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Dermatology > Lecture 6: Dermatitis and Eczema > Flashcards

Lecture 6: Dermatitis and Eczema Flashcards

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1
Q

What is the triad of atopy?

A
  1. Atopic dermatitis
  2. Allergic rhinitis/hay fever
  3. Asthma
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2
Q

What is the underlying mediating physiology for atopic dermatitis?

A

IgE mediation

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3
Q

Where does atopic dermatitis MC occur?

A
  • Face/scalp/torso/extensors
  • Flexures
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4
Q

What is the cycle of atopic dermatitis?

A
  • Dry skin
  • Pruritis
  • Increased inflammation
  • Lichenification
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5
Q

Why does skin get dehydrated in atopic dermatitis?

A
  • Impaired filagrin production
  • Reduced ceramide levels
  • Increased trans-epidermal water loss
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6
Q

What ILs tend to be expressed in atopic dermatitis?

A
  • IL-4
  • IL-13
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7
Q

What are the 3 types of atopic dermatitis?

A
  1. Acute: erythema/vesicles/bullae/weeping/crusting
  2. Subacute: scaly plaques/papules/round erosions/crusts
  3. Chronic eczema: lichenification/scaling/hyper/hypo-pigmentation (itch that rashes)
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8
Q

Hallmark sign of atopic dermatitis

A

Intense pruritis

Leading to lichenification as you keep scratching

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9
Q

What should we be worried about in atopic dermatitis as they continue scratching?

A

Secondary impetiginization via staph/HSV/coxsackie/vaccinia

Breaking skin = prone to infection

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10
Q

What features suggest someone has atopic dermatitis?

A
  • Chronic: periorbital plaques
  • Hyperpigmentation
  • Hyperlinear palms
  • Keratosis pilaris
  • Hx of allergies
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11
Q

What is the primary thing that clues you into atopic dermatitis?

A

Hx and FHx

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12
Q

What is the tx for atopic dermatitis?

A
  • Gentle cleansers
  • Low strength steroids
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13
Q

How do you manage striae in atopic dermatitis?

A
  • Ointment without preservatives
  • Damp skin or under occlusive dressings
  • AVOID soap except in body folds
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14
Q

Cream for localized dermatitis

A
  • Low potency: desonide BID
  • Medium potency: Triamcinoline/mometasone/fluocinolone BID
  • Non-steroidals (only use if >2y): Tacrolimus/pimecrolimus/crisaborole
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15
Q

Systemic tx for atopic dermatitis

A

Dupulimab SC

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16
Q

Tx for pruritis in atopic dermatitis

A
  • Benadryl
  • Hydroxyzine
  • Zyrtec
  • Claritin

Antihistamines

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17
Q

How do you differentiate between irritant contact dermatitis vs allergic contact dermatitis?

A
  • ICD: confined to area, sharply marginated, never spreads
  • ACD: spreading, type IV HSR
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18
Q

Where does airborne contact dermatitis tend to affect?

A
  • Face (upper eyelids)
  • Neck
  • Upper chest
  • Forearms
  • Hands (palmar)

AKA exposed skin

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19
Q

How do you test for contact dermatitis?

A
  • Hx
  • Patch testing ((+) still requires you to clinically correlate)
  • Do not use skin prick test, which only tests Type 1 HSR

Patch testing is not the same as skin prick testing

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20
Q

What is the underlying physiology of allergic contact dermatitis?

A

Haptens, which bind to a carrier and cause a Type IV HSR

Re-exposure to a substance already sensitized to

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21
Q

Tx of allergic contact dermatitis

A
  1. Avoid offending agents
  2. Topical steroids (2wk on, 2wk off)
  3. Oral steroids
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22
Q

What non-pharmacological therapy can help with contact dermatitis?

A

PUVA Phototherapy

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23
Q

What can cause diaper dermatitis?

A
  • Cutaneous candidiasis
  • ICD
  • Miliaria (blocked sweat ducts)
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24
Q

Who is diaper dermatitis MC in?

A

3 weeks old to 2y in age

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25
How does diaper dermatitis tend to present?
* Fussiness * Crying during diaper change * Diarrhea * Shiny erythema with dull margins * Potentially candidiasis or miliaria
26
Management of diaper dermatitis
* Change the diaper ofc * **Dry** after bathing * **Barrier creams** (zinc oxide/petroleum jelly) * If candidiasis: nystatin/clotrimazole/econazole
27
How does nummular eczema present?
Like atopic dermatitis but **no HX/FHx of atopy** | Ring-shaped
28
Who is nummular eczema MC in and what predisposing factor may result in lesions on the legs?
* MC in **50-65y men** * **Venous stasis** will lead to lesions on the legs
29
What is nummular eczema associated with?
* Frequent bathing * Low humidity * Irritating/drying soaps * **Interferon therapy for Hep C** * Exposure to irritating fabrics | Irritants and drying
30
Where is nummular eczema MC found on the body?
Trunk and extremities
31
How is nummular eczema diagnosed?
**Clinically**, but you can do cultures if bacteria, scrapings if fungus, and biopsy if necessary
32
How do you treat nummular eczema?
The same as atopic dermatitis: * Gentle cleansers * Low strength steroids
33
What characterizes seborrheic dermatitis?
* Affecting the sebum-rich areas of the body * Face/scalp/neck/upper chest/back * **Pityrosporum yeast** | sebum is like an oily wax
34
Describe the clinical presentation of seborrheic dermatitis
* Simple dandruff fulminant rash * Dryness/pruritis/erythema/fine greasy scaling * Darker skin | Idk why darker has a **
35
Who is seborrheic dermatitis MC in?
* HIV * Parkinsons
36
What other derm conditions may coexist with seborrheic dermatitis?
* Rosacea * Psoriasis
37
How is seborrheic dermatitis dxd?
Clinically | KOH for fungal, biopsy may help
38
Management of seborrheic dermatitis
* **Ketoconazole Shampoo** * Steroids | Its yeast related!
39
MCC of stasis dermatitis
Chronic venous insufficiency
40
Symptoms of stasis dermatitis
* Pruritis * Heaviness * Edema
41
Clinical presentation of stasis dermatitis
* MC on the **medial ankle** * Lichenification * Shiny skin with loss of hair * Later: Hyperpigmentation
42
Management of stasis dermatitis
* Treat venous insufficiency * If lesion is weeping = wet compresses * **Topical steroids: triamcinolone/clobetasol**
43
MC predisposing factor to lichen simplex chronicus
**Atopic Dermatitis** | All that scratching = lichenification
44
What are the 3 predisposing factors for lichen simplex chronicus?
* MC: AD * Emotional stress * Habit forming scratching (anxiety)
45
Clinical presentation of lichen simplex chronicus and MC locations
* Thick plaques that are lichenified * Small papules, hyperpigmentation, excoriations * MC locations: scalp/ankles/lower legs/upper thighs/forearms/vulva/pubis/anal/scrotum/groin
46
Tx for lichen simplex chronicus
* Pt ed on avoiding scratching * Topical steroids: TAC (triamcinolone?) * ILK (intralesional kenalog injections?) * Emollients | More advanced AD so need better steroids
47
Where does perioral dermatitis NOT affect specifically?
* Lip margin * Immediate circumoral area
48
Who does perioral dermatitis MC affect?
Women aged 18-40
49
What are the typical complaints associated with perioral dermatitis?
* Burning * Pruiritis * Scaling * Erythema | The main differentiating factor is the perioral distribution
50
How is perioral dermatitis dxd?
Clinically
51
What should we be careful of when discontinuing perioral dermatitis caused by steroids?
You **need to taper down using low-potency**, otherwise it will flare up drastically. | Condition will generally flare before improving.
52
Tx of perioral dermatitis
* Tapering steroids if on them * Topical pimecrolimus 1% * Topical metro or erythro * See below for others
53
What is dyshidrotic eczema?
Pruritic **vesicular** rash common on the hands and feet | Itching/burning/pain
54
MC age range for dyshidrotic eczema
20-40
55
How do we dx dyshidrotic eczema?
* Classic tapioca vessels on appearance * **Clinically** * C&S to check infections * Patch test to check for ACD * Biopsy can rule out other DDx
56
Tx of dyshidrotic eczema without infection
* **Topical steroids** * Severe: PO prednisone for 2 week taper * PUVA therapy (also used in contact dermatitis)
57
What is the typical clinical course of dyshidrotic eczema?
Chronic, relapsing
58
What do emollients do?
Increasing skin moisture, flexibility, and preventing cracking/fissuring. | Non-cosmetic emollients are like vaseline
59
What are the 3 types of emollients and their pros/cons?
1. Creams: best for most dermatoses, cooling effect 2. Lotion: more watery, mainly for hairy areas 3. Ointment: Greasy **do not use on weeping eczema**, best for dry/thick skin
60
What are the 4 ways topical steroids decrease the immune response?
* **Stabilize** leukocyte/histatmines * **Constrict capillaries**/reduce permeability * **Decrease complement** cascading * **Reduce fibroblast proliferation** and collagen deposition, leading to reduced scar formation
61
CIs to topical steroids
* Underlying bacterial infection * HSR * Ophthalmic use | Chronic use can inhibit growth in kiddos
62
How are topical steroids classified?
* 1 = highest potency * 7 = lowest potency | Aka if severe, prob use a class 1-2 steroid
63
What is the most potent vehicle for a corticosteroid?
Petroleum based ointment | Semi-occlusive + superior lubrication **Potent Petroleum**
64
What is the main benefit of using steroid cream?
Cosmetic absorption
65
What is the least potent vehicle for topical steroids?
Lotion | Low Lotion ## Footnote Shake prior to use since its mainly powder in water.
66
Whats the most expensive form of topical steroids?
Foam | No residue, easy spread
67
Table of steroid potencies
1. Hydrocortisone is the weakest 2. Flucinonide acetonide is the strongest
68
What is the maximum duration of tx based on steroid potency?
* Class I (strongest) = 3 wks * Class 2-4 = 6-8 wks * Class 5-7 = chronic intermittent (1-2 weeks in the more delicate areas)
69
What should we be wary about when it comes to long-term steroid use on the same dose?
Tachyphylaxis (progressive decrease in clinical response to same dose) | Do holidays or switch
70
What is the drug class and MOA for pimecrolimus cream and tacrolimus ointment?
* **Calcineurin inhibitors** * MOA: **inhibition of T-lymphocyte activation**, which prevents release of cytokines.
71
When are calcineurin inhibitors used and how are they dosed?
* Atopic dermatitis * BID until clearing is noted | Pime = 2 yrs max, tacro = 4 yrs max
72
What are the BBWs and CIs to calcineurin inhibitors?
* BBW: rare lymphoma and skin cancer (**teratogenicity**) * CIs: HSR or **< 2y/o** | DNU with occlusive dressing and reassess if no improvement in 6 wk
73
MC SEs for calcineurin inhibitors
1. MC: **burning sensation** which gets better if you keep using it 2. HA 3. URI/FLS
74
What does selenium sulfide do and when do we use it?
* Reduces corneocyte production * Used in **seborrheic derm and tinea versicolor**
75
CIs to selenium sulfide use
* HSR * Oral/ophthalmic/anal/intravaginal use
76
How do you dose selenium sulfide for seborrheic derm and tinea versicolor?
* Sebb: apply for 2-3 mins, rinse, repeat 2x/wk then once weekly for maintenance. * Tinea versicolor: Shampoo/lotion for 10 mins, rinse, apply daily for a week. * Tinea versicolor: foam: rub BID x 1 wk ## Footnote Sebb is Short
77
MC SEs of selenium sulfide
* Burning * Stinging
78
MOA and use of pyrithione zinc
* MOA: reduce cell turnover * Use: **seborrheic derm** | That stuff in head and shoulders dandruff shampoo
79
Tx for perioral dermatitis
Topical metronidazole/erythro/clinda
80
Tx for irritant contact dermatitis related to occupation
Appropriate PPE
81
Tx for facial seborrhea
Hydrocortisone cream

Dermatology (12 decks)

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