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Eczematous Disorders Flashcards

1
Q

What is the pathophysiology for atopic dermatitis? (eczema)

A

one or more layers of the skin barrier is broken down →→→→
- ↓natural oils = ↑skin drying = skin cells shrink bc no moisture = skin brittle and cracking = allow pathogens in = irritation and itchy skin

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2
Q

What is another way of saying eczema?

A

chronic pruritic inflammatory disease

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3
Q

Etiology of atopic dermatitis eczema?

A
  • FMHx of atopy
  • ## loss of function FLG gene (epidermal protein filaggrin)
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4
Q

What triggers atopic dermatitis flareups?

A
  • dust
  • heat
  • stress
  • dry/humid climates
  • irritants
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5
Q

What is atopy?

A

eczema, asthma, allergies

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6
Q

What is the pathophysiology for atopic dermatitis relating to inflammation of the skin? (eczema)

A

= severe pruritis

↑ T-cell proliferation
↑ IgE-mediated hypersensitivity = ↑IgE in serum (lab result)
triggers epidermal barrier dysfunction

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7
Q

What info in the patient’s history will indicate atopic dermatitis?

A
  • childhood onset (50% 1yo, 85% by 5yo)
  • can have adult onset
  • FMHx of atopy or similar sxs
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8
Q

What is the clinical presentation of atopic dermatitis that is required for diagnosis?

A

dry skin WITH pruritis

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9
Q

What are the dermatological symptoms of atopic dermatitis?

A
  • erythematous maculo-papular rash
  • hypo/hyper-pigmentation
  • acute flare = vesicles with exudate/crusting
  • chronic lesions = dry, scaly, excoriated patches; lichenification if severe
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10
Q

What are associated symptoms of atopic dermatitis?

A
  • irritability
  • insomnia/persistent fidgeting due to pruritis
  • decreased concentration due to pruritis
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11
Q

Clinical presentation of atopic dermatitis for infants to 2yo?

A

starts on face/scalp (occ. extensor surfaces)

SPARES genitals/butt

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12
Q

Clinical presentation of atopic dermatitis for 2yo to Teens?

A

main = flexor surfaces = antecubital fossa and popliteal fossa

volar wrists, ankles, and neck

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13
Q

Clinical presentation of atopic dermatitis for adults

A

flexor surfaces and hands

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14
Q

Differential diagnoses for atopic dermatitis.

A
  • hyper IgE syndrome
  • Omenn syndrome
  • psoriasis
  • T-cell lymphoma
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15
Q

What is clinical diagnosis of atopic dermatitis based on?

A

history and presentation

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16
Q

What is the Hanifin and Rajka criteria for diagnosing atopic dermatitis?

A

3 of 4 the following must be met:

  • pruritis
  • morphology/distribution = adults flexural lichenification; infancy facial and extensor involvement
  • chronic relapsing dermatitis
  • FMHx of atopy
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17
Q

What does the treatment of atopic dermatitis depend on?

A

severity of symptoms, based on patient = personalized

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18
Q

Treatment for atopic dermatitis for kids.

A

skin barrier ointments like aquaphor + moisturizing 2-3x/day or as needed

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19
Q

What to avoid with atopic dermatitis.

A

fragrances, wool, extreme temps, food allergens, soaps/detergents

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20
Q

What are the 4 topical medications available for atopic dermatitis?

A
  • corticosteroids
  • calcineurin inhibitors
  • phosphodiesterase-4 (PDE-4) inhibitors
  • systemic immunosuppressants
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21
Q

What is treatment for atopic dermatitis?

A

moisturizing ointments to lock in moisture in and protect skin barrier

topical medications, injectable medications, oral antihistaminess

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22
Q

What are special considerations to keep in mind when using topical steroids to treat atopic dermatitis?

A

steroids can thin skin = use sparingly, use lowest potency

ointment&raquo_space;> creams/lotions

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23
Q

What medication is commonly used to treat eyelid and hand atopic dermatitis?

A

topical calcineurin inhibitors (risk of photosensitivity)

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24
Q

What unit is used to apply ointments for treatment of atopic dermatitis?

A

fingertip unit = FTU

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25
What is contact dermatitis?
common inflammatory eczematous condition
26
What is contact dermatitis characterized by?
erythema and pruritis due to direct skin contact with an allergic substance
27
What are the 2 types of contact dermatitis?
irritant and allergic
28
What is Irritant contact dermatitis?
(non-immune mediated; common type) chemical irritant exposure → direct cytotoxicity on normal skin or can exacerbate pre-existing eczema sxs asap
29
What is Allergic Contact Dermatitis?
delayed Type IV hypersensitivity = T-cell mediated
30
Pathophysiology of Allergic Contact Dermatitis.
contact with allergic substance = delayed hypersensitivity reaction
31
How long is the sensitization process in Allergic Contact Dermatitis?
10-14 days = sxs show re-exposure = sxs w/in 12-48hrs = quicker
32
What is the most common cause of Allergic Contact Dermatitis?
Rhus dermatitis (the posion plants ie: poison ivy) = contain resin urushiol
33
What are other causes of Allergic Contact Dermatitis?
Nickle, rubber, fragrances, dyes
34
What are the most common allergens in Allergic Contact Dermatitis?
nickle and poison ivy
35
Clinical presentation of Allergic Contact Dermatitis.
**pruritis** - eczematous scaly edematous plaques - vesiculation distribution on contact areas
36
With Allergic Contact Dermatitis due to a Rhus allergy, when does the initial episode occur and how long do symptoms last?
initial episode = 7-10 days s/p exposure (delayed response) Sxs last: - initial = up to 6 weeks - subsequent = 10-21 days depending on severity
37
What are associated symptoms of Allergic Contact Dermatitis with a Rhus allergy?
**linear distribution** blisters w/in 1-2 days s/p rash onset
38
How is Allergic Contact Dermatitis diagnosed?
Patch testing
39
What is patch testing?
apply diluted allergens on skin of back and leave it for 48hrs → read results at 96hrs
40
Treatment for Allergic Contact Dermatitis
avoid allergen 1) topical corticosteroids (PO if severe) - topical/oral antihistamine = pruritis - emollients
41
What is a major risk factor for Irritant Contact Dermatitis?
Hx of Atopic Dermatitis due to impaired skin barrier function
42
Etiology of Irritant Contact Dermatitis
chemicals solvents, heavy metals, strong acids/bases, alcohols/creams, etc.
43
Clinical presentation of Irritant Contact Dermatitis
Mild = erythema, chapped skin, dryness & fissuring after repeated exposure Pruritis & pain Severe = edema, exudate, tenderness, painful bullae
44
Treatment for Irritant Contact Dermatitis
topical corticosteroids and emollients refer to Derm
45
What is dyshidrotic eczema?
recurrent, acute blistering eczema of palms/soles
46
Etiology of dyshidrotic eczema
unknown, multifaceted
47
Risk factors for dyshidrotic eczema
Hx atopic and contact dermatitis dermatophyte infections
48
Clincal presentation for dyshidrotic eczdema
pruritic vesicular/bullous eruptions (itchy blisters) on palms/soles multiple deep-seated lesions can involve nail changes
49
Exacerbation/trigger for dyshidrotic eczema
warm weather
50
How is dyshidrotic eczema diagnosed?
clinical (Hx and PE) skin biopsy
51
Why would one perform a skin biopsy on someone with dyshidrotic eczema? What will results show?
Results = intraepidermal spongiotic vesicles/bullae w/o involving eccrine sweat glands r/o DDx (ie: psoriasis) if poor response to tx
52
Treatment for dyshidrotic eczema
topical corticosteroids (PO if severe) UVA tx w/ refractory disease skin care + avoid triggers
53
What is Lichen Simplex Chronicus?
secondary skin lesions due to chronic scratching
54
Clinical presentation of Lichen Simplex Chronicus
Lichenified plaques + excoriations (from scratching
55
Histopathology of a skin sample taken from patient with Lichen Simplex Chronicus
hyperplasia and hyperkeratosis of squamous epithelium
56
How is Lichen Simplex Chronicus diagnosed?
clincially (Hx of constant scratching; PE)
57
Treatment for Lichen Simplex Chronicus?
topical corticosteroids, antihistamines, avoid scratch/itch cycle
58
What is Nummular eczema?
coin-shaped eczema on extensor surfaces of lower legs
59
Eczema morphology and distribution of Nummular eczema
erythematous coin-shaped plaques on dry skin extensor surfaces of lower extremities pruritic
60
Etiology of Nummular eczema
dry skin aggravated by wool, soaps, frequent bathing, staph aureus
61
What can Nummular eczema be a clinical presentation of?
atopic dermatitis in adults
62
What is seborrheic dermatitis?
eczema on oily parts of body, mainly scalp
63
Epidemiology of seborrheic dermatitis
infants 2-10wks old until 8-12mo old reappears in puberty
64
How does seborrheic dermatitis clinically present in adults?
1) dandruff 2) yellow/red demarcated lesions w/ greasy scales on oily parts of body (nonpruritic)
65
Etiology of seborrheic dermatitis
Pityrosporum or Mallasezia yeasts
66
Treatment for seborrheic dermatitis
anti-pityrosporum shampoo combo w/ anti-inflammatory cream

Dermatology (5 decks)

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