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26 Cards in this Set
- Front
- Back
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Scale
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Primary epidermal process
-proliferation (eg psoriasis) Secondary epidermal repair -after any "bright red rash" (eg peeling after sunburn or drug eruption) |
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Atopic dermatitis overview and epidemiology
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This is a common, inherited problem often in association with other related atopic diseases such as asthma and hayfever
All AD patients have itchy skin Dry skin Minor irritants can cause significant itch, starting an itch-scratch cycle Atopic skin is prone to Staphylococcal overgrowth Prevalence of AD increased in the last 40 years reaches 10-17% of population. Much variation in different countries; western industrialized countries have higher rates. 90% clear over 15 years |
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Atopic dermatitis clinical presentation
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Distribution of lesions varies with age
Early infancy: Scalp involvement face and chins and extensor areas. Childhood; Prominent flexural areas; antecubital fossa and popliteal fossa, neck wrists. Adolescents: similar to childhood Adults: nummular eczema, Lichen simplex chronicus |
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Lichenification
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Lichenification: thickening of the skin due to repeated scratching
Severe forms: Generalized erythroderma; All body involvement requires occasionally hospitalization and aggressive systemic therapy |
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Erythroderma key features
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Erythroderma is defined clinically as generalized redness and scaling of the skin
Systemic manifestations include peripheral edema, tachycardia, loss of fluid and proteins, and disturbances in thermoregulation Erythroderma has multiple etiologies; the most common causes are atopic dermatitis, psoriasis, cutaneous T-cell lymphoma (CTCL), and drug reactions |
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Pathophysiologiy of atopic dermatitis
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Genetic disease with multiple genes involved
Mutation in Fillagrin protein gene part of the skin barrier function Increased IgE Environmental factors: Improved hygiene in infancy and the protection by early use of antibiotics promote the development Endogenous anti microbial peptides are low in AD ( definsin, cathelicidins) |
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Atopic dermatitis and allergies
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House dust mite allergens associated with AD.
Simple mite allergen avoidance improved AD significantly Food allergy: Cow milk, peanut butter common allergens |
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Treatment for atopic dermatitis
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Moisture the Skin
Avoid irritants and harsh soaps Topical mild to moderate corticosteroid treatments Topical immunomodulators: Ascomycins; tacrolimus pimecrolimus Oral antibiotics for acute flare ups Oral sedating anti histamines: better sleep- less itch |
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Side effects of topical corticosteroids
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Atrophy: thinning of the skin
Striae: stretch marks Telangiectasis: prominent fine blood vessels Systemic effects are unusual but can occur with large quantities applied for long periods |
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Psoriasis: overview
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Common 2-3% of population
Proliferative epidermal immune disorder Scalp, Extensor body surfaces: knees, elbows 10% may develop arthritis |
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Psoriasis clinical variants
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Plaque type: erythematous scaly plaques: most common type
Gutate: small scaly papules, abrupt onset after Strep infections Pustular: sterile pustules on red scaly plaques Erythrodermic: Involvement of all body ( like a burn) Nail involvement -pitting of nails |
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Psoriasis pathophysiology
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Pathophysiology: immune mediated disease: T cells involved
Hyperproliferation of keratinocytes: 10 times faster than normal→scales Massive invasion by neutrophils |
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Psoriasis treatment
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Anti inflammatory and anti proliferative topicals:
-Topical Corticosteroids -Vitamin D -Tar & Anthralin -Salicylic acid Phototherapy: UV-B, Psoralen + UVA Systemic therapy: -Methotrexate -Oral Retinoids( vitamin A Analogues) -Biologic Therapies: 2 major targets T cells and TNF- alpha |
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Seborrheic dermatitis
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Red scaly rash on face around perinasal areas and eyebrows, scalp and ears
Common Aggravated by stress Common in atopic eczema Variants -Cradle cap in infants -Worse with mental/physical stress -Neuropsych patients -May be severe in HIV patients |
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Seborrheic dermatitis pathophysiology and treatment
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Reactive epidermal proliferation to a normal skin organism
Antiproliferative: -tar -topical steroid Antifungal: -selenium -zinc pyrithrione -ketoconazole |
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Dermatophyte infection clinical features
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Red scaling
Ring or serpinginous More scale at edge |
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Variants of dermatophyte infections
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Scalp- tinea capitis
Feet- tinea pedis Hands- tinea manum Groin- tinea cruris Whole body- tinea corporis Nails- Onychomycosis |
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Tinea capitis
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In kids
Patchy hair loss with itch Mild scale to severe inflammation Severe forms: kerion with pustules crusting and oozing Systemic oral medication: grisofulvin USA- Tr. Tonsurans |
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Tinea corporis
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Rings: annular –circinate
Asymmetric Edge more distinct than the rest Scaling more obvious at the edge Itch |
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Tinea cruris
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“Jock itch”- inner thighs spares the scrotum and genitals
Bilateral M>>F Common in adults rare in children Common in obese |
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Tinea pedis
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Chronic
-powdery scale of web spaces and toes Acute -red, vesicular itchy in arch and webs If weepy, painful, smelly -may have bacterial mixed infection Uncommon in kids |
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Dermatophyte pathophysiology
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Thrive on keratin protein of skin, hairs, nails
Evokes mild inflammatory and proliferative response Variable immune response to infection |
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Dermatophyte diagnosis
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Clinical diagnosis
Scrape for KOH ( pottaisum hydroxide) Look for Hyphae |
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Dermatophyte treatments
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Topicals
-Azoles ( miconazoles, ketoconazoles) -Terbinafine ( Lamisil) Orals -Grisofulvin( Best for scalp, not effective for nails -Terbinafine( best for nails and body) -Azoles |
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Other cutaneous fungal infections
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Red+ scaly+ satelite pustules= Candidal intertrigo
Slightly red+ slightly scaly + hyperpigmentation or hypopigmentation= Tinea versicolor |
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Chronic cutaneous lupus
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Discoid lupus erythematosus
Sun exposed areas: face, chest Plaques with central atrophy and scarring Scalp involvement: with scarring hair loss+ alopecia Treatment; Sun protection Antiinflammatories: Topical Corticosteroids Hydroxychloroquine : Plaquanil |
