DOCSLIB.ORG

Tinea, Eczema, and All Things Alike

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Tinea, Eczema, and All Things Alike PODIATRIC DERM REVIEW Painting from Philadelphia Art TRACEY C. VLAHOVIC, DPM FFPM RCPS (GLASG) Museum CLINICAL PROFESSOR, TEMPLE UNIV SCHOOL OF PODIATRIC MEDICINE PHILADELPHIA, PA DISCLOSURES • None for this presentation • Clinical Trials, Speaker: Valeant • Consultant, Speaker: Bako Dx THE ISSUES I GET DAILY CONSULTS ON THE MOST • Various Inflammatory skin conditions • Verruca • Onychomycosis INFLAMMATORY BASED SKIN CONDITIONS • Atopic Dermatitis • Contact Dermatitis • Nummular Dermatitis • Id Reaction • Stasis Dermatitis • Lichen Simplex Chronicus • Psoriasis • Tinea pedis • Xerosis HOW WOULD YOU APPROACH THESE? None of these Are Fungal!!!! THOU SHALL NOT USE CLOTRIMAZOLE-BETAMETHASONE FOR EVERYTHING THAT LOOKS RED AND SCALY • Antifungal/Class I steroid preparation (fluorinated and high potency) • “the corticosteroid component may interfere with the therapeutic actions of the antifungal agent, or fungal growth may accelerate because of decreased local immunologic host reaction, such that underlying infection may persist, and dermatophytes may even acquire the ability to invade deeper tissues” Am J Clin Dermatol. 2004;5(6):375- 84. • Tinea incognito! J Biomed Res. 2010 Jan; 24(1): 81–83. • AAD guidelines state to use topical antifungal first for superficial fungal infections • Most antifungals have a NATURAL anti-inflammatory property and have a higher cure/lower relapse rate • Don’t take the “easy” way out EVEN METHLYPREDNISOLONE DOSE PACKS CARRY RISK • I NEVER use for any skin condition---I do prednisone tapers over 4-6 weeks, and I never give to a potential psoriasis patient (controversy) • Recent study showed: over 300,000 patients received a low dose oral steroid (less than 30 day dose), 46.9% received the med dosepack • Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07) BMJ. 2017;357:j1415 ORAL PREDNISONE TAPERING BASICS • For an acute dermatitis in an adult, you can prescribe: • 10 mg prednisone tablets or 1-2mg/kg/day • Rx to take 5 days of 60 mg, 5 days of 40 mg, 5 days of 20 mg, 5 days of 10 mg and in some cases 10 mg every other day till they finish. • They must finish all meds and not skip a dose! • HPA axis suppression can occur after just 5 days of taking 40 mg/day WHAT WE TYPICALLY SEE… • Bilateral and symmetrical presentation on • Scalp/hairline • Elbows • Hands (palmar) • Gluteal cleft • Knees • Feet (plantar) WHAT WALKS INTO THE OFFICE: PHENOTYPIC EXPRESSION OF PALMOPLANTAR PSORIASIS Retrospective review of 150 patients with palmoplantar psoriasis defined subtypes: 1. Purely hyperkeratotic 2. Purely pustular 3. Mixed hyperkeratotic/pustular 4. With or without psoriasis elsewhere Farley E, et al. J Am Acad Dermatol 2009; 60(6):1024-31 1ST LINE TO APPROACH PLANTAR PSORIASIS • Refer patient to National Psoriasis Foundation for support/resources • Topical corticosteroid (clobetasol to hydrocortisone butyrate) • No OTC hydrocortisone • Thou shall not use Lotrisone!!! • NO ORAL STEROIDS---that means no dose pack! • Topical Vitamin D Analog (calcipotriene or calcitriol) • Combo of betamethasone and calcipotriene (foam and ointment) • Rx or OTC moisturizer • Should you Rx Urea? Sal acid 6%? Lactic acid? • Let the medications do their work---no pumice stone or excess soaking! VITAMIN D ANALOG • Dovonex (calcipotriene) cream, ointment, scalp solution • Taclonex (calcipotriene/betamethasone) ointment • Vectical (calcitriol) ointment After 2 months of use A FORGOTTEN TREATMENT FOR INFLAMMATORY BASED CONDITIONS: MOISTURIZERS • We should have patients using 10x the amount than they already are • Best time to apply: within minutes of getting out of tub/shower • Try to choose fragrance-free preps: Hylatopic Plus, Epiceram, Ceramax, Neosalus, Neocera (all Rx) • Add a keratolytic topical (lactic acid, salicylic acid, urea) • 59% reduction on AD pts when used for two months---J Dermatol Treat 2006 • The vehicle effect? ADDING A KERATOLYTIC… 9/07 1/08 DON’T DEBRIDE PSORIATIC PLAQUES WITH A BLADE PUSTULAR PSORIASIS Medication Use in Psoriasis Side Effects Topical Steroids Plaque Skin atrophy, hypopigmentation, striae Vitamin D Analog Use in combo with topical Skin irritation, photosensitivity, steroids but can be used with UVB therapy Topical Retinoid Plaque; Use with topical Skin irritation, photosensitivity steroids Salicylic or Lactic Acid or Urea Plaque to soften plaques Sal acid can be systemically absorbed if applied to >20% BSA Coal tar Plaque Skin irritation, odor, stain clothes Calcineurin inhibitors: Off label use for facial and Skin burning and itching Protopic and Elidel intertriginous HOME NB-UVB PHOTOTHERAPY https://www.natbiocorp.com/handisol.htm https://www.daavlin.com/patients/uv-phototherapy/home- phototherapy-products/ WHAT IF NOTHING TOPICAL WORKS/PHOTOTHERAPY NOT COVERED? • Our next step is systemic…and the biologics • Systemic Therapies • Cyclosporine, Methotrexate, Acitretin, Dapsone • Biologic therapy • Plaque affecting >5% of the BSA • Erythrodermic, pustular, or guttate forms/Psoriatic Arthritis • Recalcitrant to topical therapies • <5% BSA, but located on FEET, NAILS, and hands • My experience has been with cyclosporine, dapsone, infliximab, ustekinumab, apremilast, adalimumab, etanercept, and brodalumab APREMILAST • Technically not a biologic, but an oral med to treat both plaque psoriasis and arthritis • Phosphodiesterase 4 inhibitor • No requirement for initial or ongoing blood test or PPD test prior • Dosage is (after a titration period), 30 mg bid for plaque psoriasis • For palmoplantar psoriasis: After four months, almost two-thirds of patients achieved clear or almost clear skin, while less than a third of patients on placebo did. J Am Acad Dermatol. 2016 Jul;75(1):99-105. • For Nail psoriasis: After four months, patients experienced an average of 29 percent improvement in their nails J Drugs Dermatol. 2016 Mar;15(3):272-6. • Side effects: diarrhea, nausea, headache 5/25/2017 6/29/2017 Apremilast for ~30 days WHAT’S NEW FOR PSORIATIC NAILS? INDIGO NATURALIS • Chinese medicine (Qing Dai—from plants indigofera tinctoria, baphieacanthuscusia, isatis tinctoria, polygonum tinctorium, and isatis indigotica) • antipyretic, anti-inflammatory, antiviral, antimicrobial, antitumor and detoxifying properties J Drugs Dermatol. 2016;15(3):319-323. WEEPY AND ITCHY SKIN ECZEMA OR DERMATITIS Personal or Family Hx Of “The Triad” + Age Specific Lesions What do they use daily? As described above: Varicosities: Positive Patch Test: Venous Stasis Atopic Eczema Allergic Contact Dermatitis Dermatitis IRRITANT CD VS ALLERGIC CD= PATCH TEST Once the allergen is known, remove from the pt’s environment SHOE CONTACT DERMATITIS (FIND THIS LIST ON PODIATRY TODAY ONLINE) 1. Askin Shoes: http://www.askin.it/eng/home.php Shoes that are excluding the following materials such as chromium salts, aluminum, zirconium, titanium, nickel, lead, copper, cadmium, and many others 2. Ausangate Socks: www.ausangatesocks.com/default.asp Offers lanolin-free socks made of breathable alpaca fiber 3.Birkenstock for cork insole replacements n.b. Birkenstock buckles are nickel-free 4. The Cordwainer Shop http://www.cordwainershop.com/: offers Glue-free linings for allergy sensitive customers 5. Loveless Orthopedic Appliance http://www.lovelessboots.com/: Offers hypoallergenic liners for shoes and boots 6. Microair Barrier Socks by Alpretec: http://www.alpretec.com/eng offers barrier socks prevent skin from contacting allergens and irritants. 7. Multnomah Leather Shop: http://www.multnomahleather.com/Allergy Offers clogs made of chromate-free vegetable-tanned cowhide and for those with rubber allergy, they use a wood midsole, isolating the wearer’s feet from the cemented outsole. 8. P.W. Minor and Son http://www.pwminor.com/ offers hypoallergenic footwear, including chrome-free leather and the use of minimal adhesives ATOPIC DERMATITIS TREATMENT ALGORITHM Moderate Atopic Dermatitis Severe Atopic Dermatitis Mild Atopic Dermatitis Consider Derm Referral Consider Derm Referral TCS* TCS* TCS* 1st Line BRMD/Emollients BRMD/Emollients BRMD/Emollients (+/-) TCI (+/-) TCI TCI 2nd Line TCI TCI Narrowband UVB Systemic medications BRMD/Emollients BRMD/Emollients BRMD/Emollients Maintenance (+/-) TCS/TCI† (+/-) TCS/TCI† (+/-) TCS/TCI† (+/-) sedating antihistaminea *Potency based on site, *Potency based on site, Special duration and age duration and age Circumstances (+/-) sodium hypochlorite (bleach bath) appropriateness appropriateness or topical hypochlorous †Rotational/intermittent †Rotational/intermittent b acid (+/-) sedating antihistaminea (+/-) sedating antihistaminea c (+/-) oral antimicrobial (+/-) sodium hypochlorite (+/-) sodium hypochlorite (bleach bath) (bleach bath) or topical hypochlorous acidb or topical hypochlorous acidb (+/-) oral antimicrobialc (+/-) oral antimicrobialc Lebwohl MG, et al. JCAD. 2013;6(7 suppl):S1-S18. CLASSES OF TOPICAL STEROIDS • Look at Steroid CLASS not the PERCENTAGE of the drug to determine potency • Pair it with the symptoms! Does this wake them during the night? Is it a mild irritation? • Class I Super Potent • Only use for 2 weeks, NEVER on face, axilla, or groin clobetasol diproprionate betamethasone diproprionate halbetasol proprionate diflorasone diacetate fluocinonide CLASSES OF TOPICAL STEROIDS • Group II—high potency– use <6-8 wks • Desoximetasone, mometasone • Group III—mid potency—use <6-8 wks • fluticasone • Group IV—low potency—side
Load more

Recommended publications
  • Skin Diseases in Wrestling
    Skin conditions in wrestling – how to prevent Krisztián Gáspár, MD, PhD Assistant professor University of Debrecen Faculty of Medicine Department of Dermatology Debrecen, Hungary Disclosure • Presenter: Krisztián Gáspár • I have the Relationships with commercial interests: – Advisory Board/Speakers Bureau: none – Funding (Grants/Honoraria): none – Research/Clinical Trials: Eli Lilly, Novartis, Pfizer, Janssen, Sanofi, Abbvie – Speaker/Consulting Fees: Eli Lilly, Novartis, Janssen, Sanofi, Abbvie • None to disclose regarding this presentation Objectives • Normal and impaired skin barrier • Atopic dermatitis – model for understanding barrier • Skin diseases in wrestling • Treatments • Prevention techniques in skin infections Skin barrier Danger model: ”The basic function of immune system is not to distinct between self and non-self, but to recognize danger” Polly Matzinger, PhD, Immunologist, NIH In order to avoid or prevent a loss on the mat you need a good defense – The same is true for skin (an active defense) Skin barrier functions Physicochemical barrier and immunological barrier – in close morphological and functional connection Physicochemical barrier Immunological barrier (SIS) Stratum corneum: corneocytes • Epidermis, dermis Stratum granulosum: keratinocytes • Keratinocytes, dendritic cells, T cells Cornified envelop , structural proteins • Defensins, cytokines, chemokines (filaggrin) Lipid layer, proteases, protease inhibitors, defensins Tight junctions, corneodesmosomes Physicochemical barrier Genetics Environmental factors
    [Show full text]
  • Dyshidrotic Eczema
    University of Calgary PRISM: University of Calgary's Digital Repository Cumming School of Medicine Cumming School of Medicine Research & Publications 2014-09-16 Dyshidrotic eczema Leung, Alexander K.C.; Barankin, Benjamin; Hon, Kam Lun Enliven Archive Leung AK, Barankin B, Hon KL (2014) Dyshidrotic Eczema. Enliven: Pediatr Neonatol Biol 1(1): 002. http://hdl.handle.net/1880/50267 journal article Downloaded from PRISM: https://prism.ucalgary.ca Research Article www.enlivenarchive.org Enliven: Pediatrics and Neonatal Biology Dyshidrotic Eczema Alexander K. C. Leung1*, Benjamin Barankin2, and Kam Lun Hon3 1Clinical Professor of Pediatrics, University of Calgary, Pediatric Consultant, Alberta Children’s Hospital 2Medical Director and Founder, Toronto Dermatology Centre 3Professor of Pediatrics, Chinese University of Hong Kong * Corresponding author: Alexander K. C. Leung, MBBS, FRCPC, FRCP Citation: Leung AK, Barankin B, Hon KL (2014) Dyshidrotic Eczema. (UK & Irel), FRCPCH, FAAP, Clinical Professor of Pediatrics, University Enliven: Pediatr Neonatol Biol 1(1): 002. of Calgary, Pediatric Consultant, Alberta Children’s Hospital, Canada, Tel: Copyright:@ 2014 Dr. Alexander K. C. Leung. This is an Open Access (403) 230-3322; Fax: (403) 230-3322; E-mail: [email protected] article published and distributed under the terms of the Creative Commons th Received Date: 14 August 2014 Attribution License, which permits unrestricted use, distribution and th Accepted Date: 10 September 2014 reproduction in any medium, provided the original author and source are th Published Date: 16 September 2014 credited. Abstract Dyshidrotic eczema, also known as dyshidrotic dermatitis or pompholyx, is characterized by pruritic, tense, deep-seated vesicles mainly on the palms and lateral surfaces of the fingers.
    [Show full text]
  • Allergic Contact Dermatitis Handout
    #30: ALLERGIC CONTACT DERMATITIS PATIENT PERSPECTIVES Allergic contact dermatitis Contact dermatitis is an itchy rash that is caused by something touching (contacting) your skin. The rash is usually red, bumpy, and itchy. Sometimes there are blisters filled with fluid. THERE ARE TWO TYPES OF CONTACT DERMATITIS: COMMON FORMS OF ALLERGIC CONTACT DERMATITIS: 1. Some things that contact skin are very irritating and will cause a rash in most people. This rash is called irritant contact dermatitis. Examples are acids, soaps, cold weather, and friction. » ALLERGIC CONTACT DERMATITIS TO HOMEMADE SLIME 2. Some things that touch your skin give you a rash because you are allergic to them. This rash is called allergic contact dermatitis. » Slime is a homemade gooey These are items that do not bother everyone’s skin. They only substance that many young people cause a rash in people who are allergic to those items. make and play with. » There are several recipes for making WHAT ARE COMMON CAUSES OF ALLERGIC slime. Common ingredients include CONTACT DERMATITIS IN CHILDREN AND boric acid, contact lens solution, WHERE ARE THEY FOUND? laundry detergent, shaving cream, and school glue. Many ingredients » Homemade slime: often irritation (irritant contact dermatitis) being used can cause irritation results from soap or detergent but can have allergic contact (“irritant contact dermatitis”) and some dermatitis to glues and other ingredients can cause allergic contact dermatitis. » Plants: poison ivy, poison oak, poison sumac » Children playing with slime may get » Metals (especially nickel): snaps, jewelry, an itchy rash on their hands. There belt buckles, electronics, toys can be blisters, flaking, peeling, and cracking.
    [Show full text]
  • Infectious ID Reaction Case Report
    EMERGENCY MEDICINE ISSN 2379-4046 http://dx.doi.org/10.17140/EMOJ-3-133 Open Journal Case Report Infectious ID Reaction *Corresponding author Larry B. Mellick, MD 1 1 2* Department of Emergency Medicine CPT. Katherine D. Percy, DO ; Lt. Col. Massimo D. Federico, MD ; Larry B. Mellick, MD Augusta University Health Sciences Campus 1 AF-1020, 1120 15th Street Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36000 Darnall Augusta, Georgia 30912, USA Loop, Fort Hood, TX 76544, USA E-mail: [email protected] 2Department of Emergency Medicine, Augusta University, Health Sciences Campus, AF-1020, 1120 15th Street, Augusta, Georgia 30912, USA Volume 3 : Issue 1 Article Ref. #: 1000EMOJ3133 CHIEF COMPLAINT Article History Redness and swelling to left leg. Received: December 9th, 2016 Accepted: February 16th, 2017 HISTORY OF PRESENT ILLNESS Published: February 17th, 2017 An otherwise healthy 7-year-old male presented to the emergency department complaining of a pruritic, red rash with that had increased in area over 7 days. The rash reportedly began Citation as a localized lesion on his left lower extremity and developed a secondary diffuse rash over Percy KD, Federico MD, Mellick LB. In- the trunk and upper extremities after the initial ED encounter. During the initial emergency fectious ID reaction. Emerg Med Open department visit he was prescribed diphenhydramine and topical hydrocortisone with minimal J. 2017; 3(1): 14-15. doi: 10.17140/ relief. He denied any known environmental or allergen exposures or asthma history suggesting EMOJ-3-133 atopic dermatitis, or new exposures to medications. The patient and his parent also denied fever, lymphadenopathy, or any respiratory signs and symptoms.
    [Show full text]
  • Skin Signs of Rheumatic Disease Gideon P
    Skin Signs of Rheumatic Disease Gideon P. Smith MD PhD MPH Vice Chair for Clinical Affairs Director of Rheumatology-Dermatology Program Director of Connective Tissue Diseases Fellowship Associate Director of Clinical Trials Department of Dermatology Massachusetts General Hospital Harvard University www.mghcme.org Disclosures “Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.” www.mghcme.org CONNECTIVE TISSUE DISEASES CLINIC •Schnitzlers •Interstitial •Chondrosarcoma •Eosinophilic Fasciitis Granulomatous induced •Silicone granulomas Dermatitis with Dermatomyositis Arthritis •AML arthritis with •Scleroderma granulomatous papules •Cutaneous Crohn’s •Lyme arthritis with with arthritis •Follicular mucinosis in papular mucinosis JRA post-infliximab •Acral Anetoderma •Celiac Lupus •Calcinosis, small and •Granulomatous exophytic •TNF-alpha induced Mastitis sarcoid •NSF, Morphea •IgG4 Disease •Multicentric Reticul •EED, PAN, DLE ohistiocytosis www.mghcme.org • Primary skin disease recalcitrant to therapy Common consults • Hair loss • Nail dystrophy • Photosensitivity • Cosmetic concerns – post- inflammatory pigmentation, scarring, volume loss, premature photo-aging • Erythromelalgia • Dry Eyes • Dry Mouth • Oral Ulcerations • Burning Mouth Syndrome • Urticaria • Itch • Raynaud’s • Digital Ulceration • Calcinosis cutis www.mghcme.org Todays Agenda Clinical Presentations Rashes (Cutaneous Lupus vs Dermatomyositis vs ?) Hard Skin (Scleroderma vs Other sclerosing disorders) www.mghcme.org
    [Show full text]
  • My Approach to Superficial Inflammatory Dermatoses K O Alsaad, D Ghazarian
    1233 J Clin Pathol: first published as 10.1136/jcp.2005.027151 on 25 November 2005. Downloaded from REVIEW My approach to superficial inflammatory dermatoses K O Alsaad, D Ghazarian ............................................................................................................................... J Clin Pathol 2005;58:1233–1241. doi: 10.1136/jcp.2005.027151 Superficial inflammatory dermatoses are very common and diagnosis of inflammatory skin diseases, there are limitations to this approach. The size of the comprise a wide, complex variety of clinical conditions. skin biopsy should be adequate and representa- Accurate histological diagnosis, although it can sometimes tive of all four compartments and should also be difficult to establish, is essential for clinical include hair follicles. A 2 mm punch biopsy is too small to represent all compartments, and often management. Knowledge of the microanatomy of the skin insufficient to demonstrate a recognisable pat- is important to recognise the variable histological patterns tern. A 4 mm punch biopsy is preferred, and of inflammatory skin diseases. This article reviews the non- usually adequate for the histological evaluation of most inflammatory dermatoses. However, a vesiculobullous/pustular inflammatory superficial larger biopsy (6 mm punch biopsy), or even an dermatoses based on the compartmental microanatomy of incisional biopsy, might be necessary in panni- the skin. culitis or cutaneous lymphoproliferative disor- ders. A superficial or shave biopsy should be ..........................................................................
    [Show full text]
  • Atopic Dermatitis (Eczema) •Chronic Inflammatory Skin Disease That Begins During Infancy Or Early Childhood
    9/18/2019 Pediatric Dermatology Jennifer Abrahams, MD, FAAD, DTM&H Collaborators: Kate Oberlin, MD; Nayoung Lee MD September 27th, 2019 1 Disclosures • Nothing to disclose 2 1 9/18/2019 Disclaimer *Pediatric dermatology is taught over 3 years of derm-specific residency training and there is an additional year of subspecialized fellowship! *We won’t cover all of pediatric derm in an hour but I hope to give you some common highlights 3 A 9 month old infant presents with the following skin lesions. Which of the following is most likely true of this disease? A.) Asthma generally precedes skin findings B.) The majority of affected children will outgrow the skin disease C.) There is no way to avoid or decrease risk of progression of the disease D.) Genetic factors account for approx 1% of susceptibility to early onset of this disease 4 2 9/18/2019 A 9 month old infant presents with the following skin lesions. Which of the following is most likely true of this disease? A.) Asthma generally precedes skin findings B.) The majority of affected children will outgrow the skin disease C.) There is no way to avoid or decrease risk of progression of the disease D.) Genetic factors account for approx 1% of susceptibility to early onset of this disease 5 6 3 9/18/2019 Atopic Dermatitis (Eczema) •Chronic inflammatory skin disease that begins during infancy or early childhood •Often associated with other “atopic” disorders • Asthma • Allergic rhinitis (seasonal allergies) • Food allergies •Characterized by intense itch and a chronic relapsing course •Prevalence almost 30% in developed countries 7 Table courtesy of Bolognia, et al.
    [Show full text]
  • Differential Diagnosis in Dermatology
    Differential Diagnosis in Dermatology ZohrehTehranchi Dermatologist COMMON ACNE AND CYSTIC ACNE Rosacea Rosacea PERIORAL DERMATITIS ECZEMA/DERMATITIS Chronic irritant dermatitis Dyshidrotic eczematous dermatitis Childood atopic dermatitis Autosensitization dermatitis (“id” reaction): dermatophytid Seborrheic dermatitis PSORIASIS VULGARIS Pemphigus vulgaris BULLOUS PEMPHIGOID (BP) Pityriasis rosea small-plaque parapsoriasis Large-plaque parapsoriasis (parapsoriasis en plaques) LICHEN PLANUS (LP) GRANULOMA ANNULARE (GA) Erythema multiforme ERYTHEMA NODOSUM Actinic keratoses Bowen disease (Squamous cell carcinoma in situ) Bowen disease and invasive SCC Squamous cell carcinoma: invasive on the lip Squamous cell carcinoma, well differentiated Squamous cell carcinoma, undifferentiated Squamous cell carcinoma, advanced, well differentiated, on the hand Keratoacanthoma showing different stages of evolution BASAL CELL CARCINOMA (BCC) Basal cell carcinoma, ulcerated: Rodent ulcer A large rodent ulcer in the nuchal and Bas cell calarcinoma: sclerosing type retroauricular area extending to the temple Basal cell carcinoma, sclerosing, nodular, Superficial basal cell carcinoma: solitary lesion and multiple lesions Superficial basal cell carcinoma, invasive Basal cell carcinoma, pigmented Dysplastic nevi Superficial spreading melanoma: arising within a dysplastic nevus Congenital nevomelanocytic nevus Melanoma: arising in small CNMN Melanoma in situ: lentigo maligna Melanoma in situ, superficial spreading type Superficial spreading melanoma, vertical
    [Show full text]
  • Diaper Dye Dermatitis
    Diaper Dye Dermatitis Lauren Alberta, BA*; Susan M. Sweeney, MD*‡; and Karen Wiss, MD*‡ ABSTRACT. Diaper dermatitis is a common problem in outpatient pediatric office settings. Although most diaper rashes represent a form of contact dermatitis in response to irritants in the diaper environment, other rashes may be the result of an allergen in the diaper. On the basis of clinical examination results for 5 patients and patch testing results for 2 patients, we suspect that the patients demonstrated allergic contact dermatitis in re- sponse to the various blue, pink, and green dyes in diapers. Although topically administered corticosteroids are useful in the treatment regimen, the preferred treat- ment for allergic contact dermatitis in the diaper area is the use of dye-free diapers for allergen avoidance. Patch testing may also be valuable in identifying the allergen, because allergen avoidance is the key to prevention of recurrent disease. Pediatrics 2005;116:e450–e452. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2004-2066; dia- per dye dermatitis, contact dermatitis, allergic contact dermatitis. Fig 1. Patient 1. Well-demarcated, linear erythema corresponds to green dye on the edge of the diaper. ABBREVIATION. ACD, allergic contact dermatitis. lated directly with the location of the green dye in his diaper. The patient was diagnosed with allergic contact dermatitis (ACD) with autoeczematization (id reaction). All symptoms improved mark- iaper dermatitis is a common problem in out- edly when he began wearing dye-free diapers; he received no other treatment. patient pediatric office settings. Although After clearance of the rash, the patient was brought back to the Dmost diaper rashes represent a form of con- clinic for patch testing with Finn chambers on Scanpor tape (Ep- tact dermatitis in response to irritants in the diaper itest, Oy, Finland).
    [Show full text]
  • Id Reaction Associated with Red Tattoo Ink
    CASE LETTER Id Reaction Associated With Red Tattoo Ink Alexandra Price, MD; Masoud Tavazoie, MD, PhD; Shane A. Meehan, MD; Marie Leger, MD, PhD 1 month later, she developed pruritic papulonodular PRACTICE POINTS lesions localized to the red-pigmented areas of the tattoo. • Hypersensitivity reactions to tattoo pigment are on Concomitantly, the patient developed a similar eruption the rise due to the increasing popularity and preva- confined to areas of red pigment in a polychromatic tattoo lence of tattoos. Systemic allergic reactions to tattoo on the right upper arm that she had obtained 10 years ink are rare but can cause considerable morbidity. prior. She was treated with intralesional triamcinolone to • Id reaction, also known as autoeczematization or several of the lesionscopy on the right dorsal foot with some autosensitization, is a reaction that develops distant benefit; however, a few days later she developed a gener- to an initial site of infection or sensitization. alized, erythematous, pruritic eruption on the back, abdo- • Further investigation of color additives in tattoo pig- men, arms, and legs. Her medical history was remarkable ments is warranted to better elucidate the compo- only for mild iron-deficiency anemia. She had no known nents responsible for cutaneous allergic reactions drugnot allergies or history of atopy and was not taking any associated with tattoo ink. medications prior to the onset of the eruption. Skin examination revealed multiple, well-demarcated, eczematous papulonodules with surrounding erythema To the Editor: Doconfined to the red-pigmented areas of the tattoo on Although relatively uncommon, hypersensitivity reactions the right dorsal foot, with several similar lesions on to tattoo pigment are on the rise due to the increasing the surrounding nontattooed skin (Figure 1).
    [Show full text]
  • Extensive Orf Infection in a Toddler with Associated Id Reaction
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Pediatr Manuscript Author Dermatol. Author Manuscript Author manuscript; available in PMC 2019 March 19. Published in final edited form as: Pediatr Dermatol. 2017 November ; 34(6): e337–e340. doi:10.1111/pde.13259. Extensive orf infection in a toddler with associated id reaction Ellen S. Haddock, AB, MBA1, Carol E. Cheng, MD2, John S. Bradley, MD3,4,5, Christopher H. Hsu, MD, PhD, MPH6,7, Hui Zhao, MD6, Whitni B. Davidson, MPH6, and Victoria R. Barrio, MD5,8,9 1School of Medicine, University of California, San Diego, San Diego, CA, USA 2Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA 3Division of Infectious Diseases, Rady Children’s Hospital-San Diego, San Diego, CA, USA 4Division of Infectious Diseases, School of Medicine, University of California, San Diego, San Diego, CA, USA 5Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, USA 6Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA 7Epidemic Intelligence Service, Atlanta, GA, USA 8Department of Dermatology, Rady Children’s Hospital-San Diego, San Diego, CA, USA 9Department of Dermatology, School of Medicine, University of California, San Diego, San Diego, CA, USA Abstract Orf is a zoonotic parapoxvirus typically transmitted to humans by a bite from goats or sheep. We present an unusual case of multiple orf lesions on the fingers of a 13-month-old child who was bitten by a goat and subsequently developed progressive swelling, blistering, and necrotic papulonodules of the hand followed by an additional diffuse, pruritic, papular rash.
    [Show full text]
  • Papular Urticaria and Things That Bite in the Night Jeffrey G
    Papular Urticaria and Things that Bite in the Night Jeffrey G. Demain, MD, FAAAAI Address external pressure, which might result in slowing of blood Allergy, Asthma & Immunology Center of Alaska, 2741 DeBarr Road, flow, thereby enhancing precipitation of immune complexes C-405, Anchorage, AK 99508, USA. [1]. Papules might also have a more diffuse, generalized dis- E-mail: [email protected] tribution involving the torso, neck, and face. The distribu- Current Allergy and Asthma Reports 2003, 3:291–303 tion of lesions serves as an important clue in identifying the Current Science Inc. ISSN 1529-7322 Copyright © 2003 by Current Science Inc. culprit arthropod (Table 1). Papules are erythematous, rang- ing from 3 to 10 mm. In the clinical setting, lesions are often excoriated and secondarily infected, contributing to the Whether we are hiking in the back country or playing in our characteristic intense pruritis. Perennial or seasonal exacer- backyard, we run the risk of exposure to offending arthro- bations are common and are presumed to be associated pods. Papular urticaria is a very common hypersensitivity with re-exposure to the offending arthropod. Recurrence of reaction to the bites, stings, and contact with critters such as papular urticaria with re-exposure seems to lessen in adoles- mites, ticks, spiders, fleas, mosquitoes, midges, flies, and even cence and adulthood. This might reflect the development of caterpillars. Children seem to be at greatest risk, although immune tolerance toward the antigenic proteins [2,3] adults are also vulnerable. The classic presentation of papular Arthropods, including mosquitoes, flies, gnats, mites, urticaria includes recurrent pruritic papules or vesicles and ticks, and caterpillars, have been linked to papular urti- varying degrees of local edema.
    [Show full text]