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Soutor 1e- Clinical Dermatology- Lecture 2- Dermatitis and Papulosquamous Diseases
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Soutor 1e- Clinical Dermatology- Lecture 2- Dermatitis and Papulosquamous Diseases
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Upload Date:
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Language: EN.
Segment:0 .
Segment:1 1. Dermatitis and Papulosquamous Diseases.
DR. SOUTOR: I'm Dr. Carol Soutor, Clinical Professor in the Department of Dermatology at the University of Minnesota Medical School.
Segment:2 2. Learning Objectives.
DR. SOUTOR: In this presentation, I will cover several common types of dermatitis and the papulosquamous diseases listed in this slide.
Segment:3 3. Dermatitis.
DR. SOUTOR: Dermatitis or as it is sometimes called eczema refers to a heterogeneous group of disorders, which share similarities in clinical appearance and histopathological findings, but may have very different etiologies.
DR. SOUTOR: Common types of dermatitis include, irritant and allergic contact dermatitis, atopic dermatitis, dyshidrotic dermatitis, and lichen simplex chronicus.
Segment:4 4. Acute and Chronic Dermatitis.
DR. SOUTOR: Acute presentations of dermatitis often appear vesicular or bollous as in the patient and Figure 1, who has an allergic contact dermatitis due to poison ivy. Chronic forms of dermatitis may be red, scaly, and lichenified with fissures as seen on the toes of the patient with atopic dermatitis in Figure 2.
DR. SOUTOR: Pruritus is a common symptom in all forms of dermatitis.
Segment:5 5. Irritant Contact Dermatitis (ICD).
DR. SOUTOR: Irritant contact dermatitis is a nonimmunological response to chemicals or physical agents which disrupt the normal epidermal barrier. Common causes include exposure to water, soaps, cleansers, acids, and alkalis. The hands are the most commonly involved site. Mild irritant contact dermatitis presents with a glazed appearance in fissures as seen in the fingertips of this patient.
DR. SOUTOR: Irritant contact dermatitis due to strong irritants, such as acids may present with pain, erythema, swelling, or blistering.
Segment:6 6. Allergic Contact Dermatitis (ACD).
DR. SOUTOR: Allergic contact dermatitis is a cell-mediated, delayed type IV hypersensitivity reaction, resulting from contact with a specific allergen. The most common allergens include urushiol, which is found in poison ivy, poison oak and sumac; metals, such as nickel, cobalt, chromate; fragrances for example, balsam of Peru; preservatives like quaternium-15; and topical antibiotics such as neomycin and bacitracin.
Segment:7 7. Allergic Contact Dermatitis.
DR. SOUTOR: Acute allergic contact dermatitis presents with papules and vesicles on an erythematous base. Chronic allergic contact dermatitis may manifest as xerosis, fissuring and lichenified eczematous plaques as seen on the hands of this patient.
Segment:8 8. Atopic Dermatitis.
DR. SOUTOR: Atopic dermatitis affects approximately 20% of children in developed countries. 65% of affected children will have symptoms by 18 months of age.
DR. SOUTOR: The etiology is multifactorial and includes a combination of genetic susceptibility and environmental triggers or exposures. Patients often have a personal or family history of atopy, which is the presence of eczema, asthma and allergic rhinitis.
Segment:9 9. Atopic Dermatitis.
DR. SOUTOR: Atopic dermatitis presents in infants with dermatitis on the cheeks, trunk and extensor extremities, as seen on the face of the child in Figure 5.
DR. SOUTOR: Young children tend to have involvement of the posterior neck, flexor extremities, such as the antecubital fossae and popliteal fossae, wrists, hands, ankles, and feet. Older children and adults have posterior neck, flexor extremities and hand involvement, as seen on the arms and legs of the child in Figure 6.
Segment:10 10. Atopic Dermatitis.
DR. SOUTOR: 90% of atopic dermatitis skin lesions are colonized with microbes, usually Staphylococcus aureus. The presence of erosions and drainage with yellow crusting may indicate that an actual infection is present.
Segment:11 11. Atopic Dermatitis and Eczema Herpeticum.
DR. SOUTOR: Eczema herpeticum is a severe herpes simplex virus infection in an atopic patient as seen in this child. It presents with multiple widespread monomorphic punched out, discrete erosions with hemorrhagic crusting. Severe cases may require hospitalization and intravenous antiviral medications.
Segment:12 12. Nummular Dermatitis.
DR. SOUTOR: Nummular dermatitis is a common form of dermatitis. The pathogenesis is unknown, but it may be linked to impaired skin barrier function.
DR. SOUTOR: It is more common in older individuals and is often associated with dry skin. Nummular dermatitis presents with round, light pink, scaly, thin, one to three centimeter plaques on the extremities or trunk as seen in this patient.
Segment:13 13. Dyshidrotic Dermatitis (Pompholyx).
DR. SOUTOR: Dyshidrotic dermatitis or pompholyx as it is sometimes called, is of unknown etiology. It may be linked to impaired skin barrier function, but it is not related to dysfunction of sweat glands, as the name may imply.
DR. SOUTOR: It presents with grouped two to five millimeter vesicles, sometimes likened to tapioca pudding as seen on the fingers of this patient. It typically occurs on the lateral fingers, central palms insteps and lateral borders of the feet.
Segment:14 14. Lichen Simplex Chronicus.
DR. SOUTOR: Lichen simplex chronicus is a chronic intensely pruritic skin condition triggered by repeated, rubbing and scratching of the skin. It typically presents with a solitary well-defined, pink to tan, thick and lichenified plaque as seen in this patient.
DR. SOUTOR: It typically occurs on the lateral neck, scrotum, vulva and dorsal foot, but any body site may be affected.
Segment:15 15. Papulosquamous Diseases.
DR. SOUTOR: Next, I will cover some common papulosquamous diseases, including psoriasis, seborrheic dermatitis, pityriasis rosea and lichen planus.
Segment:16 16. Psoriasis.
DR. SOUTOR: Psoriasis is a common chronic inflammatory skin disease that affects approximately 2.1% of the population. It is caused by dysregulation of the cell-mediated, adaptive immune response resulting in hyperproliferation of the epidermal keratinocytes.
DR. SOUTOR: Psoriasis has a polygenic inheritance pattern. It may be associated with inflammatory arthritis, which may present with pain and swelling of the distal small joints.
Segment:17 17. Psoriasis.
DR. SOUTOR: Flares of psoriasis may be associated with group A beta-hemolytic streptococcal infections, medications, such as beta-blockers, ACE-inhibitors, nonsteroidal anti-inflammatory drugs, lithium, interferon, and the antimalarial medications.
DR. SOUTOR: Physical and emotional stress has also been reported to be related to psoriatic flares. Comorbidities associated with psoriasis include cardiovascular disease, neurological conditions, gastrointestinal disorders, liver disease, anxiety, and depression.
Segment:18 18. Plaque Psoriasis.
DR. SOUTOR: Plaque type psoriasis accounts for 90% of all cases of psoriasis. It presents with red to salmon pink colored plaques with white or silvery scale as seen in the patient in Figure 11.
DR. SOUTOR: Lesions typically occur on the scalp as seen in the patient in Figure 12, and on the knees elbows, gluteal cleft, lumbosacral region, and the umbilicus.
Segment:19 19. Guttate and Erythrodermic Psoriasis.
DR. SOUTOR: Guttate presentations of psoriasis are more common in children and young adults. Guttate psoriasis presents with small drop-like, thin, pink to salmon colored plaques and papules, with a fine white scale on the trunk and proximal extremities as seen in this patient.
DR. SOUTOR: It frequently occurs after a group A beta-hemolytic streptococcal infection. Erythrodermic psoriasis is uncommon and presents with total body redness and desquamation of the skin.
Segment:20 20. Pustular and Inverse Psoriasis.
DR. SOUTOR: Pustular psoriasis is also uncommon. It presents with small monomorphic sterile pustules on painful, inflamed, erythematous plaques, as seen in the hand of this patient in Figure 14. It typically occurs on the palms and soles.
DR. SOUTOR: Inverse or intertriginous psoriasis can be seen in plaque type psoriasis or patients may have only intertriginous involvement. It presents with thin pink plaques with minimal scale as seen in the axilla of the patient in Figure 15. Lesions may also occur in the inguinal and body fold areas.
Segment:21 21. Seborrheic Dermatitis.
DR. SOUTOR: Seborrheic dermatitis is a very common disorder associated with sebum production and Malassezia yeast. In infants, it presents with cradle cap, which appears as pink to yellow macules and patches with white greasy scales on the scalp, face and diaper areas.
DR. SOUTOR: In adults, seborrheic dermatitis presents with erythematous plaques with white greasy scales on the scalp, as seen in Figure 16. The forehead, eyebrows, eyelash line, nasolabial folds are commonly involved as seen in the patient in Figure 17. The ears, upper chest and intertriginous areas may also be involved.
Segment:22 22. Pityriasis Rosea.
DR. SOUTOR: Pityriasis rosea is common in young adults. It typically has an acute onset and lasts six to eight weeks.
DR. SOUTOR: It may be associated with human herpes virus-6 or -7. It presents initially with a single herald patch, which is a pink salmon colored, oval, two to 10 millimeter plaque with central fine collarette scale as seen on the upper chest of this patient. Eventually, smaller, numerous similar lesions appear on the trunk and arms, dispersed on the trunk in a Christmas-tree like pattern, with the lesions sloping downward.
Segment:23 23. Lichen Planus.
DR. SOUTOR: Lichen planus is an uncommon papulosquamous skin disease. It usually occurs in individuals between ages 30 to 60 years. It may be triggered by a hepatitis C infection or medications including diuretics and antimalarial medications. It presents with violaceous flat-topped firm papules on the flexor wrists, forearms, ankles, lower back and genitals.
DR. SOUTOR: The patient in this slide demonstrates typical lesions on the volar wrist. Oral lesions are often seen and they present as net-like white streaks, typically on the buccal mucosa.
Segment:24 24. Summary.
DR. SOUTOR: In summary, dermatitis and papulosquamous diseases present with papules and plaques with some degree of scale. Although they may have similar morphology, their etiologies vary. These diseases are inflammatory disorders that usually respond to topical steroids.
DR. SOUTOR: Many of these diseases, with the exception of pityriasis rosea, are chronic and will require long-term treatment.
Segment:25 25. Contributors.