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Dermatology > Lecture 6: Dermatitis and Eczema > Flashcards

Lecture 6: Dermatitis and Eczema Flashcards

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1
Q

What is the triad of atopy?

A
  1. Atopic dermatitis
  2. Allergic rhinitis/hay fever
  3. Asthma
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2
Q

What is the underlying mediating physiology for atopic dermatitis?

A

IgE mediation

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3
Q

Where does atopic dermatitis MC occur?

A
  • Face/scalp/torso/extensors
  • Flexures
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4
Q

What is the cycle of atopic dermatitis?

A
  • Dry skin
  • Pruritis
  • Increased inflammation
  • Lichenification
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5
Q

Why does skin get dehydrated in atopic dermatitis?

A
  • Impaired filagrin production
  • Reduced ceramide levels
  • Increased trans-epidermal water loss
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6
Q

What ILs tend to be expressed in atopic dermatitis?

A
  • IL-4
  • IL-13
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7
Q

What are the 3 types of atopic dermatitis?

A
  1. Acute: erythema/vesicles/bullae/weeping/crusting
  2. Subacute: scaly plaques/papules/round erosions/crusts
  3. Chronic eczema: lichenification/scaling/hyper/hypo-pigmentation (itch that rashes)
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8
Q

Hallmark sign of atopic dermatitis

A

Intense pruritis

Leading to lichenification as you keep scratching

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9
Q

What should we be worried about in atopic dermatitis as they continue scratching?

A

Secondary impetiginization via staph/HSV/coxsackie/vaccinia

Breaking skin = prone to infection

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10
Q

What features suggest someone has atopic dermatitis?

A
  • Chronic: periorbital plaques
  • Hyperpigmentation
  • Hyperlinear palms
  • Keratosis pilaris
  • Hx of allergies
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11
Q

What is the primary thing that clues you into atopic dermatitis?

A

Hx and FHx

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12
Q

What is the tx for atopic dermatitis?

A
  • Gentle cleansers
  • Low strength steroids
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13
Q

How do you manage striae in atopic dermatitis?

A
  • Ointment without preservatives
  • Damp skin or under occlusive dressings
  • AVOID soap except in body folds
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14
Q

Cream for localized dermatitis

A
  • Low potency: desonide BID
  • Medium potency: Triamcinoline/mometasone/fluocinolone BID
  • Non-steroidals (only use if >2y): Tacrolimus/pimecrolimus/crisaborole
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15
Q

Systemic tx for atopic dermatitis

A

Dupulimab SC

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16
Q

Tx for pruritis in atopic dermatitis

A
  • Benadryl
  • Hydroxyzine
  • Zyrtec
  • Claritin

Antihistamines

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17
Q

How do you differentiate between irritant contact dermatitis vs allergic contact dermatitis?

A
  • ICD: confined to area, sharply marginated, never spreads
  • ACD: spreading, type IV HSR
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18
Q

Where does airborne contact dermatitis tend to affect?

A
  • Face (upper eyelids)
  • Neck
  • Upper chest
  • Forearms
  • Hands (palmar)

AKA exposed skin

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19
Q

How do you test for contact dermatitis?

A
  • Hx
  • Patch testing ((+) still requires you to clinically correlate)
  • Do not use skin prick test, which only tests Type 1 HSR

Patch testing is not the same as skin prick testing

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20
Q

What is the underlying physiology of allergic contact dermatitis?

A

Haptens, which bind to a carrier and cause a Type IV HSR

Re-exposure to a substance already sensitized to

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21
Q

Tx of allergic contact dermatitis

A
  1. Avoid offending agents
  2. Topical steroids (2wk on, 2wk off)
  3. Oral steroids
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22
Q

What non-pharmacological therapy can help with contact dermatitis?

A

PUVA Phototherapy

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23
Q

What can cause diaper dermatitis?

A
  • Cutaneous candidiasis
  • ICD
  • Miliaria (blocked sweat ducts)
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24
Q

Who is diaper dermatitis MC in?

A

3 weeks old to 2y in age

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25
Q

How does diaper dermatitis tend to present?

A
  • Fussiness
  • Crying during diaper change
  • Diarrhea
  • Shiny erythema with dull margins
  • Potentially candidiasis or miliaria
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26
Q

Management of diaper dermatitis

A
  • Change the diaper ofc
  • Dry after bathing
  • Barrier creams (zinc oxide/petroleum jelly)
  • If candidiasis: nystatin/clotrimazole/econazole
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27
Q

How does nummular eczema present?

A

Like atopic dermatitis but no HX/FHx of atopy

Ring-shaped

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28
Q

Who is nummular eczema MC in and what predisposing factor may result in lesions on the legs?

A
  • MC in 50-65y men
  • Venous stasis will lead to lesions on the legs
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29
Q

What is nummular eczema associated with?

A
  • Frequent bathing
  • Low humidity
  • Irritating/drying soaps
  • Interferon therapy for Hep C
  • Exposure to irritating fabrics

Irritants and drying

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30
Q

Where is nummular eczema MC found on the body?

A

Trunk and extremities

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31
Q

How is nummular eczema diagnosed?

A

Clinically, but you can do cultures if bacteria, scrapings if fungus, and biopsy if necessary

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32
Q

How do you treat nummular eczema?

A

The same as atopic dermatitis:

  • Gentle cleansers
  • Low strength steroids
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33
Q

What characterizes seborrheic dermatitis?

A
  • Affecting the sebum-rich areas of the body
  • Face/scalp/neck/upper chest/back
  • Pityrosporum yeast

sebum is like an oily wax

34
Q

Describe the clinical presentation of seborrheic dermatitis

A
  • Simple dandruff fulminant rash
  • Dryness/pruritis/erythema/fine greasy scaling
  • Darker skin

Idk why darker has a **

35
Q

Who is seborrheic dermatitis MC in?

A
  • HIV
  • Parkinsons
36
Q

What other derm conditions may coexist with seborrheic dermatitis?

A
  • Rosacea
  • Psoriasis
37
Q

How is seborrheic dermatitis dxd?

A

Clinically

KOH for fungal, biopsy may help

38
Q

Management of seborrheic dermatitis

A
  • Ketoconazole Shampoo
  • Steroids

Its yeast related!

39
Q

MCC of stasis dermatitis

A

Chronic venous insufficiency

40
Q

Symptoms of stasis dermatitis

A
  • Pruritis
  • Heaviness
  • Edema
41
Q

Clinical presentation of stasis dermatitis

A
  • MC on the medial ankle
  • Lichenification
  • Shiny skin with loss of hair
  • Later: Hyperpigmentation
42
Q

Management of stasis dermatitis

A
  • Treat venous insufficiency
  • If lesion is weeping = wet compresses
  • Topical steroids: triamcinolone/clobetasol
43
Q

MC predisposing factor to lichen simplex chronicus

A

Atopic Dermatitis

All that scratching = lichenification

44
Q

What are the 3 predisposing factors for lichen simplex chronicus?

A
  • MC: AD
  • Emotional stress
  • Habit forming scratching (anxiety)
45
Q

Clinical presentation of lichen simplex chronicus and MC locations

A
  • Thick plaques that are lichenified
  • Small papules, hyperpigmentation, excoriations
  • MC locations: scalp/ankles/lower legs/upper thighs/forearms/vulva/pubis/anal/scrotum/groin
46
Q

Tx for lichen simplex chronicus

A
  • Pt ed on avoiding scratching
  • Topical steroids: TAC (triamcinolone?)
  • ILK (intralesional kenalog injections?)
  • Emollients

More advanced AD so need better steroids

47
Q

Where does perioral dermatitis NOT affect specifically?

A
  • Lip margin
  • Immediate circumoral area
48
Q

Who does perioral dermatitis MC affect?

A

Women aged 18-40

49
Q

What are the typical complaints associated with perioral dermatitis?

A
  • Burning
  • Pruiritis
  • Scaling
  • Erythema

The main differentiating factor is the perioral distribution

50
Q

How is perioral dermatitis dxd?

A

Clinically

51
Q

What should we be careful of when discontinuing perioral dermatitis caused by steroids?

A

You need to taper down using low-potency, otherwise it will flare up drastically.

Condition will generally flare before improving.

52
Q

Tx of perioral dermatitis

A
  • Tapering steroids if on them
  • Topical pimecrolimus 1%
  • Topical metro or erythro
  • See below for others
53
Q

What is dyshidrotic eczema?

A

Pruritic vesicular rash common on the hands and feet

Itching/burning/pain

54
Q

MC age range for dyshidrotic eczema

A

20-40

55
Q

How do we dx dyshidrotic eczema?

A
  • Classic tapioca vessels on appearance
  • Clinically
  • C&S to check infections
  • Patch test to check for ACD
  • Biopsy can rule out other DDx
56
Q

Tx of dyshidrotic eczema without infection

A
  • Topical steroids
  • Severe: PO prednisone for 2 week taper
  • PUVA therapy (also used in contact dermatitis)
57
Q

What is the typical clinical course of dyshidrotic eczema?

A

Chronic, relapsing

58
Q

What do emollients do?

A

Increasing skin moisture, flexibility, and preventing cracking/fissuring.

Non-cosmetic emollients are like vaseline

59
Q

What are the 3 types of emollients and their pros/cons?

A
  1. Creams: best for most dermatoses, cooling effect
  2. Lotion: more watery, mainly for hairy areas
  3. Ointment: Greasy do not use on weeping eczema, best for dry/thick skin
60
Q

What are the 4 ways topical steroids decrease the immune response?

A
  • Stabilize leukocyte/histatmines
  • Constrict capillaries/reduce permeability
  • Decrease complement cascading
  • Reduce fibroblast proliferation and collagen deposition, leading to reduced scar formation
61
Q

CIs to topical steroids

A
  • Underlying bacterial infection
  • HSR
  • Ophthalmic use

Chronic use can inhibit growth in kiddos

62
Q

How are topical steroids classified?

A
  • 1 = highest potency
  • 7 = lowest potency

Aka if severe, prob use a class 1-2 steroid

63
Q

What is the most potent vehicle for a corticosteroid?

A

Petroleum based ointment

Semi-occlusive + superior lubrication Potent Petroleum

64
Q

What is the main benefit of using steroid cream?

A

Cosmetic absorption

65
Q

What is the least potent vehicle for topical steroids?

A

Lotion

Low Lotion

Shake prior to use since its mainly powder in water.

66
Q

Whats the most expensive form of topical steroids?

A

Foam

No residue, easy spread

67
Q

Table of steroid potencies

A
  1. Hydrocortisone is the weakest
  2. Flucinonide acetonide is the strongest
68
Q

What is the maximum duration of tx based on steroid potency?

A
  • Class I (strongest) = 3 wks
  • Class 2-4 = 6-8 wks
  • Class 5-7 = chronic intermittent (1-2 weeks in the more delicate areas)
69
Q

What should we be wary about when it comes to long-term steroid use on the same dose?

A

Tachyphylaxis (progressive decrease in clinical response to same dose)

Do holidays or switch

70
Q

What is the drug class and MOA for pimecrolimus cream and tacrolimus ointment?

A
  • Calcineurin inhibitors
  • MOA: inhibition of T-lymphocyte activation, which prevents release of cytokines.
71
Q

When are calcineurin inhibitors used and how are they dosed?

A
  • Atopic dermatitis
  • BID until clearing is noted

Pime = 2 yrs max, tacro = 4 yrs max

72
Q

What are the BBWs and CIs to calcineurin inhibitors?

A
  • BBW: rare lymphoma and skin cancer (teratogenicity)
  • CIs: HSR or < 2y/o

DNU with occlusive dressing and reassess if no improvement in 6 wk

73
Q

MC SEs for calcineurin inhibitors

A
  1. MC: burning sensation which gets better if you keep using it
  2. HA
  3. URI/FLS
74
Q

What does selenium sulfide do and when do we use it?

A
  • Reduces corneocyte production
  • Used in seborrheic derm and tinea versicolor
75
Q

CIs to selenium sulfide use

A
  • HSR
  • Oral/ophthalmic/anal/intravaginal use
76
Q

How do you dose selenium sulfide for seborrheic derm and tinea versicolor?

A
  • Sebb: apply for 2-3 mins, rinse, repeat 2x/wk then once weekly for maintenance.
  • Tinea versicolor: Shampoo/lotion for 10 mins, rinse, apply daily for a week.
  • Tinea versicolor: foam: rub BID x 1 wk

Sebb is Short

77
Q

MC SEs of selenium sulfide

A
  • Burning
  • Stinging
78
Q

MOA and use of pyrithione zinc

A
  • MOA: reduce cell turnover
  • Use: seborrheic derm

That stuff in head and shoulders dandruff shampoo

79
Q

Tx for perioral dermatitis

A

Topical metronidazole/erythro/clinda

80
Q

Tx for irritant contact dermatitis related to occupation

A

Appropriate PPE

81
Q

Tx for facial seborrhea

A

Hydrocortisone cream

Dermatology (12 decks)

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