Dermatitis101 Diagnosis Treatment Eczema

8/17/2019 Dermatitis101 Diagnosis Treatment Eczema

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Dermatitis 101:Dermatitis 101:

Diagnosis andDiagnosis and

Treatment ofTreatment of

EczemaEczema

Adrian Guevara MD Adrian Guevara MD


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Dermatitis 101Dermatitis 101

Atopic Atopic

SeborrheicSeborrheic

ContactContact Allergic Allergic

IrritantIrritant

NummularNummular

Asteatotic Asteatotic StasisStasis

Neurodermatitis/Lichen Simplex ChronicusNeurodermatitis/Lichen Simplex Chronicus


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Dermatitis=!c"ema#=SpongiosisDermatitis=!c"ema#=Spongiosis


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Acute Dermatitis Acute Dermatitis



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Subacute DermatitisSubacute Dermatitis

Commonl$ misdiagnosed as tinea


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Chronic DermatitisChronic Dermatitis

Commonl$ misdiagnosed as psoriasisCommonl$ misdiagnosed as psoriasis


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24 y/o male 2 year h/o24 y/o male 2 year h/o

red, scaly feetred, scaly feet


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Allergic Contact Allergic Contact

DermatitisDermatitis %$pe & '$persensitivit$ (esponse%$pe & '$persensitivit$ (esponse

Classicall$ )ell demarcated/patternedClassicall$ )ell demarcated/patterned

!xposure can be in*re+uent ,once a!xposure can be in*re+uent ,once amonth-month-

.atch testing is gold standard *or.atch testing is gold standard *or

diagnosisdiagnosis

Severe reactions need s$stemicSevere reactions need s$stemic

steroidssteroidsorget the dosepac0


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DermatitisDermatitis .oison Iv$/1a0/Sumac.oison Iv$/1a0/Sumac

linearit$


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DermatitisDermatitis .otassium Dichromate.otassium Dichromate

in Leatherin Leather


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DermatitisDermatitis LatexLatex

Cleaning productsCleaning products

CosmeticsCosmetics 1ccupational1ccupational

exposuresexposures

Chec0 the *eetand nails222


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DermatitisDermatitis


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40 y/o female homemaker40 y/o female homemaker

ith dry, itchy hands ith dry, itchy hands


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!rritant Contact!rritant Contact

DermatitisDermatitis Most contact dermatitis is irritant inMost contact dermatitis is irritant in

naturenature

1ccupational1ccupational

morbit$morbit$

Irritant vs allergicIrritant vs allergic

.revention is 0e$2.revention is 0e$2


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Loo0 at the

cuticles


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"i# licker dermatitis"i# licker dermatitis

3lunting o* vermillion Accentuation o*


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4 y/o $oy ith chronic,4 y/o $oy ith chronic,

itchy, $leeding #la%&esitchy, $leeding #la%&es


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Ato#ic Dermatitis Ato#ic Dermatitis

456758 o*456758 o*

populationpopulation

.rimar$ s$mptom9.rimar$ s$mptom9

itchitch Location: location:Location: location:

locationlocation

Associated )ith Associated )ithatopic bac0groundatopic bac0ground

.eriorbital pallor

http://162.129.70.33/images/ad_1_020527.jpg


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Loo0 *or0eratosispilaris


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'2 / l ith'2 / l ith


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'2 y/o male ith'2 y/o male ith

erythemato&s, scaly #atcheserythemato&s, scaly #atches

of face and scal#of face and scal#


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(e$orrheic Dermatitis(e$orrheic Dermatitis

DistributionDistribution ace: scalp: axillae: upper chestace: scalp: axillae: upper chest

Chronic conditionChronic condition Nonsteroidal ad;uvantsNonsteroidal ad;uvants

Disease associationsDisease associations

4' / f l ith4' y/o female ith


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4' y/o female ith4' y/o female ith

intermittent )f&ng&s allintermittent )f&ng&s all

o*er+o*er+


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&mm&lar Dermatitis&mm&lar Dermatitis

Coin shaped patchesCoin shaped patches

and pla+uesand pla+ues

Secondar$ to xerosisSecondar$ to xerosis

cutiscutis

.rimar$ s$mptom itch.rimar$ s$mptom itch

Notice thesurrounding xerosis


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Asteatotic Dermatitis Asteatotic Dermatitis

!xtreme case o*!xtreme case o*

xerosisxerosis

(iverbed t$pe(iverbed t$pe

crac0ingcrac0ing


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'2 y/o male ith #ainf&l,'2 y/o male ith #ainf&l,

itchy rash on right legitchy rash on right leg


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(tasis Dermatitis(tasis Dermatitis


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!d reaction!d reaction

Superimpos

ed allegiccontact

Do9 4- dr$ )eepinglesions 7- cover *or

in*ection

Dont9 4- appl$neosporin

7- ;ust hope


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Ele#hantiasis err&cosaEle#hantiasis err&cosa

ostrasostras


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14 y/o anio&s female ho14 y/o anio&s female ho

can.t sto# itchingcan.t sto# itching


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e&rodermatitis/"ichene&rodermatitis/"ichen

(im#le Chronic&s(im#le Chronic&s .arox$smal pruritus.arox$smal pruritus

'abitual excoriating'abitual excoriating

or rubbingor rubbing

S0in thic0ens toS0in thic0ens tode*endde*end

Consider underl$ingConsider underl$ing

diseasedisease

Increased s0in

mar0ings

"ichen sim#le"ichen sim#le


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"ichen sim#le"ichen sim#lechronic&schronic&s

.rurigo

No *ungus on thescrotum2

http://162.129.70.33/images/scrotal_contact_dermatitis_1_050730.jpg


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3utter?$sign

.rurigo

Nodularis

Consider


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-re*ention-re*ention

(emove the o@ending agent(emove the o@ending agent !dema: allergen: irritant: $east: long!dema: allergen: irritant: $east: long

>ngernails>ngernails

Dail$ cleansing andDail$ cleansing and

3!(T56!7!83!(T56!7!8 Dove: 1il o* 1la$: NeutrogenaDove: 1il o* 1la$: Neutrogena

Mild temperaturesMild temperatures Cream/1intment based emollientsCream/1intment based emollients

Neosporin: anti*ungals

moisturi"ers


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TreatmentTreatment

%opical Steroids%opical Steroids ClobetasolClobetasol II

%riamcinolone%riamcinolone I


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TreatmentTreatment

%IM%IM .rotopic 5B48 oint.rotopic 5B48 oint !lidel cr!lidel cr

LightLight nb


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TreatmentTreatment

Antihistamines Antihistamines Mechanism o* action9Mechanism o* action9 so#ori9cso#ori9c

Indications *or Dermatitis rticaria

i f i h i h


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m/o infant ith itchy m/o infant ith itchy

skinskin


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' y/o n&rsing home #atient' y/o n&rsing home #atient

ith intolera$le itchy skin ith intolera$le itchy skin


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Common -itfallsCommon -itfalls

MisdiagnosisMisdiagnosis Scabies ,intensel$ pruritic:Scabies ,intensel$ pruritic:

burro)s/vesicles: others itch-burro)s/vesicles: others itch-

.soriasis ,elbo)s/0nees/in?ammator$.soriasis ,elbo)s/0nees/in?ammator$arthritis/nail changes-arthritis/nail changes-

ungus ,central sparing: )ellungus ,central sparing: )ell

marginated: scal$ border-marginated: scal$ border-

Lose the Lindane2

2' y/o male t.d for eczema2' y/o male t.d for eczema


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2' y/o male t d for eczema2' y/o male t d for eczemain antec&$ital fossa ithin antec&$ital fossa ith

)some cream+)some cream+


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Common -itfallsCommon -itfalls

MistreatmentMistreatment Lose the Lotrisone2Lose the Lotrisone2

4- Commit to a diagnosis4- Commit to a diagnosis 7- Shotgunners9 Dont be a )imp#7- Shotgunners9 Dont be a )imp#

uadriderm9 betamethasone:uadriderm9 betamethasone:

gentam$cin: clotrima"olegentam$cin: clotrima"ole Animax Animax

http://www.entirelypets.com/enlarge-image.htmlhttp://www.entirelypets.com/enlarge-image.htmlhttp://www.entirelypets.com/enlarge-image.html


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The EndThe End

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Dermatitis101 Diagnosis Treatment Eczema