eczema/dermatitis Flashcards
What are the most common types of eczema?
- contact dermatitis - atopic dermatitis - seborrheic dermatitis - pompholyx - nummular eczema - lichem simplex chronicus
type of eczema that can be acute or chronic and is often vesicular and oozing with positive history of contact
contact dermatitis
acute, dry, scaly, itchy skin at joints
typically has allergic or family history
atopic dermatitis
diffuse, yellowish oily patches near nose or scalp that are less itchy
seborrheic dermatitis (AKA dandruff)
acute, recurring, pruritic, weeping vesicles on hands and feet
pompholyx/ dyshidrosis eczema
pruritic papulovesicular or scaly coin-shaped lesions
nummular eczema
single dry, thick scaly lesion with a chronic itch-scratch cycle
Lichen Simplex Chronicus
What stage of eczema/dermatitis is characterized by well demarcated plaques of erythema and edema with vesicles, blisters and intense itch?
acute
What stage of eczema/dermatitis is characterized by redness, scaling, fissuring, parched appearance, scaled appearance, slight to moderate itch, pain, stinging and burning?
subacute
What stage of eczema/dermatitis is characterized by thickened skin, skin lines accentuated (lichenified), excoriations, fissuring and moderate to intense itch
chronic
80% of all dermatitis is _____ dermatitis and is most common on _____.
irritant contact
hands
What are some preventative measures that can be taken for irritant contact dermatitis?
- avoid irritant
- rinse if there is exposure
- use barrier creams such as petrolatum
- change of job may be necessary
What are some topical treatments for irritant contact dermatitis?
- powder (baby powder)
- ointment (calendula, A&D, Comfrey)
- wet soaks containing tap water, saline, colloidal oatmeal
- wet soaks containing Burow’s (aluminum acetate) solution
- honey, olive oil, beeswax mixture
- corticosteroids
What are oral treatments for severe irritant contact dermatitis?
systemic corticosteroids (prednisone)
What is the typical course of irritant contact dermatitis?
- usually heals within 2 weeks, 6 for chronic cases
- occupational exposures only have 1/3 complete remission
- atopic individuals have poor prognosis
dermatitis at site of contact (watchband, earrings) that appears 24-48 hours after contact
allergic contact dermatitis
Allergic dermatitis is what class of immune response?
type IV (delayed) hypersensitivity
what are the top 10 allergens that can cause dermatitis?
- nickel sulfate
- neomycin sulfate
- balsam of peru
- fragrance mix
- thimerisol
- sodium gold thiosulfate
- formaldehyde
- quaternium - 15
- cobalt chloride
- bacitracin
sensitization and dermatitis 7-10 days after exposure fo toxicodendron haptens
allergic contact dermatitis due to plants (APD)
* poison oak/ivy
What are some preventative measures against poison oak/ivy?
- avoid contact
- wash entire body with copious water after exposure
- barrier creams
- wash clothing and pets that were exposed
- trim fingernails
- avoid soap as it can spread resin
What are some topical treatments for allergic dermatitis due to plants?
- calendula lotion
- calamine (zinc and ferrous oxide)
- Burow’s solution (aluminum acetate)
- EtOH, Comfrey, mugwart and seasalt
- oatmeal, starch or vinegar bath
- aloe gel
- glucocorticoids
When are oral steroids indicated for poison oak/ivy exposure and dermatitis?
if greater than 25% of the body surface is affected
if there is severe itching or blistering
if there is significant involvement of the face, hands or genitals
What is the normal course for poison oak?
- rash begins 24-36 hours after exposure
- lasts 3-4 days, clears within next 5 days
inflammation of the dermis and epidermis with unknown cause
atopic dermatitis
What is the prevalence of atopic dermatitis in the general population?
7-15% (increasing incidence in Western World
What are some key factors for the pathogenesis of atopic dermatitis?
- terrain
- genetic susceptibility or abnormality
- immune dysfunction
- epidermal barrier dysfunction
- IgE mediated hypersensitivity
- increased cAMP levels
- defect in delts-6-desaturase
- dry skin in childhood
What are the 4 major features of atopic dermatitis, 3 out of 4 of which should be present for diagnosis?
- pruritis
- typical morphology and distribution
- chronic relapsing dermatitis
- personal or family history of atopic dermatitis
What are other minor features of atopic dermatitis that may be present?
- cataracts
- caonjunctivitis
- infraorbital folds (dennie-morgan lines)
- keratosis pilaris (chicken skin)
- palm creases
- keratoconus
- food intolerance
- etc.
What are the stages of atopic dermatitis?
- infantile (2 mos - 2 years)
- childhood (2 -12 years)
- adult (12+ years)
In the infantile stage of atopic dermatitis, what areas of the body are involved?
scalp, face, extensor surface
In the childhood stage of atopic dermatitis, what areas of the body are affected?
antecubital and popliteal fossae, posterior neck
What is characterized by yellowish oily patches near nose and scalp?
Seborrheic dermatitis
More images: Left is cradle cap and Right is periorbital S.D.
What is acute, chronic, recurrent dermatitis of the hands and soles that affects F>M?
Pompholyx/dyshidrotic eczema
“Pompholyx” = bubble
What is characterized by sudden deep-seated pruritic, clear “tapioca-like” vesicles on palms and sides of fingers that later lead to scaling fissures and lichenification?
Pompholyx/dyshidrotic eczema
Define: lichenified skin means skin that has become thickened and leathery. This often results from continuously rubbing or scratching the skin.
Photo: 2-4 weeks complications may occur with 2˚ infections
Sudden onset
tapioca-like vesicles
unknown etiology
What is the treatment for this condition that affects females more than males and is characterized by thick plaques (usually 1 lesion) with severe pruritus and lasts indefinitely and recurs frequently?
What are CAM treatments for lichen simplex chronicus (LSC)?
Occlusive barrier-unna and dome paste boot
tranquilizer
acupuncture
transcutaneous electrical nerve stimulation
What condition is characterized by common, chronic, coin-shaped plaques?
Nummular eczema (or numular dermatitis)
“Nummular” = coin-shaped
What is the condition that is characterized by an initial onset of closely grouped, small vesicles and papules that coalesce into plaques where the itching is moderate to severe?
Nummular eczema
An itchy, dyhidrotic-like vesicular eruption on the fingers, forearms, thighs, legs, trunk
Id reaction
Characterized by cracked porcelain pattern. Erythema, inflammation and scaling with pruritus.
Asteatotic dermatitis
Condition that occurs from venous return failure and increased presssure of capillaries where multiple progressive dermatological changes occur
Stasis Dermatitis
Associated with chronic venous insufficiency from venous return failure and increased capillary pressure.
Mgmt/tx = improve venous return
Characterized by progressive complication of CVI (chronic venous insufficiency). Non-healing shallow painful ulcer in the lower extremities above the ankle or at the malleolus.
Venous leg ulcers
Nonhealing shallow painful ulcer in LE above ankle or at malleolus. Sharply demarcated ulcer surrounded by atrophied Blanche. Pale plaques of scar tissue surrounded by stasis dermatitis
Venous leg ulcers
Delayed abnormal reaction to UV light.
Polymorphous light eruption
Characterized by the presentation of vesicles, papules, erythematous macules, urticaria plaques. Pink to red in color. Onset after sun exposure.
Polymorphous light eruption
Mgmt/treatment for this condition that has an onset after sun exposure?
Condition: polymorphous light eruption
Prevention: sun block (though not always helpful)
CAM: beta-carotene, niacinamide, vit b6
Prednisone, trimcinolone
photochemotherapy (PUVA)
Sudden, fixed, symmetrical or generalized skin eruption occurring after starting a new drug or OTC
Drug dermatitis (Drug-related eczema)
