inhalants (dust mites and pollens)

microbial agents (exotoxins of staph aureus)

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

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

dehydration

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

(skin barrier disruption)

Eczema: Skin Lesions

Acute

Eczema : Skin Lesions

Chronic

mixed

more wide spread

stop scratching

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

hydration + emollients

topical glucocorticoids

tacrolimus or pimecrolimus (immunosuppresents)

H₁ antihistamines

UVA-UVB therapy

irritant contact dermatitis (ICD) 

allergic contact dermatitis (ACD)

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 

Symptoms 

burning, tingling, smarting (stabbing-type pain)

cumulative (mild irritants)

irritant reaction (wet work)

wet chemicals would be worse (spread)

avoidance of irritant

wet dressings - burrow's solution

topical/oral steroids

lubricating/protective creams/ointments

allergic contact dermatitis

place different things and look for reaction 

well demarcated, erythema, inflamed, swollen areas

papules, dry scales

vesicular & bullous

exudative and crusty

often linear

itchy 

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

Treament for Nummular eczema

skin hydration - moisturize

glucocorticoids

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

PUVA or UVB 311-nm therapy 

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

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

fungal

B6

Zn deficiences

cradle cap - unknown

on the scalp there is mostly marked scaling 

("dandruff")

selenium sulfide or zinc pyrithione shampoos - 

ketaconazole shampoo 

mineral oil/baby oil/olive oil

seborrheic dermatitis

cradle cap

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

bronze, red-brown

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

Treatment for stasis dermatitis

topical glucocorticoids (short term)

topical antibiotics (mupirocin) - secondary infection

culture for MRSA?

treatment for dyshidrosis eczema 

wetdressing

vesicular stage: Burow's wet dressings  

treatment for dyshidrosis eczema 

fissures

treatment for dyshidrosis eczema

glucocorticoids

treatment for dyshidrosis eczema

intralesional injection

treatment for dyshidrosis eczema

systemic

localized form of lichenification

results from repetitive rubbing and scratching

lichen simplex chronicus

physical trauma = skin hyperplasia

emotional stress

habit forming/unconscious habit

"pleasure habit"

itch attack from minor stimuli

nervousness, anxiety, depression, and other psychological disorders

excoriations are often present

usually dull, red, later brown, or black hyperpigmentation

difficult

stop scratching or rubbing

topical glucocorticoid preparations or tar preparations + occlusive dressings

intralesional triamcinolone

oral hydroxyzine (night)

atopic dermatitis (eczema)

contact dermatitis - irritant and allergic

Nummular eczema

seborrheic dermatitis

perioral dermatitis

stasis dermatitis

dyshidrosis eczema

lichen simplex chronicus

idiopathic (most cases)

cell-mediated immunity (lymphocytes) plays a major role

Onset - acute (days) 

OR

insidious (over weeks)

papules, purple, polygonal, pruritic 

lichen planus

wrists (flexor)

lumbar

shin

scalp

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

topical or systemic glucocorticoids

cyclosporine or tacrolimus soln.

PUVA

systemic retinoids

if Hep C, don't want to give immunosuppressants

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

pruritus

post-viral infection

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

80% of patients with pityriasis rosea have this

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

fine scaling papules and plaques with marginal colarrette

Dull pink or tawny

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

polygenic trait 

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

physical injury (Koebner's phenomenon)

infections

stress

drugs

ETOH

keratinocyte cycle alteration 

(shortened cell cycle) 

excessive epidermalpoiesis - skin basically goes into hyperdrive

eruptive, inflammatory - multiple small lesion

chronic stable (plaque)

sharp margins, bright erythema, nonconfluent whitish or silvery scales

lesions may occur at any site 

psoriasis

nonconfluent means they dont really flow in a pattern

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)

lichen planus

PIH

Pityriasis rosea

Psoriasis