Dermatitis

Question 1

List history taking questions to ask the patient

Answer 1

1. Onset (when did it start), duration (how long has it been?), periodicity (do you recognise when the rash gets worse)
2. Site of onset
3. How is it spread? (discrete - normal skin between rashes, coalescing, grouped)
4. Distribution (symmetrical/asymmetrical, unilateral, localised)
5. Feel of lesion (smooth/rough)
6. Any triggers or things you know that makes it better
   * Previous history of same symptoms AND family history
   * What medications are you taking?
   * Any medical conditions (e.g. diabetes)
   * Any allergies (e.g. drugs, foods, clothing, footwear, jewellery, toiletries, cosmetics, animals)
   * What is your occupation?
   * Any sports or hobbies
   * Any human contact
   * TRAVEL
   * RECENT STRESS
   * DIETARY HISTORY

Question 2

Define lesion

Answer 2

A single area of altered skin

Question 3

Define rash

Answer 3

Widespread eruption of lesions

Question 4

Define dermatitis

Answer 4

eczema = inflammation of the skin

Question 5

Define tinea

Answer 5

group of diseases cause by fungus

Question 6

Define Pruritis

Answer 6

Itchy skin

Question 7

Define erythema

Answer 7

redness due to dilated blood vessels
that blanch when pressed

Question 8

Define pigmentation

Answer 8

any shade of brown, black, grey or blue due to melanin at diff. depths of the skin

Question 9

Define hyper-pigmentation

Answer 9

excessive colour in the skin that causes it
to be darker than the normal background skin

Question 10

Define hypo-pigmentation

Answer 10

Loss of melanin - pale skin- but not completely white

Question 11

Define macule (a type of lesion)

Answer 11

a flat lesion < 1 cm in diameter

Question 12

Define patch (a type of lesion)

Answer 12

a flat lesion > 1cm in diameter

Question 13

D

Define papule (a type of lesion)

Answer 13

a raised solid lesion < 1cm in diameter

Question 14

Define nodule (a type of lesion)

Answer 14

A raised solid lesion > 1 cm in diameter

Question 15

Define vesicle (a type of lesion)

Answer 15

a clear, fluid-filled lesion, < 1 cm in diameter

Question 16

Define bulla (a type of lesion)

Answer 16

clear, fluid filled lesion, > 1cm in diameter

Question 17

Define cyst

Answer 17

sac or cavity containing FLUID or SEMISOLID or AIR

Image in google docs

Question 18

Define pustule

Answer 18

< 1cm in diameter filled with pus. May be yellow or white

Image in google docs

Question 19

Define Abscess

Answer 19

A sac or cavity (cyst) filled with pus - red, infected and painful

Image in google docs

Question 20

Define scale

Answer 20

Increased dead skin cells stuck together on the skin surface

Question 21

Define plaque

Answer 21

a solid, raised, plateau-like (flat-topped) lesion
> 1cm in diameter

Question 22

Lichenification (secondary skin changes)

Answer 22

thickening and accentuation of the skin as a
result of the chronic rubbing or scratching

Question 23

Crusting (secondary skin changes)

Answer 23

Plasma exudating through an eroded epidermis. **Yellow or brown **and may ooze

Question 24

Excoriation (secondary skin changes)

Answer 24

Scratching (excoriation marks are linear)
–> removes epidermis
–> localised damage to skin: bleeding and oozing

Question 25

Annular (shape or configuration of lesions)

Answer 25

1. In a circle or ring

Question 26

Discoid (shape or configuration of lesions)

Answer 26

Disc or coin shaped circular lesion

Question 27

Wheal/weal (shape or configuration of lesions)

Answer 27

skin-coloured or pale skin swelling surrounded by erythema and the **skin surface is smooth**

Question 28

Define dermatitis

Answer 28

Non-specific inflammatory response of the skin

Question 29

Causes of dermatitis

Answer 29

Endogenous (internally): atopic and sebbhoric Exogenous (from outside): contact Environmental: irritants

Question 30

Specific questions to ask if a patient presents with atopic dermatitis symptoms

Answer 30

1. **Is the rash itchy (**atopic dermatitis is very itchy) 2. Where is the rash located? **Infants**=face, cheeks, flexures, **toddlers/school-aged**=elbows, wrists, knees, ankles, **adults** = rash may diffuse (all over body) 3. **Family history?** (atopy is genetic) 4. **Any other medical conditions?** atopic tendencies --> hay fever, ashtma or food allergies

Question 31

Atopic Dermatitis 1. Symptoms 2. Treatment - Dosage - Benefits, - Precautions - Side effects, 3. Counselling 4. Referral

Answer 31

1. Generalised skin dryness, itch and rash 2. **Dermaid** (hydrocortisone 0.5%) - apply enough to affected area 1-2 times daily until dermatitis is gone and skin is clear - relieves inflammaton (redness+swelling) and itch - Pregnancy: **Safe to use** but use lowest strength and for the shortest time possible. Breastfeeding: **Safe to use**: make sure breast area is free of corticosteroids - **stinging or pain upon application** 3. limit shower time to 5-10 minutes with lukewarm water, fragrance free soaps, oatmeal bathes, wear loose clothing 4.** Weeping, oozing, signs of secondary infection, non-prescription Tx fail**

Question 32

Is atopic dermatitis the most common inflammatory condition?

Answer 32

yes

Question 33

Symptoms of Atopic Dermatitis

Answer 33

Generalised skin dryness, itch and rash

Question 34

People who cannot tolerate topical corticosteroids they can use: | Atopic Dermatitis

Answer 34

Topical calcineurin inhibitors (e.g. pimecrolimus 1% cream topically, once or twice daily)

Question 35

If a patient has atopic dermatitis and has a bacterial skin infection what would be the Tx options

Answer 35

Bleach Baths and Antibiotic Therapy

Question 36

Cradle Cap (infantile sebborhoeic dermatitis) 1. Causative Pathophysiology 2. Identification: 3. Sx. 4. Treatment 5. Referral

Answer 36

1. Babies are born with active sebaceous glands - extra oil leads to build up of dead skin on scalp 2. Yellow and greasy crusts on scalp 3. No other symptoms experienced 4. **Mild Cases**: vaseline into crusts followed by a mild-baby shampoo to wash it out. Remove scales using a soft toothbrush **Moderate Cases:** Massage Johnsons Baby oil into lesions overnight followed by baby shampoo in the morning **Persistent cases**; Salicylic acid 2% + LPC 2% + Sulfur 2% in Aqueous Cream, leave on for 6-8 hours then wash out daily **Lesions that are not on the scalp (e..g eyebrows):** hydrocortisone ointment 1% twice a day 5. Non-responsive to OTC treatment – Skin under crusts become infected/inflamed/weeping – Baby is unwell – Baby seems irritated by the cradle cap or scratching it – Spreading rash to other areas including the face

Question 37

Specific questions to ask if a patient presents with cradle-crap symptoms

Answer 37

**How old is the child?** happens between 3to 12 weeks **Is it itchy**? Does not itch **Where is the rash located?** scalp, hairline and/or eyebrows **Family history?** not genetic **Any other symptoms?** General health of baby is unaffected **What products have been tried? ** need to avoid food-containing products

Question 38

Specific questions to ask if a patient presents with contact dermatitis

Answer 38

1. Where is the rash located? Rash occurs when you have been in contact with 2. When did the rash first occur? 3. What allergies do you have if any? 4. What is your occupation? 5. Do you have any allergies? 6. What do you think triggered the rash?

Question 39

Contact Dermatitis 1. Cause 2. Symptoms 3. Treatment - dosage - benefits - precautions - side effects 4. Counselling 5. Referral

Answer 39

Most common occupational condition 1. caused by skin contact with allergen or irritant 2 Redness, Irritation, Itchiness 3. Dermaid (hydrocortisone 0.5%) -- apply enough to affected area 1-2 times daily until dermatitis is gone and skin is clear (should be cleared in 7 days if not higher potency corticosteroid is required) - relieves inflammaton (redness+swelling) and itch - Pregnancy: **Safe to use** but use lowest strength and for the shortest time possible. Breastfeeding: **Safe to use**: make sure breast area is free of corticosteroids - **stinging or pain upon application** 4. Cool moist compress, avoid further contact with allergen , rubber gloves with cotton linear 5. **Severe and acute**: oral prednisolone/sone 25 to 50mg once d for 5 to 7 days