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45 Cards in this Set
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There are 2 types of contact dermatitis, what are they and how frequently do they occur?
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Allergic contact dermatitis- 20%
Irritant contact dermatitis- 80% |
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Irritant contact derm. is subdivided into 2 types?
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Chronic cumulative insult rxn (most common)- multiple exposures to low level irritants, may take weeks to months to appear
Acute toxic eruptions- single exposure to strong chemical |
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Which type of irritant contact dermatitis exhibits lichenification?
Bullas & skin slough? |
Chronic cumulative insult rxn.
Acute toxic eruption. Makes sense b/c a strong chemical can make your skin slough off. BULLA BULLA! |
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Allergenic contact dermatitis has 2 types, what are they?
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Acute & Chronic.
AACD: Erythema, edema, vesicles, pruritis, and spreads beyond contact site>> poison ivy |
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CACD presents as what. . .
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Erythema, pruritis, lichenified
Mimics CICD. |
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The most common Allergenic Contact Dermatitis causing agents are?
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Poison Ivy -most common Type IV allergen
Nickel |
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What is the test used to distinguish between ACD & ICD?
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Patch Test.
Positive results in spreading erythema, edema, closely set vesicles that persist if ACD. |
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ACD occurs where?
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Dorsum of feet.
Weightbearing, allergen in soles of shoes |
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Atopic dermatitis typically presents as a triad, specifically?
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1. ALLERGIC RHINITIS
2. SKIN DISEASE 3. ASTHMA |
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What Ig is increased in the TYPE IV like response to atopic dermatitits?
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IgE
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What are the 4 diagnostic criteria for atopic dermatitis, OF WHICH 3 MUST BE PRESENT?
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1. Pruritis
2. Distributions appropriate for age 3. Chronic relapsing course 3. Personal/family hx for the triad |
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What areas are affected in the infant affected with atopic dermatitis?
spared? |
Affected- cheeks, scalp, forehead
Spared- diaper area |
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What is the TX for atopic dermatitis?
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A lot of stuff!
Cotton clothes if they wear wool (irritant) Emolients Oral anti histamine. Antibiotics Protopic/elidel/UVB/PUVA/Cyclosporin NO COMPLETE CURE-- Chronic, relapsing |
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Juvenile plantar dermatitis is also known as atopic winter feet/sweaty sock dermatitis.
Where does it commonly occur and what areas are spared?! |
Occurs at balls of feet, and toes are erythematous, tender, dry and shiny, cracks and fissures
Dorsum, interdigital areas are spared. Self-Limiting, but supportive therapy helpful, emollients, keratolytics |
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This condition is also known as disydrotic eczema.
It presents as clear, deep seated tapioca vesicles on palms and soles. |
Pompholyx.
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What are some of the tx options regarding pompholyx?
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Emmolients/Burows solution/drain large blisters
Oral antibiotics Aluminum Chloride solution! |
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This condition presents with "coin like"- pts see tiny papules and vesicles that form erythematous coin shaped plaques.
Pin point vesicles and erosions on dry skin. Extensor surfaces of legs, B/L, symmetrical. Men and women 55-65, in winter. Unknown cause. What is the name of the condition!?? |
Nummular Dermatitis.
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What is the TX options for nummular dermatitis?
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Same as atopic.
(PUVA/PUBA/cyclosporine/cotton clothes/topical steroids) Some require 2-3 weeks KEFLEX |
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What is the ID reaction/ AKA autosensitization dermatitis?
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It is a 2* acute, papulovesicular, derm distant to the primary site of dermatitis.
It coalesce into small plaques. |
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What are some of the infectious causes of the ID rxn?
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Leprosy, TB. Candida, dermatophytes!!
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What is TRUE ID rxn?
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An exacerbation of an already existing dermatitis. (stasis, burns, contact)
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What is the tx for ID rxns?
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YOU GUESSED RIGHT!!
TOPICAL STEROIDS. TOPICAL ANTI-PRURITECS! |
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How does asteatotic eczema present?
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Dry, rough, scaly, inflamed skin with cracking that looks like a "dried river bed"
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What is asteatotic eczema associated?
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Associated with aging, xerosis, low humidity, frequent bathing
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Asteatotic eczema causes a decrease of intercellular lipids in s. corneum.
Now that you have read the above random fact, what is the tx homeboy? |
YOU WIN.
Topical steroids. Emollients, bath oils |
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What is stasis dermatitis?
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Condition results b/c of venous hypertension which leads to a cascade of events: slow blood flow, increased capillary permeability, edema, RBC extravasation, which then leads to microangiopathy
Free iron from hemosiderin deposits causes inflamm. rxn, as does free radicals |
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Stasis dermatitis occurs when the skin, fat, and deep fascia become indurated and firm (process is lipdermatosclerosis)
What is the first sign of chronic venous insufficiency? |
Cushion-like PITTING EDEMA.
Different from lymphadema- which is non pitting! |
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What is the TX for stasis dermatitis?
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Compression stockings, exercise, ligation, stripping of veins, topical steroids, moisturize
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Lichen Simplex Chronicus aka neurodermatitis, is not disease, but a rxn pattern. Occurs in adults over 60.
How would you describe it? |
Hyper pigmented, lichenified, leathery plaques, well demarcated
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What is the tx for lichen simplex chronicus?
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Anti-pruritics, moisturize, top steroid, oral doxepin
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Prurigo Nodularis occurs where?
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The extensor surfaces
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How does prurigo nodularis present?
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Hard keratotic nodules with scale
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What is the tx for prurigo nodularis?
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Anti-OCD/ Anti-depressants
Topical steroids, pramosone, zonalon, moisturize |
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Which class of steroids is the strongest?
The weakest? |
Class 1 strongest.
Class 7 weakest. |
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Name 2 Class 1 STEROIDS.
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Diprolene, Ultravate, Psorcon, Temovate
Class 1s should never be used on the face, axilla, or groin unless directed by derm. |
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What is the relationship between topical steroids and tinea infections?
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Topical steroids reduce inflammation BUT they lower the body's defense system, thus allowing the fungus to GROW!!
Known as tinea incognito! TAKE HOME: do not use topical steroids on superficial fungal infections fool!! |
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Name 2 topical immunomodulators and the major risk associated with using them.
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Elidel & Protopic.
Cancer risk Never use for those under 2! |
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Name 3 non steroidals that are anti-pruretic.
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Pramasone, Sarna (both OTC)
Zonalon (doxepin topical!) - makes pts drowsy |
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What are some other helpful agents that aren't topical steroids?
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Aquaphor, eucerin dry skin therapy, oatmeal baths to soothe, burrow's solution (aluminum acetate)
Do you know what Burrow's solution is? |
Didn't think so.
Burrows solution is an OTC formulation of aluminum acetate. It is marketed in a modified form by Bayer called Domeboro. he preparation has astringent and antibacterial properties and is used to treat a number of skin conditions such as insect bites, rashes caused by poison ivy and poison sumac, swelling, allergies and bruises. Burow's solution is traditionally applied in cold compresses over the affected area |
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Name 2 oral steroids!!
Both are intermediate acting! |
Prednisone
Methylprednisone |
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Name 3 conditions that you can give oral steroids for!
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Contact dermatitis
Atopic Eczema Lichen Planus Bullus Pemphigoid BONUS: name others! |
Pyoderma gangrenosum
Sarcoidosis Vasculitis Erythema Multiforme minor Sunburn |
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What are some of the side effects of LONG TERM use of systemic steroids?
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Hyperglycemia
HTN Cushing like changes Osteoporosis Peptic ulcer disease Psychosis (Chris Benoit!) Cataracts Abrupt cessation of steroids leads to? |
Adrenal crisis
Myopathy |
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Discuss contraindications for systemic steroid use?
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Systemic fungal infections (AIDS pts)
Hypersensitivity Moderate risk>> HTN/CHF Severe depression TB Diabetic Pregnancy Osteoporosis |
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What can you NEVER EVER EVER EVER give to patients for any skin condition?
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Medrol dose pack
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Why do physicians taper steroids?
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Suppresion of the Hypothalamic pituitary adrenal axis (HPA) begins as little as 5 days!
What is the HPA axis? |
The hypothalamic-pituitary-adrenal axis (HPA or HTPA axis), also known as the limbic-hypothalamic-pituitary-adrenal axis (LHPA axis) and, occasionally, as the hypothalamic-pituitary-adrenal-gonadotropic axis, is a complex set of direct influences and feedback interactions among the hypothalamus, the pituitary gland (a pea-shaped structure located below the hypothalamus), and the adrenal (or suprarenal) glands (small, conical organs on top of the kidneys). The interactions among these organs constitute the HPA axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure. A wide variety of species, from the most ancient organisms to humans, share components of the HPA axis. It is the common mechanism for interactions among glands, hormones, and parts of the midbrain that mediate the general adaptation syndrome
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