Eczema & Dermatitis - KK Flashcards
What are the characteristics of Acute Eczematous Inflammation?
- Acute
- Erythema, papules, vesicles
- oozing +/- crusting
- Distinct margins
- intense pruritus
What is the Tx for Acute Eczematous Inflammation?
topical steroids
antihistamines
oral steroids
antibiotics
What are the characteristics of Subacute Eczematous Inflammation?
- Most frequently encountered
- Erythema, scale, scalded appearance, fissuring
- Moderate itch, pain, stinging
- Indistinct margins
What is the Tx for Subacute Eczematous Inflammation?
topical steroids
lubrication
antihistamines
antibiotics
What are the characteristics of chronic eczematous inflammation?
- Thick Skin (lichenification)
- excoriations, fissuring
What is the Tx for chronic eczematous inflammation?
- Topical steroids
- intralesionals
- antihistamines
- antibiotics
- lubrication
What is the pathogenesis for atopic dermatitis?
- Skin barrier abnormalities
- defects in innate immunity response
- th2-skewed adaptive immune response
- Altered skin resident microbial flora
Is atopic dermatitis more common in adults or children? males or females?
More common in children and female to male preponderance of 1.3:1
Atopic Dermatitis is associated with elevated serum levels of…?
Immunoglobulin E (family history of atopy)
What are the clinical features of Atopic Dermatitis?
- Dry skin and severe pruritus
- Can be acute or subacute/chronic
What are the primary treatment recommendations for Atopic Dermatitis?
- Avoid triggers (heat)
- Treat stress and anxiety
- Minimize use of soap (superfatted soaps best)
- Frequent systemic lubrication with oil baths, moisturizers, etc.
- Humidify the house (40% to 60% in all rooms, all-year round)
- After bathing pat dry (avoid rubbing, which removes natural skin oils) and put on ointment, oils, or emolient moisturizer
- Use oil/moisturizer within 3 minutes after soaking/bathing
What medications can be used to treat Atopic Dermatitis?
- Topical Corticosteroids → First line (triamcinolone 0.1%, betamethasone diproprionate 0.05% q day-BID x 2 weeks)
- May need to consider systemic corticosteroids
- Topical calcineurin inhibitors (if on face, neck)
- Treat skin infections
- Use antihistamines and control itching
What is the cause of a Secondary Infection of Atopic Dermatitis, and what medication would you use to treat?
-Due to skin barrier being broken, secondary infection common (S. aureus)
-Medications
→ MSSA: Amoxicillin/clavulanic acid
→ MRSA: Mupirocin 2%, Bactrim
What are the two categories of contact dermatitis?
Allergic & Irritant Contact Dermatitis
What type of hypersensitivity reaction does Allergic Contact Dermatitis elicit?
Delayed (type IV) hypersensitivity
What is the most common sensitizer in North America?
Oleoresin urushiol (poison ivy, oak, sumac)
What is the GOLD standard for Dx of allergic contact dermatitis?
Patch Testing
What are the characteristics of Rhus Dermatitis Rash?
Intense pruritus and erythema then develop papules or plaques, vesicles, and/or bullae
What is the most common metal contact allergen?
Nickel (women > men)
What is the primary treatment for Contact Dermatitis?
1) emollients, soap substitutes → repair the skin barrier
2) Prevention!
3) Topicals containing menthol & phenol
4) High potency topical corticosteroids
5) Oral antihistamines
6) systemic corticosteroids
What distinguishes a mild diaper dermatitis from a moderate/severe diaper dermatitis?
Mild → mild maceration and frictional irritation
Moderate → maceration or superficial erosions
Severe → extensive, glossy, painful erosions, papules, nodules
What is the Tx for Diaper dermatitis?
- dry diapers after proper cleaning with mild soap/H20
- Zinc oxide
- Steroids if severe
What is the difference between Contact/Irritant diaper dermatitis and Candida diaper dermatitis?
Contact: no satellite lesions & avoids creases
Candida: satellite lesions & in creases predominantly
What is dyshidrotic eczema and where is it found normally?
- intensely pruritic chronic and recurrent vesicular dermatitis of unknown etiology
- Involves the palms and soles and lateral aspects of the fingers
What are the metals associated as possible triggers for dyshidrotic eczema?
Nickel, Cobalt, Chromium
What is the Tx of dyshidrotic eczema?
1) Aluminum subacetate (Burow’s solution) or witch hazel for weeping
2) Systemic corticosteroids if severe
3) PUVA therapy for non-responsive cases
What are the characteristics of nummular eczema?
- chronic
- multiple pruritic, coin-shaped eczematous lesions involving the extremities
What is the Tx for severe unresponsive nummular eczema?
Narrowband ultraviolet B (NBUVB) therapy x 10-30 treatments
Seborrheic Dermatitis is found in areas with a high density of…?
sebaceous glands
Seborrheic Dermatitis is found in areas with a high density of…?
sebaceous glands
What is stasis dermatitis and what condition is it associated with?
-Inflammatory dermatosis of the lower extremities occuring in patient with chronic venous insufficiency
What is lipidodermatosclerosis?
chronic form of panniculitis resulting from chronic inflammation, fat degeneration, and fibrosis (usually associated with the ankle region)
What is the Tx for stasis dermatitis?
- Tx of the underlying chronic venous insufficiency
- Symptomatic Tx of skin dryness, pruritus, and inflammation
Where is asteatotic eczema commonly seen and when does it have its highest incidence?
- occurs on the lower extremities of older individuals with dry skin
- incidence most in cold winter months (↓ environmental humidity)
What is the treatment for Asteatotic eczema?
topical corticosteroids
wet dressing with Burows solution
What is perioral dermatitis?
- small inflammatory papules around the mouth, nose, or eyes
- primarily women between ages 16-45
What is the treatment of perioral dermatitis?
- elimination of corticosteroids and skin irritants
- calcineurin inhibitors
- metronidazole
What causes Lichen Simplex Chronicus and what is its appearance?
1) Secondary skin disorder that results from excessive scratching
→ Created and perpetuated by constant scratching and rubbing in patient with no underlying dermatologic condition
2) Appearance
-Lichenified plaques and excoriations
-Very thick oval plaques
-Leathery skin
What is the treatment of lichen simplex chronicus?
- Discontinuation of the itch-scratch cycle
- Topical corticosteroids
What is the cause of lichen planus?
an immune-mediated mechanism involving activated T-cells (Hep C)
What are the 6 “P”s of Lichen Planus?
- Pruritic
- Purple
- Polygonal
- Papules
- Plaques
- Planar
What is the treatment of lichen planus?
- high potency or super high potency topical corticosteroid (Betamethasone dipropionate 0.05%)
- Intralesional corticosteroids
