D: Eczematous Disorders (#7)

Front 1

What is a non-specific term describing inflammation in the skin?
- what does it usually denote?

What is a clinical term, describing skin disease with erythema, vesicles, oozing, crusting, scale, and lichenification?

Back 1

dermatitis
- perivascular infiltrate of lymphocytes with spongiosis

eczema

Front 2

What are the phases of dermatitis?
- is there a particular presenting stage?
- necessary to progress through all stages?

Back 2

Acute, Subacute, Chronic
- no
- no

Front 3

Example/characteristics of acute dermatitis?

Subacute dermatitis?

Key aspect of chronic dermatitis?

Back 3

erythema, vesicles, oozing, crusting --> intensely itchy: acute poison ivy, infantile atopic dermatitis.

erythema, scale, minimal crusting; itchy; commonly caused by childhood atopic dermatitis.

lichenification, scale, hyperpigmentation; common causes (adult atopic dermatitis, chronic contact dermatitis)

Front 4

Atopic dermatitis, contact dermatitis, hand dermatitis, nummular dermatitis, asteatotic eczema, venous stasis dermatitis...
...all are causes of what?

Back 4

eczematous dermatitis

Front 5

What dz has a strong association with other atopic disorders, in which 90% of pts develop dz before 5 yo?
- what % of kids in industriailized countries have this?

Back 5

atopic dermatitis
- 10+%

Front 6

What is the clinically predominant feature of atopic dermatitis?
- does this sx partially determine distribution of lesions?
- other features of the dz?
- where in infants?
- what develops by 2 years of age?
- most commonly affected areas in childhood?
+ is lichenification seen?
- how does it change as pt moves into adulthood?
- common complications?

Back 6

itching.
- yes
- dry skin, ichthyosis vulgaris, keratosis pilaris, pityriasis alba
- facial, extensor surfaces of extremities (diaper area spared)
- flexor surface involvement
- neck, antecubital fossa, popliteal fossa, periorbital area, and hands/feet
+ yes
- freq becomes less severe, distribution remains similar.. (commonly hand and periorbital)
- staph (true of majority) / viral superinfection.

Front 7

What is the pathogenesis of atopic dermatitis?
- what's wrong with the immune response?

Main tx goals?
- pts w/ severe dz might require what?

Back 7

multifactorial
- Dysregulation of immune response
T-helper cell 2 dominated
IgE and eosinophilia
Impaired skin barrier function

"our world is too clean?"

Moisturize the skin, decrease inflammation.(topical corticosteroid & emollients)
- immunosuppression

Front 8

Differentiate between irritant and allergic contact dermatitis on the following characteristics:
- people at risk
- # of exposures
- nature of substance
- concentration of substance required
- onset
- distribution

Back 8

Irritant:
- everyone
- non immunologic; a physical and chemical alteration of the epidermis
- few-to-many; depends on ability to maintain epidermal barrier
- organic solvent
- high
- immediate
- indistinct

allergic:
- genetically predisposed
- type IV delayed hyperS rxn
- repeated to cause sensitization
- low molecular weight hapten
- low
- 24-48hrs afterward
- corresponds closely to contactant.

Front 9

Which is 5 times more common: allergic contact dermatitis or irritant contact dermatitis?

Back 9

irritant is more common (5x)

Front 10

What sort of appearance is seen with a strong irritant CD (like acid alkalis)?

Weak (detergent, solvent)?

Back 10

Sharply demarcated erythema with vesicles in exposed area, onset immediate, common reaction

Erythema, scale, fissures in thin or otherwise compromised skin, uncommon reaction

Front 11

In which populations is allergic contact dermatitis less common?

Does ACD require prior sensitization?

Three phases of ACD pathogenesis?

What type of testing can be done to help dx etiology?
- helpful in irritant CD?

Treatment for widspread severe lesions?

Localized chronic lesions?

Back 11

infants and elderly due to decreased cell mediated immune response.

yes.

Sensitization, elicitation, resolution

patch testing: applied to the back.
- no

Steroids

Potent topical glucocorticoids