Eczematous Eruptions Flashcards

Question

Diagnosis of Allergic contact dermatitis

Answer 1

● Clinical evaluation ● Patch testing to identify allergens

Answer 2

● Avoid allergens ● Simplify skin regimens to avoid additional allergens ● Use a topical corticosteroid ○ Avoid hydrocortisone since it can cause cases of contact allergy ○ May require course of oral steroids ● Symptom relief

Answer 3

● Exposure of skin to a photosensitizing agent followed by direct sunexposure ● Most common irritant is sunscreen. Also, aftershave lotions, perfumes, citrus fruits (especially the peel) ● Treatment: avoid exposure to sun and offending agent

Answer 4

● Irritant contact dermatitis ● Candida is a common cause of diaper dermatitis ● Occurs as bright-red (beefy-red) plaques on convex skin surfaces in direct contact with the diaper and prolonged exposure to urine and feces ● The most common skin eruption in infants and toddlers

Answer 5

● Factors that disrupt the local skin barrier include: excessive moisture, friction, increased pH, and high enzymatic activity ● Diapers occlude the skin leading to skin maceration → skin infection and inflammation

Answer 6

● Infants with diarrhea or chronic stooling due to continuous local skin irritation ● Dietary factors ○ Breast-fed infants have a lower incidence perhaps because of a lower stool pH ● Recent use of broad-spectrum antibiotics → increases risk of diarrhea and secondary yeast infections

Answer 7

● Mild: scattered erythematous papules or asymptomatic erythema over limited skin areas with minimal maceration and frictional irritation ● Moderate: more extensive erythema with maceration or superficial erosions; pain and discomfort are present ● Severe: extensive erythema with a glossy appearance, painful erosions, papules, and nodules

Answer 8

satellite pustules

Answer 9

● Clinical evaluation ● Rule out candidiasis

Answer 10

General skin care measures to minimize wetness in the diaper area, restore the skin barrier, and treat candida infection ○ Frequent diaper changes ○ Clean area completely ○ Barrier ointments - petrolatum, zinc oxide etc. ○ Topical nystatin application ○ Get air on area, diaper free time ○ Avoid acidic foods

Answer 11

A - air B - barrier C - cleansing D - diaper E - education

Answer 12

● An inflammation of the skin characterized by coin-shaped or discoid eczematous lesions which are extremely itchy ● Often chronic and difficult to treat ● Most common in adults ● Onset is gradual, often no clear precipitant, and usually no history of eczema

Answer 13

● Sharply demarcated, scaling, round eczematous plaques on trunk and extremities ● Lesions often start as patches of confluent vesicles and papules that ooze serum and form crusts ● Plaques are extremely itchy ● May begin with a few isolated lesions on the legs but with time, multiple lesions occur with no particular distribution

Answer 14

● Clinical evaluation ● May consider patch testing

Answer 15

● One of the most difficult forms of eczema to treat ● The course is variable and unpredictable ● Condition may be chronic and relapse for years ● After lesions are established, they tend to remain the same size and recur on previously affected skin

Answer 16

● No treatment is uniformly effective ● Hydrate skin! ● Topical steroids (medium- to high-potency concentrations) ● Topical immunomodulators → reduce inflammation ● Light therapy (narrowband ultraviolet B - NBUVB) can help resolve lesions when topical treatments have failed ● Refer to derm for refractory cases

Answer 17

● Chronic inflammation of skin regions with high density of sebaceous glands ○ Face, scalp, trunk ● Likely caused by normal skin yeast, Malassezia furfur, with an abnormal immune response

Answer 18

● Causes occasional pruritus and dandruff ● Pink to yellow papules and plaques with greasy scale involvement ○ Scalp, central face, ears ○ Also, eyebrows, base of eyelashes, nasolabial folds and paranasal skin and external ear canals ● May be present in newborns → “cradle cap” ○ Thick, yellow, crusted scalp lesions

Answer 19

Seborrheic dermatitis

Answer 20

● Topical therapy with antifungals, corticosteroids, and calcineurin inhibitors ○ Antifungals for mild to mod SD (eg, ketoconazole cream or ciclopirox) ○ Group VI or VII topical steroid creams/lotions applied twice a day ○ Tacrolimus and pimicrolimus are effective ● Frequent washing of face and scalp with OTC antidandruff soaps or shampoo containing zinc pyrithione, selenium sulfide, or ketoconazole ○ These shampoos are drying, may also need a light moisturizer ● Thick scale can be removed by applying warm mineral or olive oil to the scalp and washing several hours later ● If severe, may require oral antifungal treatment

Answer 21

● Inflammation of the skin of the lower legs caused by chronic venous insufficiency ○ Pooled venous blood in the legs compromises endothelial integrity in the microvasculature → fibrin leakage, local inflammation, and local cell necrosis ○ Associated with edema, varicose and dilated veins, and hyperpigmentation ● A chronic problem that frequently relapses

Answer 22

● Affected leg may have dilated and tortuous veins ● Significant pruritus ● Dermatitis is obvious; can become generalized if condition continues ● Common findings: edema, brown discoloration, erosion, and ulceration ● White scars on medial calf indicate previous ulceration ● Secondary infection with S. aureus is common, especially in excoriated skin

Answer 23

● Clinical evaluation ● May use a color duplex US to confirm venous stasis

Answer 24

● Elevation and compression stockings ○ To treat chronic venous insufficiency ● Prevent occurrence or progression of ulcers ● Apply cool-water dressings for 10-20 minutes twice a day for acute exudative inflammation ● Apply topical steroids (Group II-V) to management the inflammation and dermatitis component ● If infected, consider oral antibiotics and astringent dressings ● May consider oral antihistamines to help with itching ● Use bland emollients to help with dryness

Answer 25

● Also known as: acute palmoplantar eczema, dyshidrotic eczema, or pompholyx ● Comprised of sudden eruptions of highly pruritic vesicles or bullae on palms, sides of fingers, or soles ● Sweat glands are not involved

Answer 26

● Sudden onset of vesicles ● Tense, deep- seated, small vesicles filled with clear fluid ○ Resemble “tapioca” ○ Erupt suddenly on palms, lateral aspect of fingers, or plantar feet

Answer 27

● Cold, wet dressings with either tap water or Burow’s solution → then apply medium- to high-potency steroids (Groups 1-3) ● Topical tacrolimus ● Antihistamines to help with itching ● If frequent eruptions, topical psoralen plus ultraviolet A radiation ● If secondary infection present, antibiotics will be needed ● If severe, may consider PO prednisone taper

Answer 28

● Lichen simplex chronicus is eczema caused by repeated scratching, which worsens itching which causes scratching which worsens itching ● The affected skin is often on the wrists, ankles, anogenital skin, and back of the neck

Answer 29

Lichen Simplex Chronicus

Answer 30

Lichen Simplex Chronicus Skin Findings: ● Lichenification- sharply demarcated, deeply violaceous colored or red scaly plaque with prominent skin lines ○ Itchy, dry, hyperpigmented plaques ● Acute changes of vesiculation and weeping may be present

Answer 31

● Clinical examination ● May use KOH prep and biopsy to rule out other diagnoses and determine underlying cause

Answer 32

● Education and behavioral techniques ○ Stress may play a role for some patients ● Apply topical corticosteroid to area after soaking in water for 5 minutes, but do not use longer than 3 weeks ● May require an intralesional injection of steroid (eg, triamcinolone) ● Antihistamines to help control the itching ● Be aware of possible secondary infections; would require treatment with abx