Inflammatory Dermatoses

Question 1

you see a baby with a square red rash on his outer hip

Answer 1

Allergic Contact dermatitis

Question 2

key clinical features of ACD?

Answer 2

linear/geometric shape
eryth papules/plaques, +/- vesicles/crust
ITCHING

Question 3

Examples of ACD

Answer 3

diaper rash, poison ivy, nickle in belt allergy, fragrance, formaldehyde, vit e, rubber, topical antibiotic

Question 4

workup on ACD?

Answer 4

Usually none. If UNKNOWN/CHRONIC cases of ACD, patch testing to ID, avoid allergens

Question 5

most appropriate tx for ACD

Answer 5

1. stop contact allergen
2. topical steroids if mild/chornic
3. severe/ widespread/ acute: oral steroids maybe
4. oral antihistamines maybe to help itch

Question 6

rule of giving oral steroids

Answer 6

must give >2-3 weeks because if shorter, rebound can occur

Question 7

Key features of young child with atopic dermatitis

Answer 7

eryth scaly plaques on cheeks, forehead, extensor. XEROSIS, PRURITIS

Question 8

key features of older child with atopic dermatitis

Answer 8

lichenified plaques on flexural surfaces. XEROSIS, PRURITIS

Question 9

adults with atopic dermatitis

Answer 9

common to have hand dermatitis. XEROSIS, PRURITIS

Question 10

Tx for atopic dermatitis

Answer 10

1. topical steroids (low potency usually. NO oral. 2nd line is tacrolimus)
2. emollients (vaseline)
3. elim. s aureus w bleach bath

Question 11

complications of atopic dermatitis

Answer 11

eczema herpeticum (punched out ulcers). IV acyclovir
Or secondary staph/strep infetion. antibiotics (mild: topical, severe: IV)

Question 12

what is eczema herpeticum

Answer 12

complication of atopic dermatitis. tx with IV acyclovir

Question 13

key features of urticaria

Answer 13

eryth, edmatous papules and plaques (wheals); surr by red halo

individ lesions last <24hr

Question 14

workup of urticaria

Answer 14

acute? probs medicine or food allergy. more likely than chronic.

Question 15

tx urticaria

Answer 15

H1 antihistamines

Question 16

potential complication of urticaria, workup, tx

Answer 16

ANAPHYLAXIS. asses airway and tx with epinephrine!

Question 17

fixed drug eruption key features

Answer 17

• eryth round patch, usually single, possible bulla
• heals w hyperpigmentation
• same place every time

Question 18

common causes of fixed drug eruption

Answer 18

laxatives, NSAIDS, tetracyclines, metronidazoles, sulfonamides, bariturates, salicylates, yellow food coloring

Question 19

what does DRESS stand for

Answer 19

drug rxn w eosinophilia, systemic symtpoms. Basically drug-induced H/S rxn

Question 20

key features of DRESS

Answer 20

morbilliform eruptions, FACIAL EDEMA, fever, LAD, malaise, >70% w eosinoph. Internal organ involvement.

Question 21

next step after dx DRESS

Answer 21

CBC w diff’l
liver function panel
BUN/crt
recent drug hx

Question 22

causes of DRESS

Answer 22

anticonvulsants, allopurinol, antibiotics, isoniazid, NSAIDS, anti HIV

Question 23

3 forms of epidermal necrolysis spectrum

Answer 23

SJS 30% BSA

Question 24

key features of SJS/TEN

Answer 24

eryth –> DUSKY macules which coalesce to form flaccid bullae
+ Nikolsky sign
mucosal involvement (ocular, oral, genital).
Epid necroses off, see red dermis under. can expand to entire body rapidly

Question 25

common causes of SJS/TEN

Answer 25

sulfa antibiotics! allopurinol, anticonvuls, NSAID, tetracycline, nevirapine, thiacetazone

Question 26

most important step in tx SJS/TEN?

Answer 26

STOP causative agent

Question 27

SJS/TEN tx

Answer 27

stop all nonessential medicines
supportive care
burn unit?
IVIg
multidisc: opthal, gyne, urology, etc