Eczematous Eruptions Questions Flashcards
What is atopic dermatitis?
A chronic pruritic inflammatory eczematous eruption which can effect any age, but is most common in childhood
What is the pathogenesis of atopic dermatitis?
An altered immunologic response, can be genetic, altered epidermal barriers/environmental exposures can drive this
What are the signs/symptoms of atopic dermatitis?
Pruritis, burning, erythema, scaling, crusting, lichenification
Commonly found on face, neck, antecubital (inner elbow) and popliteal (back of the knee), flexor surfaces (skin folds): clinical diagnosis
Differential: Contact derm, cellulitis, seborrheic derm
**check for secondary bacterial infection
What are the treatments available for atopic dermatitis?
No cure, management/control is the goal!
Good skin care: moisturize, decrease bathing frequency, gentle cleansers/laundry detergent
Topicals: Topical steroids, clacineurin inhibitors (not for acute episodes), eucrisa (topical/non-steroidal), phototherapy
Systemic: steroids (acute episodes), antihistamines, antibiotics if infection present, Dupixent (SQ injectable for moderate/severe), JAK inhibitors (oral or topical)
What is contact dermatitis?
An inflammatory reaction of the skin to external stimuli
What is the difference between irritant and allergic contact dermatitis?
Irritant contact derm: substance that produces direct toxic effect to skin
Allergic contact derm: immunologic reaction which triggers inflammation
What are the signs/symptoms of contact dermatitis?
Erythema, scaling, pruritis (may see edema/vesicles)
DDx: atopic derm, psoriasis, herpes zoster
How can you test for contact derm?
Patch testing: chemicals/materials/fragrances are applied to skin using adhesive strips, 1st reading in 48 hours, 2nd reading 48 hrs after
**Used to determine degree of allergic reaction/find offender
Common offenders: cosmetics, rubber, nickel, poison ivy, medications
What are the treatments available for contact dermatitis?
REMOVE THE OFFENDER!
Can use topical and oral steroids, antihistamines
Prevention/avoidance (i.e. reading labels for possible allergens in products)
What is seborrheic dermatitis?
A superficial inflammatory response that can be chronic
Thought to be inflammatory response to yeast
What are the signs/symptoms of seborrheic dermatitis?
White or yellow scale, flaky, background, erythema, greasy appearance (can be pruritic)
Commonly on hairy areas of body (scalp, face, chest)
Can affect all ages (cradle cap)
Mild: dandruff
DDx: Psoriasis, Rosacea, Contact derm
Patients with what diseases have a higher occurrence rate of Seb Derm?
HIV/AIDS, Parkinson Disease
What are the treatments available for seborrheic dermatitis?
Shampoos: Selenium sulfide, ketaconazole, zinc pyrithione- use 3x a week for 3 min after regular shampoo
Topical Steroids: Low potency cream, foam, oil, lotion, solution, shampoo- used 1-2 times a day/PRN and taper
Topical Antifungals
Immunomodulators (elidel and protopic)
Keratolytics: for thick scales (salicyclic acid, mineral oil)
What is lichen simplex chronicus/how is it caused?
Lichenified skin caused by a chronic itch/scratch cycle (self perpetuated)
What are the features of lichen simplex chronicus?
Lihenified skin which can be anywhere but commonly areas that patient can reach
Patient may wake from sleep (itching)
Can be secondary to another diagnosis like chronic AD
Ddx: psoriasis
differentiate by looking at scalp/nails
What treatments are available for lichen simplex chronicus?
Potent topical steroids (must travel through thick skin)
IL steroids
Anti pruritics (oral/topical)
Behavior modification (stopping the action of excessive scratching)
What is neurodermatitis?
Dermatitis that occurs because of patient picking (real or perceived stimuli)
-maybe manifestation of OCD, SSRI/antipsychotics can be useful
What are the features of stasis dermatitis?
Skin: erythematous, or brown pigment
Texture: shiny, edematous, can ulcerate
Commonly found on lower legs in people with vascular disease
What treatments are available for stasis dermatitis?
Topical steroids, elevation, compression
What is dyshidrotic eczema?
(Acute palmoplantar eczema)
Vesicular eczematous eruption usually on hands/feet
What causes dyshidrotic eczema?
High moisture and water exposure (certain professions where washing hands frequently) think: hairdressers, medical field
What are the features of dyshidrotic eczema?
Small vesicles (tapioca), very pruritic, diffuse peeling after flares
Not seasonal, but recurrent
DDx: MRSA, cellulitis, HSV, Pustular psoriasis
What treatments are available for dyshidrotic eczema?
Prevention of moisture/water exposure: decrease hand washing, avoid irritants
Topical and/or systemic steroids
Phototherapy
What is Nummular Eczema?
Erythematous, pruritic round patches
Treated same as atopic derm
(Differentiate between Tinea)
