Dermatitis and Eczema

Question 1

WHat are the three types of dermatitis we talked about?

Answer 1

atopic dermatitic (eczema)

contact dermatitis

seborrheic dermatitis

Question 2

What happens in atopic dermatitis? Who get is?

Answer 2

It’s Eczema - usually childhood onset and 50% resolve by adolescence

it’s a chronic, pruritic condition of the skin of unknown etiology -

there seems to be a genetic suscptibility, immune dysfunction and epidermal barrier dysfunction leading to increased histamine and leukotriene production

Question 3

What conditions are often found in people who have atopic dermatitis (eczema)?

Answer 3

asthma and allergies

Question 4

Which antibody is elevated in atopic dermatitis (eczema)?

Answer 4

IgE

Question 5

Even though eczema usually resolves, what are some poor prognostic features found in people with eczema in adulthood?

Answer 5

fam history

early disseminated in infancy

female

coexisting allergic rhinitis and asthma

Question 6

What is the pathophysiology of dermatitis?

Answer 6

1. epidermal edema (spongiosis)
2. Pale epidermis
3. swelling of keratinocytes
4. leaky cells with fluid pockets
5. clinically = weeping vesicles

Question 7

What is the clinical hallmark of eczema?

Answer 7

“the itch that rashes”

VERY itchy

Question 8

Where do kids usually get eczema on their bodies?

adults?

Answer 8

kids get it on their cheeks, chin, and extensor surfaces

adults with flexor surfaces, buttocks, neck, face, upper chest/ adults get lichenification

Question 9

WHat percentage of children have eczema in the US?

What percentage of those affecetd also have a respiraotry allergy?

Answer 9

10%

80%

Question 10

While there is definitely a genetic component to eczema, what are some environmental factors that could be involved?

Answer 10

pollutatns

indoor allergens

decline in breast feeding

Question 11

What is the relation between allergenc and eczema?

Answer 11

the allergens don’t cause it, but they aggregate it and exacerbate the rash

Question 12

What is the treatment of atopic dermatitis?

Answer 12

cutaneous hydration is huge (avoid soaps)

topical glucocorticoid Rx an option

newer prescriptions include protopic (an immunomodulator that inhibits T-ceel activation) and elidel (a calcineurin inhibitor)

Question 13

What are two ways you can treat the pruritis of the eczema (the itchiness)?

Answer 13

antihistamines at bedtime

tar preparations

basically just moisturize

Question 14

What are some additional optoins for refractory atopic dermatitis?

Answer 14

wet cressings

systemic glucocorticoids

phototherapy (PUVA)

Leukotriene inhibitors

Immunosuppressants

Question 15

What are the main complications asociated with atopic dermatitis?

Answer 15

eyelid dermatitis can lead to corneal scarring, vernal conjunctivitis (inflammation of upper eyelid), keratoconus (conical deformity of the corna from chronic rubbing), cataracts

secondary infections (most common is HSV, but also fungal, staph aureus, HPV, molluscum)

Hand dermatitis

Exfoliative dermatitis

Question 16

What are the two secondary infections that cause issues in atopic dermatitis?

Answer 16

bacterial impetigization from staph aureus

secondary herpetic infection causing eczema herpeticum

Question 17

What is contact dermatitis?

Answer 17

An inflammatory reaction of the skin precipitated by an exogenous chemical

Question 18

what are the two types of contact dermatitis?

Answer 18

irritant - direct toxic effect on the skin

allergic - immunologic reaction that causes tissue inflammation - occurs 24-48 hours after exposure (type 4 hypersensitivity)

Question 19

What are 5 big examples of sensitizers for contact dermatitis?

Answer 19

poison ivy

paraphenylendiamine (in hair dyes)

nickel

rubber compounds

ethylenediamine (preservative in mycolog cream)

Question 20

What will contact dermatitis from poison ivy look like?

Answer 20

erythematous vesicular rash in a linear pattern (usually)

it does NOT have to be only on the area of the skin that came in contact with the plant

Question 21

WHat are some common locations on the body for contact dermatitis?

Answer 21

it depends on the trigger….

head and neck for cosmetics

scalp for hair dyes or shampoo

eyelids for cosmetics and nail polish

dorsum of hand for industrial chemicals

dorsum of feet for rubber and leather from shoes

Question 22

Which types of contact dermatitis can be tested for and which can’t?

Answer 22

the allergic dermatitis can be tested for using the patch test

there it no testing for irritant contact dermatitis

Question 23

What is the treatment for contact dermatitis?

Answer 23

prevent exposure to the allergen!

SYmptomatic therapy - drying agents for the vesicular weeping, oral anithistamines and glucocorticoids. Predisone is often necessary because the type 3 hypersensitivity reaction is internal.

wear barriers like gloves

tolerance induction to the known allergen

Question 24

What is seborrheic dermatitis? What is the clinical hallmark?

Answer 24

It’s a chornic superficial inflammatory process affecting the hairy regions of hte body especially the scalp, eyebrows, ears, and face

It’s scaly!!!

Question 25

People with what disease will almost always have seborrheic dermatitis?

Answer 25

HIV

Question 26

People with diseases in what body system also have a tendency towards seborrheic dermatitis?

Answer 26

oddly enough, nervous system disorders like parkinson’s disease, dranial nerve palsis, and paralysis - maybe increased pooling of sebum from immobility…

Question 27

When are the two age peaks in incidence of seborrheic dermatitis?

Answer 27

infancy int he first 3 months (cradle cap)

adults 40-70 yrs

Question 28

How can you distinguish seborrheic dermatitis from atopic dermatitis in infants?

Answer 28

it’s hard, but it it’s affectig the diaper area and the axilla, it’s usually seborrheic dermatitis because atopic dermatitis tends to spare the diaper area

Question 29

WHat are some drugs that can cause a seborrheic dermatitis-like rash?

Answer 29

arsenic

gold

methyldopa

cimetidine

neuroleptics (haldol, thorazine)

Question 30

WHat time of year is seborrheic dermatitis most common?

Answer 30

late fall and winter

Question 31

DOes PUVA help for seborrheic dermatitis?

Answer 31

no - it actually makes it worse

Question 32

What are the treatment goals of seborrheic dermatitis?

Answer 32

loosening and removal of scales/crusts

inhibition of yeast colonization

control of secondary infection

reduction of erythema and itching

CONTROL, NOT CURE

Question 33

What is the treatment for infants with cradlecap?

Answer 33

remove the drusts with salicylic acid in olive oil

can also use low potency glucocorticoids and mild baby shampoos

Question 34

Is the use of soaps good for seborrheic dermatitis?

Answer 34

actually, yes - it removes oils form affected areas and improved the seborrhea

Question 35

What is the treatment for seborrheic dermatitis in adults?

Answer 35

anti-inflammatories

anti-fungals

kerolytics like salicylic acid or coal tar preparations to remove the dense scale before topical steroids may be applied

Use daily champoo containing selenium sulfide, antifungals, zinc, benzoyl peroxide, salicylic acid, coal or juniper tar

Question 36

WHat is photodermatitis?

Answer 36

An immune-based dermatitis in which UV light alters the antigen to make is an effective immunogen resulting in a type 4 cell-mediated reaction

commonly seen with thiazide diuretics and tetracyclines

STOP the med and use sunscreen