eczema and hair and nails Flashcards

1
Q

AD caused by

A

Caused by skin barrier dysfunction AND immune dysregulation

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2
Q

“Allergic March”

A

progression from AD to allergic rhinitis to asthma

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3
Q

risk factors for AD

A

fillagrin gene, family hx

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4
Q

80% of childhood AD does not persist past the age of

A

12

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5
Q

TCS in AD, s/e

A
Suppress inflammation, BID. Children have a higher BSA:Weight ratio ➡ higher degree of absorption• Striae
• Cataracts
• Adrenal insufficiency
• Growth Delay in Children
• Osteoporosis
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6
Q

TCI

A

2nd line, Pimecromilus (Elidel) BID x 6 weeks for > 2 years. Tacrolimus 0.03 > 2, 0.1 > 16

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7
Q

Eucrisa

A

BID > 2 years, can burn on application, wet wrap

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8
Q

Dupilimumab

A
  • IL-4 & IL-13 (1+3=4) receptor antagonist (inhibits IL-4 & IL-13 signaling)
  • 12 years and older
  • No labs required
  • Not an immune suppressing medication
  • Loading dose then every other week dosing
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9
Q

Irritant Contact Dermatitis (ICD)

A

burning, stinging, pain
immediate
• 80% of occupational contact dermatitis cases are localized to area of exposure
• Most frequent cause of hand dermatitis (”wet work”)

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10
Q

Allergic Contact Dermatitis (ACD)

A
  • IMMUNE MEDIATED!
  • Delayed-type hypersensitivity reaction- Requires sensitization!
  • 20% may initially present as localized eruption but then become generalized
  • T-cell mediated reaction elicited by contact with a previously sensitized chemical agent
  • The dominant symptom is PRURITUS!
  • Reaction typically occurs 48-72 hours after exposure
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11
Q

Onychomycosis- management

A

oral terbinafine is first line, if they dont want systemic - cicloperox or kerydin, topical urea

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12
Q

terbinafine and dose

A

Continuous: 250mg/day 12 wks for toenails,

6 wks fingernails, LFT’s/CBC baseline; repeat at 6wks

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13
Q

s/e terbinafine

A

Elevated LFT’s, taste disturbance, exacerbation of psoriasis, headache, dizziness, contraindicated with statins or excessive alcohol

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14
Q

fluconazole dose

A

Pulsed: 150mg

1 day/week for 9 months, good for yeast, interacts with many drugs

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15
Q

Itraconazole dose

A

200mg day 12 wks for toenails

6 weeks for fingernails Contraindicated w/meds metabolized through CYP-450 Many drug interactions Take with a full meal

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16
Q

80/20 nails

A

terry nails, liver disease

17
Q

half and half nails

A

kidney disease

18
Q

dilated capillary loop nails

A

lupus

19
Q

pitting nails

A

AD, pso

20
Q

onycholysis seen in this systemic disease

A

pso

21
Q

longitudinal ridging and pterygium

A

LP

22
Q

patchy non scarring hair loss

A

• Alopecia areata • Trichotillomania • Tinea capitis

23
Q

diffuse non scarring hair loss

A

• Androgenic alopecia (AGA) • Telogen or anagen

effluvium

24
Q

patchy scarring hair loss

A
  • Discoid lupus erythematosus
  • Central centrifugal cicatricial alopecia (CCCA)
  • Acne keloidalis
  • Traction alopecia (end stage)
  • Infections
  • Trauma
25
Q

diffuse scarring hair loss

A
  • Lichen planopilaris
  • Chronic cutaneous lupus
  • Dissecting cellulitis
26
Q

Male Pattern Hair Loss (MPHL)

A

minoxidil bid to damp scalp, can take months, scalp irritation. or finasteride - may drop PSA by 50 percent, sexual side effects

27
Q

clinical presentation AA

A
  • Abrupt onset; well circumscribed/demarcated, round patches (can be generalized)
  • Exclamation mark hairs; shedding is prominent
  • Nails: pitting, ridging, trachyonychia
28
Q

Telogen Effluvium

A

• Shift of hair follicles from anagen (growing) to telogen (resting) • Can be triggered by stress, medications and hormonal changes
hair pull positive, spontaneous resolution, diffuse shedding 3 mo after trigger

29
Q

Traction Alopecia

A

Traction or pulling that causes inflammation Initially- temporary broken shaft
Advanced- scarring without inflammation
• Usually frontal and/or temporal
• Can take years/decade to develop

30
Q

mgmt traction alopecia

A

stop tension, permanece depends on how long

31
Q

Central Centrifugal Cicatricial Alopecia (CCCA)

A
  • Premature desquamation of inner root sheath → scarring
  • Attributed to trauma, chemicals and heating
  • Most common hair loss in AA females
32
Q

CCCA presentation and mgmt

A

• Poorly defined areas of vertex and crown, w/centrifugal expansion
• Shiny, smooth, white/gray peripilar halos and broken hairs
• +/- inflammation
Management
• Stop stressful hair processing and grooming practices
• Can still progress even though stop
• High potency topical corticosteroids, tetracycline class abx

33
Q

Lichen Planopilaris (LPP)

A

Clinical Presentation
• 2 subtypes: classic and frontal fibrosing (FFA)
• Perifollicular erythema and hyperkeratosis and scarring
• FFA frontotemporal loss of both terminal and vellus hair
• more than half also have alopecia of the eyebrow (may precede)

34
Q

LPP dx

A

Diagnostics

• MUST take punch bx from area of active disease. Both horizontal & vertical

35
Q

LPP mgmt

A
  • Chronic, unpredictable, no cure, goal is prevention worsening
  • Treatment in earlier active (inflammatory) stage
  • First line:
  • High or super high potency topical steroids, tapered when erythema subsides; intralesional triamcinalone, q6wks 10mg/ml (5mg/ml if frontal areas); Using 30g needle, deposition of 0.1ml every 1cm into dermis 1-2mm (not to exceed 40mg in a single treatment)
36
Q

Dissecting Cellulitis

A

• Most common AA young adult males; follicular occlusion tetrad
Clinical Presentation
• Firm boggy nodules and plaques • Sinuses and drainage Management
• Intralesional corticosteroids, abx, oral isotretinoin, surgical

37
Q

Hirsutism

A

• Increased number of terminal hairs in male pattern distribution
• Caused by adrenal (tumor or hyperplasia), pituitary or ovarian tumors; medications
Clinical Presentation
• Terminal hairs androgen-dependent areas
• Signs of virilization which can help differentiate diagnosis

38
Q

Hirsutism dx and mgmt

A

Diagnostics
• Labs: testosterone (free & total), LH, FSH, DHEA-S, androstenedione, fasting glucose
Management
• Based on underlying cause: i.e. OCPs for hormonal imbalance or dexamethasone for adrenal
• Topical: efluornithine cream (Vaniqa)
• Systemics: Spironolactone
• Other: electrolysis or laser hair removal, waxing