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Flashcards in eczema/dermatitis Deck (78)
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1
Q

What are the most common types of eczema?

A
  • contact dermatitis - atopic dermatitis - seborrheic dermatitis - pompholyx - nummular eczema - lichem simplex chronicus
2
Q

type of eczema that can be acute or chronic and is often vesicular and oozing with positive history of contact

A

contact dermatitis

3
Q

acute, dry, scaly, itchy skin at joints

typically has allergic or family history

A

atopic dermatitis

4
Q

diffuse, yellowish oily patches near nose or scalp that are less itchy

A

seborrheic dermatitis (AKA dandruff)

5
Q

acute, recurring, pruritic, weeping vesicles on hands and feet

A

pompholyx/ dyshidrosis eczema

6
Q

pruritic papulovesicular or scaly coin-shaped lesions

A

nummular eczema

7
Q

single dry, thick scaly lesion with a chronic itch-scratch cycle

A

Lichen Simplex Chronicus

8
Q

What stage of eczema/dermatitis is characterized by well demarcated plaques of erythema and edema with vesicles, blisters and intense itch?

A

acute

9
Q

What stage of eczema/dermatitis is characterized by redness, scaling, fissuring, parched appearance, scaled appearance, slight to moderate itch, pain, stinging and burning?

A

subacute

10
Q

What stage of eczema/dermatitis is characterized by thickened skin, skin lines accentuated (lichenified), excoriations, fissuring and moderate to intense itch

A

chronic

11
Q

80% of all dermatitis is _____ dermatitis and is most common on _____.

A

irritant contact

hands

12
Q

What are some preventative measures that can be taken for irritant contact dermatitis?

A
  • avoid irritant
  • rinse if there is exposure
  • use barrier creams such as petrolatum
  • change of job may be necessary
13
Q

What are some topical treatments for irritant contact dermatitis?

A
  • powder (baby powder)
  • ointment (calendula, A&D, Comfrey)
  • wet soaks containing tap water, saline, colloidal oatmeal
  • wet soaks containing Burow’s (aluminum acetate) solution
  • honey, olive oil, beeswax mixture
  • corticosteroids
14
Q

What are oral treatments for severe irritant contact dermatitis?

A

systemic corticosteroids (prednisone)

15
Q

What is the typical course of irritant contact dermatitis?

A
  • usually heals within 2 weeks, 6 for chronic cases
  • occupational exposures only have 1/3 complete remission
  • atopic individuals have poor prognosis
16
Q

dermatitis at site of contact (watchband, earrings) that appears 24-48 hours after contact

A

allergic contact dermatitis

17
Q

Allergic dermatitis is what class of immune response?

A

type IV (delayed) hypersensitivity

18
Q

what are the top 10 allergens that can cause dermatitis?

A
  • nickel sulfate
  • neomycin sulfate
  • balsam of peru
  • fragrance mix
  • thimerisol
  • sodium gold thiosulfate
  • formaldehyde
  • quaternium - 15
  • cobalt chloride
  • bacitracin
19
Q

sensitization and dermatitis 7-10 days after exposure fo toxicodendron haptens

A

allergic contact dermatitis due to plants (APD)

* poison oak/ivy

20
Q

What are some preventative measures against poison oak/ivy?

A
  • avoid contact
  • wash entire body with copious water after exposure
  • barrier creams
  • wash clothing and pets that were exposed
  • trim fingernails
  • avoid soap as it can spread resin
21
Q

What are some topical treatments for allergic dermatitis due to plants?

A
  • calendula lotion
  • calamine (zinc and ferrous oxide)
  • Burow’s solution (aluminum acetate)
  • EtOH, Comfrey, mugwart and seasalt
  • oatmeal, starch or vinegar bath
  • aloe gel
  • glucocorticoids
22
Q

When are oral steroids indicated for poison oak/ivy exposure and dermatitis?

A

if greater than 25% of the body surface is affected

if there is severe itching or blistering

if there is significant involvement of the face, hands or genitals

23
Q

What is the normal course for poison oak?

A
  • rash begins 24-36 hours after exposure
  • lasts 3-4 days, clears within next 5 days
24
Q

inflammation of the dermis and epidermis with unknown cause

A

atopic dermatitis

25
Q

What is the prevalence of atopic dermatitis in the general population?

A

7-15% (increasing incidence in Western World

26
Q

What are some key factors for the pathogenesis of atopic dermatitis?

A
  • terrain
  • genetic susceptibility or abnormality
  • immune dysfunction
  • epidermal barrier dysfunction
  • IgE mediated hypersensitivity
  • increased cAMP levels
  • defect in delts-6-desaturase
  • dry skin in childhood
27
Q

What are the 4 major features of atopic dermatitis, 3 out of 4 of which should be present for diagnosis?

A
  • pruritis
  • typical morphology and distribution
  • chronic relapsing dermatitis
  • personal or family history of atopic dermatitis
28
Q

What are other minor features of atopic dermatitis that may be present?

A
  • cataracts
  • caonjunctivitis
  • infraorbital folds (dennie-morgan lines)
  • keratosis pilaris (chicken skin)
  • palm creases
  • keratoconus
  • food intolerance
  • etc.
29
Q

What are the stages of atopic dermatitis?

A
  • infantile (2 mos - 2 years)
  • childhood (2 -12 years)
  • adult (12+ years)
30
Q

In the infantile stage of atopic dermatitis, what areas of the body are involved?

A

scalp, face, extensor surface

31
Q

In the childhood stage of atopic dermatitis, what areas of the body are affected?

A

antecubital and popliteal fossae, posterior neck

32
Q

red, finely vesicular, oozing, crusting and pus with increased likelihood of secondary infection is descriptive of what stage of atopic dermatitis?

A

infantile atopic dermatitis

33
Q

erythema, papules, scaling, licenification, patches of hypopigmentation and hair loss are descriptive of what stage of atopic dermatitis?

A

childhood atopic dermatitis

34
Q

many children with atopic dermatitis will develop what other conditions?

A

allergic rhinitis

asthma

35
Q

In the adult stage of atopic dermatitis, what part of the body is affected?

A

same as childhood but it extends to the neck, upper chest, hands and feet

36
Q

marked drying-resembling ichthyosis, intense pruritis, infraorbital fold (dennie-morgan) and thinning lateral eyebrows is descriptive of what stage of atopic dermatitis

A

adult atopic dermatitis

37
Q

What condition is triggered by temp changes and sweating? And is worse in the winter and excessive bathing?

A

Atopic dermatitis

38
Q

What is the treatment for atopic dermatitis

A

Topical immunosuppresives calcineurin inhibitors: cyclosporine

systemic steroids either oral (prednisone) or intramuscularly (trimcinolone)

39
Q

What is a natural topical application for atopic dermatitis?

A

Honey, beeswax, olive oil (1:1:1)

40
Q

Necklaces, buckles, clips, buttons can all irritate the skin and cause

A

Allergic contact dermatitis

41
Q

What diet modifications might be suggested for dermatitis?

A

Avoid eggs, peanuts, milk, fish, soy, wheat

Add Lactobacillus, Glutamine-enriched food, oral cholecalciferol (Vit D)

42
Q

What herbs might be suggested for AD?

A

Coleus forskohlii, licorice, ginkgo, oolong tea

green tea, grape seed extract, iris, taraxacum, rumex, phytolacca, turmeric, rhubarb

43
Q

What is characterized by yellowish oily patches near nose and scalp?

A

Seborrheic dermatitis

More images: Left is cradle cap and Right is periorbital S.D.

44
Q

Who is affected by seborrheic dermatitis?

A

Males more than females

Infancy and 20-50 yo

45
Q

What locations are common for seborrheic dermatitis

A

Scalp, eyebrows, eyelids, nasolabial fold, paranasal area, ears, sternum, inframammary fold, axilla, pubic area, gluteal and inguinal fold, umbilicus

46
Q

What is the treatment for infantile seborrheic dermatitis

A

Anti-inflammatory/elimination/detox diet

orally: zinc, b vitamins, niacin, biotin, omega fatty acids
topically: gentle shampoo, emollients like olive oil, antifungals like bifonazole 1% shampoo, corticosteroids like hydrocortizone cream

47
Q

Seborrheic dermatitis treatment for adults

A
48
Q

Topical CAM option for seborrheic dermatitis

A
49
Q

What is acute, chronic, recurrent dermatitis of the hands and soles that affects F>M?

A

Pompholyx/dyshidrotic eczema

“Pompholyx” = bubble

50
Q

What age is affected most by Pompholyx/dyshidrotic eczema

A

12-40 yo

51
Q

What is characterized by sudden deep-seated pruritic, clear “tapioca-like” vesicles on palms and sides of fingers that later lead to scaling fissures and lichenification?

A

Pompholyx/dyshidrotic eczema

Define: lichenified skin means skin that has become thickened and leathery. This often results from continuously rubbing or scratching the skin.

Photo: 2-4 weeks complications may occur with 2˚ infections

52
Q

Sudden onset

tapioca-like vesicles

unknown etiology

A
53
Q

What are treatment options for Pompholyx/dyshidrotic eczema

A

Antiinflammatory diet

wet astringent compress with dilute vinegar

heliotherapy

acupuncture, homeopathy, herbal, meditation

topical or intralesional trimcinolone

prednisone, antibiotics with infection

54
Q

What is the treatment for this condition that affects females more than males and is characterized by thick plaques (usually 1 lesion) with severe pruritus and lasts indefinitely and recurs frequently?

A
55
Q

What are CAM treatments for lichen simplex chronicus (LSC)?

A

Occlusive barrier-unna and dome paste boot

tranquilizer

acupuncture

transcutaneous electrical nerve stimulation

56
Q

What are Rx treatments for Lichen simplex chronicus

A

Glucocorticoid gauze dressing

intralesional trimcinolone

lidocane

hydroxyzine

antihistamines

57
Q

What are complications to Lichen simplex chronicus?

A
58
Q

What condition is characterized by common, chronic, coin-shaped plaques?

A

Nummular eczema (or numular dermatitis)

“Nummular” = coin-shaped

59
Q

Where is nummular eczema commonly located

A
60
Q

How long does nummular eczema last?

A
61
Q

What is the condition that is characterized by an initial onset of closely grouped, small vesicles and papules that coalesce into plaques where the itching is moderate to severe?

A

Nummular eczema

62
Q

An itchy, dyhidrotic-like vesicular eruption on the fingers, forearms, thighs, legs, trunk

A

Id reaction

63
Q

Treatment for Id reaction?

A

Prednisone to help control pruritus

64
Q

Characterized by cracked porcelain pattern. Erythema, inflammation and scaling with pruritus.

A

Asteatotic dermatitis

65
Q

Mgmt/treatment of asteatotic dermatitis?

A
66
Q

Condition that occurs from venous return failure and increased presssure of capillaries where multiple progressive dermatological changes occur

A

Stasis Dermatitis

67
Q

Locations of Stasis Dermatitis

A
68
Q

Stasis Dermatitis is associated with

A

Edema, varicose and dilated veins

69
Q

Mgmt/treatment of Stasis Dermatitis

A

Improve venous return through cool water dressing, cool water walking, compression stockings, anti-inflammatory diet, herbs (ginkgo, aesculus, centella)

bland emollients

topical steroids

oral antihistamines

vein stripping or sclerotherapy

70
Q

Associated with chronic venous insufficiency from venous return failure and increased capillary pressure.

Mgmt/tx = improve venous return

A
71
Q

Characterized by progressive complication of CVI (chronic venous insufficiency). Non-healing shallow painful ulcer in the lower extremities above the ankle or at the malleolus.

A

Venous leg ulcers

72
Q

What are Tx for venous leg ulcers?

A

Same as stasis dermatitis

Compression therapy, leg elevation

Supervised exercises

73
Q

Nonhealing shallow painful ulcer in LE above ankle or at malleolus. Sharply demarcated ulcer surrounded by atrophied Blanche. Pale plaques of scar tissue surrounded by stasis dermatitis

A

Venous leg ulcers

74
Q

Delayed abnormal reaction to UV light.

A

Polymorphous light eruption

75
Q

Characterized by the presentation of vesicles, papules, erythematous macules, urticaria plaques. Pink to red in color. Onset after sun exposure.

A

Polymorphous light eruption

76
Q

Mgmt/treatment for this condition that has an onset after sun exposure?

A

Condition: polymorphous light eruption

Prevention: sun block (though not always helpful)

CAM: beta-carotene, niacinamide, vit b6

Prednisone, trimcinolone

photochemotherapy (PUVA)

77
Q

Sudden, fixed, symmetrical or generalized skin eruption occurring after starting a new drug or OTC

A

Drug dermatitis (Drug-related eczema)

78
Q

Mgmt/Treatment for drug dermatitis

A

Identify and eliminate medication