Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Derm Exam 1 > Eczematous Eruptions > Flashcards

Eczematous Eruptions Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

Atopic Dermatitis (Eczema)

A

● A chronic inflammatory skin disorder with a
complex pathogenesis
● An eczematous eruption that is
distressingly pruritic, recurrent, often
flexural, and symmetric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Atopic dermatitis features and course

A

● Generally begins early in life and often
improves by adulthood
● Characterized by periods of remission and
exacerbation
● Primarily affects children in urban areas or
developed countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathogenesis of atopic dermatitis

A

● “Outside-in” vs “inside-out”??
● Epidermal barrier dysfunction → increased transepidermal water loss
○ Stratum corneum layer dysfunction
○ Decreased ceramides
● Genetic component
○ Mutation of gene that encodes for filaggrin, a protein produced by
differentiating keratinocytes
● Immune dysregulation
○ Increased T cell activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Etiology of Atopic dermatitis

A

● Genetic factors
● Epidermal barrier dysfunction
● Immunologic mechanisms
● Environmental triggers
○ Foods (eg, milk, eggs, soy, wheat, peanuts)
○ Airborne allergies (eg, dust mites, mold)
○ Staph aureus colonization
○ Topical products (eg, cosmetics, fragrances, harsh soaps)
○ Sweating
○ Rough fabrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Atopic dermatitis presentation

A

● Pruritus
● Rash on face and/or extensors in
infants and young children
● Lichenification in flexural areas
● Tendency toward chronic relapsing
dermatitis
● Personal or family history of atopic
disease: asthma, allergic rhinitis,
atopic dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Minor (or less specific) Features of atopic dermatitis

A

● Dryness
● Allergic shiners
● Facial pallor
● Conjunctivitis
● Hyperlinearity of palms and
soles
● Immediate skin test reactivity
● Keratosis pilaris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Skin findings of Atopic Dermatitis (Eczema)

A

● Severe itching!
● Appears suddenly
● Acute phase - lesions are red, edematous, scaly patches or plaques that may be
weep. Occasionally vesicles are present
● Chronic phase - scratching and rubbing create skin lesions that appear dry and
lichenified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Atopic Dermatitis (Eczema) diagnosis

A

● Clinical evaluation
● Patch testing
● No definitive lab testing
● Elevated serum IgE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Atopic Dermatitis (Eczema)
Management

A

● Avoidance of precipitating factors
● Lifestyle modifications
○ Sensitive laundry detergent, avoid extremely dry air, wear clothes without tags
● Supportive care (eg, moisturizers and dressings)
● Antihistamines for pruritus
● Topical corticosteroids
○ Ointments are preferred
○ Class 7 steroid (low potency - Hydrocortisone 1%) → face and flexural
lesions
○ Class 4 or stronger steroid (triamcinolone) → trunk lesions
● Immunomodulators - suppress the immune system, prevent interleukin-2
production in T cells
● Targeted biologic therapies (monoclonal antibodies)
● Sometimes UV therapy is helpful for extensive AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

General measures to reduce skin dryness and exposure to skin irritants

A

● Limit bathing to once daily with lukewarm water using mild cleansers.
● Apply a moisturizer at least twice a day and immediately after bathing.
● Use a mild laundry detergent and/or double-rinse the laundry
● Consider oral supplementation with L-histidine. L-histidine has been shown to
increase filaggrin levels in keratinocytes and improve xerosis
● Consider obtaining a whole house humidifier or a room humidifier for the bedroom.
● Hydrate with water
● Take baths with diluted bleach or colloidal oatmeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is The “hygiene hypothesis” ?

A

The unproven hygiene hypothesis is that decreased early childhood exposure
to infectious agents (ie, because of more rigorous hygiene regimens at home) may increase the
development of atopic disorders and autoimmunity to self-proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Eczema herpeticum

A

● A diffuse herpes simplex infection occurring in
patients with AD
● Will appear as grouped vesicles in areas of
active or recent dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Contact Dermatitis

A

● An acute inflammation of the skin caused by irritants or allergens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of Eczema herpeticum

A

acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Involvement of the eye is considered an ophthalmic emergency with ____

A

Eczema herpeticum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Irritant contact dermatitis (ICD)

A

a nonspecific inflammatory reaction to
substances contacting the skin; the immune system is not activated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Contact Dermatitis irritants

A

● Chemicals (eg, acids, solvants, metal salts)
● Soaps (eg, abrasives, detergents)
● Plants (eg, poinsettias, peppers)
● Body fluids (eg, urine, saliva)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Skin findings with Contact Dermatitis

A

● Can begin quickly, within minutes of exposure
● More painful/burning than pruritic
● Mild erythema to hemorrhage, crusting, erosion, pustules, bullae, edema
● Hands are most often affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnosis of Contact Dermatitis

A

● Clinical evaluation
● Patch testing, to rule out ACD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Contact Dermatitis treatment

A

● Avoid offending agents
● Limit the number of wet-dry cycles,
such as hand washing
● Use mild cleansers
● Apply bland emollients frequently
● Wear appropriate protective equipment, like gloves
● Supportive care (eg, cool compresses, dressings, antihistamines)
● Corticosteroids (generally topical, occasionally oral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

a delayed-type hypersensitivity reaction
caused by skin contact to an allergen to which an individual has become
sensitized.

A

Allergic contact dermatitis (ACD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Allergic contact dermatitis (ACD) - two phases

A
  1. Sensitization phase - Allergens (haptens) are captured by Langerhans cells
    which migrate to regional lymph nodes. There they process and present the
    antigen to naive T cells.
    a. Generally lasts 10-15 days
    b. Typically asymptomatic
  2. Elicitation phase - Sensitized T cells then migrate back to the epidermis and
    activate on any reexposure, releasing cytokines, recruiting inflammatory
    cells and lead to clinical manifestations of ACD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Allergic Contact Dermatitis - potential allergens

A

● Metals (eg, nickel, cobalt, chromate)
● Rubber additives (eg, carbamates, thiurams)
● Poison ivy
● Preservatives
● Fragrances, hair dye
● Topical medications (eg,
bacitracin, neomycin,
hydrocortisone)

24
Q

Skin findings with Allergic Contact Dermatitis

A

● The intensity of the eczema will depend on the individual’s degree of
sensitivity, concentration of the allergen, and quantity of the allergen
exposure
● Intense pruritus
● May have transient erythema, vesicles, edema, redness, ulceration
● Dermatitis is usually confined to area of direct exposure

25
Q

Diagnosis of Allergic contact dermatitis

A

● Clinical evaluation
● Patch testing to identify allergens

26
Q

Allergic contact dermatitis treatment

A

● 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

27
Q

Photocontact dermatitis

A

● 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

28
Q

Diaper dermatitis

A

● 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

29
Q

Pathogenesis of Diaper dermatitis

A

● 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

30
Q

Risk Factors for Diaper dermatitis

A

● 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

31
Q

Diaper dermatitis
Clinical presentation

A

● 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

32
Q

Hallmark of diaper dermatitis:

A

satellite pustules

33
Q

Diagnosis of diaper dermatitis

A

● Clinical evaluation
● Rule out candidiasis

34
Q

Treatment of diaper dermatitis

A

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

35
Q

Diaper Dermatitis Prevention
ABCDE

A

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

36
Q

Nummular dermatitis

A

● 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

37
Q

Nummular dermatitis presentation

A

● 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

38
Q

Nummular dermatitis diagnosis

A

● Clinical evaluation
● May consider patch testing

39
Q

Prognosis of nummular dermatitis

A

● 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

40
Q

Nummular dermatitis
Treatment

A

● 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

41
Q

Seborrheic dermatitis

A

● 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

42
Q

Seborrheic dermatitis presentation

A

● 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

43
Q

“cradle cap” is also a type of

A

Seborrheic dermatitis

44
Q

Seborrheic dermatitis
Treatment

A

● 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

45
Q

Stasis dermatitis

A

● 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

46
Q

Stasis dermatitis
Clinical presentation:

A

● 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

47
Q

Stasis dermatitis diagnosis

A

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

48
Q

Stasis dermatitis treatment

A

● 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

49
Q

Dyshidrosis

A

● 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

50
Q

Dyshidrosis
Clinical presentation

A

● 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

51
Q

Dyshidrosis treatment

A

● 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

52
Q

Lichen Simplex Chronicus

A

● 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

53
Q

Used to be called “localized neurodermatitis”

A

Lichen Simplex Chronicus

54
Q

Lichen Simplex Chronicus
Skin Findings

A

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

55
Q

Lichen Simplex Chronicus diagnosis

A

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

56
Q

Lichen Simplex Chronicus
Treatment

A

● 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

57
Q
A

Derm Exam 1 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions