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Toronto Notes 2019 Dermatitis (Eczema) Dermatology D15 Dyshidrotic Dermatitis
Clinical Presentation
• “tapiocapudding”papulovesiculardermatitisofhandsandfeetthatcoalesceintoplaques,followedby painful fissuring
• acutestageoftenverypruritic
• secondaryinfectionscommon
• lesionshealwithdesquamationandmayleadtochroniclichenification
• sites:palmsandsoles±dorsalsurfacesofhandsandfeet
Pathophysiology
• unknown
• NOTcausedbyhyperhidrosis(excessivesweating) • emotionalstressmayprecipitateflares
Management
• topical:highpotencycorticosteroidwithplasticclingwrapocclusiontoincreasepenetration • intralesionaltriamcinoloneinjection
• systemic
■ prednisone in severe cases
■ altretinoin (Toctino) for all types of chronic hand dermatitis, including dyshidrotic dermatitis ■ antibiotics for secondary S. aureus infection
Nummular Dermatitis
Clinical Presentation
• nummular(coin-shaped),pruritic,dry,scaly,erythematousplaques • oftenassociatedwithatopicanddyshidroticdermatitis
• secondaryinfectioncommon
Pathophysiology
• littleisknown,butitisoftenaccompaniedbyxerosis,whichresultsfromadysfunctionoftheepidermal lipid barrier; this in turn can allow permeation of environmental agents, which can induce an allergic or irritant response
Management
• moisturization
• midtohighpotencycorticosteroidointmenttwicedaily
Seborrheic Dermatitis
Clinical Presentation
• greasy,erythematous,yellow,scaling,minimallyelevatedpapulesandplaquesinareasrichinsebaceous glands, can look moist and superficially eroded in flexural regions
• infants:“cradlecap”
• children:maybegeneralizedwithflexuralandscalpinvolvement
• adults:diffuseinvolvementofscalpmarginwithyellowtowhiteflakes,pruritus,andunderlying
erythema
• sites:scalp,eyebrows,eyelashes,beard,glabella,post-auricular,oversternum,trunk,bodyfolds,
genitalia
Pathophysiology
• possibleetiologicassociationwithMalasseziaspp.(yeast)
Epidemiology
• commonininfantsandadolescents
• increasedincidenceandseverityinimmunocompromisedpatientsandParkinsondisease • inadultscancausedandruff(pityriasissicca)
Management
• face:ketoconazole(Nizoral®)creamdailyorbidand/ormildsteroidcreamdailyorbid
• scalp:salicylicacidinoliveoilorDerma-SmootheFS®lotion(peanutoil,mineraloil,fluocinolone
acetonide 0.01%) to remove dense scales, 2% ketoconazole shampoo (Nizoral®), ciclopirox (Stieprox®) shampoo, selenium sulfide (e.g. Selsun®) or zinc pyrithione (e.g. Head and Shoulders®) shampoo, steroid lotion (e.g. betamethasone valerate 0.1% lotion bid)