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Dermatology > Eczematous and Papulosquamous disorders > Flashcards

Eczematous and Papulosquamous disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

How do papulosquamous disorders present? What are these disorders?

A

with papules and scales

  • lichen planus
  • pityriasis rosea
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2
Q

Eczematous disorders have what kind of characteristics?

A
  • scaling
  • crusting
  • serous oozing
  • dermatitis is used to describe mult. type of skin disorders
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3
Q

What is atopic dermatitis? AKA? How common and when do they manifest?

A
  • AKA eczema
  • common (11% of US pop)
  • 85% of cases present by ages 5-7
  • 40% clear by adulthood
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4
Q

Two theories behind pathogenesis of atopic dermatitis?

A

1- impaired epidermal barrier fxn due to intrinsic structural and fxnl abnormalities in the skin - abnormal epidermal barrier as the primary defect
2- immune fxn disorder in which Langerhans cells, T cells, and immune effector cells modulate an inflammatory response to enviro factors - previously thought to be due to allergies but support for this is lacking

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5
Q

Clinical manifestations of atopic dermatitis? hallmark?

A
  • hallmark - pruritus
  • scratching leads to eczematous change and lichenification
  • tiny erythematous, edematous ill-defined blisters
  • lesions may ooze, crust, and become purulent: may need tx for bacterial infection
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6
Q

Characteristics of atopic dermatitis for adults and kids?

A
  • MC in flexure creases
  • adults:
    location - neck, wrists, behind ears, antecubital and popliteal flexure areas
  • children: all the locations listed above and including the cheeks/face
  • worry about scratching leading to secondary infection (staph)
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7
Q

Tx of atopic dermatitis?

A
  • eliminate exacerbating factors: avoid poss. triggers (heat, low humiditiy, perspiration)
    tx stress and anxiety
  • antihistamine used to tx pruritus - doxepin (TCA) or vistaril (antidepressants with antihistamine SEs)
  • Hydration - first line***
  • topical steroids (don’t use topical benadryl in kiddos)
  • burrow’s soln for oozing lesions
  • tx skin infections when appropriate
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8
Q

Tx for mild to moderate cases of atopic dermatitis?

A
  • topical corticosteroids and emollients
  • topical steroids can be applied 1 or 2x daily for 2-4 wks
  • mild to mod: use low potency corticosteroid cream or ointment (desonide 0.05% or hydrocortisone 2.5%)
  • moderate disease use medium to high potency corticosteroids (fluocinolone 0.025%, triamcinolone 0.1%, betamethasoine dipropionate 0.05%)

** don’t use steroids for over a month - break down skin

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9
Q

SEs of topical steroid use?

A
  • atrophy, telangiectasia, purpura, striae, and acneform eruption
  • higher the potency the more likely to have SEs
  • limit higher potency topical steroids to no more than 45g/week for no longer than 2 wks
  • use less potent steroids for face, dorsum of hands and genitalia
  • use even lower potency for around the eyes
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10
Q

What is used in atopic dermatitis pts if the face is affected and they need long term therapy?

A
  • pts who reqr therapy to face or skin folds for more than 3 wks can be tx with a *topical calcineurin inhibitor
  • tacrolimus (protopic) or pimecrolimus (Elidel) rather than topical steroids
  • less side effects and is as effective as medium potency topical steroids
  • topical med used BID
  • immunomodulators
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11
Q

BBW for topical calcineurin inhibitors? Who can’t use these?

When should these be used?

A
  • BBW: may increase the incidence of skin cancer and lymphoma with long term use
  • 2nd line agents
  • not for use under 2yo
  • not for continual use
  • not for use in immunocompromised
  • use for lesions on face, eyelids, neck and skin folds (b/c steroids cause more atrophy in these places)
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12
Q

What is nummular eczema?

A
  • atopic dermatitis that is described as coin shaped lesions
  • tx is same as atopic dermatitis (topical steroids, hydration)
  • usually occurs on trunk and lower extremities (esp on dorsal hand, feet extensor surface)
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13
Q

Tx of atopic dermatitis - if pt fails first line tx?

A
  • most pts do respond to hydration and topical meds
  • a small number are resistant to tx
  • may reqr:
    phototherapy with UV light
    or immunosuppressants: methotrexate, azithiorpine, cyclosporine, systemic steroids, IV immunoglobulin
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14
Q

What is lichen simplex chronicus? What is an easy tx for this?

A
  • this is what occurs as result of chronic eczematous changes and scratching (itch and scratch cycle)
  • circumscribed plaque of thickened skin with increasing markings with some scaling
  • stop the scratching and lesions may regress
  • can use topical steroids
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15
Q

What is dyshydrotic eczema?

A
  • cause is unknown
  • vesicular eruption on skin of hands and feet marked by intense itching (vesicles are deep)
  • scaling, fissures, and lichenification may follow
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16
Q

Tx of dyshydrotic eczema?

A
  • high potency topical steroids
  • may need to be given with occlusion (ointment and covered in saran wrap)
  • hydration of the skin with emollient cream
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17
Q

What is contact dermatitis?

A
  • direct exposure to a substance

- from allergy or irritation

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18
Q

Most common plant causes in North America - of contact dermatitis?

A

Oleoresin urushiol which is found in:

  • poison ivy
  • poison oak
  • poison sumac
  • skin of mangoes
  • gingko fruit
  • may spread from pets or from oils trapped under finger nails
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19
Q

What are other common offenders of contact dermatitis other than plants?

A
  • nickel (jewelry, buttons, belts)
  • formaldehyde, quanternium-15 (clothing, nail polish)
  • perfumes, cosmetics
  • preservatives (topical meds, cosmetics)
  • rubber and chemicals in shoes
  • topical hydrocortisone, topical abx (neomycin, bacitracin), topical meds - benzecaine, thimersol
  • laundry detergents may be a rare cause
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20
Q

Presentation of contact dermatitis?

A
  • intense pruritus
  • rash
  • papular, erythematous lesions
  • papules from fluid in epidermis and in severe cases produces vesicles and serous oozing
  • exposure may have been as far back as 2 wks ago
  • may develop a rxn to products that have been used for months - years
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21
Q

Tx of plant based contact dermatitis?

A
  • topical sx therapy: oatmeal baths, cool, wet compresses, calamine lotion, burrow’s or Domeboro soln for weeping lesions, zanfel soap
  • antihistamines: rxn isn’t due to histamine release so use for sedation
  • topical corticosteroids: high potency - clobetasol 0.05% cream
  • systemic corticosteroids: needed if large area, face or genitals, 2-3 week taper of prednisone (max: 60 mg/day)
22
Q

Tx of other types of contact dermatitis other than plant caused?

A
  • remove offending agent
  • topical sx therapy
  • medium to high potency topical steroids: clobetasol 0.05% cream
  • systemic steroids in severe cases (more than 10% of BSA): medrol dose pack or prednisone 40 mg x 6 d followed by 20 mg x 6 d
  • burrows soln for weeping blisters
  • antihistamines for tx of pruritus
  • tx any recognized secondaray bacterial infections
23
Q

What is diaper dermatitis? What secondary infection may occur?

A
  • caused by combo of wetness, pH elevation and friction
  • elevated pH activates proteolytic enzymes that injure the skin
  • secondary infection may occur with Candida albicans (will be in skin folds)
  • if sparing skin folds - diaper dermatitis (will have erythema where diaper touches baby)
24
Q

Clinical presentation of diaper dermatitis?

A
  • erythema in diaper area
  • if predominantly in creases and there are satelite lesions (will appear as plaques and pustules) most likely have candidal infection as well
  • need to determine if it is from wetness, irritation from the diaper or yeast infection
25
Q

Tx of diaper dermatitis?

A
  • w/o secondary yeast infection: frequent diaper changes, barrier tx with vaseline or Desitin
  • w/ secondary yeast infection:
    topical antifungal such as nystatin, miconazole or clotrimazole
    barrier lubricants such as vaseline, no steroids (thin skin - systemic absorption)
26
Q

Tx of diff types of candidiasis?

A
  • thrush: nystatin, clotrimazole
  • cutaneous:
    powder for macerated areas (nystatin), clotrimazole (lotrimin), ketoconazole
  • if failure to topical therapy: oral fluconazole (diflucan)
27
Q

What is perioral dermatitis? Clinical manifestations?

A
  • etiology: unknown but does have a strong correlation with topical steroid use
  • clinical manifestations:
    1-2 mm clustered erythematous papules, papulovesicles or papulopustules with or w/o scale
  • occurs most often around the mouth **sparing the vermillion border
  • can be asx or assoc with burning or stinging
28
Q

Dx and findings suggestive of POD?

A
  • dx can be made clinically
  • PE supports dx

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
  • hx of lesions worsening after withdrawal of steroids in the past
29
Q

Tx of perioral dermatitis?

A 
- may resolve on it's own
1st line:
-topical calcineurin inhibitor (pimecrolimus, protopic 1% cream)
- or topical erythomycin
- or topical metronidazole

for moderate to severe cases:

  • systemic agents: tetracycline, doxycycline, or minocycline
  • systemic therapy for kids - use erythromycin
  • use combo therapy of topical and systemic (just don’t use same abx)
30
Q

What is seborrheic dermatitis? May be widespread in what pts? Caused by what?

A
  • etiology is unknown
  • may be widespread in HIV and Parkinson’s disease
  • erythematous scaling patches develop in areas of sebaceous glands (scalp, face, trunk)
  • thought to be caused by saphrophyte infection by Malessezia (aka Pityrosporum ovale).
    Colonization noted on skin of affected individuals, normal skin flora but to a lesser degree
31
Q

What are the clinical manifestations of seborrheic dermatitis?

A
  • erythema (reddish or pink color)
  • swollen and greasy appearance
  • scale (white or yellowish)
  • some pruritus
  • distribution:
    lateral sides of nose
    eyebrows
    glabella
    scalp
    may also involve: chest, upper back, axillae
32
Q

Dx of seborrheic dermatitis?

A
  • usually made by PE
    bx:
    -mounds of parakeratotic scale around hair follicles
  • mild superficial inflammatory cell infiltrate of lymphocytes
  • increased number of malessezia furfur spores in stratum corneum on periodic acid schiff or gomori methenamine silver stains
33
Q

Tx of seborrheic dermatitis depends on what?

A
  • location
34
Q

Tx of seborrheic dermatitis - scalp?

A

antiproliferative shampoo:

  • T gel extra
  • selenium sulfide (selsun, exelderm)
  • zinc pyrithione (Head and shoulders, zincon, DHS zinc)

Antifungal shampoo:

  • ketoconazole 2% (rx better than 1% OTC formulation), or ciclopirox shampoo 1%
  • used 2x weekly x 4 wks then may be used periodically for maintenance
35
Q

Tx of non-scalp seborrhea?

A
  • 1st line: ketoconazole 2% cream or gel (BIDx 4 wks)
  • ciclopirox 1% cream: BIDx 4 weeks then q day x 4 weeks
  • tacrolimus 0.03% and 0.1%
  • pimecrolimus 1% cream
  • severe cases add low potency topical corticosteroid for 1-2 wks and taper off to QOD x 1wk
36
Q

What is stasis dermatitis?

A
  • occurs from blood pooling due to chronic venous insufficiency
  • increased pressure in capillaries with subsequent extravasation
  • hemosiderin from blood cells stain the skin
  • erythema, scaling, hyperpigmentation can lead to erosions, crusts and can develop venous stasis ulcers
  • may be assoc with generalized eczematous dermatitis
37
Q

tx for stasis dermatitis?

A
  • tx 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
  • need to keep skin hydrated!
  • compression stockings
  • keep legs elevated
38
Q

What is lichen planus? locations?

A
  • uncommon disorder of unknown cause - may be med induced (griseofulvin, ketoconazole, tetracyclines, ACEI, BBlockers, hydroxycholorquine, diuretics, sulfonylureas, NSAIDs, PPIs)
  • MC affects middle-aged adults
  • may effect:
    skin (cutaneous lp)
    oral cavity (oral lp)
    genitalia (penie or vulvar lp)
    scalp (lichen planopilaris)
    nails
    esophagus
39
Q

Clinical manifestations of lichen planus? Dx?

A
  • shiny, flat, polygonal, **violaceous papules or plaques with white lacy pattern called Wickham’s striae
  • white reticulate lesions occur on mucosal surfaces
  • see on wrists, ankles
  • intensely pruritic (very hard to tx)
  • dx: bx
40
Q

Tx of lichen planus?

A
  • high potency or super high potency topical corticosteroids as initial tx of localized cutaneous lp on trunk or extremities
  • intralesional corticosteroids can be helpful in pts with hypertrophic lp
  • pts with widespread cutaneous disease may benefit from phototherapy, acitretin (oral retinoid - causes photosensitivity, only for severe cases), or short course of systemic glucocortiocoid therapy
41
Q

What is Pityriasis rosea? Characterisitcs?

A
  • etiology is unclear, self-limiting, likely viral source (reactivation of HHV-7 and HHV-6)
  • more common in spring and fall, can mimic syphilis so get RPR if sexually active
  • 1st sign is a herald patch then multiple new lesions appear usually on central trunk
  • lesions are often oval with long axis paralleling the lines of skin stress
  • rash may have christmas tree pattern
  • lesions resolve in 6-10 weeks
  • may be pruritic
  • not contagious
42
Q

Tx of pityriasis rosea?

A
  • generally self limiting
  • if needed for pruritus: medium potency topical steroid
  • oatmeal baths
  • acyclovir or phototherapy for severe cases
43
Q

Greasy or yellow appearing scales, esp at margins of hair, eyebrows and facial folds are characteristic of?

A
  • seborrheic dermatitis
44
Q

What is the mildest form of seborrheic dermatitis?

A
  • dandruff
45
Q

If the lesion starts small and grows and it has central clearing - it is mostly likely what?

A
  • fungal
46
Q

Should you tx fungal infections with a steroid?

A
  • NO! it will help the infection grow
47
Q

How do you diff b/t vitiligo and tinea versicolor?

A
  • looking carefully for scaling - this should be present in TV
48
Q

Simple tx for fungal infection?

A

Dry, dry, dry!

49
Q

Simple tx for eczema?

A
  • hydrate, hydrate, hydrate!
50
Q

5 p’s of lichen planus?

A
  • purple
  • polygonal
  • planar
  • pruritic
  • papules
    w/ fine scales and irregular borders
  • lacy lesions common in oral mucosa (wickham striae)

Dermatology (12 decks)

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