Inflammatory Disorders of the Skin Flashcards
Case 1
A 6-year-old girl presents for this itchy condition that has been present since she was a baby. What other conditions have been reported to be associated with it?
Tinea corporis
Asthma
Angioedema
Allergic rhinitis
A,B
B,C
C,D
B,D
None of the above
B,D (Asthma and allergic rhinitis. Atopic march: atopic dermatitis asthma allertic rhinitis)
Atopic Dermatitis
Most common chronic inflammatory skin disease
Usually begins in infancy but occasionally develops during adulthood
Often accompanied by other atopic disorders such as asthma and allergic rhinitis
Chronic or chronically relapsing course
Pathogenesis: complex genetic and environmental predisposing factors
Mutations in filaggrin gene predispose due to skin barrier dysfunction
Clinical Features
Atopic Dermatitis
Intense pruritus
Sites of involvement vary by age group
Infants: predilection for face
Children/adults: predilection for flexural areas of extremities
Disease course
Acute: erythema, vesicles, bullae, weeping, crusts
Subacute: scaly papules and plaques, erosions, crusts
Chronic: lichenification, scaling, hyper-and hypopigmentation
What is the diagnosis?
Seborrheic Dermatitis
Infantile (cradle cap) and adult forms
Lesions favor the scalp (dandruff), ears, nasolabial folds
Areas with high sebum production
Dryness, pruritus, erythema, and greasy scaling
Etiology: active sebaceous glands, abnormal sebum composition, and Malassezia ( Pityrosporum ) spp
Can be a cutaneous sign of HIV infection
Treatment: topical antifungals and corticosteroids
What is the diagnosis?
Bites
Bullous pemphigoid
Allergic contact dermatitis
Acute atopic dermatitis
None of the above
Allergic contact dermatitis
Allergic Contact Dermatitis
•Delayed type IV hypersensitivity reaction•Well demarcated borders and localization to the site of contact with the allergen, suggestive of an external cause•Poison ivy: linear•Fragrance: neck, behind ears, wrists•Nickel: abdomen (belt buckle), wrists (watch)•Neomycin/bacitracin: ”worsening” superficial skin infection•Patch testing remains the gold standard for diagnosis
Nickel Dermatitis
Patch Testing
- Panels with pre-impregnated allergens are placed on the back
- Two readings to check for reaction
s•First reading: 48 hours
•Second reading: 72 hours to 1 week to assess for delayed reaction to some allergens (e.g., gold, neomycin, and corticosteroids)
What is the diagnosis?
Acne Vulgaris
•Chronic inflammatory condition of the pilosebaceous unit•Pathogenesis•Hormonal influences on increased sebum production•Follicular hyperkeratinization•Proliferation of the bacterium Cutibacterium acnes•Inflammation•Typically begins at puberty due to androgen stimulation of the pilosebaceous unit and changes in keratinization at the follicular orificeCan last through adulthood
Clinical Features- Acne Vulgaris
Treatment- acne vulgaris
Rosacea
•Chronic inflammatory condition with a relapsing-remitting course•Middle-aged women > men (except rhinophyma)•More common in lighter skin types but may be underdiagnosed in individuals with darker skin due to difficulty in discerning erythema and telangiectasias•Etiology: vascular changes, UV and microbial exposure (increase demodex mites in pilosebaceous unit) all play roles
Clinical Features Roscea and types
- Characterized by erythematous papules and pustules, no comedones(differentiates it from acne)•Facial flushing in response to external stimuli (e.g., alcohol, heat, etc).•Four types
- Erythematotelangiectatic: erythema, telangiectasias and flushing
- Papulopustular: Erythema, papules and pustules
- Phymatous: Thickened skin and sebaceous hyperplasia with a cobblestoned appearance, most commonly on the nose (rhinophyma)
- Ocular: Symptoms of gritty sensation, dryness, tearing, etc, often nonspecific
Treatments Rosacea
•Identify and avoid triggers•Sunscreen and photoprotection•Topicals (metronidazole, azaleic acid, ivermectin, α2-adrenergic agonist)•Oral antibiotics•Laser
Pseudofolliculitis Barbae
•“Shaving or razor bumps”•More common in men of African descent with curly hair in the beard area•Close shaving causes hair to curve back into the skin, leading to foreign body inflammatory reaction (next slide)•Lesions include papules, pustules, keloidal scars and hyperpigmentation•Exacerbating factors: razors with multiple blades, tweezing hair, shaving against the grain of hair growth, and pulling the skin taut while shaving•Treatment: stop shaving, optimize shaving techniques, laser hair removal
Pathogenesis of pseudofolliculitis
A 29-year-old woman reports a 2-week history of itchy bumps that appear suddenly, last <24 hours, and disappear. She reports that she was sick with an upper respiratory illness before they appeared. Otherwise, she is healthy and does not take any medication. Which of the following is the most likely diagnosis?
A.BitesB.Bullous pemphigoidC.Contact dermatitisD.Viral exanthemE.UrticariaF.AngioedemaG.Erythema multiforme
A.Urticaria
What is the diagnosis?
Melasma
•Acquired disorder of hyperpigmentation•More common in women with darker skin types•Pathogenesis: UV radiation and hyperestrogenism (pregnancy and hormonal contraception)•Sun-exposed areas of the face•Irregularly bordered, evenly pigmented tan macules and patches•Treatments•Strict photoprotection•Topicals (retinoids, hydroquinone, azelaic acid, cosmeceuticals)•Chemical peels, oral tranexamic acid, laser•Recurrence is common
PFB
AD
Rosacea
SD
urticaria
SD
AD
Melasma
Rosacea
ACD poison ivy
ACD to nylon
