Contact eczema, Allergic, ALLERGENS, Lotions, perfumes, spices, Rubber compounds, Medicines, Chlorpromazine, Antibiotic creams, Steroid creams, Metals, Cobolt, Nickel, Chrome compounds, Chromate (Cr salt) = very allergenic!, (Metallic chrome = not allergenic!), Plastics, Unhardened plastics only, Acrylics, epoxy resins, Plants, Tulips, lilies, herb extracts, Poison Ivy, PATHOGENESIS, Cellmediated, delayed hypersensitivity (Coombs type 4), No reaction at first exposure..., ...but eczema at later exposure., 1 - SENSITIZATION, Antigens (usually haptene) form Complete Antigens when covalently bound to proteins in the living layers of the skin..., Such a "Complete Antigen" may stimulate Cells of Langerhans to a immune response..., ...the activated "L cells" migrate to the lymphatic system and "teach" the T cells of the new antigen..., ...and the individual is thus SENSITIZED., 2 - ELICITATION, Later binding of antigen activates T-cells..., ...Activated T-cells generates inflammatory cytokines..., Spongiosis, Infiltration, Symtoms!, TREATMENT, Elimination of contact allergen, Reduction of skin irritating factors, Sick leave, change of work, LOCAL TREATMENT, Steroid creams, softening cream, Antibiotics if necessary, PICTURES, Contact eczema, Nickel allergy, Nonallergic, PROGRESS, Dryness & small cracks..., ...Rubor, papules, scaling..., ...often 2' infection due to barrier damage., ETIOLOGY, Traumaiterative & skin irritation, Damages barrier function, Detergents, E.g. washing detergent, Diluted alkalis, E.g. soap, soda, Organic solvents, E.g. Alcohol, acetone, OFTEN WORK RELATED!, Specific history on chemicals etc, Rubber gloves may trap mild irritants and cause excessive skin exposure
Atopical eczema, PICTURE, DIAGNOSTICS, Itching skin disease + 3 of:, Debut before age 2, History of flexural engagement, History of asthma or hay fever, History of dry skin over the last year, Visible eczema in flexure or face, INVESTIGATION, ImmunoCAP Phadiatop!, Prick testing (what allergen?), Total IgE, IgE elevated?, Then also do the RAST test for Malazessia, C. Albicans and Mites!, Some clinical signs, Generally dry skin, Patient scratches him/herself, Intolerable to wool, Keratosis pilaris, Vasoconstriction, Toddlers have..., ...itching papules/vesicles on cheeks, ...on extensor side on legs/arms, ...symtom debut when sampling new food, ...lichenification, Adults have..., ...Engagement on face, neck, upper thorax, ...Hand eczema (nonallergic), ETIOLOGY, Altered Tcell function, Excess tendency of IgE production, Psychiatric factors, Scratching, COMPLICATIONS, Contact allergy, Herpex simplex eczema, Molluscum contagiosum, Impetigo, TREATMENT, Creams, Steroids class I-III, Softeners, Kalcineurin inhibitors, (=Tacrolimus), Break the "itch circle"!, Light treatment, UVA/UVB 2-3 times/week
Nummular eczema, New node
Seborroic eczema, ETIOLOGY, Malassezia furfur (?), Inherited
Localized types, Neurodermatitis, Diaper eczema, Picture, Statis eczema
Eczema = Epidermotitis = Inflamed skin
All eczemas are dermatites, but..., ...not all dermatites are eczemas!
I'll happily receive all and any feedback, suggestions, copyright violations or error reports: firstname.lastname@example.org Got a better idea of how to structure this map? Tell me! Thank you! Daniel Nygren Junior MD / AT-läkare Höglandssjukhuset Hospital Eksjö, Sweden
Speckled nevus, Pic (forehead of woman)
BASIS, Patient history, Clinical examination, Lab results, Blood, Urine, Microbiology, Fungal culture, Bacterial culture, If therapy resistant, Virological examination, Commonly done by PCR, Histopathology, Biopsy!, Possible Malignant Melanoma?, Always remove entire lesion!
TERMINOLOGY OF SKIN CHANGES, TISSUE GAIN, Vesicle (small blister), Liquid blister < 0,5cm, Urtica (medium bump), EXAMPLES:, Urticaria., Papule (small bump), EXAMPLES:, Eczemas. Lichen ruber., Confluent papules = A Plaque, Pustule (blister of pus), In reality a small abscess!, Many are aseptic despite their infectious apprearance., Nodule (firm bump), Larger than a papule (>0,5mm), Always firm. Synonymous to "tumor", EXAMPLES:, Dermatofibroma. Nodulous acne., Tumor (firm elevation), Well-defined solid elevation, EXAMPLES:, Basal cell cancer. Fibroma., IMPORTANT:, The term "tumor" chiefly refers to neoplasia. Use with care., Less well-defined? A nodule., A thin-walled, fluid/fat-containing body? A Cyst., Hypertrophia, Thickening of any skin layer., EXAMPLES:, Thickening of palms after hard labour, Crust, EXAMPLES:, Impetigo., Dried exsudate 2' to vital layers of epidermis (and possibly Corium), Hemorrhagic crust = dermal damage!, Bulla (blister), Liquid blister >0,5 cm, EXAMPLES:, Eczema, burn blister., Lichenification, Hypertrophia of ED & dermis by constant scratching. Coarse surface., Useful atlas here!, TISSUE LOSS, Excoriation, Mechanical Rupture, Epidermal & dermal loss, EXAMPLES:, Torn atopical eczema., Scale (epidermal fragment), Visible, coherent squamous discharge, EXAMPLES:, Psoriasis. Ichtyosis., Cicatrix, Scarring after dermal damage, EXAMPLES:, Late stage Discoid Lupus, Sclerosis, EXAMPLES:, Scleroderma., Excess collagen formation →, Thickening of skin →, Thick, smooth feel, Looks taut & stiff, Fissure, EXAMPLES:, Anal fissure. Corner-of-mouth fissure., Linear crack., Commonly mucuos membranes. Little/no substance loss., Atrophia, Thinning of both dermis & epidermis, EXAMPLES:, Age atrophia. Striae., Erosion, Defined epidermal tissue loss, 2' to burst Vesicle or Bulla, EXAMPLES:, Superficial acid damage, (others?), Ulcus (wound), EXAMPLES:, Venous shin wound., Epidermal & dermal tissue loss., NO GAIN / LOSS, Erythema (redding), EXAMPLES:, Common at inflammation., Caused by microvascular dilatation., Visible blood vessels?, =Telangiectasia, Blue-ish color?, Poor saturation / venous dilatation, Macula (spot), EXAMPLES:, Freckles. Purpura., Does not disappear with pressure.
Function, Protection, Sensation, Production, of Vitamin D, Signalling, Social, Sexual, Heat reduction
Layers, Epidermis (top), Barrier to the outside world, From 0.05 mm (eyelids) to >1mm (heels), Dermis, CONTAINS, Capillaries, Sebaceaous glands, Hair follicles (with one Arrector Pilii muscle each), Subcutis (bottom)
Abbreviations = less clutter!
BM = Basement Membrane
ED = EpiDermis
SC = SubCutis / SubCutaneous
2' = Secondary (e.g. " 2' infection")
For students taking the KI dermatology course, all diseases in the Core list are written in Bold!
Erythema multiforme, Minor, Major (Steven-Johnson syndrome), Pic (hand on 6yo Boy)
Telangiektasier, "Spider nevus"
Urge to pull out hair
a.k.a. "Trich" or TTM