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Dermatology > Eczemas and Allergic Skin Diseases > Flashcards

Eczemas and Allergic Skin Diseases Flashcards

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1
Q

What are the characteristics of Pityriasis Alba?

A

Mild form of Atopic Dermatitis Commonly presents as hypopigmented macules on the face and neck.

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1
Q

What is a simple drug eruption?

A

ACDR that is limited to the exanthem (skin) only.

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1
Q

What findings would indicate Chronic Urticaria?

A

If the individual lesions resolve within 24-48 hours, but the reaction continues for >6 weeks. Also, there are no confounding symptoms such as arthralgias or fever.

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2
Q

What is a complex drug eruption?

A

ACDR that has constitutional symptoms (multi system)

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2
Q

Describe Steven-Johnsons Syndrome and Toxic Epidermal Necrolysis.

A

They are the same condition, TEN is more severe. Acute, life-threatening reactions to drugs (occasionally idiopathic) Result in extensive necrosis and detachment of the epidermis.

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3
Q

Describe Anaphylaxis.

A

A severe allergic reaction with life-threatening systemic findings, mainly laryngospasm, airway obstruction, vascular collapse, and hypotension. Usually occurs within 1 hour of exposure.

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4
Q

What medications can be used for atopic dermatitis?

A

Antihistamines - for itching Skin hydration - emollients and limited use of soap Topical calcineurin inhibitors - for itching, not for use on children

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5
Q

How should emergency department care begin for a patient with anaphylaxis?

A

O2 2 large-bore IVs for hypotension IV antihistamines IV steroids

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6
Q

What type of reaction is an ACDR?

A

Most are hypersensitivity, immunologic reactions, varying widely between Type I, II, III, and IV

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7
Q

What precautions should patients at risk for anaphylaxis take?

A

Carrying an epinephrine auto-injector

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8
Q

How do you diagnose ICD?

A

Through the history and clinical exam

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8
Q

How may SJS or TEN present?

A

Begin as target-like lesions or diffuse erythema. Progress to necrosis and epidermal detachment.

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9
Q

What is the Nikolsky sign/phenomenon?

A

Where the epidermis is dislodged from the dermis when rubbed laterally with your hand. May be seen in EM Major.

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10
Q

What findings would indicate Acute Urticaria?

A

If the individual lesions resolve within 24-48 hours and the overall reaction resolves in

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10
Q

How do you manage Acute Urticaria?

A

Remove triggers Antihistamines - H1 blockers for skin and vasculature, reducing pain, itching, and edema H2 blockers - parietal cells (stomach) Corticosteroids (prednisone) - short oral course

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10
Q

How do you manage Chronic Urticaria?

A

Remove triggers. Refer all cases that are not Acute or Physical. Antihistamines - H1 blockers for skin and vasculature, reducing pain, itching, and edema H2 blockers - parietal cells (stomach)

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11
Q

What findings would indicate Physical Urticaria?

A

If the individual lesions AND the overall reaction resolves within 2 hours (such as sweat, cold, solar…)

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12
Q

What are symptoms of chronic ICD?

A

painful burning and itching USUALLY evolves through several stages: chapping, hyperkeratosis with scaling, fissures, and crusting

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12
Q

Where does atopic dermatitis commonly manifest on the body?

A

Commonly found on the face and flexor surfaces, neck, dorsa of feet and hands

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12
Q

What age group is commonly affected by Pityriasis Alba?

A

preadolescents

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14
Q

What type of hypersensitivity response can you generally use antihistamines with to treat symptoms?

A

Type I Immediate - usually involves release of histamines

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14
Q

What are the symptoms of atopic dermatitis?

A

Pruritic (itchy), excoriated inflammation of the skin Poorly defined erythematous patches, papules, and plaques that may result in a puffy appearance. Linear or punctate erosions develop from scratching. Infants, scaling and wet crusts are common.

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16
Q

What is hypersensitivity?

A

a local or generalized reaction following contact with a specific allergen to which previous exposure and sensitization has occurred.

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16
Q

Describe Lichen Simplex Chronicus.

A

Manifests as a chronic patch of lichenification that forms from repetitive rubbing or scratching. This patch has a hypersensitive itch response, which creates a habit of rubbing or scratching that continues its cycle.

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18
Q

Which form of ICD is the most common, acute or chronic?

A

Chronic. Frequently seen on hands of people exposed to wet work

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19
Q

How do you manage ACD?

A

Burow’s solution Topical glucocorticoids (ointments preferred over creams) Prednisone - severe cases Oral soporific antihistamines - may help patient sleep

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19
Q

Describe Erythema Multiforme

A

A cutaneous reaction to antigenic stimuli (autoimmune). May present as a drug reaction or bacterial organism, but MOST COMMONLY a reaction to herpes simplex virus.

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21
Q

What is a Type I Immediate hypersensitivity response?

A

IgE mediated (antibody) reaction that occurs within minutes of exposure.

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21
Q

What are examples of common irritants/toxic agents?

A

soaps, detergents, cement, petroleum, acetone, fiberglass, wool, friction, pressure

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21
Q

Describe Urticaria.

A

A pruritic skin eruption characterized by transient, blanchable wheals of varying shapes and sizes that may become confluent. Usually resolves in 48 hours

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22
Q

Do irritants cause hypersensitivity reactions?

A

No.

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23
Q

What test might you use to test for a Type I response?

A

Prick test, testing for IgE

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24
Q

What age group is most commonly affected by atopic dermatitis?

A

Often begins in infancy and generally resolves in later teenage years

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25
Q

What is a Type IV Delayed hypersensitivity response?

A

a cell-mediated (T cell) response, usually occurs 48-72 hours of exposure

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25
Q

What are some examples of Type IV Delayed hypersensitivity responses?

A

Tuberculin skin test Contact Dermatitis

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26
Q

Describe Dyshidrosis (Dyshidrotic Eczematous Dermatitis, DED)

A

A type of visicular eczema, commonly found on the dorsum of the hand, possibly on the palms of hands and on feet. Recurrent attacks with spontaneous remissions.

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28
Q

What are common allergens that cause ACD?

A

nickel metal, cosmetic ingredients (fragrances), preservatives, rubber, latex, dyes, plants (poison ivy)

29
Q

Describe Atopic Dermatitis.

A

A complex disease that involved genetics, immunology (hypersensitivity), environment (exposure), and skin health. Flare-ups are commonly caused by environmental or irritating agents.

30
Q

Do irritant reactions stay limited to the site of exposure, or spread beyond the exposed sites?

A

Limited to area of exposure

32
Q

What test might you use for a Type IV response?

A

Patch test, testing for delayed response

33
Q

How do you diagnose ACD?

A

through history and physical exam. biopsies may help confirm confusing cases patch tests can help identify offending agents

33
Q

What is the treatment of Nummular Eczema?

A

Moisturizers and TOPICAL STEROIDS.

34
Q

How is the severity of SJS or TEN determined?

A

Scoring system based on age, heart rate, presence or absence of malignancy, percent of body surface involved, blood tests

36
Q

What are some examples of Type I Immediate hypersensitivity reactions?

A

Urticaria, Anaphylaxis

37
Q

What are the most common cause of simple drug eruptions?

A

Antibiotics

38
Q

What is the treatment for Pityriasis Alba?

A

avoiding triggers topical steroids reassurance that the condition is self limiting

38
Q

What lab findings may you find with complex drug eruptions?

A

eosinophilia abnormal liver or kidney function

40
Q

What factors may exacerbate Dyshidrosis?

A

Friction, cold, excessive exposure to water. Considered endogenous (not from an allergen or irritant.

41
Q

Why must you consider the development of a rash while taking a medication to be an ACDR?

A

ACDRs can mimic ANY inflammatory skin condition.

42
Q

What are some common causes of urticaria and angioedema?

A

Drugs, Insects, Parasitic infections, Foods, Preservatives, Latex, Aeroallergens, Dermographism from scratching, cold exposure and rewarming, solar exposure, sweat or increase in body temperature, pressure, hereditary (triggered by trauma)

44
Q

Under what conditions would a patient experience Allergic Contact Dermatitis (ACD)?

A

Re-exposure to a substance that the person has become sensitized to.

44
Q

How do you manage atopic dermatitis?

A

Be aware of secondary bacterial infections (S. aureus) and viral infections (herpes simplex). Prevent rubbing and scratching - use moisturizers to maintain skin health and prevent dryness. Can use RAST or prick test to identify causative agent.

45
Q

What type of pathology can you see in acute ICD?

A

damage to keratinocytes (single exposure)

47
Q

What are ways to manage ICD?

A

Prevention - gloves Removal of irritant Burow’s solution Oral glucocorticoids - severe acute cases Topical glucocorticoids - chronic cases (steroids should be started off in a high dose and tapered off)

48
Q

How is a patient with SJS or TEN treated?

A

Discontinue Drug! Hospitalize and treat similar to a burn patient - fluids, electrolytes, pain management Avoid debridement Treat complicating infections PREVENT recurrence - medical alert bracelet.

49
Q

What blood test can identify Hereditary Angioedema?

A

C’1 Esterase Inhibitor test (C’1 INH) Decreased values indicate a production flaw in the glycoproteins necessary for the body’s complement system to function.

50
Q

Repeated rubbing of atopic dermatitis lesions may cause what results?

A

lichenification fissures alopecia

52
Q

What can cause Eczema?

A

Irritants or Allergens

53
Q

What are the symptoms of acute ICD?

A

painful sensation of burning OR may evolve through stages of Blistering, erosion, crusting, scaling, necrosis, shedding, ulceration, and healing

54
Q

What are the most common cause of complex drug eruptions?

A

Sulfonamides Allopurinol Anticonvulsants

55
Q

Describe Nummular Eczema

A

Type of eczema with a characteristic coin shape. Commonly distributed on forearms and calves. Unknown Etiology

56
Q

What may trigger Pityriasis Alba?

A

sun exposure frequent bathing heat

57
Q

What age group is primarily affected by Lichen Simplex Chronicus?

A

Mainly occurs in adults, who often have a history of Atopic Dermatitis.

58
Q

What might cause Acute Urticaria?

A

Drug or food reaction. Possibly a parasitic infection.

60
Q

What is Allergic Phytodermatits?

A

ACD due to plants - Poison Ivy, Poison Oak, Poison Sumac…

62
Q

What is the most common form of occupational skin disease?

A

Irritant Contact Dermatitis (ICD)

64
Q

What type of pathology can you see in chronic ICD?

A

damage to cell membranes and disruption of the skin barrier (repeated exposures)

65
Q

What are the two types of Contact Dermatitis?

A

Irritant and Allergic

67
Q

What is Eczema (aka Dermatitis)?

A

A general superficial inflammatory reaction, usually characterized by pruritus and erythema (plus a wide variety of other findings).

68
Q

What other symptoms may present with SJS or TEN?

A

Severe pain, fever, tachycardia. Sloughing of epithelium from respiratory and GI tracts. Renal Failure.

69
Q

What are the indications of Erythema Multiforme Minor?

A

Presents as target lesions and vesicles predominantly on the extremities. Little mucous membrane involvement and no systemic symptoms. Often occurs recurrently in association with HSV outbreaks.

71
Q

What is an allergen?

A

an offending agent that produces a CELL-MEDIATED reaction in some patients, depending on their sensitivity.

71
Q

What are the symptoms of Lichen Simplex Chronicus?

A

Either appears as a confluence of small papules, or as a solid plaque. Black skinned patients tend to have a paular pattern. Commonly distributed on the neck, arms or legs, but can be anywhere.

72
Q

How does the necrotic epidermis from SJS or TEN appear?

A

Flaccid blisters (with positive Nikolsky sign) When fully detached, exposes a red, oozing dermis that resembles a second-degree burn.

73
Q

Describe Angioedema.

A

A swelling of the subcutaneous tissue (usually near eyes and mouth), and mucosa of the respiratory and GI tracts. Usually resolves in 2-4 days.

75
Q

What findings may indicate Urticaria associated with vasculitis?

A

If the lesions last longer than 48 hours AND have confounding symptoms, such as arthralgias or fever.

76
Q

What other conditions are commonly found in patients with atopic dermatitis? (the Triad)

A

asthma allergic rhinitis

77
Q

What may be the cause if the patient has angioedema WITHOUT urticaria?

A

ACE inhibitors. If no history of ACE inhibitors, consider hereditary angioedema (HAE)

78
Q

Do allergen reactions stay limited to the site of exposure, or spread beyond the exposed sites?

A

May stay local, May spread beyond the exposed site

79
Q

What might cause Chronic Urticaria?

A

An autoimmune disorder or an idiopathic cause.

80
Q

What is the management of Lichen Simplex Chronicus?

A

Stop rubbing and scratching! Topical Steroids, most effective under an occlusive dressing Antihistamines at night to prevent scratching.

81
Q

How is EM Minor treated?

A

Antivirals to control HSV - Acyclovir, Valacyclovir, or Famciclovir

83
Q

What age groups do you typically find nummular eczema?

A

young adults the elderly

84
Q

How is Allergic Phytodermatitis usually spread?

A

Through oleoresin (plant oil), not blister fluid. Contaminated skin should be washed within 30 minutes and clothing washed ASAP

85
Q

How is EM Major treated?

A

Oral corticosteroids - high dose, then taper down

86
Q

What are the indication of Erythema Multiforme Major?

A

Presents as target lesions with vesicles AND bullae on the extremities, also involving the mucous membrane. May take a severe and extensive course associated with detachment of large sheets of skin. Systemic symptoms - fever, prostration (extreme exhaustion) Often results as a DRUG REACTION.

87
Q

What are the characteristics of Adverse Cutaneous Drug Reactions (ACDRs)?

A

Erythematous eruptions with abrupt onset. Mostly mild, but severe, life-threatening ACDRs can occur.

88
Q

What is Hereditary Angioedema (HAE) caused by?

A

Improper function of protein C1 inhibitor, which can result in swelling of the face, hands, feet, intestinal tract, and trachea

89
Q

What is an irritant?

A

an offending agent that is toxic to the skin and produces inflammation in ALL PATIENTS when sufficient concentration is applied.

90
Q

What are the symptoms of ACD?

A

Usually progress from erythema, PAPULES, vesicles, erosions, crusts, and scaling Lichenification and excoriation is possible. Pruritis Linear lesions

91
Q

What type of mechanism may cause urticaria or angioedema?

A

May be allergic OR non-allergic. Not limited to a drug reaction.

92
Q

How is dyshidrosis managed?

A

Topical steroids with an occlusive dressing (gloves) are commonly used to quickly resolve an acute attack.

Dermatology (12 decks)

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