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 101Dermatitis 101
Dermatitis=!c"ema#=SpongiosisDermatitis=!c"ema#=Spongiosis
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Acute Dermatitis Acute Dermatitis
Dermatitis 101Dermatitis 101
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Dermatitis 101Dermatitis 101
Subacute DermatitisSubacute Dermatitis
Commonl$ misdiagnosed as tinea
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Dermatitis 101Dermatitis 101
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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Allergic Contact Allergic Contact
DermatitisDermatitis .oison Iv$/1a0/Sumac.oison Iv$/1a0/Sumac
linearit$
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Allergic Contact Allergic Contact
DermatitisDermatitis .otassium Dichromate.otassium Dichromate
in Leatherin Leather
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Allergic Contact Allergic Contact
DermatitisDermatitis LatexLatex
Cleaning productsCleaning products
CosmeticsCosmetics 1ccupational1ccupational
exposuresexposures
Chec0 the *eetand nails222
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Allergic Contact Allergic Contact
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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