Dermatitis :

Diagnosis and Treatment

of Eczema

Adrian Guevara MD
 Dermatitis
 Atopic
 Seborrheic
 Contact
 Allergic
 Irritant
 Nummular
 Asteatotic
 Stasis
 Neurodermatitis/Lichen Simplex Chronicus
 Dermatitis 101
Dermatitis=“Eczema”=Spongiosis
Dermatitis 101
Acute Dermatitis
 Dermatitis 101
Subacute Dermatitis

Commonly misdiagnosed as tinea

 Dermatitis 101
Chronic Dermatitis

Commonly misdiagnosed as psoriasis

24 y/o male 2 year h/o red,
scaly feet
 Allergic Contact Dermatitis
 Type 4 Hypersensitivity Response
 Classically well demarcated/patterned
 Exposure can be infrequent (once a month)
 Patch testing is gold standard for diagnosis
 Severe reactions need systemic steroids

Forget the dose pack

 Allergic Contact Dermatitis
 Poison Ivy/Oak/Sumac
linearity
 Allergic Contact Dermatitis
 Potassium Dichromate
in Leather
 Allergic Contact Dermatitis
 Latex
 Cleaning products
 Cosmetics
 Occupational
exposures

Check the feet and

nails!!!
Allergic Contact Dermatitis
40 y/o female homemaker with dry,
itchy hands
 Irritant Contact Dermatitis
 Most contact dermatitis is irritant in nature
 Occupational
morbity
 Irritant vs allergic
 Prevention is key!
Look at the cuticles
 Lip licker dermatitis

Blunting of vermillion
Accentuation of angles
4 y/o boy with chronic, itchy,
bleeding plaques
 Atopic Dermatitis
 10-20% of population
 Primary symptom: Periorbital pallor
itch
 Location, location,
location
 Associated with atopic
background
Look for
keratosis
pilaris
52 y/o male with erythematous, scaly
patches of face and scalp
 Seborrheic Dermatitis
 Distribution
 Face, scalp, axillae, upper chest
 Chronic condition
 Nonsteroidal adjuvants
 Disease associations
45 y/o female with intermittent
“fungus all over”
 Nummular Dermatitis
 Coin shaped patches and
plaques
 Secondary to xerosis cutis
 Primary symptom itch

Notice the surrounding

xerosis
 Asteatotic Dermatitis
 Extreme case of xerosis
 Riverbed type cracking
52 y/o male with painful, itchy rash
on right leg
 Stasis Dermatitis
 Venous hypertension
 Full spectrum of timing
 Id reaction common
 Complicated by ulceration
 Pseudokaposi’s Lipodermatosclerosis
(acroangiodermatitis)

Venous ulceration

Dispigmentation
(chronic)
 Superimposed
allegic contact

Do: 1) dry weeping lesions

2) cover for infection

Don’t: 1) apply neosporin

2) just hope steroids
will fix it

Id reaction
Elephantiasis Verrucosa Nostras
14 y/o anxious female who can’t stop
itching
 Neurodermatitis/Lichen Simplex
Chronicus
 Paroxysmal pruritus
 Habitual excoriating or
rubbing
 Skin thickens to defend
 Consider underlying
disease

Increased skin markings

Lichen simplex chronicus

No fungus on the scrotum!

Prurigo simplex
 Butterfly sign

Prurigo Nodularis

Consider screening
 Prevention
 Remove the offending agent
 Edema, allergen, irritant, yeast, long fingernails
 Daily cleansing and MOISTURIZING
 Dove, Oil of Olay, Neutrogena
 Mild temperatures

 Cream/Ointment based emollients

Neosporin, antifungals ≠ moisturizers

 Treatment
 Topical Steroids
 Clobetasol I
 Triamcinolone IV
 Desonide VI
 Hydrocortisone VII
 Treatment
 TIM
 Protopic 0.1% oint Only on thin skin !!!
 Elidel cr
 Light
 nbUVB
 Systemic immunosuppressives
 Prednisone
 Cyclosporine
 Azathioprine
 IVIG
 Treatment
 Antihistamines
 Mechanism of action: soporific

Indications for Dermatitis ≠ Urticaria

7 m/o infant with itchy skin
75 y/o nursing home patient with
intolerable itchy skin
 Common Pitfalls
 Misdiagnosis
 Scabies (intensely pruritic, burrows/vesicles, others
itch)
 Psoriasis (elbows/knees/inflammatory arthritis/nail
changes)
 Fungus (central sparing, well marginated, scaly
border)

Lose the Lindane!

 25 y/o male tx’d for eczema in
antecubital fossa with “some cream”
 Common Pitfalls
 Mistreatment
 Lose the Lotrisone!

 1) Commit to a diagnosis
 2) Shotgunners: “Don’t be a wimp”

 Quadriderm: betamethasone, gentamycin,

clotrimazole
 Animax
The End