What is another name for atopic dermatitis?
eczema
What is atopic dermatitis?
chronic pruritic, inflammatory skin disease often associated w/ atopy
What are the risk factors for atopic dermatitis?
Genetics -FMHx, environmental exposure
What is the atopic triad?
atopic dermatitis, asthma, allergies
What is the pathophysiology behind atopic dermatitis?
complex and multifactoral: filaggrin deficiency → epidermal barrier dysfunction, TH2 cell immune dysfunction → promote inflammatory IgE response, altered skin microbiome, environmental factors
What are the clinical features of atopic dermatitis?
pruritic, inflammatory, dry skin, itch-scratch cycle, lichenification
How does eczema commonly present in pts < 2 yo?
common on extensor surfaces, cheeks, scalp; pruritic, red, weeping, scaling, crusting
How does eczema commonly present in pts > 2 yo?
common on flexural distribution, more dry, lichenification
What are the secondary features of atopic dermatitis?
infra/reto auricular fissuring, dermographism, Dennie-Morgan infraorbital folds, keratosis pilaris
If you are prescribing a biologic, what do you HAVE to do?
run labs
How do you dx Atopic Dermatitis?
clinical usually
culture if infxn suspected
Labs: CBC -eosinophilia
Skin biopsy: spongiotic tissue
How do you treat mild to moderate Atopic Dermatitis?
topical corticosteroids and emollients:
Low potency (group 5 & 6)
Alternative (non-steroid) topical calcineurin inhibitors:
Tracrolimus, Pimecrolimus
How do you treat moderate to severe Atopic Dermatitis?
Topical corticosteroids:
medium to high potency (group 3-5)
Systemic Immunosuppressants
Dupixent
Alternative
narrowband UVB phototherapy
How does UVB phototherapy help with eczema?
UV rays reduce histamine production
When should you use low potency TCS for eczema pts?
when its on the face/neck and skin folds due to risk of atrophy
How can you manage Atopic Dermatitis w/o pharmacologic tx?
oral antihistamines, lukewarm baths, wet dressings, topical emollients and creams > lotion, products w/ ceramides, manage stress and anxiety, avoid fragranced products
Why is it important not to scratch eczema?
can lead to secondary infection
What is Seborrheic Dermatitis?
papulosquamous disorder patterned on sebum-rich areas of the scalp, face, and trunk
What pattern does Seborrheic Dermatitis follow?
biphasic: occurs in infants btwn 2 wks-12 mo and later in the 4th decade
What is craddle cap?
Seborrheic Dermatitis on the scalp of babies
What causes Seborrheic Dermatitis?
exact cause unknown; linked to Malassezia furfur colonization
What are the risk factors for Seborrheic Dermatitis?
age, M > F, Meds (dopamin agonists, immunosuppressants, lithium, psoralen), immunocompromised
What are the clinical features of Seborrheic Dermatitis?
well demarcated, erythematous plaques, “greasy” yellow scales, pruritis, pityriasis sicca (dandruff)
Where does Seborrheic Dermatitis typically occur?
face/scalp, periocular, trunk, intertriginous areas, genitalia
How do you treat Seborrheic Dermatitis?
OTC medications for scalp
Infants: mineral oil/baby shampoo
1st line
topical antifungal (ketoconazole)
low potency TCS or Topical calcineurin inhibitor
Severe: oral antifungal
What is allergic contact dermatitis?
contact w/ a substance elicits a delayed Type 4 hypersensitivity rxn, often occurs w/in 48hrs of contact, more exposure = greater reaction
What are the causes of allergic contact dermatitis?
poison ivy, oak, nickel, preservatives, fragrances, antibiotics, paraphenylenediamine (hair dye)
What are the risk factors for allergic contact dermatitis?
hx of atopy, age, occupation
What is the pathophysiology behind allergic contact dermatitis?
exposure to antigen → T cells activated → release pro inflammatory cytokines; has IgE involvement
What are the clinical features of acute allergic contact dermatitis?
well demarcated, pruritic, erythema, edema localized/ confined to the area of contact, papules, vesicles, and/or blistering
What are the clinical features of subacute allergic contact dermatitis?
plaques of mild erythema w/ small dry scales sometimes associated w/ small, red, firm papules; can be generalized
What are the clinical features of chronic allergic contact dermatitis?
plaques of lichenification, scaling w/ small round papules, excoriations, and erythema
How is allergic contact dermatitis diagnosed?
usually clinical
patch test can done
Skin biopsy: eosinophilic spongiosis and exocytosis of eosinophils & lymphocytes
What is the tx for allergic contact dermatitis?
1st line: TCS
potency depends on location of rash
Alternative: topical calcineurin inhibitors
Severe: oral corticosteroids
2nd line
phototherapy or immunodilators
What is Poison Ivy/Oak Dermatitis?
subtype of allergic contact secondary to direct exposure to olioresin urushiol found inside plant leaves
What are the clinical features of Poison Ivy/Oak Dermatitis?
acute, very pruritic, eczematous dermatitis, often in linear arrangement; usually 4-96 hrs post exposure
Why should you NOT perform a patch test to see if a pt is allergic or having a response to poison ivy/oak?
can sensitize the individual
What is the tx for Poison Ivy/Oak?
calamine lotion, antihistamines, topical steroids; resolves on its own in 1-3 weeks
What is the pt education for allergic contact dermatitis?
remove the offending agent; calamine lotion and oatmeal baths may help w/ pruritis
What is irritant contact dermatitis?
type of contact dermatitis confined to areas exposed to chemical or physical irritants
What are the clinical features of irritant contact dermatitis?
erythema, burning/stinging/pain, painful fissure; sharply marginated, NEVER spreads
Where is irritant contact dermatitis most common?
hands (can also present on face or extremities)
What is the pathophysiology behind Irritant Contact Dermatitis?
direct cytotoxic damage to keratinocytes; repeated exposure damages cell membranes → PTN denaturation and cellular toxicity
What is the tx for Irritant Contact Dermatitis?
remove irritant → resolves w/in 2 weeks; mod/severe: high potency class 1-3 TCS; on face: low/medium potency class 4-6 TCS
What is Stasis Dermatitis?
common inflammatory skin condition of the LE occuring in pts w/ chronic venous stasis
What are the clinical features of Stasis Dermatitis?
erythematous, scaling, and eczematous patches or plaques over the areas of chronic edema on the legs, ulceration, atrophy, lichenification
Where does Stasis Dermatitis most commonly occur?
medial ankle, can extend up to the knee
What are risk factors for Stasis Dermatitis?
old age, FMHx of venous disease, chronic edema, obesity, Hx of DVT, HF, HTN
What is the tx for Stasis Dermatitis?
tx underlying insufficiency!!
leg elevation, walking, wt loss, compression hose
Emollients to help keep moisture in
Acute: TCS
Group 3-4
long term = risk of ulceration
What is another name for Dyshidrotic Eczema?
pompholyx or acute palmoplantar eczema
What is Dyshidrotic Eczema?
intensely pruritic chronic and recurrent vesicular dermatitits of unknown etiology that affects the palms, soles, and lateral aspect of digits
What are the clinical features of Dyshidrotic Eczema?
intense pruritus, “tapioca-like” vesicles → may form bullae, lesions
Where does Dyshidrotic Eczema usually occur?
palms/soles
What is the tx for Dyshidrotic Eczema?
spontaneous remissions occur in 2-3 wks
mild/moderate
TCS: high potency
Severe
Oral glucocorticoids (prednisone, medrol)
What is another name for Nummular Eczema?
discoid eczema, nummular dermatitis
What is Nummular Eczema?
chronic inflammatory condition characterized by coin shaped lesions, often itchy, and well defined; M > F
Where does Nummular Eczema usually occur?
extremities > trunk
What are the risk factors for Nummular Eczema?
stress, xerosis, heat, humidity, hx of skin injury, alcohol
What are the clinical features of Nummular Eczema?
highly pruritic, round, coin shaped patches of eczematous dermatitis w/ central clearing; ranging in size from 1-10 cm; composed of small papules and vesicles, crusting, dry, scaly
What is the tx for Nummular Eczema?
1st line: high potency TCS
class 1-3
Alternative: phototherapy
Severe/refractory
systemic immunosuppressants
Non-pharm:
emollients, lukewarm showers, humidifier
What are Class 7 TCS?
hydrocortisone
What are Class 1 TCS?
clobetasol propionate (Clobex), halobetasol propionate (Ultravate)