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Habif Clinical Dermatology > Chapter 3: Eczema and Hand Dermatitis > Flashcards

Chapter 3: Eczema and Hand Dermatitis Flashcards

1
Q

What is acute eczematous inflammation

A

Inflammation caused by contacted with specific allergens found in items such as (poison ivy, oak, or sumac)

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2
Q

Can poison ivy be spread by contents within the blister

A

No. Blister fluid does not contain the offending chemical

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3
Q

What is the treatment of an acute eczematous reaction

A

Cool, wet dressings.

The evaporative cooling caused by wet compresses causes vasoconstriction and rapidly suppresses inflammation and itching.
- Wet compresses should be replaced after 30 minutes and replaced with a freshly soaked cloth

  • severe cases can use oral steroids
  • oral antihistamines can help minimize itch
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4
Q

If oral corticosteroids are required for treatment of a rhus allergy, how long should treatment last

A

7-14 days of BID 20 mg prednisone for adults.

  • commercially available steroid dose pack tapers should be avoided.
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5
Q

What is the id reaction

A

Vesicular reactions occur at a distant site during or after a fungal infection, stasis dermatitis, or other acute inflammatory process.

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6
Q

What is subacute eczematous inflammation

A

Erythema and scale are present in various patterns, usually with indistinct borders.

  • may be initial stage or may follow acute inflammation
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7
Q

What is the treatment for subacute eczema

A

Topical steroids are the treatment of choice.

Tacrolimus (protopic) and Pimecrolimus (elidel)

topical doxepin (children over 12)

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8
Q

What is the mechanism of action of the topical macrolide immune suppressants

A

Tacrolimus and elidel

Inhibit the production of inflammatory cytokines in T cells and mast cell and prevent the release of preformed inflammatory mediators from mast cells

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9
Q

When should lubricants be applied to the skin and how long after topical steroids for the treatment of subacute eczema

A

Apply lubricants directly after the skin has been patted dry following a shower seals in moisture.

best if applied if a few hours after topical steroids

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10
Q

What effect does drying soaps such as ivory have on eczema?

A

Frequent washing with a drying soap will delay healing.

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11
Q

Can generalized eczema or erythroderma be a presenting sign cutaneous T cell Lymphoma

A

ummmm yea.

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12
Q

Unexplained eczema of adult onset may be associated with what pathology

A

an underlying lymphoproliferative malignancy

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13
Q

What is chronic eczematous inflammation

A

the inflamed area thickens and surface skin markings may become more prominent. Thick plaques with deep parallel skin marking are said to be lichenified

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14
Q

What are the most common types of hand eczema

A

irritant contact dermatitis (35%)

followed by atopic dermatitis (22%)

Allergic Contact dermatitis (19%)

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15
Q

What are the most common contact allergies

A 
Nickel 
Cobalt
Fragrance mix
Balsam of Peru
Colophony
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16
Q

What is lichen simplex chronicus

A

a localized plaque of chronic eczematous inflammation that is created by habitual scratching

  • common on the back of the wrist
  • sharp margins
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17
Q

What is keratolysis exfoliativa

A

Reccurrent focal palmar peeling is a common, chronic, asymptomatic, noninflammatory bilateral peeling of the palms of the hands and occasionally soles of the feet; its cause is unknown.

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18
Q

What is hyperkeratotic eczema

A

A very thick, chronic form of eczema that occurs on the palm and occasionally the soles and is seen almost exclusively in men.
- Dense scale, unlike a callus, moist below the surface and not easily paired off with a blade.

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19
Q

What is fingertip eczema

A

A very dry, chronic form of eczema of the palmar surface of the finger tip - may be the resultant of an allergic reaction.

  • may last for months to years and may be resistant to treatment
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20
Q

How do you treat finger tip eczema

A

After ruling out allergy and psoriasis. Managed the same way you would for subacute or chronic eczema
- topical steroids, elidel and protopic

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21
Q

What is pompholyx

A

dishydrosis

a distinctive reaction pattern of unknown etiology presenting as symmetric vesicular hand and foot dermatitis

  • Moderate to severe itching precedes the appearance of vesicles on the palms and sides of the fingers
  • Vesicles slowly resolve in 3-4 weeks and are replaced by 1 to 3 mm rings of scale.
  • Pain rather than itching is the chief complain
  • Differentiated from pustular psoriasis due to the persistent nature of psoriasis
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22
Q

What is the treatment for pompholyx

A

topical steroids;
cold, wet compresses;
possibly oral antibiotics are used

  • resistant cases may respond to psoralen plus ultraviolet A (PUVA) therapy
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23
Q

What is the id reaction

A

itchy dyshidrotic like vesicular eruption

  • eruptions are most common on the sides of the fingers, but may be generalized
  • diagnosis of an id reaction should not be made unless there is an acute inflammatory process at a distant site and the id reaction disappears shortly after the acute inflammation is controlled.
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24
Q

What is asteatotic eczema

A

(Eczema Craquelé)

occurs after excess drying, especially during the winter months and among the elderly.

  • most commonly seen on the anterolateral aspects of the lower legs
  • demonstrate xerosis
  • Pain rather than itching is the chief complaint
25
Q

What is xerosis

A

accentuation of the skin lines

26
Q

What is nummular eczema

A

common disease of unknown cause that occurs primarily in the middle-aged and elderly

  • when itching becomes habitual the term nummular neurodermatitis is used
  • Individual lesions tend to remain in the same area and do not increase in size.
  • The back of the hand is the most common site. Other common areas include extensor aspects of the forearms and lower legs, the flanks and the hips
27
Q

What is the treatment for nummular eczema

A

The red Vesicular lesions are treated as acute, the red scaling plaques as subacute, and the habitually scratched thick plaques as chronic eczematous inflammation.

28
Q

What is chapped fissured feet

A

Also known as sweaty sock dermatitis, Or peridigital dermatitis, juvenile plantar Dermatosis.

– The mean age of onset is 7.3 years, the mean age of remission is 14.3 years

29
Q

What is the treatment for chapped fissured feet

A

Topical steroids and lubrication provide some relief. Treatment is less than satisfactory

30
Q

What are self-inflicted dermatoses

A

A number of skin disorders created or perpetuated by manipulation of the skin surface

31
Q

What is lichen simplex chronicus

A

Also known as circumscribed neurodermatitis

– Eczematous eruption that is created by habitual scratching of a single localized area. Patients derive great pleasure in the relief that comes with frantically scratching the inflamed site

– Red papules coalesce to form a red, scaly, and thick plaque with the situation of scan lines

32
Q

what is lichen simplex nuchae

A

Occur almost exclusively in women who reach for the back of the neck during stressful situations

33
Q

What is prurigo nodularis

A

An uncommon disease of unknown cause that may be considered a nodular form of lichen simplex chronicus

34
Q

What is the treatment for prurigo nodularis

A

Often resistant to treatment and last for years.

– Steroid injections may be effective.
– Capsaicin
– oral cyclosporine

35
Q

What are neurotic excoriation’s

A

Patient induced linear excoriation’s

– Most consistent psychiatric disorders reported or perfectionistic and compulsive traits; patients manifest repressed aggression and self-destructive behavior.

36
Q

What is the treatment for neurotic excoriation’s

A

Use of group 1 topical steroids applied twice a day
– group 5 topical steroids under plastic wrap occlusion

– Resistant lesions are treated with monthly intralesional injections with triamcinolone

– Those with depression may be treated with SSRI’s, SNRI’s, or TCA’s

37
Q

What or psychogenic parasitosis

A

Patients believe they are infested with parasites.

38
Q

What is the classification for the four groups of patients with psychogenic parasitosis

A
  1. Anxiety/hypochondriasis
  2. Anxietyhypochondriasis with depression
  3. Delusional parasitosis
  4. Delusional parasitosis with depression
39
Q

What is the treatment for patients with psychogenic parasitosis

A

Listen and show concern; examine the skin with and magnification and prepare scrapings; rule out true infestations

40
Q

What is stasis dermatitis

A

eczematous eruption on the lower legs in some patients with venus insufficiency.

41
Q

What treatment considerations should be given for stasis dermatitis in regards to allergy

A

Topical medications that contain potential sensitizer such as lanolin, benzocaine, parabens, and neomycin should be avoided by patients with stasis dermatitis

42
Q

Describe the etiology of stasis dermatitis

A

Subacute inflammation usually begins in the winter months when the legs become dry and scaly.

– Brown staining of the skin (hemosiderin) may have appeared slowly for months.
– the pigments is iron left after disintegration of red blood cells that leaked out of veins because of increased hydrostatic pressure.

43
Q

What is the treatment for stasis dermatitis

A

The inflammation responds to systemic antibiotics, wet compresses, and group 3 – 5 topical steroids

– The early, dry, superficial stage is managed as subacute eczematous inflammation with group 2 to 5 steroids creams or ointments and lubricating creams or lotions.

– moist exudative inflammation and moist ulcers respond to wet compresses of Burrows solution or just saline or water for 30 to 60 minutes several times a day

44
Q

What are the three types of lower extremity ulcers

A
  1. Venus
  2. arterial
  3. Neuropathic
45
Q

What is the most frequent precursor of lower leg venous insufficiency

A

Deep vein thrombophlebitis, which may have been asymptomatic earlier.

46
Q

What technique may be used to differentiates from a venous stasis ulcer from a ischemic ulcer

A

Ischemic ulcers are more intense and do not improve with elevation.

– Venous stasis ulcers have a dullconstant pain that improve leg elevation

47
Q

What is the physical exam description of stasis dermatitis

A

Chronic edema, that leads to inflammation and subcutaneous tissue fibrosis giving the scanning firm, non-petting, “Woody” quality

48
Q

What is stasis papillomatosis

A

A condition usually found in chronically congested limbs.

-Lesions vary from small to large plaques that consists of aggregated brownish pinkish papules with a smooth or hyper keratotic surface

49
Q

What are varicose veins

A

Varicose veins are superficial vessels that are caused by defective venous valves

50
Q

What is the treatment for varicose veins

A

Sclerotherapy is used to treat isolated perforator incompetence

51
Q

What is the treatment for venous ulcers

A

Venous pressure in leg edema can be reduced with bed rest, leg elevation, and compression.
– Stop cigarette smoking and excessive alcohol intake
– elevation of the legs above the heart level for 30 minutes, 3 to 4 times per day, allows swelling to subside

52
Q

What topical medication should be avoided with venous ulcers

A

Neomycin, paraben preservatives, and lanolin should be avoided to prevent sensitization

53
Q

Does the use of systemic antibiotics increase healing rates of Venus ulcers

A

No, despite its these ulcers are typically contaminated with different aerobic and anaerobic bacteria.

54
Q

What is the definitive treatment for venous ulcers

A
  1. Measure the ulcer at each visits
  2. Encourage elevation and periods of exercise and ambulation.
  3. Minimize bacteria and necrotic debris
  4. Promote granulation tissue formation
  5. Induce reeepithelialization
  6. Reduce edema
  7. Protect from trauma
55
Q

What is the cornerstone for therapy of venous ulcers

A

Compression; improves venous hypertension and improves edema

– Compression bandages can be applied over occlusive dressings during the healing phase.

– Measure the ankle-brachial pressure index before compression to avoid necrosis or gangrene of the foot

56
Q

What is in unna boot

A

Gauze bandages impregnated with zinc oxide paste to create a semi rigid “boot” when applied

– The unna boot should be applied in the morning after edema has drained

57
Q

What medication is associated with an increased rate of venous ulcer healing

A

300 mg Oral enteric coated aspirin

58
Q

What vitamins should be considered in the setting of malnutrition to help with venous ulcer healing

A
  1. Ascorbic acid (1 to 2 g per day)
  2. Zinc sulfate (220 mg three times per day)
  3. Vitamin E (2 mg per day)

Habif Clinical Dermatology (8 decks)

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