dermatology - guida

Dermatitis

• Endogenous dermatitis is constitutional and cannot be prevented
• Unlike exogenous dermatitis, which is caused by external factors
• Irritant dermatitis can be prevented by avoiding contact with the irritant
• Endogenous dermatitis includes atopic, seborrheic, and nummular eczema, as well as dyshidrosis
• Exogenous dermatitis includes irritant and allergic contact dermatitis
• Two major groups of dermatitis are atopic and contact dermatitis
• Atopic dermatitis is a genetically predisposed condition, primarily in children
• It involves IgE-mediated hypersensitivity reactions and results from continuous exposure
• Allergic contact dermatitis is an immune-mediated type 4 reaction with an initial sensitization phase
• Acute eczema is characterized by vesicles that can turn into erosions, with erythema and scales
• Atopic dermatitis can lead to lichenification, which presents plaques, inflammatory infiltrate, and "wrinkly" skin
• Skin variations may also be seen in patients who sweat a lot or have persistent eczema

Atopic Dermatitis

• Common during childhood and may disappear after adolescence
• Elderly individuals may have a history of uninvestigated atopic dermatitis
• Atypical dermatitis, common in pediatric age, involves itchy eczema with a chronic-relapsing progression
• It shows topographical characteristics, with associations to atopy manifestations like asthma, rhinitis, and conjunctivitis
• Often associated with elevated IgE levels to aeroallergens or food allergens
• Atopy is a general predisposition to allergies
• These patients may experience other allergies, asthma or rhinitis
• These cases display a type 4 immune reaction mediated by IgE
• Diagnosis requires a family history of allergic predisposition
• Environmental factors, immunologic (inhalants, food) or non-immunologic, also play a role
• Lesion appearance varies with age
• Infants tend to have more lesions on the face, with vesicles, erythema, and scales
• Adolescents experience involvement in the "folds" like the posterior knee or anterior forearm
• Lesions can appear on the face, neck, periauricular area, and scalp

Atopic vs. Contact Dermatitis

• As patients age, hand involvement becomes more likely, making it hard to differentiate between atopic and contact dermatitis
• 5-10% of the child population is affected
• 75% of predisposed individuals show atopic dermatitis in the first year, and 90% within the first 5 years
• Incidence decreases in adulthood, with equal prevalence in both sexes
• Etiology includes genetic factors (barrier defect) and environmental factors, immunologic-inhalants (dust mites), food, contact, or non-immunologic factors
• Diagnose eczema of the hands by assessing atopic background, including family history, personal allergies, and reactions to inhalants and dust
• Prick tests are performed for standard inhalants
• Patch tests are used to exclude contact dermatitis by detecting type 4 immune reactions
• Diagnosis requires at least one major and three minor criteria
• Major criteria: early age of onset, typical morphology and distribution, chronic relapsing dermatitis, and personal or family history of atopy

Prick and Patch Tests

• Prick tests indicate a predisposition to allergy, revealing immune type 1 hypersensitivity reactions
• Dermatitis is marked by lesions with erythema and scales
• Both atopic and contact dermatitis may involve vesicles that lead to erosions and crusts

Allergic Contact Dermatitis

• Common allergens include nickel, parfumes, and colorants
• Dermatitis on the earlobe or wrist may indicate nickel allergy
• Requires detailed patient questioning
• Requires multiple patient visits for a final diagnosis

Irritant vs. Allergic Contact Dermatitis

• Irritants/allergens can give rise to either condition
• Irritant contact dermatitis appears after contact with strong acids/liquids
• It typically remains localized to the contact area
• Necrotic reactions can be strong, leading to bullae
• Strong irritants can cause erythema, scales, vesicles, and bullae, even without predisposition
• Allergic contact dermatitis starts at the contact area
• Allergic contact dermatitis can spread to other body areas due to type 4 immune reaction and T cell memory
• Result in suberythroderma, causing redness all over the body
• Patch tests use standard and specialized kits (e.g., for hairdressers)

Contact Dermatitis Treatment

• There are no other treatments other than avoiding the substance you are allergic to

Patch Test Application and Results

• Applied to the back, which must be free of lesions
• Reactions are read 2-3 days after patch removal
• Erythema is marked as "+", erythema plus vesicles as "++", and erythema with bullae as "+++"

Eczema and Dermatitis

• In Italian, the terms "eczema" and "dermatitis" are used interchangeably ("dermatite eczematosa")
• In English, they have distinct meanings

Differential Diagnosis of Dermatitis

• Location and time of onset are important
• Differentiating from psoriasis can be difficult, although psoriasis usually affects opposite areas of forearms (elbow) and knee
• Mycoses may present with erythema, scales, and vesicles
• Lymphoma must be considered for patients treated for atopic dermatitis

Seborrheic Dermatitis

• Steroids and/or topical antimycotic agents reduce Malassezia Yeast is used for treatment

Acne

• Acne affects the pilosebaceous unit and is common in dermatology
• Usually affects adolescents due to hormonal reasons
• Rare cases arise in newborns due to the mother's hormones
• Acne is expected in areas with increased pilosebaceous unit activity: face, trunk (upper anterior), and anterior back
• Endogenous and exogenous forms exists
• Example an exogenous form could come from thick creams
• It can develop in adulthood or as late acne
• Acne diagnosis involves observing typical lesions: comedones (whiteheads or blackheads)
• Other lesions: pustules, papules, nodules, or cysts
• Nodules or cysts underneath the skin indicate severe acne, which is then treated with oral retinoids
• Oral retinoids are avoided if contraindications exist, due to risk of scarring
• Open comedones appear black due to oxidation
• Closed comedones appear white or pinkish
• Increasing severity shows crusts and scarring
• Patients touching their skin contribute to scars
• Patients with pustules and cysts should be be given retinoids
• Inflammatory acne is treated with topical and oral retinoids and antibiotics
• Microbiota contributes to its development and course
• Nodules and cysts may be present with comedones too and can also be appear and leave scars
• Outcomes can not be predicted, leading to possible keloids

Nodulocystic Acne

• Characterized by comedones, inflammatory lesions, and large cysts/nodules over 5 mm
• Scarring is often evident
• Scar tissue can be atrophic ("depressed") or hypertrophic ("protruding")
• Keloid is when it extends beyond the border of the original scar
• Pathogenesis is multifactorial with genetic, hormonal (androgens from adrenal and gonadal), and endogenous/exogenous factors
• Certain drugs, cosmetics, environmental toxins, stress, nutrition, dairy products, and high glycemic foods contribute
• Hormones are involved in the pathogenesis of acne
• Oral contraceptives combined with systemic retinoids are used in females. Systemic retinoids are not used during pregnancy due to teratogenic effects

Acne Development Moments

1. Hyperproliferation of keratinocytes blocks the duct near the hair follicle, caused by genetic disposition or improper cosmetics and hyperkeratosis
2. Increased sebum production creates a loop response due to duct closure
3. Colonization by microbes (G+ anaerobic diphtheroid; C. acnes prefers lipids) stimulates an inflammatory response
4. Duct closure, excess sebum, and bacteria lead to skin rupture and cause inflammation with cytokines and triggers redness

• C. acnes hydrolyzes sebum triglycerides into proinflammatory free fatty acids

Differentials For Acne

• Psoriasis affects pilosebaceous unit
• Psoriasis has no extra secretion of sebum
• Acne is a result of combination of all moments
• Rosacea needs to be considered

Rosacea

• Called acne of adults
• Chronic dermatosis with skin pustules
• Located primary in midface region
• No Comedones
• Fair Skin and middle aged are more affect (Women: 3, Men:1)
• Opthalmologist an detected it
• inflammation of eyelids, or conjunctivitis
• Can be static or Starts as flashing of skin
• No mandatory for flashing to give Rosacea,
• Flashing can come from vasodilation of food and alcohol

Rosacea Stages

• Erythematous telangiectatic phase: has Flashing
• Telangiectasia is reoccured
• Tumors are NETs
• Increased flashing triggers erythema of the nose and medial cheeks are localized

Acne phases

• Papular of pustular
• Have to manage like ACNE
• Generally in nose. cheekbones and rear cases forehead and chin Phymatous phase
• Enlarged cases for nose
• Ocular Phase
• Glands are revolved
• Keratitis and Uvetities are rarer
• Exacerbated by Vasodilation

Triggers for flare ups

• emotional stress, sun exposure, alcohol, hot and spicy meals, the abrupttransitionect, role of radiation damage elastic tissue

Rosacea Cellular and Humoral immune

• Antibiotics deal with collagen
• Gastrointestinal deal with bacteria
• Folliculrom deal with parasites
• Overgrowth of bacteria for H pylori give over produce cytokine

Acne differencial

Also with seborrheic dermatitis and form for SLE

• You Can get overlap with Rosacea

Seborrheic dermatitis Traits

• Affect scalp and eyebrows, nose
• Lupus has erythema on face

Alopecia

• Units: Limited or destroyed hair

Scarring of Alopecia

• Can autoimmune (Lupus)
• From tumors
• From Infection (Kerion Celsi)

Types of alpecia

• Plaque in infection
• Auto Immine

Temporary alpecia

• chemo cause tellogen efluvium
• Autumn cause it is more sever

Other alpecia

• Aplasia cutis (congenita)- No form
• Alopecia areata- Immune stem and are

Allopecia Andgrogenic

• more common with adults each stem are effected.
• Hormonal reasons for females and males
• Females show thinning, not loss

Other info

• Important cycle with
• Catagen is
• Tologen
• Efluvium causes
• Trichologist can determine facts

STD

• some are not visible
• treated patients

Symptoms

• Incresae <25 Homosexual
• most common are herpes, warts,

Syphilis

• pre is 1 mil, 56 millions
• Penicliin treament, famous people died during those moments
• Neurosphylls will occur
• HIV

Congeitral Syphlis

• Abortion
• New born Infection
• Nervous and brain damage

Other Syphilis

• Heart, skin, bums, joint damage,gums
• Test it
• VDRL
• TPHA

Early Syphillis

• Treat from anti btitiocs

Urethirhis

• Discharges means
• Vainititis means
• Gonnerhea is
• Incturabal is .2 weeeks

More gonnerhea

• Mucos membrane for birth
• Treat orafisucm for mucleuc , or they get a form
• Cervical canal

Final Gonnerhea

• Posterior hematruia
• Bulbcan be detected
• Ascending of Gonnherias can be deteced

Final STD

• Use micto or antiobtoicts
• clamyditia trachomatis and others,
• More STD is more easy to happen
• Colonzie epuilitilhm to infect