Dermatitis

    Definition

    • Dermatitis is defined as:
    1. Ill Defined
    2. Scaly
    3. Red/"inflamed"
    • Examples:

     

    Dermatitis Dermatitis.png

    Not Dermatitis

    • Well demarcated
    • This is psoriasis
    NotDermatitis.png

    Acute Dermatitis

    • Often comes with excoriations due

    to itching

     

    DermatitisAcute.png

    Chronic Dermatitis

    • Lichenification
    • Post-inflammatory dyspigmentation
    DermatitisChronic.png

    Atopic Dermatitis

    • Stages:
    1. Infantile (to age 1) - extensor: face, scalpAtopicDermatitis.png
    2. Childhood - lichenified plaques and patches: neck, extremities with flexual accentuation
    3. Adult - Hand and periorbital areas
    • Varies with extremes of temperature (seasonal)
    • Complications
      • Seconary bacterial infection (Staph aureas, GAS)
      • Seconary viral infection (HSV - eczema herpeticum)
      • Keratoconus (eye rubbting)
      • Pruritis
      • Scarring/Lichenification
      • Pigment changes.
    • Tx:
      • Course: Improves with age - 70% outgrow by late childhood
      • Skin Care: Moisturize with thick lubricants & emollients
      • Steroids: Appropriate strength topical steroids
        • Topical immunomodulators - Tacrolimus, Pimecrolimus
      • Itching: Oral H1 blockers (antihistamines) for itch
      • Infection: Oral and topical abx for infections
      • If SEVERE: treat with systemic immunosuppressants like methotrexate & azathioprine.

    Contact Dermatitis

    • Occurs in contact with substance (can be papullar - see image)
    • Two forms: Allergic and Irritant...ContactDermatitis.png
    1. Allergic Contact Dermatitis

      • Only people with allergy react 
      • i.e. poison ivy
      • Common Allergens:
        • Neomycin - topical OTC medication
        • Ethylenediamine
        • Nickel (costume jewellery, metal products)
        • Lanolin - topical moisturizers
        • Formaldehyde - preservative
        • Quaternium-15 - A preservative
        • Benzacaine - A local ester anesthetric (anti-itch medications)
        • PPD (Paraphenylenediamine) - a tar derivative in hair dyes
        • Rubber / Latex
        • Poison Ivy
      • Poison Ivy Dermatitis:
        • Reaction to substance Urushiol (also in poison oak, poison sumac, cashew nut oil, gingko biloba)
        • Treatment
          • Compresses,
          • Topical Steroids,
          • Short course oral steroids
          • Oral H1 antihistamines
          • Avoid cross reactors
    2. Irritant Contact Dermatitis

      • Almost everyone who comes in contact would react
      • i.e. hydrogen peroxide

    Seborrheic Dermatitis

    • Common: dandruff
    • Lots of sebum production - seborrhea, but seborrheic dermatitis has nothing to do with sebum.
      • Due to Malasseiza furfur yeast
      • Can be severe with HIV and Parkingson's
    • Greasy to white flakes, itch +/- erythema
    • Tx:
      • Shampoos with selenium sulfide
      • Topical antifungal (azole group)
      • Short course of oral antifungal (azole group)

    Stasis Dermatitis

    • Persistent skin inflammation of lower legs with brown pigmentation, erythema, xerosis, and scaling
    • Associated with venous insufficiency
    • Can be complicated by ulceration, and bacterial infections

    StasisDermatitis.png

     

     

    Dyshidrotic Eczema

    • acute "pseudovesicular" lesions, coalesce into plaques, which dry and develop scales
    • VERY itchyDyshidroticEczema.png
    • Usually due to frequent hand washing
      • Common in occupations with frequent hand washing (i.e. healthcare)
    • Lesions heal with desquamation (peeling) and can lead to chronic lichenification
    • Sites: palms, soles, dorsal surfaces of hands and feet.
    • Tx:
      • Skin Care: Moisturize frequently especially after handwashing
      • Steroid: Topical steroid (high potency)
        • Injection of corticosteroids
      • If SEVERE: oral prednisone
      • Infection: abx.

    Diaper Dermatitis

    • Inflammation 2ndary to candidiasis
    • "Diaper dermatitis" is not a diagnosis, cause can be:
      • Atopic dermatitis
      • Seborrheic dermatitis
      • Irritant from voiding

    DiaperDermatitis.png

     

    Seborrheic Dermatitis

    • Oily crust, often on face, between eye brows etc..
    • seborrheic.jpg    seborrheic2.jpg

    Other Dematitis Types

    • Asteotic Dermatitis
      • Usually in older individuals "dried riverbed look"
      • Usually due to extreme dryness.
    • Flexural dermatitis
      • On insides of joints
      • Use low-dose steroids (well absorbed, thin skin)
    • Nummular Dermatitis
      • Coin-shaped
    • Perioral Dermatitis
      • Gets WORSE with steroid cream.
      • Treat with topical agent for rosacea.
      • Or rosacea antibiotics (tetracycline etc..)
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