Excematous Dermatoses Flashcards
1
Q
atopic dermatitis - pathogenesis
A
- mutation in filaggrin (component of stratum cornuem), resulting a barrier dysfunction defect of epidermis characterized by
-
water loss & xerosis (dry skin) leading to
- -> penetration of allergens / irritants
-
water loss & xerosis (dry skin) leading to
2
Q
atopic dermatitis - demographics
A
- high income / urban areas (hygeine hypothesis)
- early onset - almost all by cases by 5 yrs
- mostly in children
3
Q
what is the atopic triad?
A
- a triad that is the most common way in which atopic dermatitis tends to present =
- atopic dermatitis
- allergic rhinitis
- asthma
4
Q
atopic dermatitis - diagnosis
A
- requires the following clinical presentation
-
pruritis during all stages + 3 of the following:
- onset < 2 yrs
- hx of xerosis (dry skin)
- hx of another component of atopic triad: rhinitis OR asthma
- hx of skin crease involvement
- visible flexural dermatitis
-
pruritis during all stages + 3 of the following:
5
Q
atopic dermatitis - infantile presentation
A
- infantile = 0 - 6mos
- acute flares
- favors face + scalp + extensor surfaces
6
Q
atopic dermatitis - childhood presentation
A
- childhood = 2 yr - 12 yr
- chronic > acute
- factors flexures
- diffuse xerosis more prominent
7
Q
atopic dermatiits - adult presentation
A
- adult / adolescent = > 12 yo
- prominent involvement of flexures
- characterized by thickened, chronic plaques
- lichenified plaques - cobblestoned appearance in areas of itching
- isolated prurigo nodularis - plaques in regions of itching
8
Q
A
infantile dermatitis:
- 0-6 mos
- acute flares on face + scalp + extensor surfaces
9
Q
A
atopic dermatitis - childhood
- 2 yrs - 12 yrs
- favors flexures
- diffuse xerosis prominent
10
Q
A
lichenification - cobblestoning plaques over skin that has been scratched
adult atopic dermatiits
11
Q
A
isolated prurigo nodularis - plaques where pt has been itching (in right pic, patient’s upper back has no plaques b/c he can’t reach there to itch)
atopic dermatitis - adults
12
Q
A
atopic dermatitis - associated feature
-
pityriasis alba: hypopigmentation
- more prominent in the summer
- clears up w/ topic steroids
13
Q
A
atopic dermatitis - associated feature
- keratosis pilaris - improves with age
14
Q
A
atopic dermatitis - associated feature
-
impetiginized lesions: infections of lesions d/t constant scratching
- staph infection = m/c (can also be d/t HIV)
15
Q
A
atopic dermatitis - associated features
- dennie-morgan lines - “pleat” under the eye
16
Q
A
atopic dermatitis - associated feature
- keratoconus - cone shaped cornea
17
Q
A
atopic dermatitis - associated feature
- allergic salute: permanent crase on the bridge of nose d/t constant runny nose & subsequent rubbing
18
Q
A
atopic dermatitis - associated feature
- sign of hertoghe: loss of lateral brow
19
Q
A
atopic dermatitis - associated feature
- ichthyosis vulgaris: “fish like scale” - polygonal white & brown scaling that favors the shins
20
Q
A
atopic dermatitis - associated feature
- palmar & plantar hyperlinearity
21
Q
summarize the associated features of atopic dermatitis
A
- pityriasis
- keratosis pilaris
- impetiginized
- dennie-morgan lines
- keratoconus
- allergic salute
- ichthyosis vulgaris
- palmar & plantar hyperlinearity
22
Q
A
- nipple dermatitis
- an example of a regional variant of atopic dermatitis
- bilateral dermatitis of the nipple
- if it is instead UNILATERAL: be sure fo consider paget’s disease!!
23
Q
A
- diapaer / napkin dermatitis
- _a regional varian_t of atopic dermatitis
- note that this sparing of the flexural crease - as opposed to candida, which causes all encompassing erythema that includes folds & flexural creases
24
Q
summarize the prevenative treatment of atopic dermatiits
A
- use of emolliants: THIS IS KEY - find an emolliant ur pt likes & can use for awhile
- short, lukewarm baths: too hot = dry skin
- bleach baths (1/3 bleach 1-2x/ week)- esp if pt has hx of skin infection (staph)
- wet dressing
- AVOID:
- fragrance filled products
- irritants
+ in pregnant women: breastfeed with hydrolyzed milk products + use probiotics
25
what are the ways that women can _prevent_ atopic dermatitis in _their newborns_?
* breastfeeding/formulas that contain _hydrolyzed milk products_ for the first 4-6 mos (esp in high risk)
* _take probiotics_ pre & post naatl
26
summarize the _medical treatment_ of atopic dermatitis
in general: treatment ladder, starting with the best:
1. **topical corticosteroids - mainstay of treatment!!**
* **steroids -\> non-steroidal maintance: calcinurin inhibitors, PDE-4 inhibitors**
* **this prevents steroid AEs**
2. light therapy - nbUVB \> bbUVB, UVA1, PUVA
3. systemic meds
for flare ups specifically:
* **topical steroids: but can alternate between potent & low/medium strengths**
* clobetasol/betmethasone BID s 2 weeks, then
* triamcinolone BID x 2 weeks
27
what is the _medical treatment_ for atopic dermatis _flares_?
* **topical steroids: but can alternate between potent & low/medium strengths**
* _clobetasol/betmethasone_ BID s 2 weeks, then
* _triamcinolone_ BID x 2 weeks
28
steroids
* have what adverse effects (AE) ?
* how do we lessen these AES in the management of atopic dermatitis ?
* AEs
* **atrophy / stretch marks**
* **acne**
* **tachyphylaxis**
* **fungal infections (tinea incognito)**
* ****steroids C/I to tx fungal infections
* steroid AES are lessened by:
* eventually switching to non-steroidals: calcinurin, PDE-4 inhibitors)
* alternating between high & lose dose topicals in acute-flare ups
29
atopic dermatits - prognosis
50% remit by early adulthood. if it does persistent beyond childhood, it tends to be chronic
30
steroid AE: steroid induced acne
31
steroid AE: steroid-induced atrophy
32
steroid AE: steroid induced atrophy
33
steroid AE: steroid induced atrophy (stretch marks(
34
steroid AE: steroid induced atrophy
35
steroid AE: steroid induced atrophy (stretch marks)
36
**tinea incognito**: a fungal infection + steroid
do NOT use steroids to tx a fungal infecgtion
37
asteototic dermatitis
* is also called?
* pathogenesis
* demographics
* presentation
* management
* **also called eczema craquele: "cracked porcelain"**
* pathogenesis: _elderly people_ have less natural moisturizing factors. in _winter_, when _humidity is low_, water loss -\> **xerosis with fine cracking**
* demographics:
* elderly people
* winter time
* presentation:
* pruritic
* erythema + scaling
* _favors lower legs_
* treatment: just like AD
* prevention: emolliants
* tx: topical steroids
38
asteototic dermatitis (eczema craquele)
39
circumostomy eczema
* pathogenesis
* demographics
* presentation
* treatment
* pathogenesis: type of _irritant contact dermatitis_ in which **fectal matter -\> skin breakdown**
* demographics: had an ostomy
* presentation: see photograph
* treatment:
* proper hygeine
* _appliance_: must be hypoallergenic & cut proplerly
40
dyshidrotic eczema
* pathogenesis
* demographics
* presentation
* treatment
* pathogenesis: **symmetrical hand & foot vesicles** d/t either allergic contact \> fungal infection
* demographics: n/a
* presentation: vesicles (\< 1 cm blisters) that
* are on hand & feet
* are symmetrical
* _appear "tapioca like"_
* _ARE PAINFUL_ (chief complaint) +/- puritis
* treatment: **topical steroids**
41
hand eczema
* pathogenesis
* demographics
* presentation
* treatment
* pathogenesis: dermatitis d/t _water exposure_ to hands
* demographics: those w/ exposure to water:
* occupation involving wet work
* 20-29 females from child care / housing cleaning
* \*possible link to with filagrin mutation
* treatment:
* general: avoidance:
* wash hands _infrequently_ !!
* wear rubber cloves when cleaning
* flares topical steroids under gloves to 3 nights
42
juvenile plantar dermatosis
* pathogenesis
* demographics
* presentation
* treatment
* pathogenesis: prologed wearing of _sports shoes_ -\> irritates plantar surface of forefoot
* presentation: **plantar surface of _forefoot_** that is dry, scaly & glazed
* demographics: preburbital children \>3
* esp those with atopic diathesis
* esp in the winter
* treatment: **replace socks with 100% cotton socks**
43
nummular eczema
* pathogenesis
* demographics
* presentation
* treatment
* pathogenesis: unknown
* demographics: n./a
* presentation: **round, coin shaped pink plaques** that are
* **m/c on the extremities**
* **very pruritic**
* treatment: **mid-high potency steroids**
44
stasis dermatitis
* pathogenesis
* demographics
* presentation
* treatment
* pathogenesis: **incompetent valves of the lower extremities:** HTN overrides capillaries -\> capillary leak -\> extravasation of fluid & blood contents into ECF
* demographics: n/a
* presentation: **pitting edema & demosiderin deposits** that are
* over distal third of leg beginning at the _median ankle_
* *can evolve to lipodermatosclerosis*: "inverted wine bottle"
* treatment: **compression stockings**
45
circumostomy eczema
46
dyshidrotic eczema
"tapioca-like", pruritic vesiscles that are symmetrical over the hand & foot
47
juvenile plantar dermatosis
dry, scaly, glazed plantar surface of the _forefoot_
48
juvenile plantar dermatosis
dry, scaly, glazed plantar surface of the _forefoot_
49
nummular eczema (discoid eczema)
round, coin shaped pink plaques over the extremities
50
stasis dermatitis
pitting edema & hemodiersin deposits over distal third of leg (starting at medial ankle)
