Types of Eczematous Disorders
Atopic Nummular eczema Lichen simplex chronica Dyshydrotic eczema Contact Diaper Candidiasis Perioral Seborrheic Stasis
Types of Papulosquamous Disorders
Lichen planus
Pityriasis rosea
Characteristics of Eczematous Lesions
Scaling
Crusting
Serous oozing
Define Dermatitis
Describes multiple types of skin disorders
Common Name for Atopic Dermatitis
Eczema
2 Theories of Atopic Dermatitis Pathogenesis
Impaired epidermal barrier function due to intrinsic structural & functional abnormalities in the skin
Immune function disorder in which Langerhans cells, T-cells, & immune effector cells modulate an inflammatory response to environmental factors
Clinical Manifestations of Atopic Dermatitis
Pruritus
Eczematous change & lichenification
Lesions ooze, crust & become purulent
Location of Atopic Dermatitis in Adults
Neck
Wrists
Behind ears
Antecubital & popliteal flexure areas
Location of Atopic Dermatitis in Children
Neck Wrists Behind ears Antecubital & popliteal flexure areas Cheeks/face
Treatment of Atopic Dermatitis Treatment
Eliminate exacerbating factors Antihistamines used to treat pruritus Hydration!! Topical steroids Burrow's solution for oozing lesions Treat skin infections
Eliminating Exacerbating Factors for Atopic Dermatitis Treatment
Avoid triggers: heat, low humidity, perspiration
Treat stress & anxiety
Antihistamines Used in Atopic Dermatitis
Doxepin
Vistaril
Mild to Moderate Cases of Atopic Dermatitis
Topical steroids & emollients
Mild: low potency steroid cream or ointment
Moderate: medium to high potency steroids
Topical Steroids SE
Atrophy Telangiectasia Purpura Striae Acneform eruption
> 3 weeks of therapy for the face or skin folds should use what class of medications
Topical calcineurin inhibitors
Black Box Warning for Topical Calcineurin Inhibitors
Increase the incidence of skin cancer & lymphoma with long term use
1st Line Treatment for Atopic Dermatitis
Hydration
Antidepressants
2nd Line Treatment for Atopic Dermatitis
Steroids
Topical calcineurin inhibitors
Define Nummular Eczema
Eczema that is described as coin shaped lesions
Where does nummular eczema usually occur?
Trunk
Lower extremities
What may be an alternative treatment for atopic dermatitis?
Phototherapy
Immunosuppressants: methotrexate, azithiorpine, cyclosporine, systemic steroids, IVIG
Describe Lichen Simplex Chronicus
What occurs as a result of chronic eczematous changes & scratching
Define Lichen Simplex Chronicus
Circumscribed plaque of thickened skin with increased markings with some scaling
Describe Dyshydrotic Eczema
Vesicular eruption on the skin of the hand & feet marked by intense itching
Scaling, fissures, & lichenification may follow
Treatment of Dyshydrotic Eczema
High potency topical steroids
May need to be given with occlusion
Hydration of the skin
Define Contact Dermatitis
Dermatitis due to a direct exposure to a substance
From allergy or irritation
Common Offenders of Contact Dermatitis in the U.S.
Poison ivy Poison oak Poison sumac Skin of mangoes Gingko fruit Nickel Formaldehyde Perfumes/cosmetics Preservatives Rubber & chemicals in shoes Topical hydrocortison Topical antibiotics Topical benzecaine, thimersol Laundry detergents
Presentation of Contact Dermatitis
Intense pruritus Rash Papular, erythematous lesions Papule from fluid in epidermis Vesicles & serous oozing
Treatment of Plant Based Contact Dermatitis
Topical symptomatic therapy
Antihistamines
High potency topical corticosteroids
Systemic corticosteroids
Topical Symptomatic Therapy for Contact Dermatitis
Oatmeal baths Cool, wet compresses Calamine lotion Burrow's or Domeboro solution for weeping lesions Zanfel soap
Treatment of Contact Dermatitis
Remove offending agent Topical symptomatic therapy Medium to high potency topical steroids Systemic steroids in severe cases Burrow's solution for weeping blisters Antihistamines for pruritis Treat secondary bacterial infections
What causes diaper dermatitis?
Combination of wetness, pH elevation, & friction
Clinical Presentation of Diaper Dermatitis
Erythema in the diaper area
Determine if it’s from wetness, irritation from diaper, or a yeast infection
Treatment for Diaper Dermatitis Without Yeast Infection
Frequent diaper changes
Barrier treatment with Vaseline or Desitin
Treatment for Diaper Dermatitis with Yeast Infection
Topical antifungal: nystatin, miconazole, clotrimazole
Barrier lubricants such as Vaseline
Treatment of Thrush
Nystatin
Clotrimazole
Treatment of Cutaneous Candidiasis Infection
Nystatin powder
Clotrimazole (Lotrimin)
Ketoconazole
Oral fluconazole (Diflucan)
Clinical Manifestations of Perioral Dermatitis
1-2 mm clustered erythematous papules, papulovesicles, or papulopustules
Most often around mouth
Spares vermillion border
Asymptomatic OR associated with burning or stinging
Treatment of Perioral Dermatitis
May resolve on own
1st: Topical calcineurin inhibitor, topical erythromycin, topical metronidazole
Moderate to severe: systemic tetracyclines (adults), Erythromycin (kids)
Describe Seborrheic Dermatitis
Erythematous scaling patches develop in areas of sebaceous glands (scalp, face, trunk)
Clinical Manifestations of Seborrheic Dermatitis
Erythema (reddish or pink color) Swollen/greasy appearance White/yellow scales Pruritis Distribution
Distribution of Seborrheic Dermatitis
Lateral sides of the nose Eyebrows Glabella Scalp Chest Upper back Axillae
Diagnosis of Seborrheic Dermatitis
Usually PE
Biopsy
Treatment of Seborrheic Dermatitis on the Scalp
Antiproliferative shampoo
Antifungal shampoo
Examples of Antiproliferative Shampoo
T-Gel extra Selenium sulfide (Selsun, Exelderm) Zinc pyrithione (Head & Shoulders, Zincon, DHS zinc)
Examples of Antifungal Shampoo
Ketoconazole 2%
Ciclopirox shampoo 1%
Treatment of Non-Scalp Seborrheic Dermatitis
Ketoconzole 2% cream or gel Ciclopirox 1% cream Tacrolimus 0.03% & 0.1% Pimecromlimus 1% cream Severe: low potency topical corticosteroid
Define Stasis Dermatitis
Occurs from blood pooling due to chronic venous insufficiency
Increased pressure in capillaries
Extravasation
Treatment of Stasis Dermatitis
Prevent edema Compression stockings Elevation of legs Skin cleansing Emollients Topical steroids for pruritis Wet dressing for crusts or open lesions
What areas can lichen planus effect?
Skin Oral cavity Genitalia Scalp (penile or vulvar) Nails Esophagus
Clinical Manifestations of Lichen Planus
Shiny, flat, polygonal, violaceous papule or plaques with white lacy pattern
Intensely pruritic
Diagnosis of Lichen Planus
Biopsy
Treatment of Lichen Planus
Localized: High potency or super high potency topical corticosteroid
Hypertrophic: Intralesional corticosteroids
Widespread severe: phototherapy, systemic steroids acitretin
Describe Pityriasis Rosea
“Herald patch”
Multiple new lesions appear centrally on trunk
Pruritic
Not contagious
Treatment for Pityriasis Rosea
Self limiting
Pruritis: medium potency topical steroid
Severe: acyclovir or phototherapy
Tinea Versicolor vs. Vitiligo
Both: hypopigmentation
TV: scaling
Vitiligo: no scaling