Transcript Powerpoint – Atopic and allergic contact dermatitis

Atopic Dermatitis
Dermatitis
• Pattern of cutaneous inflammation
– Acute: erythema, vesicles, pruritis
– Chronic: dryness, scaling, lichenification, fissuring,
pruritus
• E.g. seborrheic, atopic, contact
Basics
• Chronic, pruritic, inflammatory skin disease
with a wide range of severity
• Affects up to 20% of children and 1-3% of
adults
• Atopic triad
• Primary symptom: pruritus (itch)
– Hence, AD is often called “the itch that rashes”
– Periods of remission & exacerbation
Note
• Eczema=/= Atopic dermatitis
• Atopic dermatitis is a specific type of
eczematous dermatitis
Clinical Findings
• Erythematous papules, which coalesce to
form erythematous plaques that may display
weeping, crusting, or scale
• Distribution by age:
– Infants: cheeks, forehead, scalp, extensors
– Older children: flexors of the neck, elbows, wrist,
and ankles
– Adults: flexors of the hands, wrists, ankles, feet,
and face (forehead, around the eyes)
Infants & toddlers
More examples
Older children & adolescents
Pathogenesis
• Not clearly understood
• Probably multifactorial
• Factors thought to play a role:
– Genetics
– Skin barrier dysfunction
– Impaired immune response
– Environment
Treatment
• Avoidance of triggers and irritants
• Gentle skin care
• Combination of short term treatment for
flares + longer-term treatment for symptoms
between flares
4-pronged approach
- Moisturizer
- Anti-inflammatory
- Topical steroids
- Topical calcineurin inhibitors
- Anti-pruritus
- antihistamines
- Antibacterial
Notes
• Safe for short intervals with intermittent
breaks
• Increase potency to control inflammation,
then stop for break
• Avoid potent steroids in areas of the face,
folds, or occluded areas (under diaper)
Take Home Points
• AD is a chronic, pruritic, inflammatory skin
disease
• Distribution varies by age
• Pathogenesis is multifactorial
• Treatment: moisturizer, anti-inflammatory,
antipruritic, antibacterial
Contact Dermatitis
Basics
• Skin condition created by a reaction to an
externally applied substance
• Two types of CD:
– Allergic CD
– Irritant CD
ACD
• Occurs when contact with a particular
substance-> delayed hypersensitivity reaction
• Which type?
• Sensitization process: 10 -14 days
• Common causes:
– Poison ivy, fragrances, formaldehyde,
preservatives, nickel, rubber, topical antibx
ACD: Clinical Findings
• Pruritus (itching)
• Eczematous, scaly edematous plaques with
vesicles in areas of exposure
Rhus Dermatitis
Medication allergy
Nickel Dermatitis
Latex allergy
History
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Important to take comprehensive hx
Onset
Location
Temporal associations
Daily skin care routine, topical products,
occupation/hobbies, regular and occasional
exposures (lawn care products, animal
shampoos)
Treatment
• Avoidance of allergens
– Patch testing
• Acute
– Mild to moderate: topical steroids of medium to
strong potenncy
– Short course of systemic steroids for acute flares
– Wet dressings for extensive oozing/crusting
• Chronic or > 10% BSA
– Refer to dermatology
Patch testing
ICD
• Inflammatory reaction from exposure to
substance that can cause an eruption in most
people who come in contact with it
• No previous exposure necessary
• May occur from single application, but most
commonly from repeated application
ICD: basics
• Accounts for 80% of all contact dermatitis
• Often occupation-related
• Remains at site of contact and resolves in a
few days after exposure (ACD: 1-3 wks)
Factors at play
• Multifactorial
– Exogenous (irritant, environmental)
– Endogenous (host)
ICD: Clinical Findings
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Erythema, chapped skin, dryness and fissuring
Pruritus
Pain when erosions and fissures are present
Severe cases: edema, exudate, tenderness
Examples
Treatment
• Avoidance of irritant
– Patient education
– Personal protective equipment
– Less irritating hygiene products
• Topical steroid-> reduce inflammation
• Emollients-> improve barrier repair
• Patch testing to r/o ACD
Take Home Points
• Contact dermatitis: ACD and ICD
• ACD= when contact elicits delayed
hypersensitivity reaction
• ICD= exposure to substance that can cause an
eruption in most people
• Identification and avoidance