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Dermatology Rashes SP

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Eczematous Eruptions
-Dermatitis
-Dyshidrosis
-Lichen simplex chronicus
Papulosquamous Diseases
-Drug eruptions
-Lichen planus
-Pityriasis rosea
-Psoriasis
Two types of dermatitis
contact and atopic
Acute dermatitis
vesicular, wet, pruritic
Chronic dermatitis
dry, scaly, fissured, lichenified, pruritic
Contact dermatitis
inflammatory reaction to substance that comes in
contact with the skin
Two types of contact dermatitis
irritant type and allergic type
Irritant contact dermatitis
-universal reaction, individual thresholds
-severity depends strength of irritant & duration of
exposure
-ex: bleach, Lip Licker's & Housewife Dermatiti
Allergic contact dermatitis
-type IV hypersensitivity reaction
-distribution is key in making the diagnosis
-reaction is highly individual
-ex: Poison Ivy, oak, Sumac, nickel, soaps, detergents, cleaning products, cosmetics
Phytophotodermatitis
allergan + sun exposure
PE of allergic contact dermatitis
often linear, with artificial patterns, especially with plant contact
Treatment of allergic contact dermatitis
-identify/ remove offending agent
-topical corticosteroid preparations
-if severe, systemic corticosteroids
-Antihistamines
"The itch that rashes"
Atopic Dermatitis/Eczema
Atopic dermatitis/eczema
pruritic inflammation of the skin of unknown etiology
Over 2/3 of patients with atopic dermatitis have a personal/ family history of __________.
allergic rhinitis, hay fever, or asthma (AKA, Atopy)
Pathophysiology of atopic dermatitis
Filaggrin mutation → transepidermal water loss & increased transepidermal penetration of environmental allergens→ increasing inflammation and sensitivity
PE of Atopic dermatitis
-poorly defined erythematous, sometimes oozing, patches, papules, and plaques with or without scale
-excoriations as a result of scratching
Hyperlinear palms, periorbital hyperpigmentation, Dennie-Morgan folds -prominent folds of skin under the lower eyelid, and nasal crease due to the "allergic salute" can be seen with _________.
atopic dermatitis
All the time (green light/good day) treatment for atopic dermatitis
-avoid rubbing and scratching
-shower/bath less than 5 min once a day
-moisturizing cream/emollient within 3 minutes of
bathing
During minor flare (yellow light/moderate rash) treatment for atopic dermatitis
-prescription topical (corticosteroid or non-steroidal)
-oral antihistamine for pruritus
During severe flare (red light/severe rash) treatment for atopic dermatitis
-oral Prednisone, 2-week taper
-prescription topical (corticosteroid or non-steroidal)
-oral antihistamine for pruritus
Secondary infections to atopic dermatitis
-s. aureus infection
-herpes simplex infection
Dyshidrotic Dermatitis
-associated with sweaty hands/feet or frequent water exposure
-initially, intensely pruritic deep-seeded vesicles on lateral aspects of fingers/center of palms/soles
-"tapioca pudding"
-later, classic eczematous features
Dyshidrotic dermatitis treatment
-drying agents for vesicles
-emollients for scales
-topical steroid
-systemic steroids if severe
-phototherapy
-Botox
Lichen Simplex Chronicus
-pink brown lichenified plaque with accentuated skin markings on the nape of neck, scalp, extremities or genitals -only in places able to be reached/rubbed
Treatment for Lichen Simplex Chronicus
-stop scratching
-steroid creams with occlusion
-antidepressants
Topical steroids are arranged by potency class from 1-7, with 1 being the _____ potent.
most
Protocol for safe usage of topical steroids
-face & genitals, Classes 5-7, BID 1 week only
-body, BID up to 2 weeks
Two types of drug eruptions
Morbilliform and fixed drug eruptions
Morbilliform drug reaction
-most common etiology: antibiotics and NSAIDS
-trunk to proximal extremities
-symmetrical
-pruritic
-widespread pink-to-red macules or papules that blanch with pressure and coalesce into patches and plaques
Erythema Nodosum
-acute, nodular, erythematous, painful eruption
-shins
-mainly women
-hypersensitivity reaction
Lichen Planus
-shiny, flat-topped, firm papules varying in size
-abnormal immune rxn provoked by viral infection or drug
-inflammatory cells mistake skin cells as foreign & attack them
5 P's of Lichen Planus
planar, polygonal, pruritic, purple, papular
Wickham's striae
painless white streaks in reticular pattern
Oral Lichen Planus
-mouth involves 50% of cases
-often only affected area
Pityriasis Rosea
-begins with single herald patch lesion, followed by generalized rash lasting 6 weeks
-often follows URI
-associated with viral human herpes virus 6/7
Associated with "Christmas tree pattern"
Pityriasis Rosea
Psoriasis
complex, chronic, multifactorial, inflammatory, autoimmune disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate
True or false, women are more likely to have psoriasis than men?
false, equal prevalence
Psoriasis is provoked and suppressed by:
-provoked by: injury to skin, strep pharyngitis, and emotional upset
-suppressed by: sun/humidity
Most common type of Psoriasis
plaque psoriasis
Psoriasis physical exam
-well-defined erythematous silvery scaly plaques
-non-pruritic
-nail pitting
Location of lesions with psoriasis
-joints and extensor surfaces of extremities (knees/elbows)
-lower back
-buttocks
-palms and soles
-scalp
-umbilicus
-genitals
PASI stands for
Psoriasis Area and Severity Index
Guttate psoriasis
-mostly trunk, appears suddenly,
-2-3 weeks after an infection with group A beta-hemolytic streptococci
-treat with antibiotics to prevent rheumatic fever
Inverse psoriasis
flexural surfaces, armpit, and groin; under the breast, and in the skin folds
Pustular psoriasis is located on ________.
palms and soles
Psoriatic Arthritis
-30% of patients have joint manifestations
-'sausage digit'
-'pencil in cup' on X-ray of fingers
-at risk for CVD
Risk of heart attack is ___ times higher than in patients without psoriasis.
3
General management of psoriasis
topical corticosteroid and vitamin D analogs
Biopharmaceutical/biologic
any medicinal product manufactured from a biological source that selectively interferes with specific component of the autoimmune response
Bullous Pemphigoid
-blistering skin disease which usually affects middle aged or elderly persons (immunobullous disease)
-crops of tense, fluid-filled, pruritic vesicles & bullae
Michel's Medium
fluorescent dye that targets a specific biomolecule allowing visualization of the distribution of the target molecule
True or false, bullous pemphigoid DIF shows linear basement membrane deposition?
true
Most frequent dermatologic issue seen in the ED
urticaria
Urticaria
raised, well-circumscribed areas of erythema & edema involving dermis and epidermis that are very pruritic
Urticaria are a ________ response.
type I allergic IgE
Treatment for urticaria
-antihistamines
-topical steroids
-systemic steroids
Alopecia Areata
-circular patch of complete loss of hair (usually scalp)
-autoimmune
-1-2% hair loss on the entire scalp (Alopecia totalis) or on entire epidermis (Alopecia universalis)
Androgenetic Alopecia affects the _______.
hairline
See hairs of varying length with _______.
Trichotillomania
Alopecia Areata treatment
steroids
Telogen Effluvium
-nonscarring alopecia
-diffuse hair shedding, often with acute onset
-reactive process caused by metabolic/ hormonal stress or by medications
-recovery is spontaneous and occurs within 6 months
Trichotillomania
-Obsessive-compulsive spectrum
-preadolescents
-pulling out one's hair (can occur anywhere within reach)
Trichotillomania treatment
-behavioral therpy
-medications
Androgenic Alopeica
-genetic
-terminal hairs→ indeterminate→vellus hairs
-extremely common disease
-affects men and women (men:hairline women: crown)