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Dermatology
1st ppt
135
Science
Graduate
01/25/2015

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Cards

Term
Acute, subacute, or chronic relapsing skin disorder that usually begins in infancy (rarely adult) and is characterized principally by dry skin and pruritis
Definition
atopic dermatitis (Eczema)
Term
"Itch-Scratch" cycle --> lichenification
Definition
atopic dermatitis (eczema)
Term
_____ is the itch that rashes
Definition
eczema
Term
People with eczema may have a family history of..
Definition
asthma, allergies (IgE mediated)
Term
Eliciting factors of eczema
Definition

inhalants (dust mites and pollens)

microbial agents (exotoxins of staph aureus)

foods (eggs, milk, peanuts, soybeans, fish, and wheat)

 

Term
Other exacerbating factors of eczema
Definition

skin barrier disruption

infections - S. aureus (watch out for MRSA)

season - improves in summer, flares in winter

clothing- pruritis flares AFTER taking off clothing (wool)

stress

Term
______ is an important exacerbating factor of eczema
Definition

dehydration

decrease of barrier function, water loss by frequent bathing and handwashing

(skin barrier disruption)

Term

Eczema: Skin Lesions

Acute

Definition
erythema progressing to papules and placques with flaking, xerosis, cracks, fissures, and excoriations
Term
xerosis means
Definition
dry flaky skin
Term

Eczema : Skin Lesions

Chronic

Definition
lichenification
Term
Distribution of Eczema on babies
Definition
face and trunk
Term
distribution of eczema on kids
Definition

mixed

more wide spread

Term
distribution of eczema on adults
Definition
flexural areas
Term
Acute treatment for eczema
Definition

stop scratching

wet dressings, topical glucocorticoids, hydroxyzine (10-100 mg QID), and oral antibiotics (dicloxacillin or erythromycin) to eliminate S. aureus

Term
Subacute/Chronic treatment for eczema
Definition

hydration + emollients

topical glucocorticoids

tacrolimus or pimecrolimus (immunosuppresents)

H1 antihistamines

UVA-UVB therapy

Term
acute or chronic inflammatory reactions to substances that come in contact with the skin
Definition
contact dermatitis
Term
Two types of contact dermatitis
Definition

irritant contact dermatitis (ICD) 

allergic contact dermatitis (ACD)

Term
This type of contact dermatitis is caused by a chemical irritant (acute vs chronic)
Definition
irritant contact dermatitis
Term
this type of contact dermatis is caused by an antigen (allergen) that elicits a type IV hypersensitivity rxn
Definition
allergic contact dermatitis
Term
What is the most commonly affected area for irritant contact dermatitis?
Definition
hands
Term
What encompasses 80% of all occupational skin disorders?
Definition
irritant contact dermatitis
Term
Isolated to area of contact (time and amount)
Definition
irritant contact dermatitis
Term
Pathogenesis of irritant contact dermatitis (ICD)
Definition

defense or repair capacity altered

chemical induced inflammatory response 

  • Becomes proinflammatory cytokine release that is causing irritation to the skin
  • Chemical can burn the skin, kill the keratinocytes, damage the collagen in the skin 

Term

Symptoms 

burning, tingling, smarting (stabbing-type pain)

Definition
irritant contact dermatitis (ICD)
Term
Skin Lesions are all about timing
Definition
Erythema with a dull, nonglistening surface àvesiculationàerosion à crusting à   shedding of crusts and scaling

(in chemical burn) erythema à necrosis à   shedding of necrotic tissue à ulceration à   healing
Term
Chronic ICD
Definition

cumulative (mild irritants)

irritant reaction (wet work)

wet chemicals would be worse (spread)

Term
Treatment for ICD
Definition

avoidance of irritant

wet dressings - burrow's solution

topical/oral steroids

lubricating/protective creams/ointments

Term
Burows solution is made from
Definition
 Domeboro (aluminum acetate) powder or tablets.
Term
Allergic contact dermatitis is a type ??
Definition
IV hypersensitive reaction (delayed)
Term
Apperance depends on severity, location, and duration
Definition
allergic contact dermatitis
Term
Investigate this with patch testing
Definition

allergic contact dermatitis

place different things and look for reaction 

Term
Allergic Contact Dermatitis - Skin lesions
Definition

well demarcated, erythema, inflamed, swollen areas

papules, dry scales

vesicular & bullous

exudative and crusty

often linear

itchy 

Term
How can you differentiate irritant contact dermatitis versus allergic contact dermatitis?
Definition
allergic itchy
Term
Treatment for allergic contact dermatitis
Definition

identify & remove agent

topical glucocorticoid ointments/gels (acute, nonbullous)

prednisone 70 mg 1-2 weeks (severe)

drain vesicles but do not remove top

wet dressings w/ cloths soaked in Burow's solution changed ever 2-3 hour

Term
chronic, pruritic, inflammatory dermatitis
Definition
nummular eczema
Term
"coin-shaped" plaques composed of grouped small papules and vesicles on an erythematous base
Definition
nummular eczema
Term
Nummular eczema peaks in..
Definition
winter but is also seen during the wall
Term
cause of nummular eczema
Definition
unknown
Term
nummular means
Definition
circular or "coin-shaped"
Term

Treament for Nummular eczema

 

Definition

skin hydration - moisturize

glucocorticoids

crude coal tar - 2-5% crude coal tar ointment daily

PUVA or UVB 311-nm therapy 

Term
PUVA
Definition
P (psolorin) is a plant base that you apply before sun therapy and it helps with absorption
Term
treament for systemic nummercular eczema
Definition
antibiotics if S. aureus is present
Term

redness and scaling and occuring in regions where the sebaceous glands are most active

(scalp, gluteal crease, neck line, breast, face)

Definition
seborrheic dermatitis
Term
"Dandruff" or "crandle cap"
Definition
seborrheic dermatitis
Term
Cause of seborrheic dermatitis
Definition

fungal

B6

Zn deficiences

cradle cap - unknown

Term
If seborrheic dermatitis is severe think...
Definition
HIV
Term
orange-red or gray-white skin, "greasy" or white dry scaling macules and papules of varying size
Definition
seborrheic dermatitis
Term
sticky crusts and fissures are common in the folds behing the external ear
Definition
seborrheic dermatitis
Term
Are seborrheic dermatitis sharply marginated or not?
Definition
sharply marginated
Term

on the scalp there is mostly marked scaling 

("dandruff")

Definition
seborrheic dermatitis
Term
scattered, discrete on the face and trunk
Definition
seborrheic dermatitis
Term
nummular, polycyclic, and even annular on the trunk; diffuse involvement of scalp
Definition
seborrheic dermatitis
Term
polycyclic
Definition
double rings
Term
treatment for seborrheic dermatitis
Definition

selenium sulfide or zinc pyrithione shampoos - 

ketaconazole shampoo 

mineral oil/baby oil/olive oil

Term
Selenium sulfide
Definition
Selsun Blue
Term
zinc pyrithione shampoos
Definition
Head & Shoulders
Term
T gel -
Definition
neutrogenia
Term
Ketaconazole shampoo
Definition
Nizoral OTC -prescription 2%
Term
mineral oil/baby oil/olive oil is used mainly for
Definition

seborrheic dermatitis

cradle cap

Term
discrete erythematous micropapules and microvesicles
Definition
perioral dermatitis
Term
Perioral dermatitis is seen mostly in what age group?
Definition
young women (16-45 years old)
Term
Cause of perioral dermatitis
Definition
unknown
Term
duration of perioral dermatitis
Definition
weeks to months
Term
Can affect periorbital area
Definition
perioral dermatitis
Term
Avoid topical steroids with...
Definition
perioral dermatitis
Term
Topical treatment for perioral dermatitis
Definition
metronidazole 0.75% cream BID or 1% QD
Term
Systemic treatment for perioral dermatitis
Definition

minocycline or doxycycline 100 mg QD until clear then

50 mg QD x 2 months

OR

tetracycline 500 mg BID until clear, 500 mg QD x 1 mo, then 250 mg QD x 1 month

Term
occur on lower extremities in patients with venous insufficiency
Definition
stasis dermatitis
Term
eczematous dermatitis w/ inflammatory papules, scaly and crusted erosions, excoriations, sclerosis, pigmentation
Definition
stasis dermatitis
Term
venous insufficiency on the legs
Definition

bronze, red-brown

blockign flow so RBC's leak into the area and is usually d/t hemoglobin

Term

Treatment for stasis dermatitis

Definition

topical glucocorticoids (short term)

topical antibiotics (mupirocin) - secondary infection

culture for MRSA?

Term
vesicular type of hand and foot dermatitis
Definition
dyshidrosis eczema
Term
deep-seated pruritic, clear "tapioca-like" vesicles; later, scaling fissures and lichenification occur
Definition
dyshidrosis eczema
Term
dyshidrosis eczema has
Definition
recurrent attacks
Term
Spontaneous remission in 2-3 weeks
Definition
dyshidrosis eczema
Term
With dyshidrosis eczema you need to r/o
Definition
bacterial or fungal
Term
usually on the medial aspect of the hands and feet
Definition
dyshidrosis eczema
Term

treatment for dyshidrosis eczema 

wetdressing

Definition

vesicular stage: Burow's wet dressings  

 

 

Term

treatment for dyshidrosis eczema 

fissures

Definition
topical flexible collodion (trying to keep skin together)
Term

treatment for dyshidrosis eczema

glucocorticoids

Definition
high-potency glucocorticoids w/ plastic occlusive dressings (saran wrap) for 1-2 weeks
Term

treatment for dyshidrosis eczema

intralesional injection

Definition
triamcinolone
Term

treatment for dyshidrosis eczema

systemic

Definition
tapered prednisone (medrol dose pack)
Term

localized form of lichenification

results from repetitive rubbing and scratching

Definition
lichen simplex chronicus
Term
individuals older than 20 years, more frequent in women, and possibly more frequent in Asians
Definition

lichen simplex chronicus

 

Term
this skin disease can last for decades
Definition
lichen simplex chronicus
Term
Pathogenesis of lichen simplex chronicus
Definition

physical trauma = skin hyperplasia

emotional stress

habit forming/unconscious habit

"pleasure habit"

itch attack from minor stimuli

nervousness, anxiety, depression, and other psychological disorders

Term
solid plaque of lichenification, arising from small papules; scaling is minimal except on lower extremities
Definition
lichen simplex chronicus
Term
lichen simplex chronicus skin lesions
Definition

excoriations are often present

usually dull, red, later brown, or black hyperpigmentation

Term
round, oval, linear (following path of scratching), sharply defined
Definition
lichen simplex chronicus skin lesions
Term
Treatment of  lichen simplex chronicus
Definition

difficult

stop scratching or rubbing

topical glucocorticoid preparations or tar preparations + occlusive dressings

intralesional triamcinolone

oral hydroxyzine (night)

Term
Eczematous eruptions
Definition

atopic dermatitis (eczema)

contact dermatitis - irritant and allergic

Nummular eczema

seborrheic dermatitis

perioral dermatitis

stasis dermatitis

dyshidrosis eczema

lichen simplex chronicus

 

Term
acute or chronic inflammatory dermatosis involving skin and/or mucous membranes
Definition
lichen planus
Term
age of onset - 30-60 yrs, F > M
Definition
lichen planus
Term
Etiology of lichen planus
Definition

idiopathic (most cases)

cell-mediated immunity (lymphocytes) plays a major role

Term
Drugs, viral (Hep C), metals (gold, mercury)
Definition
lichen planus
Term
HLA associated - various HLA antigens that predispose pt's to developing....
Definition
lichen planus
Term

Onset - acute (days) 

OR

insidious (over weeks)

Definition
lichen planus
Term
If you biopsy this you would have lymphocytes that migrated to that area
Definition
lichen planus
Term
papules, flat topped, 1-10 mm, sharply defined, shiny
Definition
lichen planus
Term
violaceous, with white lines (Wickham's striae)
Definition
lichen planus
Term
Polygonal or oval.  Grouped, linear, annular, or disseminated scattered discrete lesions when generalized
Definition
lichen planus
Term
In dark-skinned individuals with lichen planus ____ is common
Definition
postinflammatory hyperpigmentation (PIH)
Term
Four P's
Definition

papules, purple, polygonal, pruritic 

lichen planus

Term
location of lichen planus
Definition

wrists (flexor)

lumbar

shin

scalp

mouth - white, lacy type appearance, may appear as white dots (confused w/ thrush, leukoplakia)

Term
treatment for lichen planus
Definition

topical or systemic glucocorticoids

cyclosporine or tacrolimus soln.

PUVA

systemic retinoids

if Hep C, don't want to give immunosuppressants

Term
acute exanthematous eruption with a distinctive morphology and often self-limited course
Definition
pityriasis rosea
Term
age of onset - 10-43 years
Definition
pityriasis rosea
Term
Etiology of pityriasis rosea
Definition
HHV 6 or 7 reactivation
Term

a single herald patch precedes the exanthematous phase; which develops over a period of 1-2 weeks

pruritus

Definition
pityriasis rosea
Term
if you ever hear exanthem it means...
Definition

post-viral infection

may have a fever then a few days later develop a rash

Term
HHV 3
Definition
zoster
Term
HHV 4
Definition
epstein barr
Term
HHV 5
Definition
CMV
Term
herald patch
Definition

80% of patients with pityriasis rosea have this

oval, slightly raised plaque 2-5 cm, salmon-red, fine collarette scale at periphery

Term
exanthem that breaks out after herald patch
Definition
pityriasis rosea
Term

fine scaling papules and plaques with marginal colarrette

Dull pink or tawny

Definition
pityriasis rosea
Term
oval, scattered, with charateristic distribution with the long axes of the oval lesions following the lines of cleavage in a "christmas tree" pattern
Definition
pityriasis rosea
Term
treatment for pityriasis rosea if not symptomatic
Definition
spontaneous remission in 6-12 weeks or less
Term
treatment for pityriasis rosea if symptomatic
Definition

oral antihistamines and/or topical antipruritic lotions for relief of pruritis

topical glucocorticoids

may be improved by UVB phototherapy or natural sunlight exposure if tx is begun in the first week of eruption

acyclovir -antiviral

 

Term
chronic disorder w/ polygenic predisposition and triggering environmental factors (bacterial infection, trauma, drugs)
Definition
psoriasis
Term
10-25% of psoriasis cases also present with...
Definition
psoriatic arthritis
Term
T-cell driven autoreactive immune response
Definition
psoriasis
Term
peak incidence is about 22.5 years old
Definition
psoriasis
Term
epidemiology - male = female
Definition
psoriasis
Term

polygenic trait 

(1 parent = 8%, 2 parents = 41%)

Definition
psoriasis
Term
HLA ags frequently associated with this disease
Definition
psoriasis
Term
trigger factors for psoriasis
Definition

physical injury (Koebner's phenomenon)

infections

stress

drugs

ETOH

Term
Pathogenesis of psoriasis
Definition

keratinocyte cycle alteration 

(shortened cell cycle) 

excessive epidermalpoiesis - skin basically goes into hyperdrive

Term
Two major types of psoriasis
Definition

eruptive, inflammatory - multiple small lesion

chronic stable (plaque)

Term

sharp margins, bright erythema, nonconfluent whitish or silvery scales

lesions may occur at any site 

Definition

psoriasis

nonconfluent means they dont really flow in a pattern

Term
affects nail bed and matrix
Definition
psoriasis
Term
Auspitz's sign - when they pick at it it forms microscopic bleeding
Definition
psoriasis
Term
treatment for psoriasis
Definition

topical fluorinated glucocorticoids

hydrocolloid dressing

vitamin D (watch hypercalcemia) +- antibiotics

scalp - mild (coal tar or ketoconazole), severe (Keralyst)

UV radiation

coal tar

methotrexate or cyclosporine

enbrel (entanercept), Remicade, Humira (TNF inhibitors)

Term
Papulosquamous Diseases
Definition

lichen planus

PIH

Pityriasis rosea

Psoriasis

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