces, popliteal fossa).
31
Atopic dermatitis Lesions continue to wax and wane for years (T/F)?
Very true!
32
Atopic dermatitis usually abates when?
Early or late teens
33
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!
34
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
34
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
35
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
```
36
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
```
37
What accounts for the infections seen in atopic dermatitis?
* viral(eczema herpeticum, Kaposi's varicelliform eruptions)
* bacterial
* fungal
38
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)
```
39
Hypopigmentation is a recognized complication of atopic dermatitis? (T/F)?
False
| It's hyperpigmentation!
40
What substances should patients with atopic dermatitis avoid?
```
Detergents
shampoo
nickel
highly chemicalized jobs
various injections
penicillin
chloroquine
horse sera
```
41
Why can patients with atopic dermatitis develop growth retardation?
may be attributable to the disease or effect of prolonged steroid therapy!
42
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
43
Mention 5 differentials of atopic dermatitis?
```
Seborrhoeic dermatitis
Allergic contact dermatitis
Irritant contact dermatitis
Psoriasis
Scabies
Tinea corporis
```
44
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.
45
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
46
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
47
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
48
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
49
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.
50
Seborrhoeic eczema classically affects what body areas?
```
the scalp
central face
nasolabial folds
eye brows
central chest
inter scapular area
armpit
umbilicus
groin
```
51
What organism is responsible for Seborrhoeic eczema?
Pityrosporum ovale(Malassezia furfur)
52
Genetic predisposition plays no role in Seborrhoeic dermatitis (T/F)?
False
| there seems to be some levels of genetic predispositon.
53
Mention 2 co-morbidities seen in Seborrhoeic eczema?
AIDS
| PARKINSONISM
54
Seborrhoeic eczema is a feature of AIDS but is usually mild in such patients (T/F)?
False
| Although it's a feature of AIDS, it's usually very severe in such ptx
55
Milder form of Seborrhoeic eczema presents as what?
Dandruff
56
Severe forms of Seborrhoeic eczema presents like?
Psoriasis
57
Post inflammatory hyperpigmentation is a characteristic feature of Seborrhoeic eczema (T/F)?
False!
| It's post inflammatory hypopigmentation
58
Superimposed cutaneous candidiasis is a common feature of Seborrhoeic dermatitis (T/F)?
Very true!
59
Seborrhoeic eczema has a very poor prognosis (T/F)?
False
| Has a good prognosis as it is self limiting within a few weeks.
60
A ptx presents with Benign looking, mildly scaling patches, with minimal or no erythema or pruritus over the chest. What's the most likely diagnosis?
Seborrhoeic eczema!
61
Outline the 2 clinical types of Seborrhoeic eczema?
Infantile type
| Adult type
62
When does infantile Seborrhoeic eczema occur?
BTW 4th and 6th week
63
Diffuse Alopecia is a xteristic feature of adult Seborrhoeic eczema (T/F)?
False
| It's infantile Seborrhoeic eczema
64
What are the commonly affected areas in infantile Seborrhoeic eczema?
scaly scalp
occurrence in flexures and nappy areas
Major sites involved are the scalp and skin folds.
65
Infantile Seborrhoeic eczema could have varied morphology but characteristic distribution (T/F)?
False!
| It's adult Seborrhoeic eczema
66
pityrosporum folliculitis is a xteristic feature of adult Seborrhoeic eczema (T/F)?
Very true!
67
Diffuse hyperpigmented macules may be seen in adult Seborrhoeic eczema (T/F)?
False
| It's diffuse HYPOPIGMENTED macules
68
Outline 3 xteristic lesions seen in adult Seborrhoeic eczema?
diffuse hypopigmented macules or patches
oily scaly eruptions
follicular eruptions with papules or pustules
69
What body areas are commonly affected in adult Seborrhoeic eczema?
Majorly affects
* portion of the skin near the scalp hairline(corona seborrhea)
* Centro-facial areas
* presternal region
* intertriginous areas
* Paranasal creases
* retroauricular folds
70
corona seborrhea is typically seen in infantile Seborrhoeic dermatitis (T/F)?
False!
| It's adult Seborrhoeic eczema
71
seborrheic dermatitis localized to the scalp is known as what?
Dandruff!
72
Outline 4 differentials of Seborrhoeic dermatitis?
Atopic dermatitis
Contact dermatitis
Pytiriasis versicolor
Drug eruptions
73
What are the treatment options for Seborrhoeic eczema?
Medicated shampoo : Containing ketoconazole
Selenium sulphide (selsun)
coal tar
2% sulphur
2% salicylic acid cream
Cream/ointment containing an imidazole plus 1% hydrocortisone.
Systemic oral itraconazole may occasionally be helpful.
74
Asteatotic eczema is otherwise called?
eczema craquelé
75
What group of patients is Asteatotic eczema commonly seen in?
hospitalized elderly persons!
76
Mention 5 predisposing factors to Asteatotic eczema?
```
Dry skin
Low humidity
weather(winter/harmattan)
aging
malnutrition
hypothyroidism
diuretics use
```
77
A hospitalized elderly ptx develops dry, itchy Erythematous lesions on the lower legs and trunk showing a rippled or ‘crazy paving’ pattern of fine fissuring on an erythematous background.
What's the most likely diagnosis?
Asteatotic eczema?
78
What are the treatment options used in the treatment of Asteatotic eczema?
Liberal use of emollients and urea-containing creams sometimes combined with hydrocortisone is effective.
STRONG CORTICOSTEROID OINTMENT should be avoided as the skin is usually already atrophic due to ageing.
79
Lichen simplex chronicus is otherwise known as?
Neurodermatitis
80
Neurodermatitis occurs most commonly in which group of individuals?
Adult women
81
What's the peak age of Neurodermatitis?
between 30 and 50
82
What are the common sites of affectation seen in Neurodermatitis?
```
nape of the neck
occipital scal
volar wrist
lower legs
anogenital area
```
83
Majority of thepatients with Neurodermatitis also reveal evidence of what?
emotional stress.
84
A circumscribed hyperkeratotic chronic dermatitis seen in patients(mostly adult women) who just seem to enjoy scratching themselves for no apparent cause is known as?
Lichen simplex chronicus/Neurodermatitis
85
How would you manage a ptx with lichen simplex chronicus?
Identifying any underlying cause of stress and tension that could be eliminated
Sedative antihistamines
2-5% sulfur-salicylic acid ointment (to decapitate the hyperkeratosis)
impregnated tar , zinc paste bandages or steroid-medicated tape can be of benefit.
86
Nummular dermatitis is strictly an exogenous dermatitis (T/F)?
False
| It could be found in both endogenous and exogenous.
87
How is Nummular dermatitis different from all other types of dermatitis?
Is differentiated from all other eczemas purely on morphological grounds because of its characteristic round lesions hence it's name discoid dermatitis
88
Discoid dermatitis may occur in atopic dermatitis is which case it's easier to treat (T/F)?
False!
| May occur in atopic dermatitis where it is more difficult to treat.
89
Nummular dermatitis is usually seen in what group of individuals?
Associated with alcohol consumption in young men and also in the elderly
90
What are the presumed etiology of Nummular dermatitis?
Chronic stress
| Rxn to bacterial antigen (staph aureus)
91
Isolated antibiotic treatment is very effective in treatment of Nummular dermatitis (T/F)?
False!
| steroid-antibiotic mixture does better in treatment than either separately
92
Weepy lesions are xteristic of discoid dermatitis (T/F)?
True!
93
Gravitational dermatitis is otherwise called?
Stasis/varicose eczema!
94
Gravitational dermatitis is always associated with varicose veins or stasis ulcer (T/F)?
False!
| May or may not be associated with varicose veins or stasis ulcer.
95
Gravitational dermatitis occurs secondary to what?
secondary to venous hypertension
96
What are the risk factors for gravitational dermatitis?
```
Caucasians
elderly obese females
history of significant leg injury
varicose veins
DVT
```
97
What is the most common site of affectation of gravitational dermatitis?
The lower third of the leg on the area just above the medial malleolus(great saphenous vein pathway)
98
Stasis dermatitis will usually heal with post inflammatory hypopigmentation (T/F)?
Very false!
| Heals with sclerodermiform scarring and hyperpigmentation.
99
What are the possible complications of stasis dermatitis?
Eventually spreads to encircle entire lower third of leg.
| Area is dark and itchy and may become ulcerated
100
What are the treatment options for stasis dermatitis?
Elimination of edema by elevation, pressure bandages or diuretics
A moderately potent steroid may be helpful
Tar-impregnated bandages (ichthopaste, coltapaste) may be useful.
101
An acute, recurrent, vesicular eruption on the palms and/or soles of the feet which may appear alone or as part of a generalized eczematous reaction with no erythema, but a preceeding sensation of heat or pricking is characteristic of what?
Pompholyx/Dishidrotic dermatitis
102
In pompholyx, Involution occurs as a result of rupture of the vesicles (T/F)?
False!
Involution occurs due to intradermal absorption of the vesicular fluid rather than by rupture as the vessicles are covered by thick stratum corneum.
103
Mention 3 co-morbidities seen in pompholyx?
* palmar hyperhydrosis (worse in hot weather) *fungal infection of the feet(dermatophytid)
* a bacterial infection e.g. tooth abscess or otitis media(bacterid)
* autosensitization eczema(eczematid)
* contact dermatitis
104
What are the treatment options for dishidrotic dermatitis?
MILD ACUTE or SUB-ACUTE POMPHOLYX *corticosteroid cream or ointment should be applied.
GROSS POMPHOLYX WITH THREATENED DEGLIVING
* use oral prednisolone 30-40 mg/day initially, then the dose reduced according to response.
* Weak potassium permanganate
* 1% Al acetate compresses
* flucloxacillin or erythromycin orally reduce the risk of secondary infection.
105
Juvenile plantar dermatosis is otherwise called what? And why?
* 'toxic sock syndrome’!
* BecauseThis condition is thought to be related to the impermeability of modern socks and shoe linings with subsequent sweat gland blockage
106
Juvenile plantar dermatosis occurs exclusively in what age group of children?
children aged 3-14
107
A 7y/o ptx presents when her mother noticed the forefeet and undersides of the toes had become dry and shiny with deep painful fissures that make walking difficult, The toe webs are however spared. What's the most likely diagnosis?
Juvenile plantar dermatosis
108
Toxic sock syndrome is usually self limiting asvit clears by itself in late teens (T/F)?
False
| Its early teens
109
What are the treatment options for a child with juvenile plantar dermatosis?
The child should use a commercially available cork insole in all shoes, and stick to cotton or wool socks.
An emollient such as emulsifying ointment or 1% ichthammol paste, or an emollient containing lactic acid, is as good as a topical steroid.
110
Irritant dermatitis is due to allergic reaction in the skin resulting from direct cell damage caused by exposure to irritating substance (T/F)?
False!
| Its a non allergic rxn
111
Outline 3 structural skin changes that occur in irritant contact dermatitis?
* exhaustion of the horny layer
* denaturing of keratin
* alteration of the water holding capacity of the skin
112
What are the subtypes of irritant dermatitis?
Acute irritation
| Chronic cumulative irritation
113
Itemize 3 distinctive features of acute irritant dermatitis?
quick reaction
sharp margins
following short-term exposure to strong irritants like acids, alkali or powerful oxidising or reducing agents.
114
Itemize 3 distinctive features of chronic cumulative dermatitis?
* slow reaction
* poorly-defined margins
* following long-term exposure to mild irritants like soap, solvent, grease
115
How would you manage a ptx with irritant contact dermatitis?
Prevention is better than cure!!
because, once started, irritant eczema can persist long after contact with offending substances has ceased, despite the vigorous use of emollients and topical corticosteroids.
Complete avoidance of irritants or minimisation of contact (protective clothing or gloves)
Topical steroids and emollients may be useful
116
How would you manage a ptx with irritant contact dermatitis?
Prevention is better than cure!!
because, once started, irritant eczema can persist long after contact with offending substances has ceased, despite the vigorous use of emollients and topical corticosteroids.
Complete avoidance of irritants or minimisation of contact (protective clothing or gloves)
Topical steroids and emollients may be useful
117
Allergic contact dermatitis may occur in all individuals who come in contact with various allergens (T/F)?
Very false
| In only those who have acquired hypersensitivity to the allergens
118
All sensitized individuals will eventually develop allergic dermatitis (T/F)?
False!
| Not all
119
Allergic dermatitis Represents a minority of contact dermatitis (T/F)?
Very true
| Only certain substances are allergens and only a small proportion of people are typically susceptible to them
120
Allergic dermatitis Represents a minority of contact dermatitis (T/F)?
Very true
| Only certain substances are allergens and only a small proportion of people are typically susceptible to them
121
Allergic contact dermatitis is a type III hyps rxn (T/F)?
Very false!
| It is a type IV (cell-mediated/delayed type) hypersensitivity reaction
122
Outline 5 sources of allergens implicated in allergic contact dermatitis?
Environmentally dependent.
NICKEL
*found in many non gold jewelries and in many metallic objects (zippers, scissors, pots, gates)
COBALT
*alloy steel, paints, ink.
CLOTHING
*caused by formaldehyde resins and dyes. Sweat is acidic and leach out formaldehyde and dyes from clothing
SHOES
*chemicals added to rubber in the process of manufacturing like sulphur containing compounds.
CHROMIUM COMPOUNDS
*also cause dermatitis from leather, cement, primer paint, anticorrosives
PLASTIC
*such as polyvinyl chloride.
PLANTS
*Garlic, onions, poison ivy, orange peel
DRUGS (Dermatitis medicamentosa)
*topical neomycin, sulfonamides, balsams, mercurials, NSAIDS
123
What single investigation is done to confirm allergic contact dermatitis and to identify the allergens responsible for it?
PATCH TEST!
124
How would you treat a patient with allergic contact dermatitis?
Allergens should be avoided
| Topical corticosteroids give temporary relief!
125
Photoallergic dermatitis can generally occur in all individuals (T/F)?
Very false !
| Its Provoked by UV radiation in individuals who have been sensitised by previous exposure to photosensitizers
126
allergic contact dermatitis localised to sun-exposed areas of the skin is known as?
Photoallergic dermatitis!
127
Outline 7 major photosensitizers implicated I. Photoallergic dermatitis?
```
phenothiazines
sulphonamides
topical NSAIDs(especially ketoprofen)
quinine and quinidine
bithionol and hexachlorophane (in toilet soaps, shampoos and deodorants)
eosin (especially in lipsticks)
thiourea (in design paper)
halogenated salicylanilides
```
128
Exfoliative dermatitis is diagnosed by involving what % of the skin?
>80%
129
Exfoliative dermatitis is a primary cutaneous manifestation (T/F)?
False!
| is usually a secondary or reactive process to an underlying cutaneous or systemic disease.
130
What condition is characterized by excessive epidermal turnover and involvement of all or most of the skin surface by scaly erythematous dermatitis?
EXFOLIATIVE DERMATITIS!
131
Itemize 6 causes of exfoliative dermatitis?
```
atopic dermatitis
seborrhoeic dermatitis
allergic contact dermatitis
Irritant contact dermatitis
drug eruption
psoriasis
pityriasis
Norwegian scabies
malignancy
AIDS
```
132
Outline the treatment options for exfoliative dermatitis?
TX is by HIGH DOSE CORTICOSTEROID 60mg/day
Supportive measures include
* erythromycin to take care of infection
* Starch bath and potassium permanganate
* High protein diet
* Septrin prophylaxis(with caution)
* Hydrate adequately and monitor urinary output
