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Common Dermatoses
Study Guide
42
Science
Graduate
01/20/2015

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Term
Rosacea : Symptoms & Signs
Definition
  • Redness,Telangiectasia,blushing,papules,pustules;
    cheeks,nose;rhinophyma 
    • Triggers: heat, hot drinks, spicy food, sunlight,exercise,alcohol,emotions,menopausal flushing 
    • a/w opthalmic ds  
  • Flushing warmth 
  • no comedones 
Term
Rosacea : Diagnosis
Definition
Stages of Evolution 
  1. Episodic Erythema 
  2. Persistent Erythema with telangiectasia 
  3. Persistent erythema, telangiectasia, papules, tiny pustules
  4. Deep erythema, dense telangiectasia, papules, pustules, nodules, solid edema of central face, rhinophyma 
Term
Rosacea: Mild Treatment
Definition
  • Avoid Triggers 
  • Mild 
    • Topical Metronidazole,
    • Sodium sulfacetamides
    • Azelaic acid cream
    • Brimonidine gel (Marvaso)
      • Decreases the size of the blood vessel (vasoconstriction)
        • Pt. with persistent erythema 
      • New treatment for rosacea
      • Works temp - last 12 hrs
    •  Response in 4-8 weeks 
Term
Rosacea: Moderate Treatment
Definition
  • Topical creams 
  • Systemic ( oral antibiotic) 
    • tetracycline, minocycline, doxycycline 
  • Laser - reduce telangiectasia 
    • Heats the hemoglobin and RBC, which causes it to disappear 
    • Works well 
Term
Rosacea: Severe Treatment
Definition
  • When topical is inadequte ( mod - sev) 
    • Tetracycline 250-500 mg PO bid on empty stomach 
    • Rhinophyma
      • Early intervention 
      • Excision to remove excess edema on nose 
    • Laser: only txt for telangtectasias 
Term
Rosacea: Patient Education
Definition
  • Prevention of flare-ups
    • Reduction or elimination of alcoholic and hot beverages 
    • Exercise in cool enviornment 
    • Daily facial moisturizer with sunscreen 
    • Green based cosmetic foundations 
      • calms & hides redness down 
Term

 

Seborrheic Dermatitis

 

Definition
  • Often coexist with psoriasis 
  • Very common dermatosis characterized by redness and scaling occuring in regions where the sebaceous glands are most active 
  • Caused by overgrowth of yeast ( M. Furfur aka pityrosporum) 
  • Not contagious  
Term
Seborrheic Dermatitis : Symptoms and Signs 
Definition
  • Signs
    • Yellowish red dry scale with "greasy"  macules and papules 
    • Scaliness in the T zone 
      • Scalp margins, nasal folds, eyebrows, behind ears, submammmary, groin, body folds
    • Acutely ill , parkinson ds. HIV pt. strokes 
    • Cradle Cap- severe dermatitis of the scalp seen in babies 
  • Symptoms 
    • Pruitis can be variable 
    • Worse with perspiration 
    • Worse during the winter  
Term
Seborrheic Dermatitis : Course and Prognosis 
Definition
  • Very common 
  • Affects majority of individuals at some point in their lives 
  • Is chornic. Can re-occur at times of stress 
  • Pt. with HIV, parkinson patients and those hospitalized are more prone to getting this 
  • Can get secondarily infected - b/c people pick at the skin 
Term
Seborrheic Dermatitis : Treatment 
Definition
  • Scalp: zinc pyrithione/ selenium shampp daily , tar or ketoconazole shampoo 
    • topical steroids - come as a foam ; mild or low potent steroids
  • Facial & Nonhairy: mild CS cream intermittently (avoid eyes), ketoconazole creams 
  • Intriginous Areas: Low-pot CS lotions or creams bid x5-7 d, then 1-2x/wk for maintenance 
  • Eyelid Margins: gentle cleaning with baby shampoo 
Term
Seborrheic Dermatitis : Pt Education 
Definition
  • Caution with long term steroid use 
    • Steroids should not be used long term 
    • Can cause atrophy, acne breakouts 
    • Hard to treat something like this , so just caution the pt. 
Term
Psoriasis
Definition
  • Common , benign, chronic , inflamm. ; genetic + env. triggers 
    • Koebner Phenomenon - injury/irritation of normal skin -> lesions of psoriasis 
    • Worsened by obesity 
Term
Psoriasis: Signs and Symptoms
Definition
  • Itching 
  • BL; scalp, elbows, knees, palms and soles, nails
    (oil drop) 
  • red, sharply-defined plaques w/ silvery scales 
Term
Psoriasis: Diagnosis
Definition
  • Atopic dermatitis ( poor demarcation, flexural) 
  • Intertrigo & candidiasis ( culture) 
Term
Psoriasis: Types
Definition
  • Plaque: m/c 
  • Guttate: small red scaly papules or plaques
    • Looks like raindrops on the skin; mc follows strep infection 
  • Inverse: Armpits,groins, skin folds
  • Pustular: White blisters, surrounded by red; hands & feet, a/w TOB 
  • Erythrodermic: Intense redness, large areas, emergency 
    • Overall body redness 
    • Thick scale over top of it 
Term
Psoriasis: Locations
Definition
  • Most commonly on elbows,knees, palms, soles and scalp 
  • Usually occurs bilaterally 
  • Nails 
    • Tiny pitts ( oil drop sign) 
    • May loosen, thicken or crumble 
    • Onycholysis 
      • Seperate the nail from the nail bed 
  • Hard to differentiate from fungus - so do a culture 
Term
Psoriasis: Treatment - Limited Disease
Definition
  • Never use systemic CS to tx flares 
    • Limited ds ( <10% BSA) 
      • Small plaques: phototherapy 
      • Large plaques: high - to ultra- high-potency top. CS cream or ointment 
      • scalp: tar shampoo daily 
      • Vit. D analog 
      • Retinoids: exfoliate thickened skinm can be irritating 
Term
Psoriasis: Treatment -Moderate Disease
Definition
  • 10-30% BSA 
    • UV phototherapy 
Term
Psoriasis: Treatment- Generalized Disease
Definition
  • ( >30% BSA) 
  • OP narrowband UVB 3x/wk - stops rapid cell turnover 
  • PO retinoids: long t1/2, avoid in women of childbearing age 
  • Cyclosporine: ADRs 
  • Biologics: Stelara, Enbrels; injection, safer, future  direct; targets T cells to tx inflammation 
Term
Ezematous Eruptions
Definition
  • Atopic Dermatitis 
  • Contact Dermatitis 
  • Nummular Dermatitis 
  • Diaper Dermatitis 
Term
Atopic Dermatitis
Definition
  • AKA eczema 
  • atopic refers to the tendency for excess inflammation in the skin 
  • Tendency toward chronic or chornically relapsing dermatitis 
  • Often genetically related 
  • Most common in infants to young adults 
  • TRIAD - eczema , asthma, allergies 
Term
Atopic Dermatitis:Signs & Symptoms
Definition
  • in infants often seen as oozing, red, crusting condition on face and scalp 
  • After infancy, skin tends to be less red. 
  • Dry, pink, with scale or thickening 
  • May see bleeding or infection 
  • in kids and adults often see ACF, popliteal fossa, neck and face 
  • Hypo/hyperpigmentation 
  • VERY ITCHY , scratch , rash cycle 
  • Burning and stining from constant itching 
Term
Atopic Dermatitis : Pt. Education
Definition
  • Avoid hot, long water exposure 
    • esp kids 
  • Gentle soaps, moisturizers, laundry detergents 
  • No fabric softners 
  • Use humidifiers at home 
Term
Contact Dermatitis
Definition
  • Acute or chronic that results from direct skin contact with chemicals or allergens 
    • jewelry - nickle is a common allergen 
    • Neosporin 
    • Poison Ivy - usually in a line in different area 
  • Are often red and scaly. Can be vesicular and weepy 
  • Very itchy 
  • Look for pattern on exposed skin, in bizarre 
Term
Nummular Dermatitis
Definition
  • Generalized, pruitic, sharply demarcated, round ( coin-shaped) lesion of eczematous inflam.
  • Usually starts with few isolated spots on legs 
  • Tends to recur in same area
  • Check IgE - would be normal 
Term
Treatment for atopic dermatitis, nummular dermatitis,and contact dermatitis
Definition
  • Follow proper skin care 
  • Antihistamines may help with itching 
  • T/C allergy testing 
  • Oral steroids if severe
  • Abx if secondary infection 
  • Non- steroid creams for face and kids 
    • Tacrolimus, Pimecrolimus, Epiceram, Hylatopic 
  • Steroids Cream 
    • use with caution on face, axillam groin- not to use long term 
    • Don't use in kids
Term
Diaper Dermatitis
Definition
  • Diaper occludes the skin and predisposes to inflammation and infection 
  • Irritant contact vs. Candida 
    • Candida more like erosion 
  • Red,scaly, eroded, painful 
  • Treat - Low potent steroid or anti-yeast cream 
Term
Perioral Dermatitis
Definition
  • Scaly papular eruption around the mouth, nose, and eyes 
    • Also get periorbital dermatitis- around the corner of the eyes 
    • Like a acne breakout and a eczema breakout
  • Occurs mostly in females , may slightly be pruitic 
  • Treatment 
    • Low potent steroid cream 
    • Topical Abx 
    • If severe, oral abx
      • Most of the time used oral abx ( doxy) 
      • couple of wks to decrease the inflam 
Term
Stasis Dermatitis
Definition
  • Eczematous Dermatitis of the legs, associated with edema, varicose and dilated veins and hyperpigmentation 
  • Is chronic, often recurs 
  • Pruitic 
  • Txt 
    • Medium to high potent steroid cream 
    • Emollient 
    • Prevention of ulcers 
    • Compression stockings - helps facillitate the blood flow 
Term
Linchen Simplex
Definition
  • Chronicus
    • Circumscribed Neurodermatitis
    • General Considerations: scratch-itch cycle in chronic eczema pts.
  • Inflammatory disorder of unknown etiology
  • Skin, nail, hair and mucous membranes may be affected. 
  • Skin lesions may be pink, but overtime become purple with well defined borders
Term
Linchen Simplex: Signs and Symptoms
Definition
  • Chronicus
    • Dry, leathery, hypertrophic, lichenified, circumscribed plaques on neck, ankles, perineum
      • Most often found in ankles and wrists and presents with pink to purple well defined papules
    • rectangular, thickened, hyperpigmented
    • accentuated skin lines
  • Itching is variable, most often intermittent – mild to severe
  • Mucous membranes – shows a white lacy reticulated pattern (Whickam’s striae)
Term

Linchen Simplex Chronicus : Diagnosis

Definition
  • psoriasis (redder, whiter scales on elbows, knees, scalp, nails)
  • lichen planus (violaceous, smaller polygonal papules)
  • nummular dermatitis (coin-shaped)
Term
Linchen Simplex: Treatment
Definition
  • CHRONICUS - VERY DIFFICULT
    • superpotent topical CS ± occlusion (extra-genital)
    • steroid injections, ↑ emollients
  • Sedating antihistamines for pruritus
  • Oral steroids for severe cases
  • Group I or II topical steroids
  • Steroid intralesional injections
Term
Pityriasis Rosacea
Definition
  • common, mild, acute inflamm.; females; young adults; spring, fall
  • First lesion appears.  Two weeks later more similar smaller “spots”  appear.
    • neck down to the middle of the thigh is the m.c area
Term
Pityriasis Rosacea: Symptoms and Signs
Definition
  • mild itching
  • oval, fawn-colored ( large single pink patch) herald plaques (≤ 2 cm) w/ “cig paper” centers and collarette scale (classic)...more after 2 wks (smaller)
  • lesions follow cleavage lines on trunk (Xmas tree pattern)
  • 50% of patients will have itching (especially when overheated)
  • Physical activity – like jogging, bathing in hot water may cause rash to temporarily worsen or reappear for several weeks
Term
Pityriasis Rosacea: Diagnosis
Definition

 

  • syphilis (serology, if typical lesions are absent)
  • tinea corporis (fewer lesions)
  • ACEi, metronidazole, flu vax can imitate
Term
Pityriasis Rosea: Treatment & Pt. Education
Definition
  • Often none req.
    • steroid creams, avoid heat; oral steroids or UVB if severe
  • Re-assurance - benign , no scar formation behind
  • Avoid aggravating activities (hot showers, exercise)
  • Oral steroids if severe
  • UVB treatment if severe
Term
Vitiligo
Definition
  • Depigmenting disease of unknown origin that causes destruction of melanocytes.
  • M=F, 1% of pop
    • Develop at ages 10-30 y.o 
  • Most likely on hands, fingers, face, body folds, axilla, groin
    • Look at these locations first ( esp mouth area) to determine diff dx.
Term
Vitiligo: Treatment
Definition
  • Treatment
    • Sunscreen
    • Concealers/camouflage
    • Limited use of low to high potent steroid cream (depending on areas involved)
    • UVB treatment
    • Removal of remaining normal pigment (Monobenzone cream)
      • Pt. have less pigment than more of your pigment - do this sometimes!
Term
Hidradenitis Suppurativa
Definition
  • Chronic, scarring, disease occuring in the axillae, anogenital regions, and under female breasts.
  • Occurs deep in the skin around oil glands and hair follicles.  
  • Hallmark is double comedone (double barrel)
  • Sinus tracts are common.  
  • Extensive, deep, dermal inflammation results in large, painful abscesses
Term
Hidradenitis Suppurativa: Treatment
Definition
  • I & D
  • steroid injections
  • Long term antibiotics
  • Surgery
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