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Dermatology > Eczematous Disorders > Flashcards

Eczematous Disorders Flashcards

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Dermatology Board Prep 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
Q

What is contact dermatitis?

A

common inflammatory eczematous condition

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26
Q

What is contact dermatitis characterized by?

A

erythema and pruritis due to direct skin contact with an allergic substance

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27
Q

What are the 2 types of contact dermatitis?

A

irritant and allergic

28
Q

What is Irritant contact dermatitis?

A

(non-immune mediated; common type)
chemical irritant exposure → direct cytotoxicity

on normal skin or can exacerbate pre-existing eczema

sxs asap

29
Q

What is Allergic Contact Dermatitis?

A

delayed Type IV hypersensitivity = T-cell mediated

30
Q

Pathophysiology of Allergic Contact Dermatitis.

A

contact with allergic substance = delayed hypersensitivity reaction

31
Q

How long is the sensitization process in Allergic Contact Dermatitis?

A

10-14 days = sxs show

re-exposure = sxs w/in 12-48hrs = quicker

32
Q

What is the most common cause of Allergic Contact Dermatitis?

A

Rhus dermatitis (the posion plants ie: poison ivy) = contain resin urushiol

33
Q

What are other causes of Allergic Contact Dermatitis?

A

Nickle, rubber, fragrances, dyes

34
Q

What are the most common allergens in Allergic Contact Dermatitis?

A

nickle and poison ivy

35
Q

Clinical presentation of Allergic Contact Dermatitis.

A

pruritis
- eczematous scaly edematous plaques
- vesiculation distribution on contact areas

36
Q

With Allergic Contact Dermatitis due to a Rhus allergy, when does the initial episode occur and how long do symptoms last?

A

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
Q

What are associated symptoms of Allergic Contact Dermatitis with a Rhus allergy?

A

linear distribution

blisters w/in 1-2 days s/p rash onset

38
Q

How is Allergic Contact Dermatitis diagnosed?

A

Patch testing

39
Q

What is patch testing?

A

apply diluted allergens on skin of back and leave it for 48hrs → read results at 96hrs

40
Q

Treatment for Allergic Contact Dermatitis

A

avoid allergen

1) topical corticosteroids (PO if severe)
- topical/oral antihistamine = pruritis
- emollients

41
Q

What is a major risk factor for Irritant Contact Dermatitis?

A

Hx of Atopic Dermatitis due to impaired skin barrier function

42
Q

Etiology of Irritant Contact Dermatitis

A

chemicals

solvents, heavy metals, strong acids/bases, alcohols/creams, etc.

43
Q

Clinical presentation of Irritant Contact Dermatitis

A

Mild = erythema, chapped skin, dryness & fissuring after repeated exposure

Pruritis & pain

Severe = edema, exudate, tenderness, painful bullae

44
Q

Treatment for Irritant Contact Dermatitis

A

topical corticosteroids and emollients

refer to Derm

45
Q

What is dyshidrotic eczema?

A

recurrent, acute blistering eczema of palms/soles

46
Q

Etiology of dyshidrotic eczema

A

unknown, multifaceted

47
Q

Risk factors for dyshidrotic eczema

A

Hx atopic and contact dermatitis
dermatophyte infections

48
Q

Clincal presentation for dyshidrotic eczdema

A

pruritic vesicular/bullous eruptions (itchy blisters) on palms/soles

multiple deep-seated lesions
can involve nail changes

49
Q

Exacerbation/trigger for dyshidrotic eczema

A

warm weather

50
Q

How is dyshidrotic eczema diagnosed?

A

clinical (Hx and PE)

skin biopsy

51
Q

Why would one perform a skin biopsy on someone with dyshidrotic eczema? What will results show?

A

Results = intraepidermal spongiotic vesicles/bullae w/o involving eccrine sweat glands

r/o DDx (ie: psoriasis) if poor response to tx

52
Q

Treatment for dyshidrotic eczema

A

topical corticosteroids (PO if severe)

UVA tx w/ refractory disease

skin care + avoid triggers

53
Q

What is Lichen Simplex Chronicus?

A

secondary skin lesions due to chronic scratching

54
Q

Clinical presentation of Lichen Simplex Chronicus

A

Lichenified plaques + excoriations (from scratching

55
Q

Histopathology of a skin sample taken from patient with Lichen Simplex Chronicus

A

hyperplasia and hyperkeratosis of squamous epithelium

56
Q

How is Lichen Simplex Chronicus diagnosed?

A

clincially (Hx of constant scratching; PE)

57
Q

Treatment for Lichen Simplex Chronicus?

A

topical corticosteroids, antihistamines, avoid scratch/itch cycle

58
Q

What is Nummular eczema?

A

coin-shaped eczema on extensor surfaces of lower legs

59
Q

Eczema morphology and distribution of Nummular eczema

A

erythematous coin-shaped plaques on dry skin

extensor surfaces of lower extremities

pruritic

60
Q

Etiology of Nummular eczema

A

dry skin aggravated by wool, soaps, frequent bathing, staph aureus

61
Q

What can Nummular eczema be a clinical presentation of?

A

atopic dermatitis in adults

62
Q

What is seborrheic dermatitis?

A

eczema on oily parts of body, mainly scalp

63
Q

Epidemiology of seborrheic dermatitis

A

infants 2-10wks old until 8-12mo old

reappears in puberty

64
Q

How does seborrheic dermatitis clinically present in adults?

A

1) dandruff
2) yellow/red demarcated lesions w/ greasy scales on oily parts of body (nonpruritic)

65
Q

Etiology of seborrheic dermatitis

A

Pityrosporum or Mallasezia yeasts

66
Q

Treatment for seborrheic dermatitis

A

anti-pityrosporum shampoo

combo w/ anti-inflammatory cream

Dermatology (5 decks)

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