COMMON SKIN TERMS - Lichenification: areas of thickened skin divided by deep linear furrows Medscape
- ECZEMATOUS DERMATOSES
- Wide group of disorders that share the common
- clinical features of Itching, Red, Scaly, vesicular to crusted rash (MKSAP 16)
- histological feature of spongiosis (intracellular edema of the skin resulting in spongy consistency (MKSAP 16)
- Atopic Dermatitis: Dermatitis, Atopic (VisualDx)
- Often termed as "eczema" but perhaps the use of the term is best avoided given the above explanation (MKSAP 16)
- Hallmark of Atopic Dermatitis is Intense Itching (Visual Dx)
- Diagnosis: Challenging as no single distinctive features / lab
- Is based on combination of patient and family history and clinical findings
- personal or family history of atopy, allergic rhinitis or asthma, and pruritus
- Reference:
- Stasis Dermatitis:
- Management:
- Goal: Reduce venous hypertension. Leg compression using knee-high support stockings (20-40 mm Hg of pressure) is recommended whenever possible but should be avoided in those with significant peripheral arterial disease (MKSAP 16)
- Nummular Dermatitis: Nummular dermatitis (VisualDx)
- Contact Dermatitis
- Allergic Contact Dermatitis: Allergic contact dermatitis (VisualDx)
- More acute and more inflammatory than irritant dermatitis
- Type IV, delayed type hypersensitivity reaction mediated by allergen specific T-Cell mediated Dermatitis
- Edema and vesicles may be present in acute phase
- Lichenification and fissuring are common in chronic phase
- Diagnosis: Epicutaneous Patch Testing (MKSAP 16)
- Note:
- Patch testing is different from prick or scratch testing.
- Prick or Scratch testing and radioallergosorbent tests (RASTs) assess for type I or IgE-mediated allergies and therefore have no role in the evaluation of allergic contact dermatitis. (MKSAP 16)
- Reference:
- Irritant Contact Dermatitis: Irritant contact dermatitis (VisualDx)
- Vesicles are rare unlike in Allergic CD
- Pathogenesis: Non-immunogenic - Direct Toxic Injury to skin
- Examples
- Chronic hand Dermatitis from frequent hand washing
- Dermatitis from lip licking
- HAND DERMATITIS Hand dermatitis (VisualDx)
- Acute Presentation: Pruritus, Vesicles (can weep and crust), Erythema
- Chronic Presentation: Scales, Lichenification, Fissuring, Skin Thickening
- Pathophysiology: Disruption of epithelial barrier (Superficial Stratum Corneum, Deficiencies of protective Lipid Layer)
- Etiology (Top 3 etiology account for 70% of Hand Dermatitis) :
- Atopic Hand Dermatitis
- Allergic Contact Hand Dermatitis : Type IV Delayed Hypersensitivity
- Irritant Contact Hand Dermatitis
- Hyperkeratotic / Psoriasiform Dermatitis
- Nummular Dermatitis
- Pompholyx / Dyshidrotic Eczema / Vesicular Hand Dermatitis
- DDx: Tinea Manum, HFMD, Secondary Syphilis, Scabies, Psoriasis
Phototoxic Dermatitis NEJM 2014
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