Eczematous Eruptions

Question 1

Pruritic, exudative, or lichenified eruptions

Acute, subacute, or chronic relapsing skin disorder that usually begins in infancy (rarely adult)

Characterized primarily by dry skin and pruritis

Genetic predisposition, skin barrier damage

Answer 1

Atopic Dermatitis (Eczema)

Question 2

The “itch-scratch” cycle can result in what?

Answer 2

Lichenification

Question 3

The itch that rashes

Answer 3

Atopic Dermatitis (Eczema)

Question 4

The atopy triad

Answer 4

Allergies
Eczema
Asthma

Question 5

What is the distribution of eczema in babies?

Answer 5

Face and trunk - Starts on the cheeks and scalp, and oval patches on the trunk

Later involves extensor surfaces

Question 6

What is the distribution of eczema in adults?

Answer 6

Flexural areas (elbow, knee)

Pigmented persons have poorly demarcated hypo-pigmented patches on the cheeks and extremities

Question 7

What are some eliciting factors for atopic dermatitis (eczema)?

Answer 7

Inhalants
Microbial Agents
Foods
**Anything can cause this really

Question 8

What are some exacerbating factors for atopic dermatitis (eczema)?

Answer 8

Skin Barrier Disruption
Infections
Seasonal
Clothing
Emotional stress

Question 9

What are some treatment options for acute atopic dermatitis (eczema)?

Answer 9

Stop scratching!

Wet dressings

Topical glucocorticoids

Hydroxyzine 10-100mg qid

Oral or topical antibiotics to eliminate S. aureus

Question 10

What are some treatment options for subacute/chronic atopic dermatitis (eczema)?

Answer 10

Stop scratching!

Hydration + emollients

Topical glucocorticoids (Put steroid on first then lotion, or else wont be able to penetrate as well)

Tacrolimus or pimecrolimus

H1 antihistamines

UVA-UVB therapy

Question 11

What are some methods for preventing atopic dermatitis (eczema)

Answer 11

Minimize baths
No harsh soaps or shampoos
Proper skin care
Avoid scratchy fabrics – cotton is preferred
Avoid any other triggers

Question 12

Acute or chronic inflammatory reactions to substances that come in
contact with the skin

Answer 12

Contact Dermatitis

Question 13

What are the two types of contact dermatitis?

Answer 13

Allergic contact dermatitis
Irritant contact dermatitis

Question 14

Acute or chronic inflammatory reactions to substances that come in contact with skin

Result can be immediate

NOT itchy

Hands are the most commonly affected area

80% of all occupational skin disorders

Isolated to area of contact (time and amount)

Answer 14

Irritant contact dermatitis

Question 15

What is the pathogenesis of irritant contact dermatitis?

Answer 15

Irritant cause cell damage if applied for sufficient times in adequate concentration

ICD occurs when defense or repair capacity of the skin is unable to maintain normal kin integrity and function or when penetration of chemical induces an inflammatory response

Question 16

Specific immune-mediated reaction to a touched substance

Delayed response - May show up in around 24 hours

Itchy

By an antigen (contact allergen) that elicits a type IV (cell mediated or delayed) hypersensitivity reaction

Appearance depends on severity, location, and duration

Answer 16

Allergic Contact Dermatitis

Question 17

What are the most common agents in allergic contact dermatitis?

Answer 17

Poison oak and poison ivy (rhus dermatitis)

Question 18

One of the most common things you’ll see in babies

Irritant in diaper area

Common between 9-12 months old

A type of contact dermatitis

A patchwork of inflamed, bright red skin on the buttocks, thighs,
and genitals

Erythema and scaling

Rarely ulcerated

Answer 18

Diaper Dermatitis

Question 19

What is a common cause of diaper dermatitis?

Answer 19

yeast infection

Question 20

Subtype of dermatitis that is characterized by erythematous, round or coin-shaped plaques

Chronic, pruritic, inflammatory dermatitis

Peaks in fall and winter

Cause: unknown

Common in older gentlemen

Lower extremities most common location

Answer 20

Nummular Eczema

Question 21

Lower extremities

“coin-shaped” plaques composed of grouped small papules and vesicles on an erythematous base

Pops up in the same spot every year typically

Answer 21

Nummular Eczema

Question 22

What are some treatment options for nummular eczema?

Answer 22

Skin hydration – moisturize

Glucocorticoids

Crude Coal tar: 2-5% crude coal tar ointment daily

Systemic therapy - Antibiotics if secondary infection with S. aureus

PUVA or UVB 311-nm therapy (very effective)

Question 23

Redness and scaling and occurring in regions where the sebaceous glands are most active

Scalp, gluteal crease, neck line, breast, face

“dandruff” or “cradle cap”

Answer 23

Seborrheic Dermatitis

Question 24

Seborrheic dermatitis is associated with what conditions?

Answer 24

yeast colonization
Extended hospital stays
Parkinsons
HIV (If severe or widespread, be concerned about HIV)
Androgen states
Some neurologic medications

Question 25

Orange-red, yellowish-red, or gray-white skin, “greasy”, or white dry scaling macules and papules of varying sizes Visual crusts and scales Pruritis and burning Sharply marginated Sticky crusts and fissures are common in the folds behind the external ear Diffuse involvement of scalp

Answer 25

Seborrheic Dermatitis

Question 26

What are some treatment options for seborrheic dermatitis?

Answer 26

Selenium sulfide (Selsun Blue) or Zinc Pyrithione (Head and Shoulders) shampoo Ketaconazole shampoo (Nizoral) Ketoconazole 2% and 2.5% hydrocortisone cream Baby shampoo for eyelids Oils: Mineral oil, baby oil, olive oil

Question 27

Common in young women (90% of cases) etiology unknown Duration: Weeks to months Can be seen in individuals who use facial creams or toothpastes that are fluorinated and they don’t wash it off appropriately (Also with topical steroids and soaps) Make sure to rule out S. aureus infection

Answer 27

Perioral Dermatitis

Question 28

Around the mouth Discrete erythematous micropapules and microvesicles May be red and scaly Mildly itchy Can affect periorbital area and nasal area as well Typically presents in 2-30 year olds, fair to delicate skin

Answer 28

Perioral Dermatitis

Question 29

What are the treatment options for perioral dermatitis?

Answer 29

Discontinue steroids - AVOID topical steroids – will worsen Topical Metronidazole 0.75% cream BID or 1% qd Systemic – add if topical cream is not enough Minocycline /Doxycycline or Tetracycline or Erythromycin

Question 30

What should be avoided in patients with perioral dermatitis?

Answer 30

Steroids (can worsen the condition)

Question 31

Occur on LE in patient’s with venous insufficiency Deposits of hemoglobin in skin 🡪 bronze color Occurs in diabetes

Answer 31

Stasis Dermatitis

Question 32

What is the treatment for stasis dermatitis?

Answer 32

Short term - Topical glucocorticoids Secondary Infections - Topical antibiotics (mupirocin) Treat underlying cause Keep clean and observation (watch for cellulitis) Stocking Wet dressings with Burow’s

Question 33

Subtype of eczema characterized by vesicles on palms and soles Vesicular type of hand and foot dermatitis Recurrent attacks are the rule Spontaneous remission in 2-3 weeks Must rule out bacterial or fungal cause

Answer 33

Dyshidrosis Eczema

Question 34

Deep-seated pruritic, clear, “tapioca-like” vesicles Later – scaling fissures and lichenification occur Located on hands and feet Typically the lateral aspects

Answer 34

Dyshidrosis Eczema

Question 35

What is the treatment for dyshidrosis eczema?

Answer 35

Steroids: High potentency glucocorticoids with plastic occlusive dressings (saran wrap) for up to 1-2 weeks - Keeps in heat, increases potency of cream Intralesional injection - Triamcinolone Systemic - Tapered Prednisone

Question 36

Localized form of lichenification resulted from repetitive rubbing and scratching 🡪 the constant scratching causes thick, leathery, brown-ish skin Can last for decades Typically a light-brown color Hyper-excitability of the epidermal nerves, exacerbated by rubbing and scratching May be a nervous habit or tic May be associated with atopic dermatitis or psoriasis

Answer 36

Lichen Simplex Chronicus

Question 37

What are the common types of patients likely to see Lichen Simplex Chronicus?

Answer 37

Individuals older than 20 years old More commonly in women More frequent in Asians Common in atopic individuals

Question 38

What is the treatment for lichen simplex chronicus?

Answer 38

Goal: stop the itch-scratch cycle (can be difficult if underlying disease) Stop scratching/rubbing: Anti-histamine at night (Hydroxyzine) Topical glucocorticoid preparations or tar preparations with occlusive dressings Intralesional triamcinolone

Question 39

What is the pathogenesis of lichen simplex chronicus?

Answer 39

Physical trauma (scratching) 🡪 skin hyperplasia (palpate – will feel thickened) Emotional stress - Can be seen with psychological disorders (look for anxiety, nervousness, depression, etc) Habit forming/unconscious habit - “pleasure habit” Itch attack from minor stimuli