aka sweaty sock syndrome location plantar surfaces of feet and big toes, palms timing toddlers and...
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Irritant dermatitides
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AKA sweaty sock syndromeLocation
Plantar surfaces of feet and big toes, palmsTiming
Toddlers and school-ageFall or winterResolution by adolescence
DescriptionChronic, red, scaly patches with fissuring
Juvenile Plantar-Palmar Dermatosis
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Due to wetting of skin during day followed by drying at night
TreatmentShoes that breatheCharcoal insolesLubrication of feet at nightTopical steroids in severe cases
Juvenile Plantar-Palmar Dermatosis
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Irritant dermatitides
Lip-licking eczema Thumb sucking eczema
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Other rashes
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Benign self-limited disorderTiming
Most common adolescents and young adultsProdrome of malaise, h/a
DescriptionHerald patch
Pink, slightly scalyMay clear centrally
Pityriasis rosea
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5-10 days laterSmall lesions: trunk, proximal extremeties
Inverse pityriasisLesions predominate on face and distal ext
(palms/soles)Description
Small, round papulesEnlarge to 2mm ovalsScaly surfaceRaised, but can be macularErythematous, hyper or hypopigmentedMay create “christmas tree” pattern over thorax
Pityriasis rosea
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CoursePeaks in several weeksDuration 2-3 mos
TreatmentNo treatment requiredOral erythromycin and
UV light may hasten resolution
Etiology unknown?infectious?
Pityriasis rosea
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Extend beyond margin of the woundMost common in BlacksTreatment
Intralesional steroidsCombination with surgical excisionOften recur
Keloids
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Unclear etiology… no treatment required
Annular eruption Begins as papule that
gradually extends peripherally to form a ringRaised, induratedOverlying epidermis intactSame color as adjacent
skinExtensor surfaces
Resolves over months
Granuloma Annulare
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Contact Dermatitis
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Irritant contact dermCaustic agents (non-allergic)Allergic contact derm
T-cell mediated (type 4- delayed)Poison Ivy or NickelInitial rxn needs 7-14 day sensitization period
Reexposure provokes rapid rxn (hours)
Categories
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DescriptionLinear streakserythematous papules and
vesciclesLarge patches (heavy exposure)Impressive swelling (face,
digits, genitalia)Contact
Sap of plants, objects, smokeWash skin immediatelyCan not spread after 20min
Rhus Dermatitis (Poison Ivy)
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Photocontact (Phototoxic)True cell-mediated delayed hypersensitivitySun exposure precipitates urticarial eruptionMarked by sun exposed areas onlyPrecipitated by
TetracyclineSulfaThiazidesNSAIDSFluoroquinolonesGriseofulvinTopical agents
Photocontact and Phototoxic Reactions
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Agents applied to skin:Non-immunologic exaggerated sunburn rxnPhotodermatitis most common
Plant-derived photosensitizers:Psoralens (lemons, limes, figs, dill, parsley,
parsnips, carrots, celery)Macules: Bullae: Hyperpigmented patchMay have bizarre patterns mimicing abuse
Phototoxins
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Phototoxic Rxn (Psoralens)
LemonsLimesFigsDillParsleyParsnipsCarrotsCelery
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Localized: topical steroidsSevere or Widespread: systemic steroids
1mg/kg/day tapered over 2wksIdentification of trigger and avoidance are
key!!
Treatment of Contact Derm
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Fungal infections
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Aka autoeczematizationWidespread secondary eczematous dermatitis
Contact dermTinea (particularly at start of therapy)
Id Reaction
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DermatophytesTinea (ringworm fungi)
YeastsCandida
Diaper dermatitisPityrosporum
Tinea versicolorBoth have been implicated in seborrhea
Classification
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DescriptionPruritic, annular lesion with central clearingBorder: microvesicles rupture then scale
AcquisitionDirect contact with infected kittens
Trichophyton tonsurans
CourseMay expand up to 5cm over several weeks
Tinea corporis
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DiagnosisConfirmed by KOH
Loose scales at marginLong, branching, septate rods of uniform width
that cross borders of epidermal cells
TreatmentGlabrous skin areas: topical antifungalsMultiple or widespread: oral griseofulvin
Tinea Corporis
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Aka: Athlete’s footLocation:
Web spaces b/w toesSides of toesMay involve the plantar or dorsal surfaces
Timing: Mostly adolescentsAcquisition: contaminated showers, etc
Warm, moist environmentsDescription:
Scaling and fissuringVesiculopustular lesions and maceration Intense burning or itching
Tinea Pedis
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Dx:Clinical groundsConfirmed by KOH
Tx:Antifungal creams or
powdersReducing foot moistureOral antifungals if
severe
Tinea Pedis