Eczematous & Papulosquamous Disorders Flashcards
Papulosquamous disease presentation and types
Present w/ papules and scales
Lichen planus
Pityriasis rosacea
Eczematous disease presentation
Present w/ scaling, crusting, serous oozing
Dermatitis - covers multiple types of skin diseases
Atopic dermatitis - AKA eczema
either impaired barrier function or immune function disorder where cells mount inflammatory response to environmental factors
Hallmark = pruritis - causing eczematous change and lichenification - lesions may crust, ooze, become purulent
Adults: neck, wrists, behind ears, flexure areas
Children: adults + cheeks & face
Chronic atopic dermatitis - may lose pruritis but lichenification remains
Atopic Dermatitis Treatment
Eliminate exacerbations
Antihistamines for pruritis
1st line: hydration w/ greasy ointment
Consider topical steroids in older kids & adults
2nd line: topical calcineurin inhibitors - BBW cancer risk
Nonresponsive: phototherapy or immunosuppressants
Nummular eczema
Coin-shaped lesions
Treat like atopic dermatitis - r/o ringworm 1st
Usually on trunk and lower extremities
Lichen Simplex Chronicus
Result of chronic eczematous changes and scratching
Circumscribed plaque w/ thickened skin and marks w/ scales
Lesions may regress if scratching stops
Dyshidrotic Eczema
Unknown cause
Vascular eruptions on sin of hands & feet w/ intense itching & deep vesicles
-Scaling, fissures, lichenification may follow
Tx: high potency topical steroids (due to depth), hydrate w/ emollient cream, consider occlusion
Contact Dermatitis
Direct exposure to substance - causes allergy/irritation
Commonly plant, nickel, preservatives
-Intense pruritis, rash, papular erythematous lesion from fluids in epidermis - get vesicles and oozing if severe
Exposure w/ chemical = immediate rxn; plant = can get rxn up to 2 wks later
Antihistamines relieve itching, not rash
Tx: topical steroids, Burrow’s solution
Diaper Dermatitis & Yeast Infections
wetness, friction, pH elevation - activates proteolytic enzymes which damage skin
Diaper dermatitis = erythema, starts in areas of contact
Yeast = satellite lesions, in creases, very painful
Tx: w/o yeast - frequent changes, barrier treatment - Vaseline, Desitin
w/ yeast - topical antifungal (nystatin), barrier treatment, no steroids
Perioral Dermatitis
Strong correlation w/ topical and intranasal steroid use
1-2 mm clustered erythematous papules w/ or w/o scale
Not as sick/tender/swollen as erysipelas
Tx: self-limiting; 1st line: Metronidazole, Erythromycin, topical calcineurin inhibitor
-Moderate/Severe = systemic agent - tetracyclin, doxy, erythromycin (kids)
Seborrheic Dermatitis
May be widespread in HIV & Parkinsons
Erythematous scaling patches in areas of sebaceous glands - scalp, face, trunk
Saprophyte infection by Malassezia-Pityrosporum Ovale
Erythema, swollen/greasy, scale, pruritis on lateral nose eyebrow, scalp - always r/o yeast
Tx: Scalp - Antiproliferative shampoo/antifungal shampoo
Non-scalp - ketoconazole, Ciclopirox, Tacrolimus, Pimecrolimus
-Low potency topical steroids for 1-2 wks
Stasis Dermatitis
Blood pooling due to chronic venous insufficiency
Increased capillary pressure
Hemosiderin from blood cells can stain skin - develop ulcers
Tx: Prevent edema & pooling w/ compression stockings & elevation
Lichen Planus
Unknown cause, middle-aged adult - hits skin, oral, genitals, scalp, nails, esophagus
Shiny, flat, polygonal violaceous papules/plaques w/ whole lacy pattern
Dx: always biopsy
Tx: High/Super high potency intralesional corticosteroids
-Phototherapy w/ acitretin if widespread
Pityriasis Rosea
Likely viral, self-limiting
Herald patch 1st w/ multiple new lesions on central trunk
Oval w/ long axis paralleling lines of skin stress
Resolve in 6-10 wks, +/- pruritic, not contagious
Tx: medium potency topical steroid
-Acyclovir, phototherapy if severe
