Eczematous and papulosquamous Disorders Flashcards
Eczematous is a broad term to describe lesions with what characteristics?
scaling, crusting, serous oozing.
Atopic dermaitis:
- aka
- cause
- sx
- common locations in adults and kids
- Tx
aka: eczema
Cause:
- impaired epidermal barrier function d/t intrinsic structural and functional abnormalities
- autoimmune
Sx:
- pruritus**
- scratchign leads to eczematous change and lichenification
- lesions ooze, crust, and become purulent
Common Locations:
- adults: neck, wrist, behind ears, antecubital and popliteal flexure areas
- children: all of the above including the cheeks/face.
Tx:
- HYDRATION!!!!!!*
- eliminate exacerbating factors (heat, low humidity, persperation)
- topical steroids and emollients (no longer than 1mo)
- topical calcineurin inhibitors: for the face of skin folds for more than 3wks (Protopic or ELidel)
Alternatives…
- antihistamines for pruritus (Doxepin or vistaril b/c of antihistamine SE.)
- burrows solution for oozing lesions
- treat skin infections when appropriate.
- phototherapy with UV light
- immunosuppressants: methotrexate, cyclosporine, systemic steroids
Atopic Dermaitis:
-topical steroids SE
SE:
-atrophy, telangiectasia, purpura, striae, and acneform eruption
Nummular Eczema:
- what is this?
- tx
- location
What: eczema that is described as coin shaped lesions
Tx: same as atopic dermatitis…hydration,steroids, calcineurin inhibitors…sx relief.
Location: trunk and lower extremities.
Lichen Simplex Chronicus
- what is this?
- Tx
what occurs as a result of chronic eczematous changes and scratching. plaque of thickened skin with increased markings and scaling.
Tx:
-stop scratching and the lesions may regress
Dyshydrotic Eczema
- cause
- what is this?
- tx
Cause: unknown
What: vesicular eruption(VERY DEEP) on the skin of the hands and feet marked by intense itching. Scaling, fissures, and lichenification may follow.
Tx:
- HIGH potency topical steroids
- may need to be given with occlusive dressing to enhance absorption
- hydration of the skin with emollient cream
Contact Dermatitis:
- cause
- presentation
- tx
Cause:
- direct exposure to a substance, from allergy or irritation
- oleoresin urushiol which is found in Poison ivy, oak, sumac, skin of mangoes, gingko fruit
- nickel
Presentation:
- intense pruritus
- rash
- papular erythematous lesions
- papules from fluid in the epidermis and in severe cases produces vesicles and serous oozing
Tx: PLANT BASED: -Symptomatic therapy: --oatmeal baths, cool, wet compresses --calamine lotions, burrows solution for weeping lesions -Anti-histamine for sedation -Topical corticosteroids -systemic corticosteroids
CONTACT DERMATITIS:
- topical steroids
- systemic steroids in severe cases(medrol dose pack)
- burrow solution for weeping blisters
- antihistamines for itching
- treat any 2ndry bacterial infection
Diaper Dermatitis:
- cause
- sx
- tx
- tx of 2ndry infections
Cause: combo of wetness, pH elevation, and friction
*2nry infection with candida albicans
Sx:
- erythema in diaper area
- if predominately in the creases and there are satellite lesions most likely candidal infection
Tx:
-frequent diaper changes, barrier tx w/ vaseline or desitin
- 2ndry infection: topical antifungal such as nystatin, miconazole, or clotrimazole.
- -if failure of topical therappy PO diflucane
- NO STEROIDS*
Perioral Dermatitis
- cause
- clinical manifestations
- dx
- tx
Cause: unknown may be due to topical steroid use
Clinical Manifestations:
- 1-2mm clustered erythematous papules/papulovesicles/papulopustules w/ or w/o scale.
- may be asymptomatic or associated with burning or stinging
- spares vermillion border
Dx: clinical
Tx:
- may resolve on its own
- Topical calcineurin inhibitor (protopic) OR erythromycin, OR topical metronidazole
- moderate to severe cases: systemic agents such as tetracycline, doxycycline, or minocycline. Erythromycin for kids.
Seborrheic Dermatitis:
- cause
- signs and sx
- dx
- tx
Causee: saphrophyte infection by Malessezia
Signs and sx:
- erythematous scaling patches develop in areas of sebaceous glands
- swollen greasy or yellow appearing scales
- pruritus
- distribution: lateral sides of the noes, eyebrows, glabella, scalp, chest, upper back, axillae
Dx:
- clinical
- bx may be done if they are not getting better and you work in a derm office.
Tx:
- scalp:
- -antiproliferative shampoo: T-gel extra, selenium sulfide*
- -antifungal shampoo: ketoconazole
- nonscalp:
- -ketoconazole**
- -ciclopirox
- -Tacrolimus or Pimecrolimus
Stasis Dermatitis:
- cause?
- pathophys
- tx
Cause: occurs from blood pooling d/t chronic venous insufficiency
Pathophys: blood pooling leading to increased pressure in the capillaries with subsequent extravasation. hemosiderin from blood cells stain the skin. Venous stasis ulcers may develop
- Tx:
- compression stockings and leg elevations
- skin cleansing, emollients, topical steroids for pruritis, wet dressings for crusts or open lesions
Lichen Planus :
- may affect which body parts?
- cause
- clinical manifestations
- dx
- tx
MC affect skin, oral cavity, genitalia, scalp, nails, esophagus
Cause: medication induced
Clinical manifestations:
- shiny, flat, polygonal, violaceous papules or plaques with white lacey pattern called Wickhams Striae
- intensly pruritic
Dx: bx
Tx:
- high potency or super high potency topical corticosteroids
- intralesional corticosteroids with hypertrophic lichen planus
- widespread cutaneous dz may benefit from phototherapy, acitretin(Vit A derivative), or short course of systemic glucocorticoid therapy
Pityriasis Rosea
- usual first sign of dz
- sx
- duration
- tx
Herald patch is usually first lesion to appear on the central trunk.
Sx:
- may be pruritic
- oval lesions with long axis paralleling dermatomes
Duration: lesions resolve in 6-10wks
Tx:
- medium potency topical steroid for pruritus
- acyclovir or phototherapy for severe cases.
What is the mildest form of seborrheic dermatitis?
DANDRUFF!!
