Inflammatory Skin diseases Flashcards
Stasis Dermatitis
With which part of the body is this skin disease related to the most?
What are some differences between stasis dermatitis and cellulitis?
–> Often seen in association with other signs of venous insufficiency of the lower extremities.
Complicating Factors
- Dryness
- Itching
-Contact dermatitis
–>Allergic due to use of topical preparations (i.e. topical antibiotics)
–>Irritant due to wound exudates
It is important to distinguish stasis dermatitis from cellulitis. Both may be warm and erythematous. The difference is that there are epidermal changes of *scaling in stasis dermatitis whereas the edema from cellulitis is dermal in nature. Additionally, stasis dermatitis may be more itchy than painful. Chronic lower extremity edema can lead to stasis ulcer formation usually near the medial ankle (above the medial malleolus). Applying topical antibiotics to lower extremity ulcers can lead to allergic contact dermatitis. Prevention of stasis dermatitis involves the use of compression hose to and leg elevation to prevent the lower extremity edema.
Venous Stasis Ulcers
Where are they usually found? What color?
- Primarily found on the medial lower leg just above the ankle
- Red in color with yellow fibrinous base.
- Borders irregularly shaped
- They may be purulent if infected
What is the treatment for stasis dermatitis?
-Treatment:
–>Compression
–>Elevation
–>Exercise calf muscles
–>Vascular surgery
–>Topical steroids
–>Avoid allergens
Difference between stasis dermatitis and cellulitis:
Which one involves erythematous papules and thin plaques with scale, and often involves the epidermis and dermis?
Which one involves warm, tender, erythematous patches or plaques but not a lot od scaling of the skin?
Atopic Dermatitis
What it atopic diathesis?
- Common skin disease which may begin at any age, however a majority begin before age 5.
- Atopic Diathesis (Atopic dermatitis runs in families with a history of asthma and allergic rhinitis in addition to eczema and this is referred to as the “atopic diathesis”):
- Asthma
- Allergic rhinitis
- Atopic dermatitis
Characteristic involvement of flexural skin:
- Antecubital fossa
- Popliteal fossa
- Neck
- Wrists
- Ankles
Atopic dermatitis diagnostic criteria:
- Must have: Itchy skin +Plus
- Three or more of the following:
- Onset under 2 years of age
- History of involvement of skin creases
- Personal history of asthma or hay fever
- History of dry skin within the last year
- Visible flexural eczema
Atopic dermatitis in adults
In adults, it may present as eyelid or hand dermatitis with or without involvement of other flexural surfaces.
Atopic Dermatitis
Infantile (Birth – 2 years)
Characterized by dry, red scaly areas confined to the_______.
- Dry, red scaly areas confined to the cheeks.
- Becomes flushed with exposure to cold**
Atopic dermatitis associated features:
**Dermatitis is also referred to as eczema**
- Dry Skin (Xerosis)
- Keratosis Pilaris (Keratosis pilaris is a common skin condition, which appears as _tiny bumps on the ski_n. Some people say these bumps look like goosebumps or the skin of a plucked chicken. Others mistake the bumps for small pimples).
- *Ichthyosis vulgaris
- **Hyperlinearity of the palms**
Irritant Contact Dermatitis
Non-immunologically mediated reaction resulting from a direct cytotoxic effect
- Either from a single or repeated exposure to the irritant
- There is no specific “test” for irritant dermatitis
- Irritant contact dermatitis is the most common type of contact dermatitis.
- Strong irritants damage skin directly even in small amounts contacting the skin for a short time (i.e. strong acids and bases).
-Strong irritants generally carry warning labels and often suggest skin protection such as gloves be used.
-Weak irritants are “harmless” by themselves, but frequent, repeated contact may damage skin.
Irritant contat dermatitis can lead to __________.
Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation
Allergic Contact Dermititis
Requires exposure to allergen, immune response and development of ________.
What cells present allergen to T cells?
- Requires contact exposure of an allergen, immune response and development of “memory” T cells
- Type IV, delayed-type hypersensitivity reaction usually starts 24-48 hours after exposure to the allergen, but it can be delayed longer.
- Allergens are small chemical molecules (haptens) usually < 500 Daltons
- Small size allows penetration through skin.
- Langerhans cells present allergen to T cells
- Most haptens are weak allergens and require repeat exposures prior to sensitization.
- Elicitation of ACD caused by inflammatory cytokines including TNFa and IL-1.
________ is the gold standard test for diagnosing ACD.
Patch testing
When do you patch test?
- Patients with suggestive history
- Patients with resistant dermatitis
- Chronic dermatitis
- Occupationally related dermatitis
- Atopic eczema - flaring
- Stasis dermatitis
- Photo or airborne distribution
What are the risk factors for Nickel sensitivity?
How is nicken allergy being prevented in some places of the world?
Can fragances and unscented products cause ACD?
Drug eruptions:
Also referred to as eczematous ractions, drug rash.
- Most common type of drug reaction in skin
- Usually cell-mediated type IV hypersensitivity
- Eruption is usually generalized.
Time course:
- Usually begins 7-14 days after starting a new medication.
- Starts sooner in cases of receiving an “old” medication (i.e. inadvertent re-challenge)
What are some of the caused of drug (Exanthematous) reactions?
Treatment?
Nummular dermatitis
Where do it occurs most commonly?
Due to what?
- Also called Discoid Eczema
- Most often occurs on legs, but can appear on arms and trunk.
- More common in men age 50+
- Due to excess use of soap and dry skin
- Patches may be red, scaly and become crusty
- Tends to be stubborn
- Moisturization, minimize soap and topical corticosteroids are first line therapy
Seborrheic Dermatitis
Due to overproduction of skin oild and irritation from a yeast called_____.
Linked to diseases such as _____.
- Seborrheic dermatitis is thought to be due to a combination of an over production of skin oil and irritation from a yeast called Malassezia furfur.
- Increased seb derm has been linked to:
- Neurologic conditions, including Parkinson’s disease, head injury, and stroke
- Human immunodeficiency virus (HIV)
Seborrheic dermatitis facial involvement:
- Facial involvement is usually symmetric over the medial eyebrows, nasolabial folds and ears.
- Occurs in areas rich in sebaceous glands (scalp, face, ears, chest).
- Characterized by flaky, “greasy” scales.
Seborrheic dermatitis in kids:
Termed __________.
Cradle Cap
- Flaky, white to yellowish oily scale on scalp
- Can become confluent with a thick scale covering most of the scalp
- Begins 1 week after birth and may persist for several months
Seborrheic dermatitis dandruf
Psoriasis
Classified as a ______ disease.
Histology shows hyperproliferation of the epidermis with elongation of the ___1____, ___2___ and dilated capillary loops in the dermal papillae.
Psoriasis is an autoimmune disease that causes raised, red, scaly patches to appear on the skin.
It typically affects the outside of the elbows, knees or scalp, though it can appear on any location.
Some people report that psoriasis is itchy, burns and stings.
- Affects up to 2% of the population
- Positive FH in 36% of psoriasis pts
- Psoriasis impacts quality of life
1-Rete ridges-****neutrophils***
Psoriasis subtypes
Psoriasis chronic plaque disease
Guttate psoriasis is associated with_______.
Psoriasis plantar and palmar
Psoriatic arthritis
How does psoriasis affects quality of life
Psoriasis and Comorbidities
Persistent low grade inflammation favor development of _____, obesity, and______.
Metabolic syndrome patients have accelerated ________ due to inflammation.
How do you treat it?
- Persistent low grade inflammation favors the development of insulin resistance, obesity and metabolic syndrome.
- Metabolic syndrome patients have accelerated *atherosclerosis due to inflammation
- Psoriasis is an independent risk factor for *Cardiovascular Disease
- Patients in their 40s with severe psoriasis double their risk for MI
=mild psoriasis RR increases by 20%
Locations:
Etiology:
Diseases associated with different rashes:
