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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.

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Dermatitis 101: Diagnosis and Treatment of Eczema

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  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

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