Dermatitis 101: Diagnosis and Treatment of Eczema
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Transcript Dermatitis 101: Diagnosis and Treatment of Eczema
Dermatitis 101:
Diagnosis and Treatment
of Eczema
Adrian Guevara MD
Dermatitis 101
Atopic
Seborrheic
Contact
Allergic
Irritant
Nummular
Asteatotic
Stasis
Neurodermatitis/Lichen Simplex Chronicus
Dermatitis 101
Dermatitis=“Eczema”=Spongiosis
Dermatitis 101
Acute Dermatitis
Dermatitis 101
Subacute Dermatitis
Commonly misdiagnosed as tinea
Dermatitis 101
Chronic Dermatitis
Commonly misdiagnosed as psoriasis
24 y/o male 2 year h/o red,
scaly feet
Allergic Contact Dermatitis
Type 4 Hypersensitivity Response
Classically well demarcated/patterned
Exposure can be infrequent (once a month)
Patch testing is gold standard for diagnosis
Severe reactions need systemic steroids
Forget the dose pack
Allergic Contact Dermatitis
Poison Ivy/Oak/Sumac
linearity
Allergic Contact Dermatitis
Potassium Dichromate
in Leather
Allergic Contact Dermatitis
Latex
Cleaning products
Cosmetics
Occupational
exposures
Check the feet and
nails!!!
Allergic Contact Dermatitis
40 y/o female homemaker with dry,
itchy hands
Irritant Contact Dermatitis
Most contact dermatitis is irritant in nature
Occupational
morbity
Irritant vs allergic
Prevention is key!
Look at the cuticles
Lip licker dermatitis
Blunting of vermillion
Accentuation of angles
4 y/o boy with chronic, itchy,
bleeding plaques
Atopic Dermatitis
10-20% of population
Primary symptom:
itch
Location, location,
location
Associated with atopic
background
Periorbital pallor
Look for
keratosis
pilaris
52 y/o male with erythematous, scaly
patches of face and scalp
Seborrheic Dermatitis
Distribution
Chronic condition
Face, scalp, axillae, upper chest
Nonsteroidal adjuvants
Disease associations
45 y/o female with intermittent
“fungus all over”
Nummular Dermatitis
Coin shaped patches and
plaques
Secondary to xerosis cutis
Primary symptom itch
Notice the surrounding
xerosis
Asteatotic Dermatitis
Extreme case of xerosis
Riverbed type cracking
52 y/o male with painful, itchy rash
on right leg
Stasis Dermatitis
Venous hypertension
Full spectrum of timing
Id reaction common
Complicated by ulceration
Pseudokaposi’s
(acroangiodermatitis)
Lipodermatosclerosis
Venous ulceration
Dispigmentation
(chronic)
Superimposed
allegic contact
Do:
1) dry weeping lesions
2) cover for infection
Don’t: 1) apply neosporin
2) just hope steroids
will fix it
Id reaction
Elephantiasis Verrucosa Nostras
14 y/o anxious female who can’t stop
itching
Neurodermatitis/Lichen Simplex
Chronicus
Paroxysmal pruritus
Habitual excoriating or
rubbing
Skin thickens to defend
Consider underlying
disease
Increased skin markings
Lichen simplex chronicus
No fungus on the scrotum!
Prurigo simplex
Butterfly sign
Prurigo Nodularis
Consider screening
Prevention
Remove the offending agent
Edema, allergen, irritant, yeast, long fingernails
Daily cleansing and MOISTURIZING
Dove, Oil of Olay, Neutrogena
Mild temperatures
Cream/Ointment based emollients
Neosporin, antifungals ≠ moisturizers
Treatment
Topical Steroids
Clobetasol
Triamcinolone
Desonide
Hydrocortisone
I
IV
VI
VII
Treatment
TIM
Light
Protopic 0.1% oint
Elidel cr
nbUVB
Systemic immunosuppressives
Prednisone
Cyclosporine
Azathioprine
IVIG
Only on thin skin !!!
Treatment
Antihistamines
Mechanism of action: soporific
Indications for Dermatitis ≠ Urticaria
7 m/o infant with itchy skin
75 y/o nursing home patient with
intolerable itchy skin
Common Pitfalls
Misdiagnosis
Scabies (intensely pruritic, burrows/vesicles, others
itch)
Psoriasis (elbows/knees/inflammatory arthritis/nail
changes)
Fungus (central sparing, well marginated, scaly
border)
Lose the Lindane!
25 y/o male tx’d for eczema in
antecubital fossa with “some cream”
Common Pitfalls
Mistreatment
Lose the Lotrisone!
1)
Commit to a diagnosis
2) Shotgunners: “Don’t be a wimp”
Quadriderm: betamethasone, gentamycin,
clotrimazole
Animax
The End