Lecture 3 Part 1

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Questions and Answers

What is the most common cause of diaper dermatitis?

  • Allergic reaction
  • Irritation from urine (correct)
  • Fungal infection
  • Bacterial infection

Which condition is characterized by the presence of satellite pustules?

  • Seborrheic dermatitis
  • Candidiasis (correct)
  • Irritant contact dermatitis
  • Histiocytosis

In which form of dermatitis is the skin often spared in the folds?

  • Candidiasis
  • Irritant contact dermatitis (correct)
  • Seborrheic dermatitis
  • Psoriasis

Which dermatitis is notably associated with cradle cap?

<p>Seborrheic dermatitis (B)</p> Signup and view all the answers

What can indicate isolated seborrheic diaper dermatitis?

<p>Absence of satellite pustules (A)</p> Signup and view all the answers

Which of the following is a rare cause of diaper dermatitis that may present with petechiae?

<p>Histiocytosis (D)</p> Signup and view all the answers

Which type of dermatitis rarely requires a biopsy?

<p>Diaper dermatitis (D)</p> Signup and view all the answers

Psoriasis is characterized by which distinctive finding that may occur in diaper dermatitis?

<p>Silvery scale (B)</p> Signup and view all the answers

What is the primary purpose of a biopsy in difficult cases of skin conditions?

<p>To differentiate between irritants, candidiasis, and seborrheic dermatitis (C)</p> Signup and view all the answers

Which barrier is NOT mentioned as effective for treating diaper rash?

<p>Talc powder (C)</p> Signup and view all the answers

What is the typical age of onset for atopic dermatitis in children?

<p>Before the age of 5 (B)</p> Signup and view all the answers

What is the significance of a family history in the context of atopic dermatitis?

<p>It suggests a higher likelihood of developing associated disorders (C)</p> Signup and view all the answers

Which of the following statements best differentiates atopic dermatitis from other conditions referred to as eczema?

<p>Eczema is a broad term that includes itchy, red, and flaky rashes (D)</p> Signup and view all the answers

What mixture is often used when anti-candida agents are combined with anti-inflammatory agents?

<p>A 1:1 mixture of hydrocortisone and nystatin (B)</p> Signup and view all the answers

How is the distribution of atopic dermatitis lesions thought to change as children age?

<p>It tends to spread to additional body areas (D)</p> Signup and view all the answers

Which protein mutation is associated with atopic dermatitis according to recent data?

<p>Filaggrin (A)</p> Signup and view all the answers

What role do filaggrins play in epithelial cells?

<p>They bind to keratin fibers. (A)</p> Signup and view all the answers

What is the predominant cytokine profile in acute lesions of atopic dermatitis?

<p>Th-2 dominant (A)</p> Signup and view all the answers

How does elevated IgE levels in patients often correlate with atopic dermatitis?

<p>It suggests systemic immune dysregulation. (A)</p> Signup and view all the answers

What is primarily responsible for exacerbating atopic dermatitis in many patients?

<p>Presence of Staphylococcal colonization. (B)</p> Signup and view all the answers

What is essential in the treatment of atopic dermatitis?

<p>Aggressive moisturization. (C)</p> Signup and view all the answers

Which type of moisturizers are recommended for repairing the skin barrier in atopic dermatitis treatment?

<p>Ceramide-based moisturizers (D)</p> Signup and view all the answers

When should topical steroids for atopic dermatitis ideally be used?

<p>Intermittently as required. (D)</p> Signup and view all the answers

What is a primary advantage of T-lymphocyte inhibitors over steroids?

<p>Less long-term side effects (B)</p> Signup and view all the answers

Which dietary allergens are commonly associated with exacerbating atopic dermatitis in children?

<p>Egg, milk, peanut, soy, and wheat (D)</p> Signup and view all the answers

What is the typical presentation of neonatal acne?

<p>Inflammatory papules and pustules on the face (A)</p> Signup and view all the answers

What two factors are thought to contribute to the etiology of infantile acne?

<p>Androgenic hormonal milieu and Pityrosporum overgrowth (A)</p> Signup and view all the answers

Which treatment options have been reported effective for infantile acne?

<p>Ketoconazole cream and benzoyl peroxide (B)</p> Signup and view all the answers

Which condition is characterized by erythema and thick, yellowish, greasy scales on the scalp of infants?

<p>Seborrheic dermatitis (D)</p> Signup and view all the answers

What is generally understood about the long-term risk of adolescents developing severe acne who had infantile acne?

<p>There is no evidence linking infantile acne to later severe acne (A)</p> Signup and view all the answers

Flashcards

Diaper dermatitis

A common condition in babies, usually due to irritation from urine, stool, or moisture. It typically causes redness, itching, and sometimes pain in the diaper area.

Irritant contact dermatitis

An inflammation of the skin caused by direct contact with irritating substances, like urine or stool.

Candida diaper dermatitis

A fungal infection that often coexists with diaper dermatitis, usually showing up as tiny white or yellow bumps on a red base, often around the edges of the diaper area. These bumps are called satellite pustules.

Seborrheic diaper dermatitis

A common skin condition in infants, affecting the diaper area, scalp (cradle cap), and sometimes other areas. It may present as red, scaly patches.

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Psoriatic diaper dermatitis

A rare occurrence, but may present as a reddish rash with a silvery scale in the diaper area.

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Histiocytosis in diaper dermatitis

A very rare and serious cause of diaper dermatitis, characterized by a severe rash with petechiae, often accompanied by a sick baby and enlarged liver and spleen.

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Atopic dermatitis and diaper area

A common skin condition that typically avoids the diaper area.

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When to biopsy diaper dermatitis

A biopsy is rarely needed for diaper dermatitis unless histiocytosis is suspected.

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Candidiasis in Diaper Dermatitis

A fungal infection that can complicate diaper dermatitis, often appearing as small white or yellow bumps on a red base, frequently around the edges of the diaper area. These bumps are called satellite pustules.

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Seborrheic Dermatitis in the Diaper Area

A skin condition that may present as red, scaly patches in the diaper area, often affecting the scalp (cradle cap) and other areas in infants.

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Atopic Dermatitis in Infants

A common skin condition that often affects the face and extensor surfaces of the extremities in infants, but may occur anywhere. It is characterized by red, scaly, itchy lesions that may weep serous fluid.

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Filaggrin

A protein that can have a mutation in people with atopic dermatitis. This mutation can contribute to the development of the condition.

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Atopic Triad

A group of conditions including atopic dermatitis, asthma, and seasonal allergies. These conditions tend to run in families.

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Biopsy for Diaper Dermatitis

A procedure that can help distinguish between diaper dermatitis, candidiasis, and seborrheic dermatitis. It involves taking a small sample of skin for examination under a microscope.

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Swab Culture for Candida

A test used to determine the presence of Candida in diaper dermatitis. It involves taking a swab of the affected area to grow the fungus in a laboratory.

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What's the role of filaggrin in skin?

Filaggrin proteins bind to keratin fibers in the skin, helping to maintain a strong barrier. This barrier protects us from allergens and infections.

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What is atopic dermatitis?

Atopic dermatitis, or eczema, is a common skin condition where the skin barrier is weakened, leading to inflammation and itching.

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What is the role of the immune system in atopic dermatitis?

In atopic dermatitis, the immune system becomes overactive and reacts excessively to allergens and irritants.

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How can hygiene affect atopic dermatitis?

Hygienic environments may increase the risk of atopic dermatitis by reducing exposure to beneficial bacteria and antigens, leading to an oversensitive immune system.

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What is the connection between Staphylococcus and atopic dermatitis?

Staphylococcus bacteria are often found on the skin of people with atopic dermatitis, and the toxins they produce can worsen inflammation.

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What is the importance of moisturizers in treating atopic dermatitis?

Moisturizers help to repair the skin barrier and reduce inflammation in atopic dermatitis.

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How are topical steroids used in atopic dermatitis treatment?

Topical steroids are used to reduce inflammation in more severe cases of atopic dermatitis.

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What are topical immunomodulators (TIMS) and how are they used in atopic dermatitis?

Topical immunomodulators (TIMS) are medications that help to regulate the immune system and reduce inflammation in atopic dermatitis.

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T-lymphocyte inhibiting medications (TIMS)

Medications that specifically inhibit the activation of T-lymphocytes, primarily used for managing autoimmune diseases.

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Infantile acne

Acne that appears in infants, typically during the first months of life.

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Pityrosporum

A yeast that normally inhabits the skin and can contribute to infantile acne.

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Cradle cap (seborrheic dermatitis of the scalp)

A common skin condition in infants, presenting as erythema and thick, yellowish, greasy scales on the scalp, often involving the diaper area.

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Androgenic hormones

Hormones, such as testosterone, that can stimulate sebaceous gland activity.

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Spontaneous resolution

The process of spontaneously resolving without any intervention or treatment.

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Study Notes

Diaper Dermatitis

  • Diaper dermatitis is common in children of diaper-wearing age.
  • It encompasses several potentially co-occurring skin conditions (diseases).
  • Irritation (e.g., urine, stool) is a common cause.
  • Irritant contact dermatitis: Skin becomes more sensitive to irritation, particularly spared in skin folds.
  • Candidiasis (yeast infection): Commonly coexists; characterized by pustules (satellite pustules).
  • Seborrheic dermatitis: Involves skin folds, without satellite pustules. Often associated with cradle cap.
  • Psoriasis: Rarely causes diaper dermatitis; silvery scale is sometimes observed.
  • Histiocytosis: Very rare cause, presenting with severe rash, often petechiae.
  • Atopic dermatitis: Typically spares the diaper area.

Diagnosis and Management

  • Biopsy is rarely needed unless histiocytosis is suspected.
  • Investigations might include a swab culture to test for Candida.
  • Frequent diaper changes to minimize moisture.
  • Barrier pastes (e.g., zinc oxide) block irritants.

Early Atopic Dermatitis

  • Prevalence is increasing.
  • Strong familial component, with atopic triad (dermatitis, asthma, and allergies).
  • "Eczema" is often used interchangeably, but includes other conditions (dry skin, contact dermatitis).
  • Most involve face and extremities.
  • Characterized by bright red, scaly, and weeping lesions.
  • Possible genetic mutation in filaggrin (protein in epithelial cells maintaining skin barrier).
  • Th-2 phenotype in acute; Th-1 in chronic lesions.
  • Increased IgE and eosinophilia.
  • Hygiene hypothesis: Lower exposure to infectious agents, lower prevalence of AD.

Infantile Acne

  • Occurs in up to 50% of infants.
  • Presents as inflammatory papules (pustules).
  • Can persist up to a year.
  • Possibly related to androgenic hormones from mother, and/or, Pityrosporum overgrowth.

Cradle Cap

  • Common in infants.
  • Erythematous, thick, yellowish, greasy scales on the scalp, potentially extending to the forehead and neck.
  • Relates to overgrowth of Pityrosporum yeast and subsequent inflammation.

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