Eczematous eruptions Flashcards
What is the clinical presentation of allergic contact dermatitis?
erythematous papules or vesicles in a linear/geometric formatioin, edema, vesiculation, weeping, pruritic. May have large bullae
how do you treat contact dermatitis?
topical corticosteroids (prednisone), antihistamines for itching, compresses for blisters.
If severe, can taper high potency steroid
What’s the difference between contact and irritant dermatitis?
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
What is the clinical presentation of scabies?
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
What can confirm a diagnosis of scabies?
scraping to look under the microscope and see the nasty thing
How do you treat scabies?
permethrin cream all over – treat all family members, suggest lidocaine cream for pruritus
What medication is needed for a scabies outbreak in nursing homes?
ivermectin orally
What is stasis dermatitis?
red rash, hyperpigmentation and pruritus on a lower leg (usually worse on left leg), pitting edema, “weeping”
How do you treat stasis dermatitis?
leg elevation, compression socks, treatment of underlying venous insufficiency (CHF) – potential for high potency topical steroids or antibiotics (mupirocin for MRSA)
What displays a risk for eczema?
allergic rhinitis and asthma. What makes it a triad is eczema!
How can you differentiate between fingertip eczema and dyshidrotic eczema?
fingertip - on fingertips, from exposure, scaling and peeling
dyshydrotic - eruption of vesicles on fingers that look like tapioca and are very itchy
What is the treatment for fingertip & dyshidrotic eczema (it’s the same)?
topical steroids, maybe prednisone, and antihistamines for itching
What are symptoms of atopic dermatitis?
pruritus, dry, red, scaly, usually on flexural parts of body and recurrent
Chronic can be lichenified
How are infants different in eczema appearance?
usually on extensors. Children are like adults with flexural involvement
What other conditions can eczema be presented with?
keratosis pilaris, cheilitis, nipple eczema
How do you treat eczema?
Emollient cream!
Start with steroid and taper down to various emollients to avoid steroidal effects
What are other treatments to consider for eczema?
-limus ointments. Systemic = -mabs
What lifestyle recommendations should you give regarding eczema?
change soaps to mild soap and moisturizer, change laundry soaps, moisturize within 3 minutes of bathing
What eczema treatment is for acute exacerbations only?
systemic corticosteroids
How does nummular eczema present?
coin shaped lesions on trunk and extremeties, often starting on legs
How can you differentiate between nummular eczema and other fungal diseases?
KOH is needed
How do you treat nummular eczema?
topical corticosteroids, calcineurin inhibitors, emollients
Systemic corticosteroids or antibiotics if needed
How does lichen simplex chronicus present?
solitary patch of thickening of the skin, scaly, well de-marcated plaques.
Often patient-caused
How do you treat lichen simplex chronicus?
stop scratching! Topical steroid, cover area, can consider topical tacrolimus, or recurrent: thalidomide, lenalidomide
What can you recommend for fissured feet?
prevent with urea, salicyclic acid, wear closed-toed shoes, moisturize, wear socks, lose weight
What is asteatosic eczema?
lacy pattern of eczematous dermatitis in lower legs, common in older people; papules or plaques
How do you treat asteatosic eczema?
moisturization! avoid irritants, humidifiers, emollient cream
What is hyperkeratotic eczema?
thick, dry, itchy plaques on palms and soles
What looks very similar to hyperkeratotic eczema?
psoriasis – differentiate with punch biopsy
How do you treat hyperkeratotic eczema?
steroid ointments, oral acitretin, methotrexate. Can consider light therapy
