Dermatitis 101: Diagnosis and Treatment of Eczema

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Dermatitis 101Diagnosis and Treatment of Eczema

• Adrian Guevara MD

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Dermatitis 101

• Atopic
• Seborrheic
• Contact
• Allergic
• Irritant
• Nummular
• Asteatotic
• Stasis
• Neurodermatitis/Lichen Simplex Chronicus

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Dermatitis 101

• DermatitisEczemaSpongiosis

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Dermatitis 101

• Acute Dermatitis

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Dermatitis 101

• Subacute Dermatitis

Commonly misdiagnosed as tinea
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Dermatitis 101

• Chronic Dermatitis

Commonly misdiagnosed as psoriasis
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24 y/o male 2 year h/o red, scaly feet

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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
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Allergic Contact Dermatitis

• Poison Ivy/Oak/Sumac

linearity
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Allergic Contact Dermatitis

• Potassium Dichromate
• in Leather

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Allergic Contact Dermatitis

• Latex
• Cleaning products
• Cosmetics
• Occupational
• exposures

Check the feet and nails!!!
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Allergic Contact Dermatitis
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40 y/o female homemaker with dry, itchy hands
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Irritant Contact Dermatitis

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

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Look at the cuticles
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Lip licker dermatitis
Blunting of vermillion Accentuation of angles
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4 y/o boy with chronic, itchy, bleeding plaques
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Atopic Dermatitis

• 10-20 of population
• Primary symptom itch
• Location, location, location
• Associated with atopic background

Periorbital pallor
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Look for keratosis pilaris
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52 y/o male with erythematous, scaly patches of
face and scalp
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Seborrheic Dermatitis

• Distribution
• Face, scalp, axillae, upper chest
• Chronic condition
• Nonsteroidal adjuvants
• Disease associations

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45 y/o female with intermittent fungus all over
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Nummular Dermatitis

• Coin shaped patches and plaques
• Secondary to xerosis cutis
• Primary symptom itch

Notice the surrounding xerosis
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Asteatotic Dermatitis

• Extreme case of xerosis
• Riverbed type cracking

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52 y/o male with painful, itchy rash on right leg
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Stasis Dermatitis

• Venous hypertension
• Full spectrum of timing
• Id reaction common
• Complicated by ulceration

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Pseudokaposis (acroangiodermatitis)
Lipodermatosclerosis
Venous ulceration
Dispigmentation (chronic)
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Id reaction
Superimposed allegic contact
Do 1) dry weeping lesions 2) cover
for infection Dont 1) apply neosporin 2)
just hope steroids will fix it
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Elephantiasis Verrucosa Nostras
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14 y/o anxious female who cant stop itching
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Neurodermatitis/Lichen Simplex Chronicus

• Paroxysmal pruritus
• Habitual excoriating or rubbing
• Skin thickens to defend
• Consider underlying disease

Increased skin markings
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Lichen simplex chronicus
No fungus on the scrotum!
Prurigo simplex
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Butterfly sign
Prurigo Nodularis
Consider screening
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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
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Treatment

• Topical Steroids
• Clobetasol I
• Triamcinolone IV
• Desonide VI
• Hydrocortisone VII

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Treatment

• TIM
• Protopic 0.1 oint
• Elidel cr
• Light
• nbUVB
• Systemic immunosuppressives
• Prednisone
• Cyclosporine
• Azathioprine
• IVIG

Only on thin skin !!!
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Treatment

• Antihistamines
• Mechanism of action soporific

Indications for Dermatitis ? Urticaria
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7 m/o infant with itchy skin
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75 y/o nursing home patient with intolerable
itchy skin
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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!
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25 y/o male txd for eczema in antecubital fossa
with some cream
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Common Pitfalls

• Mistreatment
• Lose the Lotrisone!
• 1) Commit to a diagnosis
• 2) Shotgunners Dont be a wimp
• Quadriderm betamethasone, gentamycin,
  clotrimazole
• Animax

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The End