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ECZEMATOUS & PAPULOSQUAMOUS DISORDERS Flashcards

1
Q

“HERALD PATCH”

A

pityriasis rosea

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2
Q

Christmas tree distribution rash

A

pityriasis rosea

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3
Q

PITYRIASIS ROSEA ETIOLOGY

A

unclear, but likely viral

is self-limiting

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4
Q

PITYRIASIS ROSEA

A
  • ETIOLOGY = unclear, but likely a viral source
  • is self-limiting
  • *First sign = “HERALD PATCH” –> then multiple new lesions appear, usually on the central trunk
  • *may appear as a “christmas tree distribution” on the back
  • lesions are often oval with long-axis paralleling the lines of skin stress
  • lesions resolve in 6-10 weeks
  • may be pruritic
  • not contagious

TREATMENT
if needed for pruritus = give medium potency topical steroids
Acyclovir or Phototherapy for severe cases

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5
Q

first sign of pityriasis rosea

A

herald patch –> then multiple new lesions appear, usually on central trunk

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6
Q

is pityriasis rosea contagious?

A

NO

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7
Q

treatment for pityriasis rosea

A

TREATMENT
if needed for pruritus = give medium potency topical steroids
Acyclovir or Phototherapy for severe cases

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8
Q

Wickham’s Striae

A

Lichen Planus

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9
Q

Polygonal

A

Lichen Planus

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10
Q

1st line treatment for lichen planus

A

topical corticosteroids (high or super-high potency)

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11
Q

Lichen Planus Treatment

A

⦁ 1st line = Topical corticosteroids (high or super-high potency) on trunk / extremities

⦁ Intralesional steroid injections can be useful in patients with hypertrophic lichen planus

⦁ Patients with widesprerad cutaneous disease may benefit from phototherapy, Acetretin (Psoriatane - systemic retinoid), or a short course of systemic glucocorticoids

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12
Q

STASIS DERM TREATMENT

A

TREATMENT = aimed at prevention of edema & blood pooling with compression stockings & elevation of the legs

o Skin cleansing, emollients, topical steroids for pruritus, wet dressings for crusts or open lesions

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13
Q

what causes stasis dermatitis

A
  • occurs from blood pooling in lower extremities due to chronic venous insufficiency
  • increased pressure in the capillaries with subsequent extravasation (leaking out)
  • Hemosiderin from the blood cells stain the skin
  • can develop venous stasis ulcers
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14
Q

__________ from the blood cells stain the skin in stasis derm

A

HEMOSIDERIN

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15
Q

Seb Derm may be widespread in ______ & ________

A

HIV & Parkinson’s disease

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16
Q
  • Have erythematous scaling patches that develop in areas of sebaceous glands (scalp / face / trunk)
A

seborrheic dermatitis

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17
Q

Malassezia furfur (pityrosporum ovale)

A

tinea versicolor & seborrheic dermatitis

seb derm = hypersensitivity to malassezia

tinea versicolor = overgrowth of malassezia

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18
Q

Thought to be caused by Saprophyte infection by Malessezia (aka pityrosporum ovale)
⦁ colonization noted on the skin of affected individuals
⦁ normal skin flora but to a lesser degree

A

seb derm

thought to be a hypersensitivity to Malessezia

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19
Q

clinical manifestations of seb derm

A 
⦁	erythema (reddish or pink color)
⦁	swollen & greasy appearance
⦁	white or yellowish scale
⦁	some pruritus
⦁	Distribution = Lateral sides of nose, eyebrows, glabella, scalp, and can also involve the chest, upper back, and axillae
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20
Q

DIAGNOSIS OF SEB DERM

A

usually can be made by physical exam

  • on Biopsy = have
    ⦁ Mounds of parakeratotic scale around hair follicles
    ⦁ Mild superficial inflammatory cell infiltrates of lymphocytes
    ⦁ Increased # of Malessezia furfur spores in stratum corneum
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21
Q

Seb derm treatment for scalp

A

o Scalp = T-gel, Selenium sulfide (Selsun blue), Zinc Pyrithione (Head & shoulders, DHS)

Ketoconazole 2% (rx > 1% OTC) or Ciclopirox shampoo 1%
⦁ use shampoo 2x/week x 4 weeks, then prn for maintenance

22
Q

seb derm treatment for skin

A

o Skin = Ketoconazole 2% cream or gel (BID x 4 wks), Ciclopirox 1% cream (BID x 4 weeks, then QD x 4 weeks),

Tacrolimus 0.03%, Pimecrolimus 1% cream

  • Severe cases = add low potency topical corticosteroid x 1-2 weeks, then taper off to prn
23
Q

perioral dermatitis Etiology = unknown, but does have a strong correlation with _________

A

topical steroid use

24
Q

clinical manifestations of perioral dermatitis

A

⦁ 1-2 mm clustered erythematous papules, papulovesicles or papulopustules with or without scale
⦁ occurs most often around the mouth, spares the vermillion border
⦁ can be asymptomatic, or associated with burning or stinging

25
FINDINGS SUGGESTIVE OF PERIORAL DERM
⦁ sparing of skin adjacent to vermillion border ⦁ co-existing feature of eczematous dermatitis ⦁ burning/stinging ⦁ recent use of topical, nasal or inhaled steroids ⦁ hx of lesions worsening after withdrawal of steroids in the past diagnosis = clinically based on PE and above hx
26
perioral dermatitis treatment
- may resolve on its own - FIRST LINE = topical calcineurin inhibitor (Protopic, Elidel), or topical Erythromycin or topical Metronidazole - for moderate to severe cases = systemic agents: Tetracycline, Doxycycline or Minocycline - systemic therapy for KIDS = ERYTHROMYCIN
27
first line tx for perioral dermatitis
topical calcineurin inhibitors (protopic / elidel) topical erythromycin topical Metronidazole
28
systemic therapy for perioral dermatitis in kids
ERYTHROMYCIN
29
diaper dermatitis caused by a combination of
wetness, pH elevation and friction a secondary infection may occur with Candida albicans
30
elevated pH activates _______ enzymes that injure the skin
proteolytic elevated pH activates proteolytic enzymes that injure the skin
31
clinical presentation of diaper dermatitis
⦁ erythema in diaper area ⦁ if predominantly in the creases and satellite lesions are present = most likely dealing with a candidal infection as well ⦁ need to determine if rash is from wetness, irritation from the diaper, or yeast infection
32
treatment for diaper dermatitis without candida infxn
frequent diaper changes, and barrier treatment with Vaseline or Desitin
33
treatment for diaper dermatitis with candida infxn
topical antifungals such as: Nystatin, Miconazole or Clotrimazole. Barrier lubricants such as Vaseline; No steroids!
34
treatment of thrush (oral candida)
o Thrush ⦁ Nystatin ⦁ Clotrimazole
35
treatment of intertrigo (cutaneous candida)
o Skin ⦁ Nystatin powder for macerated areas ⦁ Clotrimazole (Lotrimin), Ketoconazole ⦁ if failure of topical therapy = give oral fluconazole (diflucan)
36
cause of contact dermatitis
- direct exposure to a substance --> allergy or irritation - most common plant causes in North America = Oleoresin Urushiol = found in Poison ivy, poison oak, poison sumac, skin of mangoes, gingko fruit - may spread from pets or from oils trapped under fingernails Other common allergens ⦁ Nickel (jewelry, buttons, belts) ⦁ Formaldehyde, quanternium-15 (clothing, nail polish) ⦁ perfumes, cosmetics ⦁ preservatives (topical medications, cosmetics) ⦁ rubber & chemicals in shoes ⦁ topical hydrocortisone, topical antibiotics (neomycin, bacitracin), topical meds (benzecaine, thimersol) ⦁ Laundry detergents - may be a rare cause
37
CLINICAL PRESENTATION OF CONTACT DERMATITIS
⦁ intense pruritus ⦁ rash ⦁ papular, erythematous lesions ⦁ papules from fluid in the epidermis and in severe cases produces vesicles & serous oozing - exposure may have been as far back as 2 weeks ago - may develop a rxn to products that you have used for months to years
38
TREATMENT OF CONTACT DERMATITIS
TREATMENT o Plant-based Contact Dermatitis ⦁ symptomatic therapy - oatmeal baths, cool/wet compresses, Calamine lotion, Burrow's or domeboro solution for weeping lesions, Zanfel soap ⦁ Antihistamines - used for sedation, as this is NOT due to histamine release ⦁ Topical Corticosteroids: high potency = Clobetasol ⦁ Systemic Steroids if needed for large areas, face or genitals = give 2-3 week taper of prednisone o Treatment of Contact Dermatitis ⦁ remove offending agent ⦁ topical symptomatic therapy ⦁ medium to high potency topical steroids = Clobetasol cream ⦁ Systemic steroids in severe cases (> 10% BSA) = medrol dose pack or prednisone taper ⦁ Burrow's solution for weeping blisters ⦁ Antihistamines for treatment of pruritus ⦁ treat any recognized secondary bacterial infections
39
dyshidrotic eczema
- Cause = unknown - Vesicular eruption on the skin of hands & feet - marked by intense itching - vesicles are deep - scaling, fissures and lichenification may follow Triggers = sweating, emotional stress, warm & humid weather, metals (nickel)
40
treatment for dyshidrotic eczema
- High potency topical steroids - may need to be given with occlusion - hydration of skin with emollient cream
41
-term used to describe what occurs as a result of chronic eczematous changes and scratching
Lichen Simplex Chronicus
42
Lichen Simplex Chronicus
- term used to describe what occurs as a result of chronic eczematous changes and scratching - circumscribed plaque of thickened skin with increased markings with some scaling - stop the scratching and lesions may regress
43
- eczema (atopic dermatitis) that is described as coin shaped lesions
nummular eczema
44
2 pathogenesis theories for atopic dermatitis (eczema)
- 2 theories 1) Impaired epidermal barrier function due to intrinsic structural & functional abnormalities in the skin; abnormal epidermal barrier = primary defect 2) immune function disorder in which Langerhans cells, T-cells and immune effector cells modulate an inflammatory response to environmental factors
45
hallmark of atopic dermatitis
pruritus
46
locations of eczema for adults & children
o ADULTS = location: neck, wrists, behind ears, antecubital & popliteal flexure areas o CHILDREN = all the above areas + cheeks/face
47
atopic dermatitis treatment
o Eliminate exacerbating factors (triggers: heat, low humidity, perspiration, stress, anxiety) o Antihistamines used to treat pruritus ⦁ Doxepin or Vistaril = antidepressants with antihistamine SE o HYDRATION, HYDRATION, HYDRATION!!! o Topical steroids o Burrow's solution for oozing lesions o Treat skin infections when appropriate FOR MILD/MODERATE CASES - topical corticosteroids & emollients ⦁ topical steroids can be applied 1-2x daily x 2-4 weeks ⦁ for mild/mod = use low potency steroid cream/ointment = Desonide or HC ⦁ Mod cases = use medium to high potency steroids = fluocinolone, TAC, betamethasone - for patients who require therapy to the face or skin folds for more than 3 weeks = can treat with protopic / elidel ⦁ less SE ; can be used BID ⦁ as effective as medium potency topical steroids ⦁ immunomodulators
48
SE OF TOPICAL STEROIDS
``` ⦁ atrophy ⦁ telangiectasias ⦁ purpura ⦁ striae ⦁ acneform eruption ``` - the higher the potency of the steroid, the more likely to have SE - limit higher potency steroids to no more than 45g/week x no longer than 2 weeks - use less potent steroids for the face, dorsum of hands and genitalia - only use low potency preparations around the eyes
49
BBW OF TOPICAL CALCINEURIN INHIBITORS
***may increase incidence of skin cancer & lymphoma with long term use
50
2nd line atopic derm agents
topical calcineurin inhibitors
51
when and when not to use topical calcineurin inhibitors
- not for use under age 2, and not for continual use - not for use in immunocompromised patients - use for lesions on the face, eyelids, neck & skin folds (as steroids cause more atrophy here)
52
if contact dermatitis is caused by an irritant, the reaction is usually ____________ if caused by an allergen, rxn may be _________
immediate delayed

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