eczematous eruptions Flashcards
Macule
Flat
<1 cm
Well circumscribed
Freckles, flat moles, measles
Layers of skin
Stratum basale
Stratum spinosa - losing nuc
Stratum granulosum - no nuc “granulated layer”
Cornified layer
Papule
Elevated
Firm
<1cm
Circumscribed
Raised moles, warts
Patch
Flat
Nonpalpable
>1cm
Vitiligo, port wine stains, cafe au lait
Plaque
Elevated, flat top
Firm
Rough
>1 cm
Psoriasis
Wheal
Elevated
Irreg shape of edema
Varied size
Allergic rxn, bug bites
Nodule
Elevated
Firm
Deeper than papule
1-2 cm
Circumscribed
Lipomas, erythema nodosum
Tumor
Elevated, solid
>2cm
Benign rumors, neoplasms, lipomas
Vesicle
Elevated,
Filled with serous fluid
<1cm
Varicella
Bulla
Vesicles >1cm
Blister, 2nd degree burn
Pustule
Elevated
Filled with purulent fluid (pus)
Impetigo
Cyst
Encapsulated in dermis
Filled with liquid
Elevated
Circumscribed
Acne, epidermoid cyst
Scale
Flaky skin
Thick or thin
Dry or oily
Irregular
Seborrhea capitis (dandruff)
Lichenification
Chronic
Rough thickened skin from itching/scratching
CHRONIC DERMATITIS
Keloid
Over scarring
Elevated
Firm
Irregular
Excoriation
Scratch
Loss of epidermis
Hollowed out line
Crusted area
Fissure
Linear crack in skin
Tinea pedis (athlete’s foot)
Erosion
Loss of epidermis
Depressed
Watery discharge
Follows rupture of bullus
Ulcer
Loss of epidermis and dermis
Concave
Statis ulcer
Telangiectasia
Dilates superficial blood vessel
Tel.angi.ectasia
Milia
Small, white papules filled with keratin
Annular lesions
Ring shaped lesions
Herpetiform
grouped lesions
Pruritus
Itchiness
**Atopic Dermatitis Presentation
Acute - erythematous papules, excoriation, pruritic
Subacute - excoriated, scaling papules
Chronic - thickened, lichenification, hyper-/hypopigementation
Babies-extensor, adults-flex folds
Atopic dermatitis risk factors
First degree relative has condition
Microbes (S aureus, Candida, Trichophyton dermatophytes
Stress
Food allergy
Allergens
Irritant contact
Term IDMs (not preterm IDMs)
Obesity
Atopic dermatitis eval
Neg skin test to r/o (pos skin test don’t tell much)
RAST (radioallergosorbent test) - good predictor
S aureus cultured from skin
** Atopic dermatitis treatment
Stress reduction Lower temp and raise humidity Moisturize: **OINTMENT>cream>lotion>solution Corticosteroid (least potent effective) Antibiotics when infected
Seborrheic dermatitis presentation
Oily flaky skin over erythematic patches Dandruff Varied pruritis < 6month old, after puberty Generally no underlying disorder
Seborrheic dermatitis treatment
Low potency glucocorticoid
Plus anti fungal (for inflammation)
Anti dandruff shampoo – leave in for 3-5 min
Lichen simplex chronicus
Circumscribed lichenified plaque
From chronic scratch
Treatment: break cycle of itching
High potency topical glucocorticoids; occlusion
Nummular (discoid) eczema
Coin like legions
Crusted and scaly (begin as edematous papules)
Mainly men
Treatment same as atopic dermatitis
Xerotic/ asteototic eczema
Winter itch
Caused by dry air, often from use of HV/AC
Treatment- topical moisturizers
Made worse by overbathing and harsh soaps
Dry skin, fine cracks and scales
Irritant contact dermatitis
Thin skin areas or where irritant touches skin
Most common from chronic hand washing (chronic low grade dermatitis)
Varies from erythema to edema vesicles and ulcers
Eg Hunan hand syndrome (chili burns)
Treatment- avoid irritant
Type I Immunological Rxn
IgE Mediated
release antihistamines : angioedema, urticaria, bronchospasm, analphylaxis
Type II Immunological Rxn
Cytotoxic
IgM and IgG recognize drug bound to cell and cell is destroyed
hemolytic anemia and thrombocytopenia
Type III Immunological Rxn
Immune Complex
soluble IgG or IgM complexes
Complexes deposit in BV walls -> complement cascade -> serum sickness
Type IV Immunological Rxn
T-cell mediated/delayed hypersensitivity
topical admin activates T-cells -> contact dermatitis
Allergic Contact Dermatitis Presentation
Erythema
Vesiculation
Server Pruritus
Allergic Contact Dermatitic Causes
Plants (poison ivy) - urushiol adheres to skin, linear eruption pattern because where touches skin
Nickel - sites of direct contact
Latex [gloves] - many possible allergens esp proteins in latex; common in spina bifida, shunts, kids with atopy; 24-48 hrs after exposure; patch tests
Hair dye and Henna - p-Phenylenediamine (PPD)
Textiles - wash and wear chemicals
Preservatives - cosmetics and topical meds
Fragrances
Drugs - corticosteroids, neomycin, benzocaine
Photoallergy - UV light
Dishydrosis/Dishydrotic Eczema presentation
pruritic vesicular eruption (“pompholyx”) on thick skin areas
burning pain or itchiness before it occurs
pruritis of hands/feet with sudden onset of vesicles (may be in waves)
Dishydrosis associated conditions
hyperhidrosis atopic dermatitis contact dermatitis stress distnat fungal infection
genetics
UV A light
Dishydrosis treatment
conld compress
high dose topical corticosteroid
botulism toxin A
immunosuppressants
low Ni or Co diets
Stasis Dermatitis/Ulceration presentation
lower extremities
secondary to venous incompetence and chrona edema
Early: mild erythema (scaling & pruritus) on medial aspect of ankle
Chronic: brawny edema, eventually develops ulcer
assoc. with DVT, vein removal, varicose veins
stasis dermatitis treatments
leg elevation
compression stockings
emollients/mid potency topical glucocorticoids
control the edema (like with diuretics)
Diaper Rash
caused by wetness, friction, and presence of urine, feces, and microoriganisms
esp fecal proteases and lipases
pH elevated - increase activity of ^ and upset normal microbiota
Kawasaki’s = rare form
Diaper Rash: Miliaria
obstruction of eccrine sweat glands
erythema and vesicles; can develop into pustules
Diaper Rash: Intertrigo
meceration and chafing of skin b/c wet skin has higher coef of friction and is more fragile
Diaper Rash: Contact Dermatitis
urine + feces + higher pH = activated fecal lipases, ureases, & proteases that irritate skin and make more permeable to other irritants
Diaper Rash: Candidal diaper dermatitis
Candida albicans infects compromised skin
often associated with thrush
worsened by antibiotics, esp amoxicillin
Diaper Rash: Bacterial diaper dermatitis
Bullous impetigo or folliculitis
most often staphylococcus or streptococcus
skin compromised by higher pH, secondary infection by fecal microorganisms
Diaper Rash: seborrheic diaper dermatitis
associated with other signs of seborrhea (cradle cap/dandruff)
Diaper rash: atopic eczema
spares diaper area - hydration/occlusion
Diaper rash: granuloma gluteal infantum
rare
inflamm. response to irritation, candidiasis, or fluorinated corticosteroids
Diaper rash treatment
airing diaper area
changing diaper type (cloth or super absorbent gels)
barrier ointments
antibacterials if infected
*look out for abuse (dunking baby bum in hot tub)
