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Dermatology > Eczematous and Papulosquamous Disorders > Flashcards

Eczematous and Papulosquamous Disorders Flashcards

1
Q

Eczematous disorders

8

A

Dermatitis

  1. Atopic
  2. Nummular eczema
  3. Dyshydrotic eczema
  4. Contact
  5. Diaper
  6. Candidiasis
  7. Perioral
  8. Seborrheic
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2
Q

Papulosquamous disorders
1. Present with what?
2. What are the kinds?
7

A
  1. Lichen planus
  2. Pityriasis rosea
    Dermatophyte infections
  3. Tinea corporis
  4. Tinea pedis
  5. Tinea cruris
  6. Tinea capitus
  7. Tinea versicolor
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3
Q

Eczematous is a broad term to describe lesions with these characteristics? 3

A
  1. Scaling
  2. Crusting
  3. Serous oozing

Dermatitis is a term used to describe multiple types of skin disorders

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4
Q

Atopic dermatitis

  1. Commonly referred to as what?
  2. 85% of casespresent by age what?
A
  1. Commonly referred to as “eczema”

2. 85% of cases present by ages 5-7
40% clear by adulthood

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5
Q

Atopic dermatitis pathogenesis

Two theories?

A
  1. Abnormal epidermal barrier as the primary defect
  2. Immune function disorder in which Langerhans cells, T-cells, and immune effector cells modulate an inflammatory response to environmental factors
    - Previously thought to be due to allergies but support for this is lacking
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6
Q

Clinical manifestations of atopic dermatitis? 3

Hallmark?

A
  1. Hallmark of the disease is pruritus
  2. Scratching leads to eczamatous change and lichenification
  3. Lesions may ooze, crust and become purulent
    - May need treatment for bacterial infection
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7
Q

Atopic dermatitis characteristics

  1. Adults? 5 common locations
  2. Children? above plus 1
A 
1. Adults
Location: 
-neck, 
-wrists, 
-behind ears, 
-antecubital and 
-popliteal flexure areas
  1. Children
    All the locations listed above and including the
    -cheeks/face
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8
Q

What is the bug that commonly infects atopic dermatitis?

A

Staph Aureus

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9
Q

Atopic dermatitis treatment

6

A
  1. Eliminate exacerbating factors
  2. Antihistamines used to treat pruritus
  3. Hydration, hydration, hydration!
  4. Topical steroids
  5. Burow’s solution for oozing lesions
  6. Treat skin infections when appropriate
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10
Q

Atopic dermatitis treatment
1. Eliminate exacerbating factors
2

  1. What antihistamines are used to treat pruritis? 2
A
    • Avoid possible triggers (heat, low humidity, perspiration)
    • Treat stress and anxiety
    • Doxepin or
    • Vistaril (antidepressants with antihistamine side effects)
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11
Q

Mild to moderate cases of Atopic dermatitis? 2

A
  1. Topical corticosteroids and emollients
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12
Q

Mild to moderate cases of Atopic dermatitis

  1. How long should the topical steriods be used for?
  2. Which steriods? 2
  3. Moderate disease use medium to high potency corticosteroids such as? 3
A
  1. Topical corticosteroids can be applied once or twice daily for two to four weeks
  2. Mild to moderate use low potency corticosteroid cream or ointment
    - desonide 0.05% or
    - hydrocortisone 2.5%
    • fluocinolone 0.025%,
    • triamcinolone 0.1%,
    • betamethasone dipropionate 0.05%
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13
Q

Topical steroid side effects
1-5

  1. When do you have a larger potential for more SE?
  2. Use less potent steroids for what areas?
  3. Only use low potency preparations where?
A
  1. Atrophy,
  2. telangiectasia,
  3. purpura,
  4. striae and
  5. acneform eruption
  6. The higher the potency the more likely to have side effects
    • face,
    • dorsum of hands and
    • genitalia
  8. around the eyes
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14
Q

Limit higher potency topical steroids to no more than 1.___g per week for no longer than 2.__ weeks

A
  1. 45

2. 2

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15
Q
  1. Patients who require therapy to the face or skin folds for more than three weeks be treated with a what?
  2. Which drugs? 2
  3. Advantages? 2
  4. Dosed how?
  5. Also a what?
A
  1. topical calcineurin inhibitor
    • acrolimus (Protopic) or
    • pimecrolimus (Elidel) rather than a topical steroids
    • Less side effects
    • As effective as medium potency topical steroids
    • Topical medication used BID
  5. -Immunomodulators
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16
Q

Topical calcineurin inhibitors

  1. BBW?
  2. Not for what age?
  3. timeline of use?
  4. Avoid treatment with this is what populations?
  5. Use for lesions where? 4
A
  1. Black box warning – may increase the incidence of skin cancer and lymphoma with long term use
  2. Not for use under the age of 2
  3. Not for continual use
  4. Not for use in immunocompromised persons
  5. Use for lesions on the
    - face,
    - eyelids,
    - neck and
    - skin folds (as steroids cause more atrophy in these places)
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17
Q

Nummular eczema

  1. Described how?
  2. Treatment?
  3. Usually occurs where?
A
  1. Eczema (atopic dermatitis) that is described as coin shaped lesions
  2. Treatment is the same as atopic dermatitis
  3. Usually occurs on the trunk and lower extremities
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18
Q

Treatment of atopic dermatitis

  1. Most pts respond to what? 2
  2. A small number of pts respond to treatment how?
  3. May require what?
A
  1. Most patients respond to
    - hydration
    - topical medications
  2. A small number of patients are resistant to treatment
  3. May require
    - Phototherapy with UV light
    - Or immunosuppressants:
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19
Q

What are the immunosuppressnats that we would use for atopic dermatitis?
5

A
  1. Methotrexate,
  2. azithiorpine,
  3. cyclosporine,
  4. systemic steroids,
  5. IV immunoglobulin
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20
Q
  1. Lichen simplex chronicus is a term used to describe the result of what?
  2. What does it look like?
  3. What may allow the lesions to regress?
A
  1. Term used to describe what occurs as a result of chronic eczematous changes and scratching
  2. Circumscribed plaque of thickened skin with increased markings with some scaling
  3. Stop the scratching and the lesions may regress
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21
Q

Dyshydrotic eczema

  1. Cause?
  2. What is it?
  3. What may follow this? 3
A
  1. Cause is unknown
  2. Vesicular eruption on the skin of the hands and feet marked by intense itching (vesicles are deep)
    • Scaling,
    • fissures and
    • lichenification may follow
22
Q

Dyshydrotic eczema treatment

3

A
  1. High potency topical steroids
  2. May need to be given with occlusion
  3. Hydration of the skin with emollient cream
23
Q

Contact dermatitis: Causes?

2

A
  1. Direct exposure to a substance

2. From allergy or irritation

24
Q
  1. Most common plant causes of Contact dermatitis in North America? 5
  2. What substance is often found in in these plants?
A
  1. Most common plant causes in North America
    - Poison ivy
    - Poison oak
    - Poison sumac
    - Skin of mangoes
    - Gingko fruit
  2. Oleoresin urushiol which is found in
25
Q

Other common offenders
of contact dermatitis?
7

A
  1. Nickel (jewelry, buttons, belts)
  2. Formaldehyde, quanternium-15 (clothing, nail polish)
  3. Perfumes, cosmetics
  4. Preservatives (topical medications, cosmetics)
  5. Rubber and chemicals in shoes
  6. Topical hydrocortisone, topical antibiotics (neomycin, bacitracin), topical meds benzecaine, thimersol
  7. Laundry detergents may be a rare cause
26
Q

Contact dermatitis Presentation?
4

Exposure may have been as far back as when?

What can you not count out?

A
  1. Intense pruritus
  2. Rash
  3. Papular, erythematous lesions
  4. Papules from fluid in the epidermis and in severe cases produces vesicles and serous oozing

Exposure may have been as far back as 2 weeks ago

May develop a reaction to products that have been used for months to years

27
Q

Treatment of Plant based contact dermatitis

4

A
  1. Topical symptomatic therapy
  2. Antihistamines
  3. Topical corticosteroids
  4. Systemic corticosteroids
28
Q

Plant based contact dermatitis

What would be included in Topical symptomatic therapy?

Antihistamines are used for what?

Topical corticosteroids. WHat kind?

Systemic corticosteroids

  1. When do you need it?
  2. How long to use?
A

Topical symptomatic therapy

  1. Oatmeal baths,
  2. cool,
  3. wet compresses
  4. Calamine lotion,
  5. Burow’s or Domeboro solution for weeping lesions,
  6. Zanfel soap
  7. This reaction is not due to histamine release so use for sedation
  8. High potency: clobetasol 0.05% cream
  9. Needed if large area, face or genitals
  10. 2-3 week taper of prednisone (max dose 60mg/day)
29
Q

Treatment of contact dermatitis

7

A
  1. Remove offending agent
  2. Topical symptomatic therapy
  3. Medium to high potency topical steroids
    (Clobetasol 0.05% cream)
  4. Systemic steroids in severe cases (>10% BSA)
    (Medrol dose pack Or prednisone 40mg X 6 d followed by 20mg X 6 days)
  5. Burow’s solution for weeping blisters
  6. Antihistamines for treatment of pruritus
  7. Treat any recognized secondary bacterial infections
30
Q

Diaper dermatitis

Caused by what? 3

A

Caused by a combination of

  1. wetness,
  2. pH elevation and
  3. friction
31
Q

Diaper dermatitis

  1. Elevated pH activates what that injure the skin?
  2. In addition, secondary infection may occur with what?
A
  1. proteolytic enzymes

2. Candida albicans

32
Q
  1. Clinical presentation diaper dermatitis?
  2. If predominantly in the creases what does that mean?
  3. What do you need to determine before treatment?
A
  1. Erythema in the diaper area
  2. If predominately in the creases and there are satellite lesions - most likely dealing with a candidal infection as well
  3. Need to determine if it is from wetness, irritation from the diaper or yeast infection
33
Q

Diaper dermatitis treatment:

  1. Without a secondary yeast infection? 2
  2. With a secondary yeast infection? 3
A
  1. Without secondary yeast infection
    - Frequent diaper changes
    - Barrier treatment with vaseline or Desitin
  2. With secondary yeast infection
    - Topical antifungal
    - Barrier lubricants such as vaseline
    - No steroids
34
Q

Diaper dermatitis: Topical antifungal such as?

3

A
  1. nystatin,
  2. miconazole or
  3. clotrimazole
35
Q

Treatment of candidiasis
1. Thrush?2

  1. Cutaneous? 4
A
  1. Thrush
    - Nystatin
    - Clotrimazole
  2. Cutaneous
    -Powder for macerated areas (Nystatin)
    -Clotrimazole (Lotrimin),
    -ketoconazole
    -If failure of topical therapy
    Oral fluconazole (diflucan)
36
Q

Perioral dermatitis
1. Has a strong correlation with what?
2. Clinical manifestations?
3

A
  1. Etiology: unknown but does have a strong correlation with topical steroid use
  2. Clinical manifestations
    - 1-2 mm clustered erythematous papules, paulovesicles or paulopustules with or without scale
    - Occurs most often around the mouth sparing the vermillion border
    - Can be asymptomatic or associated with burning or stinging
37
Q

Perioral dermatitis
1. Dx made how?

  1. PE findings suggestive of POD?
    5
A
  1. Diagnosis can be made clinically
    - Physical exam supports diagnosis
  2. Other findings suggestive of POD
    - Sparing of skin adjacent to vermillion border
    - Co-existing feature of eczematous dermatitis
    - Burning/stinging
    - Recent use of topical, nasal or inhaled steroids
    - History of lesions worsening after withdrawal of steroids in the past
38
Q

Treatment of perioral dermatitis

  1. May resolve how?
  2. First line? 3
  3. For moderate to severe cases? 2
A
  1. May resolve on it’s own
  2. First line:
    - Topical calcineurin inhibitor (Pimecrolimus , Protopic 1% cream)
    - Or topical erythromycin
    - Or topical metronidazole
  3. For moderate to severe cases:
    - Systemic agents – Tetracycline, doxycycline or minocycline
    - Systemic therapy for kids use erythromycin
39
Q

Seborrheic dermatitis

  1. May be wisepread in?
  2. Erythematous scaling patches develop in areas of what?
  3. Thought to be caused by what?
A
  1. HIV and Parkinson’s disease
  2. sebaceous glands (scalp, face, trunk)
  3. saphrophyte infection by Malessezia (aka Pityrosporum ovale)
40
Q

Clinical manifestations of seborrheic dermatitis? 4

Distributions where? 4

A
  1. Erythema (reddish or pink color)
  2. Swollen and greasy appearance
  3. Scale (white or yellowish)
  4. Some pruritus
  5. Lateral sides of the nose
  6. Eyebrows
  7. Glabella
  8. Scalp
41
Q

Seborrheic dermatitis: Diagnosis made how?

2

A
  1. Usually can be made by physical exam

2. Biopsy

42
Q

Seborrheic dermatitis: Biopsy will show what?

3

A
  1. Mounds of parakeratotic scale around hair follicles
  2. Mild superficial inflammatory cell infiltrate of lymphocytes
  3. Increased number of Malessezia furfur spores in stratum corneum on perodic acid schiff or gomori methenamine silver stains
43
Q

Treatment depends on the location
Scalp? 2
(what are the types of each?
3 and 2)

A
  1. Antiproliferative shampoo
    - T-Gel extra
    - Selenium sulfide (Selsun, Exelderm)*****
    - Zinc pyrithione (Head & Shoulders, Zincon, DHS zinc)
  2. Antifungal shampoo
    - Ketoconazole 2% shampoo*****
    - Used 2 X weekly X 4 weeks then may be used periodically for maintenance
44
Q

Treatment of non-scalp seborrhea
4

Severe cases what should we add?

A
  1. Ketoconazole 2% cream or gel*****
  2. Ciclopirox 1% cream
  3. Tacrolimus 0.03% and 0.1%
  4. Pimecrolimus 1% cream

-Severe cases add low potency topical corticosteroid for 1-2 weeks and taper off to QOD X 1 week

45
Q

Lichen planus
1. Most commonly affects what age?

  1. May affect what areas? 6
A
  1. Most commonly affects middle-aged adults
  2. May effect
    - skin (cutaneous lichen planus)
    - oral cavity (oral lichen planus)
    - genitalia (penile or vulvar lichen planus)
    - scalp (lichen planopilaris)
    - nails
    - esophagus
46
Q
  1. Clinical manifestations of Lichen planus? 2
  2. What occurs on mucosal surfaces?
  3. What other symtpom associated with this?
  4. Dx?
A
    • Shiny, flat, polygonal, violaceous papules or plaques
    • with white lacy pattern called Wickham’s striae
  2. . White reticulate lesions occur on mucosal surfaces
  3. Intensely pruritic
  4. Diagnosis
    biopsy
47
Q

Treatment of lichen planus

  1. First line?
  2. For hypertrophic lichen planus?
  3. Widespread cutaneous? 3
A
  1. High potency or super high potency topical corticosteroids as initial treatment of localized cutaneous lichen planus on the trunk or extremities
  2. Intralesional corticosteroids can be useful in patients with hypertrophic lichen planus
  3. Patients with widespread cutaneous disease may benefit from
    - phototherapy,
    - acitretin, or a
    - short course of systemic glucocorticoid therapy
48
Q

Stasis dermatitis
1. Occurs from what? 2

  1. What causes the skin staining?
  2. Can develop what?
  3. Treatment is aimed at what? (using what two things?)
  4. Treatment? 4
A
    • Occurs from blood pooling due to chronic venous insufficiency
    • Increased pressure in the capillaries with subsequent extravasation
  2. Hemosiderin from the blood cells stain the skin
  3. Can develop venous stasis ulcers
  4. Treatment is aimed at prevention of edema and blood pooling with
    - compression stockings and
    - elevation of the legs
    • Skin cleansing,
    • emollients,
    • topical steroids for pruritus,
    • wet dressings for crusts or open lesions
49
Q

Pityriasis rosea

  1. First sign?
  2. Describe the lesions?
  3. Lesions usually resolve when?
  4. Itching?
  5. Contagious?
  6. Treatment? 3
A
  1. First sign is a “herald patch” then multiple new lesions appear usually on the central trunk
  2. Lesions are often oval with long axis paralleling the lines of skin stress
  3. Lesions resolve in 6-10 weeks
  4. May be pruritic
  5. Not contagious
  6. Treatment
    - If needed for pruritus – medium potency topical steroid
  • Acyclovir or
  • phototherapy for severe cases
50
Q
  1. Greasy or yellow appearing scales, especially at the margins of hair, eyebrows and facial folds = what?
  2. if caused by a chemical irritant the reaction is usually immediate. If due to an allergan may be delayed. What is this?
  3. If the lesion starts small and grows than it is likely?
  4. If the lesion has central clearing than it is likely what?
  5. Avoid combination products that contain what? 2
A
  1. seborrheic dermatitis
  2. Contact dermatitis
  3. fungal
  4. fungal
  5. steroid and antifungal.

Dermatology (12 decks)

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