Eczematous eruptions

Question 1

What is the clinical presentation of allergic contact dermatitis?

Answer 1

erythematous papules or vesicles in a linear/geometric formatioin, edema, vesiculation, weeping, pruritic. May have large bullae

Question 2

how do you treat contact dermatitis?

Answer 2

topical corticosteroids (prednisone), antihistamines for itching, compresses for blisters.
If severe, can taper high potency steroid

Question 3

What’s the difference between contact and irritant dermatitis?

Answer 3

irritant dermatitis is a much less extreme reaction and is much more common- can be from handwashing, soaps, or fumes. Emollients can help, or topical steroids and antihistamines. NO BULLAE

Question 4

What is the clinical presentation of scabies?

Answer 4

INTENSELY itching – shouldn’t stop itching when seeing you. Worse at night, papules in web spaces, burrows between fingers
if any on penis, should assume scabies or otherwise

Question 5

What can confirm a diagnosis of scabies?

Answer 5

scraping to look under the microscope and see the nasty thing

Question 6

How do you treat scabies?

Answer 6

permethrin cream all over – treat all family members, suggest lidocaine cream for pruritus

Question 7

What medication is needed for a scabies outbreak in nursing homes?

Answer 7

ivermectin orally

Question 8

What is stasis dermatitis?

Answer 8

red rash, hyperpigmentation and pruritus on a lower leg (usually worse on left leg), pitting edema, “weeping”

Question 9

How do you treat stasis dermatitis?

Answer 9

leg elevation, compression socks, treatment of underlying venous insufficiency (CHF) – potential for high potency topical steroids or antibiotics (mupirocin for MRSA)

Question 10

What displays a risk for eczema?

Answer 10

allergic rhinitis and asthma. What makes it a triad is eczema!

Question 11

How can you differentiate between fingertip eczema and dyshidrotic eczema?

Answer 11

fingertip - on fingertips, from exposure, scaling and peeling
dyshydrotic - eruption of vesicles on fingers that look like tapioca and are very itchy

Question 12

What is the treatment for fingertip & dyshidrotic eczema (it’s the same)?

Answer 12

topical steroids, maybe prednisone, and antihistamines for itching

Question 13

What are symptoms of atopic dermatitis?

Answer 13

pruritus, dry, red, scaly, usually on flexural parts of body and recurrent

Chronic can be lichenified

Question 14

How are infants different in eczema appearance?

Answer 14

usually on extensors. Children are like adults with flexural involvement

Question 15

What other conditions can eczema be presented with?

Answer 15

keratosis pilaris, cheilitis, nipple eczema

Question 16

How do you treat eczema?

Answer 16

Emollient cream!
Start with steroid and taper down to various emollients to avoid steroidal effects

Question 17

What are other treatments to consider for eczema?

Answer 17

-limus ointments. Systemic = -mabs

Question 18

What lifestyle recommendations should you give regarding eczema?

Answer 18

change soaps to mild soap and moisturizer, change laundry soaps, moisturize within 3 minutes of bathing

Question 19

What eczema treatment is for acute exacerbations only?

Answer 19

systemic corticosteroids

Question 20

How does nummular eczema present?

Answer 20

coin shaped lesions on trunk and extremeties, often starting on legs

Question 21

How can you differentiate between nummular eczema and other fungal diseases?

Answer 21

KOH is needed

Question 22

How do you treat nummular eczema?

Answer 22

topical corticosteroids, calcineurin inhibitors, emollients

Systemic corticosteroids or antibiotics if needed

Question 23

How does lichen simplex chronicus present?

Answer 23

solitary patch of thickening of the skin, scaly, well de-marcated plaques.

Often patient-caused

Question 24

How do you treat lichen simplex chronicus?

Answer 24

stop scratching! Topical steroid, cover area, can consider topical tacrolimus, or recurrent: thalidomide, lenalidomide

Question 25

What can you recommend for fissured feet?

Answer 25

prevent with urea, salicyclic acid, wear closed-toed shoes, moisturize, wear socks, lose weight

Question 26

What is asteatosic eczema?

Answer 26

lacy pattern of eczematous dermatitis in lower legs, common in older people; papules or plaques

Question 27

How do you treat asteatosic eczema?

Answer 27

moisturization! avoid irritants, humidifiers, emollient cream

Question 28

What is hyperkeratotic eczema?

Answer 28

thick, dry, itchy plaques on palms and soles

Question 29

What looks very similar to hyperkeratotic eczema?

Answer 29

psoriasis – differentiate with punch biopsy

Question 30

How do you treat hyperkeratotic eczema?

Answer 30

steroid ointments, oral acitretin, methotrexate. Can consider light therapy