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Dermatology > Eczematous Eruptions > Flashcards

Eczematous Eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

Pruritic, exudative, or lichenified eruptions

Acute, subacute, or chronic relapsing skin disorder that usually begins in infancy (rarely adult)

Characterized primarily by dry skin and pruritis

Genetic predisposition, skin barrier damage

A

Atopic Dermatitis (Eczema)

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2
Q

The “itch-scratch” cycle can result in what?

A

Lichenification

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3
Q

The itch that rashes

A

Atopic Dermatitis (Eczema)

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4
Q

The atopy triad

A

Allergies
Eczema
Asthma

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5
Q

What is the distribution of eczema in babies?

A

Face and trunk - Starts on the cheeks and scalp, and oval patches on the trunk

Later involves extensor surfaces

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6
Q

What is the distribution of eczema in adults?

A

Flexural areas (elbow, knee)

Pigmented persons have poorly demarcated hypo-pigmented patches on the cheeks and extremities

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7
Q

What are some eliciting factors for atopic dermatitis (eczema)?

A

Inhalants
Microbial Agents
Foods
**Anything can cause this really

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8
Q

What are some exacerbating factors for atopic dermatitis (eczema)?

A

Skin Barrier Disruption
Infections
Seasonal
Clothing
Emotional stress

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9
Q

What are some treatment options for acute atopic dermatitis (eczema)?

A

Stop scratching!

Wet dressings

Topical glucocorticoids

Hydroxyzine 10-100mg qid

Oral or topical antibiotics to eliminate S. aureus

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10
Q

What are some treatment options for subacute/chronic atopic dermatitis (eczema)?

A

Stop scratching!

Hydration + emollients

Topical glucocorticoids (Put steroid on first then lotion, or else wont be able to penetrate as well)

Tacrolimus or pimecrolimus

H1 antihistamines

UVA-UVB therapy

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11
Q

What are some methods for preventing atopic dermatitis (eczema)

A

Minimize baths
No harsh soaps or shampoos
Proper skin care
Avoid scratchy fabrics – cotton is preferred
Avoid any other triggers

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12
Q

Acute or chronic inflammatory reactions to substances that come in
contact with the skin

A

Contact Dermatitis

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13
Q

What are the two types of contact dermatitis?

A

Allergic contact dermatitis
Irritant contact dermatitis

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14
Q

Acute or chronic inflammatory reactions to substances that come in contact with skin

Result can be immediate

NOT itchy

Hands are the most commonly affected area

80% of all occupational skin disorders

Isolated to area of contact (time and amount)

A

Irritant contact dermatitis

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15
Q

What is the pathogenesis of irritant contact dermatitis?

A

Irritant cause cell damage if applied for sufficient times in adequate concentration

ICD occurs when defense or repair capacity of the skin is unable to maintain normal kin integrity and function or when penetration of chemical induces an inflammatory response

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16
Q

Specific immune-mediated reaction to a touched substance

Delayed response - May show up in around 24 hours

Itchy

By an antigen (contact allergen) that elicits a type IV (cell mediated or delayed) hypersensitivity reaction

Appearance depends on severity, location, and duration

A

Allergic Contact Dermatitis

17
Q

What are the most common agents in allergic contact dermatitis?

A

Poison oak and poison ivy (rhus dermatitis)

18
Q

One of the most common things you’ll see in babies

Irritant in diaper area

Common between 9-12 months old

A type of contact dermatitis

A patchwork of inflamed, bright red skin on the buttocks, thighs,
and genitals

Erythema and scaling

Rarely ulcerated

A

Diaper Dermatitis

19
Q

What is a common cause of diaper dermatitis?

A

yeast infection

20
Q

Subtype of dermatitis that is characterized by erythematous, round or coin-shaped plaques

Chronic, pruritic, inflammatory dermatitis

Peaks in fall and winter

Cause: unknown

Common in older gentlemen

Lower extremities most common location

A

Nummular Eczema

21
Q

Lower extremities

“coin-shaped” plaques composed of grouped small papules and vesicles on an erythematous base

Pops up in the same spot every year typically

A

Nummular Eczema

22
Q

What are some treatment options for nummular eczema?

A

Skin hydration – moisturize

Glucocorticoids

Crude Coal tar: 2-5% crude coal tar ointment daily

Systemic therapy - Antibiotics if secondary infection with S. aureus

PUVA or UVB 311-nm therapy (very effective)

23
Q

Redness and scaling and occurring in regions where the sebaceous glands are most active

Scalp, gluteal crease, neck line, breast, face

“dandruff” or “cradle cap”

A

Seborrheic Dermatitis

24
Q

Seborrheic dermatitis is associated with what conditions?

A

yeast colonization
Extended hospital stays
Parkinsons
HIV (If severe or widespread, be concerned about HIV)
Androgen states
Some neurologic medications

25
Q

Orange-red, yellowish-red, or gray-white skin, “greasy”, or white dry scaling macules and papules of varying sizes

Visual crusts and scales

Pruritis and burning

Sharply marginated

Sticky crusts and fissures are common in the folds behind the external
ear

Diffuse involvement of scalp

A

Seborrheic Dermatitis

26
Q

What are some treatment options for seborrheic dermatitis?

A

Selenium sulfide (Selsun Blue) or Zinc Pyrithione (Head and Shoulders) shampoo

Ketaconazole shampoo (Nizoral)

Ketoconazole 2% and 2.5% hydrocortisone cream

Baby shampoo for eyelids

Oils: Mineral oil, baby oil, olive oil

27
Q

Common in young women (90% of cases)

etiology unknown

Duration: Weeks to months

Can be seen in individuals who use facial creams or toothpastes that
are fluorinated and they don’t wash it off appropriately (Also with topical steroids and soaps)

Make sure to rule out S. aureus infection

A

Perioral Dermatitis

28
Q

Around the mouth

Discrete erythematous micropapules and microvesicles

May be red and scaly

Mildly itchy

Can affect periorbital area and nasal area as well

Typically presents in 2-30 year olds, fair to delicate skin

A

Perioral Dermatitis

29
Q

What are the treatment options for perioral dermatitis?

A

Discontinue steroids - AVOID topical steroids – will worsen

Topical Metronidazole 0.75% cream BID or 1% qd

Systemic – add if topical cream is not enough
Minocycline /Doxycycline or Tetracycline or Erythromycin

30
Q

What should be avoided in patients with perioral dermatitis?

A

Steroids (can worsen the condition)

31
Q

Occur on LE in patient’s with venous insufficiency

Deposits of hemoglobin in skin 🡪 bronze color

Occurs in diabetes

A

Stasis Dermatitis

32
Q

What is the treatment for stasis dermatitis?

A

Short term - Topical glucocorticoids

Secondary Infections - Topical antibiotics (mupirocin)

Treat underlying cause

Keep clean and observation (watch for cellulitis)

Stocking

Wet dressings with Burow’s

33
Q

Subtype of eczema characterized by vesicles on palms and soles

Vesicular type of hand and foot dermatitis

Recurrent attacks are the rule

Spontaneous remission in 2-3 weeks

Must rule out bacterial or fungal cause

A

Dyshidrosis Eczema

34
Q

Deep-seated pruritic, clear, “tapioca-like” vesicles

Later – scaling fissures and lichenification occur

Located on hands and feet

Typically the lateral aspects

A

Dyshidrosis Eczema

35
Q

What is the treatment for dyshidrosis eczema?

A

Steroids:

High potentency glucocorticoids with plastic occlusive dressings
(saran wrap) for up to 1-2 weeks - Keeps in heat, increases potency of
cream

Intralesional injection - Triamcinolone

Systemic - Tapered Prednisone

36
Q

Localized form of lichenification resulted from repetitive rubbing and scratching 🡪 the constant scratching causes thick, leathery, brown-ish skin

Can last for decades

Typically a light-brown color

Hyper-excitability of the epidermal nerves, exacerbated by rubbing and scratching

May be a nervous habit or tic

May be associated with atopic dermatitis or psoriasis

A

Lichen Simplex Chronicus

37
Q

What are the common types of patients likely to see Lichen Simplex Chronicus?

A

Individuals older than 20 years old

More commonly in women

More frequent in Asians

Common in atopic individuals

38
Q

What is the treatment for lichen simplex chronicus?

A

Goal: stop the itch-scratch cycle (can be difficult if underlying disease)

Stop scratching/rubbing: Anti-histamine at night (Hydroxyzine)

Topical glucocorticoid preparations or tar preparations with occlusive dressings

Intralesional triamcinolone

39
Q

What is the pathogenesis of lichen simplex chronicus?

A

Physical trauma (scratching) 🡪 skin hyperplasia (palpate – will feel thickened)

Emotional stress - Can be seen with psychological disorders (look for anxiety, nervousness, depression, etc)

Habit forming/unconscious habit - “pleasure habit”

Itch attack from minor stimuli

Dermatology (17 decks)

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