1 / 45

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.

abie
Télécharger la présentation

Dermatitis 101: Diagnosis and Treatment of Eczema

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dermatitis 101:Diagnosis and Treatment of Eczema Adrian Guevara MD

  2. Dermatitis 101 • Atopic • Seborrheic • Contact • Allergic • Irritant • Nummular • Asteatotic • Stasis • Neurodermatitis/Lichen Simplex Chronicus

  3. Dermatitis 101 Dermatitis=“Eczema”=Spongiosis

  4. Dermatitis 101 Acute Dermatitis

  5. Dermatitis 101 Subacute Dermatitis Commonly misdiagnosed as tinea

  6. Dermatitis 101 Chronic Dermatitis Commonly misdiagnosed as psoriasis

  7. 24 y/o male 2 year h/o red, scaly feet

  8. 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

  9. Allergic Contact Dermatitis • Poison Ivy/Oak/Sumac linearity

  10. Allergic Contact Dermatitis • Potassium Dichromate in Leather

  11. Allergic Contact Dermatitis • Latex • Cleaning products • Cosmetics • Occupational exposures Check the feet and nails!!!

  12. Allergic Contact Dermatitis

  13. 40 y/o female homemaker with dry, itchy hands

  14. Irritant Contact Dermatitis • Most contact dermatitis is irritant in nature • Occupational morbity • Irritant vs allergic • Prevention is key!

  15. Look at the cuticles

  16. Lip licker dermatitis Blunting of vermillion Accentuation of angles

  17. 4 y/o boy with chronic, itchy, bleeding plaques

  18. Atopic Dermatitis • 10-20% of population • Primary symptom: itch • Location, location, location • Associated with atopic background Periorbital pallor

  19. Look for keratosis pilaris

  20. 52 y/o male with erythematous, scaly patches of face and scalp

  21. Seborrheic Dermatitis • Distribution • Face, scalp, axillae, upper chest • Chronic condition • Nonsteroidal adjuvants • Disease associations

  22. 45 y/o female with intermittent “fungus all over”

  23. Nummular Dermatitis • Coin shaped patches and plaques • Secondary to xerosis cutis • Primary symptom itch Notice the surrounding xerosis

  24. Asteatotic Dermatitis • Extreme case of xerosis • Riverbed type cracking

  25. 52 y/o male with painful, itchy rash on right leg

  26. Stasis Dermatitis • Venous hypertension • Full spectrum of timing • Id reaction common • Complicated by ulceration

  27. Lipodermatosclerosis Pseudokaposi’s (acroangiodermatitis) Venous ulceration Dispigmentation (chronic)

  28. Id reaction Superimposed allegic contact Do: 1) dry weeping lesions 2) cover for infection Don’t: 1) apply neosporin 2) just hope steroids will fix it

  29. Elephantiasis Verrucosa Nostras

  30. 14 y/o anxious female who can’t stop itching

  31. Neurodermatitis/Lichen Simplex Chronicus • Paroxysmal pruritus • Habitual excoriating or rubbing • Skin thickens to defend • Consider underlying disease Increased skin markings

  32. Lichen simplex chronicus No fungus on the scrotum! Prurigo simplex

  33. Butterfly sign Prurigo Nodularis Consider screening

  34. 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

  35. Treatment • Topical Steroids • Clobetasol I • Triamcinolone IV • Desonide VI • Hydrocortisone VII

  36. Treatment • TIM • Protopic 0.1% oint • Elidel cr • Light • nbUVB • Systemic immunosuppressives • Prednisone • Cyclosporine • Azathioprine • IVIG Only on thin skin !!!

  37. Treatment • Antihistamines • Mechanism of action: soporific Indications for Dermatitis ≠ Urticaria

  38. 7 m/o infant with itchy skin

  39. 75 y/o nursing home patient with intolerable itchy skin

  40. 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!

  41. 25 y/o male tx’d for eczema in antecubital fossa with “some cream”

  42. Common Pitfalls • Mistreatment • Lose the Lotrisone! • 1) Commit to a diagnosis • 2) Shotgunners: “Don’t be a wimp” • Quadriderm: betamethasone, gentamycin, clotrimazole • Animax

  43. The End

More Related