Contact Dermatisis: Atopic Dermatitis

A. aka: housewives (househusbands) eczema, dishpan hands b. Most common cause of hand eczema (35% of cases) c. Etiology: excessive dryness leading to eczematous inflammation d. History: frequent hand washing, exposure to chemicals, previous eczema e. Clinically: dryness, chapping, fissures, itching f. Treatment: based on stage g. Prevention: decrease hand washes, moisturizers, avoid caustic chemicals and detergents, use mild soaps or non soap cleansers

A. the most common presentation of atopic dermatitis in adults, and the second most common cause of hand eczema (22%). b. Think of atopic dermatitis if hand eczema before age 15, has eczema on the body, or history of “eczema” as a child c. All of the information on Irritant Contact Dermatitis of the Hand is the same with atopic, except that this is the underlying predisposition

a. True allergic reaction causing hand dermatitis is the cause in 10% of cases. b. Etiology: Nickel (metal exposure), potassium dichromate (cement, leather), rubber (gloves), fragrances (cosmetics), formaldehyde (fabrics, paper, cosmetics) and lanolin (lubricants) c.) Clinically: may have distinct signs that is allergic (rash under jewelry), but in most cases presents as regular hand eczema d.) All of the information on Irritant Contact Dermatitis of the Hand is the same with Allergic Contact dermatitis, except to further investigate cause and remove from exposure once identified.

A. A variant of hand eczema, that stops just prior to the distal interphalangeal joint b. Resistance to standard treatment is seen, and will come and go for months to years

a. General info: A distinct hand eczema characterized by sweaty palms (and soles), itching, and vesicular eruptions b. Clinically: Tapioca like vesicles appear on sides of fingers, worsened by emotional stress c. Etiology: unknown, patients sweat 2.5 times more than normal d. Treatment: Topical steroids, cool compresses, oral antibiotics (if infected). Worse cases may require oral steroids. Decrease stress may also help.

1. aka: eczema craquele 2. Etiology: excessive dryness leading to eczematous inflammation 3. History: previous eczema, underlying atopic state, winter exacerbation 4. Clinically: dryness, cracking, superficial fissures, lower legs; “cracked porcelain” appearance; pain rather than itching 5. Treatment: based on stage (acute, subacute, chronic) Topical steroids, cool compresses, oral antibiotics (if infected),and frequent moisterizing

1. General: Coin shaped papules and plaques of eczema 2. History: middle aged patients, worse in winter, back of hand most common site, extremities 3. Clinically: erythematous, annular papules and plaques, can display vesicles, dryness, and scale; itching is moderate to severe 4. Treatment: based on stage (acute, subacute, chronic) Topical steroid, frequent moisturizing, and antihistamines

1. aka: neurodermatitis; chronic itchy spot 2. Etiology: excessive rubbing and scratching 3. History: previous eczema or itchy skin, subconscious rubbing 4. Clinically: Pruritic, erythematous and lichenified plaque(s), on lower leg, neck, scrotum, vulva. Can lead to true neurotic excoriations 5. Treatment: Topical steroids, antihistamines and frequent moisturizing

A. Allergen - resinous sap known as urushiol b. Cross reactions to cashew trees, mango tress, Japanese lacquer trees, and ginkgo c. Clinically: erythematous based vesicles in linear fashion, 8 hours to 1 week after exposure. Blister fluid does not spread the eruption. d. Treatment: Wash with soap to clear resin (should be done within 15 min of exposure). Cold compresses, high potency topical steroids, oral or intramuscular steroids for full 3-4 weeks, and antihistamines.

a.) Allergen - Mercaptobenzothiazole, a rubber component of adhesives used to cement shoe uppers, leached into skin due to perspiration b.) Clinically: erythema and dermatitis of feet, usually sparing the interdigital space c.) Treatment: Cold compresses, high potency topical steroids, oral or intramuscular steroids for full 3-4 weeks, and antihistamines. Control perspiration

A.) Allergen - Nickel, used as alloy in most jewelry; may even be present in “hypoallergenic gold” b.) Clinically: erythema and dermatitis of earlobes, neck line, abdomen, etc.

1. A term given to patients with a history of hay fever, asthma, dry skin and eczema

Major Features (must have 3 or more) a. Pruritus b. Typical morphology and distribution (Flexural lichenfication in adults, Facial and extensor involvement in infants and children) c. Dermatitis-chronically or chronically relapsing d. Personal or family history of atopy-asthma, allergic rhinitis atopic dermatitis Minor: (must have 3 or more)-> see book

1. Elevated T lymphocyte activation leading to an overproduction of IgE (80% of patients have elevated IgE) 2. Defective cell mediated immunity with common bacterial infections

1. Infantile Atopic Dermatitis (birth to 2 years): a. Starts the 3rd month of life b. Cheeks (perioral sparing), trunk, extremities, spares diaper area c. Resolves in 50% of infants by 18 months 2. Childhood Atopic Dermatitis: a.) Flexural involvement - antecubital fossae, neck, wrists, ankles, popliteal fossae b.) Persipirations of opposing skin surfaces leads to increased pruritus and initiates the itch scratch cycle c.) Scratching will lead to lichenfication 3. Adult Atopic Dermatitis: a. Flexural involvement, like childhood phase b. Hand dermatitis c. Periocular dermatitis d. Lichenfication of the anogential area