Dermatology - Eczema and Urticaria
Urticaria (Hives) Presentation
-Allergic skin rash with itching -Transient erythematous plaques, each individual lesion lasts < 24 hours -Acute = < 6 weeks, Chronic = > 6 weeks
Pruritic Papules of Pregnancy
-Also called polymorphic eruption of pregnancy (PEP) -Etiology unknown -Usually 3rd trimester -Pruritic but benign
Nummular Eczema
-Coin shaped lesions often after minor skin injury -Pruritic -Common in children with hypopigmented macules and patches -Treat with emollients, low potency steroids if inflamed -Resolves with time
Foot Eczema
-Commonly confused with tinea -KOH prep negative -Will not respond to antifungals -Obtain history to diagnose (atopy as child, etc.)
True Eczema (Atopic Dermatitis) Presentation
-Eczematous eruption that is distressingly pruritic, recurrent -Chronic, with periods of remission and exacerbation -Appears on flexor surfaces in adolescents/adults, extensor surfaces in children
Pompholyx - Dyshidrotic Hand Eczema
-Itching vesicles on hands and feet -Sometimes associated with past tinea -Reoccurs, heals as brown spots -Treat w/ topical steroids
Autosomal Dominent Ichthyosis Vulgaris
-Itching, drying, scaling - not uncommon -Onset early to mid childhood -Usually with family history of same, associated strongly with atopy -Treated with emollients
Lichen Simplex Chronicus
-Localized plaques of chronic eczematous inflammation 2/2 scratching -Red/violet color -Most common on back of neck, scalp -Treat like CEI - no scratching
Urticaria (Hives) Etiology
-Often obscure -IgE mediated Type I immediate hypersensitivity reaction (if allergic)
Angioedema Etiology
-Often occurs with urticaria -Acute = Type 1 immediate hypersensitivity reaction, IgE mediated (usually caused by drugs, especially ACE inhibitors, contrast dye) -Chronic etiology unknown
Physical Urticaria Types
-Pressure - dermatographia -Cold -Cholinergic - from overheating (use hydroxyzine prior to exercise) -Solar
Keratosis Pilaris
-Small, follicular bumps often on upper arms, occasionally on face -Common -No tx necessary
Angioedema Presentation
-Swelling on face, lips, hands, feet, eyelids, tongue, genitals -More painful than itchy -Acute or chronic
Evaluating for Chronic Urticaria
5 I's: Ingestants Inhalants Injectants Infections Internal Diseases
Angioedema Treatment
Acute attacks with epi, antihistmaines, maybe steroids Protect airway (intubation) EpiPen if severe reactions
Urticaria (Hives) Treatment
Avoid triggers Antihistamines No topical steroids Prednisone taper when needed Epi when severe
Acute Eczematous Inflammation (Contact Dermatitis) Treatment
Cool or tepid wet to dry dressings with Burow's solution Cool or tepid baths Topical steroids x 7 days (medium potency, low potency for face) Oral steroids only if severe/diffuse (2-3 wk taper) Oral antihistamines
True Eczema (Atopic Dermatitis) Treatment
Eliminate triggers Emollients (bland) Topical steroids Topical immune modulators Oral abx for secondary infection Wet dressings for severe flares
True Eczema (Atopic Dermatitis) Etiology
IgE mediated reaction, often familial Begins in early life and often associated with atopy (asthma, allergic rhinitis) Personal or family hx of atopy
Chronic Eczematous Inflammation Etiology
May start as atopic dermatitis or AEI (contact dermatitis), self perpetuating from prolonged itching and scratching
Acute Eczematous Inflammation (Contact Dermatitis) Etiology
Often 2/2 to contact with allergens. Type 4 delayed hypersensitivity reaction. Allergic contacts include plants (rhus dermatitis), neomycin/benzocaine, personal care products, nickel, latex, rubber, PPD hair dye
Fingertip Eczema
Often associated with occupation
Chronic Eczematous Inflammation Treatment
Often resistant to treatment, treat as atopic dermatitis (eczema)
Acute Eczematous Inflammation (Contact Dermatitis) Presentation
Rash with erythema, edema, vesicles, often weeping and pruritic
Chronic Eczematous Inflammation Presentation
Red, thickened, scaly skin and lichenification from prolonged itching
