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DERM > Excematous Dermatoses > Flashcards

Excematous Dermatoses Flashcards

1
Q

atopic dermatitis - pathogenesis

A
  • mutation in filaggrin (component of stratum cornuem), resulting a barrier dysfunction defect of epidermis characterized by
    • water loss & xerosis (dry skin) leading to
      • -> penetration of allergens / irritants
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2
Q

atopic dermatitis - demographics

A
  • high income / urban areas (hygeine hypothesis)
  • early onset - almost all by cases by 5 yrs
  • mostly in children
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3
Q

what is the atopic triad?

A
  • a triad that is the most common way in which atopic dermatitis tends to present =
    • atopic dermatitis
    • allergic rhinitis
    • asthma
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4
Q

atopic dermatitis - diagnosis

A
  • requires the following clinical presentation
    • pruritis during all stages + 3 of the following:
      • onset < 2 yrs
      • hx of xerosis (dry skin)
      • hx of another component of atopic triad: rhinitis OR asthma
      • hx of skin crease involvement
      • visible flexural dermatitis
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5
Q

atopic dermatitis - infantile presentation

A
  • infantile = 0 - 6mos
    • acute flares
    • favors face + scalp + extensor surfaces
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6
Q

atopic dermatitis - childhood presentation

A
  • childhood = 2 yr - 12 yr
    • chronic > acute
    • factors flexures
    • diffuse xerosis more prominent
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7
Q

atopic dermatiits - adult presentation

A
  • adult / adolescent = > 12 yo
    • prominent involvement of flexures
    • characterized by thickened, chronic plaques
      • lichenified plaques - cobblestoned appearance in areas of itching
      • isolated prurigo nodularis - plaques in regions of itching
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8
Q
A

infantile dermatitis:

  • 0-6 mos
  • acute flares on face + scalp + extensor surfaces
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9
Q
A

atopic dermatitis - childhood

  • 2 yrs - 12 yrs
  • favors flexures
  • diffuse xerosis prominent
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10
Q
A

lichenification - cobblestoning plaques over skin that has been scratched

adult atopic dermatiits

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11
Q
A

isolated prurigo nodularis - plaques where pt has been itching (in right pic, patient’s upper back has no plaques b/c he can’t reach there to itch)

atopic dermatitis - adults

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12
Q
A

atopic dermatitis - associated feature

  • pityriasis alba: hypopigmentation
    • more prominent in the summer
    • clears up w/ topic steroids
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13
Q
A

atopic dermatitis - associated feature

  • keratosis pilaris - improves with age
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14
Q
A

atopic dermatitis - associated feature

  • impetiginized lesions: infections of lesions d/t constant scratching
    • staph infection = m/c (can also be d/t HIV)
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15
Q
A

atopic dermatitis - associated features

  • dennie-morgan lines - “pleat” under the eye
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16
Q
A

atopic dermatitis - associated feature

  • keratoconus - cone shaped cornea
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17
Q
A

atopic dermatitis - associated feature

  • allergic salute: permanent crase on the bridge of nose d/t constant runny nose & subsequent rubbing
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18
Q
A

atopic dermatitis - associated feature

  • sign of hertoghe: loss of lateral brow
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19
Q
A

atopic dermatitis - associated feature

  • ichthyosis vulgaris: “fish like scale” - polygonal white & brown scaling that favors the shins
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20
Q
A

atopic dermatitis - associated feature

  • palmar & plantar hyperlinearity
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21
Q

summarize the associated features of atopic dermatitis

A
  • pityriasis
  • keratosis pilaris
  • impetiginized
  • dennie-morgan lines
  • keratoconus
  • allergic salute
  • ichthyosis vulgaris
  • palmar & plantar hyperlinearity
22
Q
A
  • nipple dermatitis
    • an example of a regional variant of atopic dermatitis
    • bilateral dermatitis of the nipple
      • if it is instead UNILATERAL: be sure fo consider paget’s disease!!
23
Q
A
  • diapaer / napkin dermatitis
    • _a regional varian_t of atopic dermatitis
    • note that this sparing of the flexural crease - as opposed to candida, which causes all encompassing erythema that includes folds & flexural creases
24
Q

summarize the prevenative treatment of atopic dermatiits

A
  1. use of emolliants: THIS IS KEY - find an emolliant ur pt likes & can use for awhile
  2. short, lukewarm baths: too hot = dry skin
  3. bleach baths (1/3 bleach 1-2x/ week)- esp if pt has hx of skin infection (staph)
  4. wet dressing
  5. AVOID:
    • fragrance filled products
    • irritants

+ in pregnant women: breastfeed with hydrolyzed milk products + use probiotics

25
Q

what are the ways that women can prevent atopic dermatitis in their newborns?

A
  • breastfeeding/formulas that contain hydrolyzed milk products for the first 4-6 mos (esp in high risk)
  • take probiotics pre & post naatl
26
Q

summarize the medical treatment of atopic dermatitis

A

in general: treatment ladder, starting with the best:

  1. topical corticosteroids - mainstay of treatment!!
    • ​steroids -> non-steroidal maintance: calcinurin inhibitors, PDE-4 inhibitors
      • ​this prevents steroid AEs
  2. light therapy - nbUVB > bbUVB, UVA1, PUVA
  3. systemic meds

for flare ups specifically:

  • topical steroids: but can alternate between potent & low/medium strengths
    • clobetasol/betmethasone BID s 2 weeks, then
    • triamcinolone BID x 2 weeks
27
Q

what is the medical treatment for atopic dermatis flares?

A
  • topical steroids: but can alternate between potent & low/medium strengths
    • clobetasol/betmethasone BID s 2 weeks, then
    • triamcinolone BID x 2 weeks
28
Q

steroids

  • have what adverse effects (AE) ?
  • how do we lessen these AES in the management of atopic dermatitis ?
A
  • AEs
    • atrophy / stretch marks
    • acne
    • tachyphylaxis
    • fungal infections (tinea incognito)
      • ​steroids C/I to tx fungal infections
  • steroid AES are lessened by:
    • eventually switching to non-steroidals: calcinurin, PDE-4 inhibitors)
    • alternating between high & lose dose topicals in acute-flare ups
29
Q

atopic dermatits - prognosis

A

50% remit by early adulthood. if it does persistent beyond childhood, it tends to be chronic

30
Q
A

steroid AE: steroid induced acne

31
Q
A

steroid AE: steroid-induced atrophy

32
Q
A

steroid AE: steroid induced atrophy

33
Q
A

steroid AE: steroid induced atrophy (stretch marks(

34
Q
A

steroid AE: steroid induced atrophy

35
Q
A

steroid AE: steroid induced atrophy (stretch marks)

36
Q
A

tinea incognito: a fungal infection + steroid

do NOT use steroids to tx a fungal infecgtion

37
Q

asteototic dermatitis

  • is also called?
  • pathogenesis
  • demographics
  • presentation
  • management
A
  • also called eczema craquele: “cracked porcelain”
  • pathogenesis: elderly people have less natural moisturizing factors. in winter, when humidity is low, water loss -> xerosis with fine cracking
    • demographics:
      • elderly people
      • winter time
  • presentation:
    • pruritic
    • erythema + scaling
    • favors lower legs
  • treatment: just like AD
    • prevention: emolliants
    • tx: topical steroids
38
Q
A

asteototic dermatitis (eczema craquele)

39
Q

circumostomy eczema

  • pathogenesis
  • demographics
  • presentation
  • treatment
A
  • pathogenesis: type of irritant contact dermatitis in which fectal matter -> skin breakdown
  • demographics: had an ostomy
  • presentation: see photograph
  • treatment:
    • proper hygeine
    • appliance: must be hypoallergenic & cut proplerly
40
Q

dyshidrotic eczema

  • pathogenesis
  • demographics
  • presentation
  • treatment
A
  • pathogenesis: symmetrical hand & foot vesicles d/t either allergic contact > fungal infection
  • demographics: n/a
  • presentation: vesicles (< 1 cm blisters) that
    • are on hand & feet
    • are symmetrical
    • appear “tapioca like”
    • ARE PAINFUL (chief complaint) +/- puritis
  • treatment: topical steroids
41
Q

hand eczema

  • pathogenesis
  • demographics
  • presentation
  • treatment
A
  • pathogenesis: dermatitis d/t water exposure to hands
  • demographics: those w/ exposure to water:
    • occupation involving wet work
    • 20-29 females from child care / housing cleaning
    • *possible link to with filagrin mutation
  • treatment:
    • general: avoidance:
      • wash hands infrequently !!
      • wear rubber cloves when cleaning
    • flares topical steroids under gloves to 3 nights
42
Q

juvenile plantar dermatosis

  • pathogenesis
  • demographics
  • presentation
  • treatment
A
  • pathogenesis: prologed wearing of sports shoes -> irritates plantar surface of forefoot
  • presentation: plantar surface of forefoot that is dry, scaly & glazed
  • demographics: preburbital children >3
    • esp those with atopic diathesis
    • esp in the winter
  • treatment: replace socks with 100% cotton socks
43
Q

nummular eczema

  • pathogenesis
  • demographics
  • presentation
  • treatment
A
  • pathogenesis: unknown
  • demographics: n./a
  • presentation: round, coin shaped pink plaques that are
    • m/c on the extremities
    • very pruritic
  • treatment: mid-high potency steroids
44
Q

stasis dermatitis

  • pathogenesis
  • demographics
  • presentation
  • treatment
A
  • pathogenesis: incompetent valves of the lower extremities: HTN overrides capillaries -> capillary leak -> extravasation of fluid & blood contents into ECF
  • demographics: n/a
  • presentation: pitting edema & demosiderin deposits that are
    • ​over distal third of leg beginning at the median ankle
    • can evolve to lipodermatosclerosis: “inverted wine bottle”
  • treatment: compression stockings
45
Q
A

circumostomy eczema

46
Q
A

dyshidrotic eczema

“tapioca-like”, pruritic vesiscles that are symmetrical over the hand & foot

47
Q
A

juvenile plantar dermatosis

dry, scaly, glazed plantar surface of the forefoot

48
Q
A

juvenile plantar dermatosis

dry, scaly, glazed plantar surface of the forefoot

49
Q
A

nummular eczema (discoid eczema)

round, coin shaped pink plaques over the extremities

50
Q
A

stasis dermatitis

pitting edema & hemodiersin deposits over distal third of leg (starting at medial ankle)

DERM (6 decks)

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