DERMATITIS ECZEMA JOHN L. BEZZANT, M.D.
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1 DERMATITIS ECZEMA JOHN L. BEZZANT, M.D.
2 THE PHYSICIAN IS PRIMARILY A PROBLEM SOLVER FACULTY TEACHING HANDBOOK UNIVERSITY OF UTAH SCHOOL OF MEDICINE, FALL 2005, p 62.
3 THE GODS ARE MORE WILLING TO HELP US IN TERMS OF PREPARATION, THAN IN TERMS OF DELIVERENCE. Jess Walker, Debate Coach
4 70 YR OLD WOMAN, 4 YEARS OF MISERY, I WAS THE 10 TH PHYSICIAN SHE SAW. 4
5 TREATMENTS GIVEN TO HIM BY HIS INTERNIST 5
6 Dr. John Zone Chairman of Dermatology University of Utah 6
7 IF YOU DON T KNOW WHAT YOU RE DOING, DR. ZONE SUGGESTS WRITING ON THE PRESCRIPTION, I AM STUPID. 7
8 PATIENT S REACTION WHEN WE MAKE A MISTAKE.
9 REPENT MEANS YOU MUST CHANGE [IMPROVE] OR YOU ARE A DEAD DUCK! Jess Walker, Debate Coach
10 SUMMARY
11 11
12 The purple dots are lymphocytes attacking the epidermis (upper purple layer), and the dermis (lower pink layer).
13 Dermatitis ITCHES!
14 ECZEMA ECZEMA: FROM ITS GREEK WORD ELEMENTS, LITERALLY MEANS THE RESULT OF (-MA) BOILING (-ZE-) OUT OR OVER (EC-). (IT IS OFTEN USED INTERCHANGEABLY WITH DERMATITIS.) (First used by Chambers 1753: OED)
15 ECZEMA: 1753
16 DERMATITIS/ECZEMA
17 DR. DUHRING, PHILADELPHIA 1876
18 DEFINITIONS DERMATITIS: DERMA (DERIVES FROM GREEK AND LITERALLY MEANS THE RESULT OF THE ACTION (-MA) OF FLAYING (DER-). IT IS LITTLE REALIZED THAT ITIS DOES NOT INHERENTLY MEAN INFLAMMATION AND THAT ITS ANCIENT FORM AND MODERN DESCENDANT (-ITE) SIMPLY RELATE THINGS TO A PERSON, PLACE OR OTHER IDENTITY. NEVERTHELESS, SINCE IT HAS COME TO MEAN SKIN INFLAMMATION: REDNESS, REDNESS & SCALING, REDNESS WITH BLISTERING. (First used by Duhring in 1876: OED)
19 SKIN DERIVES FROM THE OLD NORSE WORD SKINN MEANING THE OUTSIDE COVERING OF HUMANS OR ANIMALS.
20 DERMATITIS/ECZEMA
21 DERMATITIS/ECZEMA
22 DERMATITIS INFLAMMED SKIN MAY APPEAR RED AND SCALY OR RED WITH VESICLES
23
24
25
26 Original atopy article & explanation.
27 My nephew and nieces. These diseases often coexist. We are a family of wheezers, sneezers, scratchers.
28 My nephew. Most of us in our family have manifest more than one of these disorders. It s (they are) the gift that keeps giving.
29 TRIAD: ECZEMA, ASTHMA, ALLERGIC RHINITIS
30 The purple dots are lymphocytes attacking the epidermis (upper purple layer), and the dermis (lower pink layer).
31 DEFECTIVE BARRIER LAYER STRATUM CORNEUM
32 DEFECTIVE STRATUM CORNEUM
33 BAD: DRY ENVIRONMENT OF WINTER
34 SUMMARY: ECZEMA Th2 BLUES
35 ATOPIC ECZEMA RESOLVED SPONTANEOUSLY AGE 5 YEARS 35
36 ADULT ATOPIC DERMATITIS ALMOST ALWAYS FLEXURAL CREASES IN THE SKIN
37 Dermatitis ITCHES!
38 ATOPIC DERMATITIS: GENERALLY FLEXURAL 38
39 1% HYDROCORTICONE OR CALCINEURIN INHIBITOR ONLY;OTHERWISE YOU RISK ATROPHY AND STRIAE! 39
40 Atopic dermatitis involving hands and scrotum. Atopic dermatitis often involves the skin of the scrotum and labia.
41 AUTOECZEMATIZATION
42 Atopic dermatitis of the hands; it can involve any place on the hands and feet. Often there is secondary staph infection.
43 ONE MILLION TO TEN MILLION/CM2
44 SECONDARY INFECTION OF DIAPER DERMATITIS CANDIDA IMPETIGO 44
45 GRAM STAIN & TZANCK (WRIGHT S)
46
47 Nummular dermatitis of thigh.
48 Nummular dermatitis, acute vesicular presentation.
49
50 In lichen simplex chronicus, persons itch and therefore scratch where baseball players itch and scratch. The skin looks normal before it is scratched.
51 ANXIETY! EXCORIATION INDUCED 51
52 LICHENIFICATION 52
53 Lichen simplex chronicus, perianal area. The perianal and genital areas are commonly involved.
54 LICHENIFIED EPIDERMIS (LEFT) NORMAL EPIDERMIS (RIGHT)
55
56 Seborrheic dermatitis. Note patchy scalp involvement.
57 Seborrheic dermatitis of beard.
58 YEAST GROWS IN PILOSEBACEOUS STRUCTURES
59 SHAVING DERMATITIS 59
60 POISON IVY DERMATITIS
61 NEVER ASSUME ANYTHING! (UNLESS YOU CAN T PROVE IT) ROBERT WEST PROVO CITY ATTORNEY
62 DIAGNOSTIC MUST S 1. IF IT IS SCALY, SCRAPE THE SCALE & PERFORM KOH MOUNT. LOOK FOR SCABIES MITES. 2. IF THERE IS FLUID, DO A GRAM AND WRIGHT S STAIN; IF INCONCLUSIVE, CULTURE AND PCR. 3. IF DX IS UNCERTAIN, PERFORM A 4 MM PUNCH BX; SEND ½ IN FORMALIN FOR H&E, AND ½ IN MICHELLE S FOR IMMUNOFLUORESCENCE. 4. SEND TISSUE TO A DERMATOPATHOLOGIST.
63 IF IT IS SCALY, SCRAPE THE SCALE AND DO A KOH PREP, AND EXAMINE UNDER THE MICROSCOPE.
64
65 This man had this eruption, and the KOH prep of the scale showed the following.
66 IF THERE IS FLUID, DO A GRAM STAIN, WRIGHT STAIN, AND CULTURE OR DO PCR IF THERE S UNCERTAINTY. 66
67 GRAM STAIN & TZANCK (WRIGHT S)
68 UNCERTAIN? CULTURE, PCR, TISSUE
69 UNCERTAIN ABOUT DIAGNOSIS? WHEN IN DOUBT, PUNCH IT OUT; WITHOUT A PUNCH IT S JUST A HUNCH 69
70 BIOPSY (PUNCH)
71
72 PUNCH BIOPSY OF HAIR: INCLUDE ALL THE FAT YOU CAN!
73
74
75 BIOPSY OF EDGE OF BLISTER IN FORMALIN BIOPSY 1 CM AWAY FROM BLISTER IN MICHEL S
76 BIOPSY SEND TO A COMPETENT DERMATOPATHOLOGIST! THE REPORT IS OFTEN UNINTELLIGIBLE: THEN 1. CALL A DERMATOLOGIST 2. REFER PATEINT TO A COMPETENT DERMATOLOGIST. 76
77 The purple dots are lymphocytes attacking the epidermis (upper purple layer), and the dermis (lower pink layer).
78 FIRST, AVOID THESE: TIGHT CLOTHING,WOOL, FRAGRANCES
79 OPTIMUM USE
80 GREASE FOR PEACE! CETAPHIL DOESN T CAUSE STINGING ON FISSURED SKIN!
81 The purple dots are lymphocytes attacking the epidermis (upper purple layer), and the dermis (lower pink layer).
82 ITCHING/BURNING PROBLEMS MATCH EXTINGUISHER TO FIRE!
83
84 John: How much should a person know about a drug before using it, Dr. Goodman? Dr. Goodman: A lot! And you can quote me on that! Dr. Goodman
85 K EY PLAYERS
86 CORTICOIDS HYDROCORTISONE TRIAMCINOLONE CLOBETASOL FLUOCINONIDE
87 INHERENT ANTI INFLAMMATORY POTENCY OF THE CORTICOID MOLECULES
88
89 VEHICLES
90 CORTICOID VEHICLES CORTICOMESS?
91 CORTICOSTEROID CHART GUIDE: THE BLESSING-CURSE OF ABUNDANCE
92 DON T PANIC! WHEN FACED WITH THE VAST EXISTENTIAL CHOICE OF TOPICAL CORTICOIDS.
93 ADULTS: FACE, AXILLAE, NIPPLES, GROIN, NATAL CLEFT TWICE DAILY TILL ITCHING STOPS CHILDREN: TWICE DAILY TILL ITCHING STOPS
94 1% HYDROCORTICONE OR CALCINEURIN INHIBITOR ONLY;OTHERWISE YOU RISK ATROPHY AND STRIAE! 94
95 IF YOU DON T KNOW WHAT YOU RE DOING, DR. ZONE SUGGESTS WRITING ON THE PRESCRIPTION, I AM STUPID. 95
96 ADULTS: TRUNK & EXTREMITIES THIN COAT TWICE DAILY TILL ITCHING STOPS
97 CORTICOID INDUCED INFLAMMATION & ATROPHY 97
98 IF YOU DON T KNOW WHAT YOU RE DOING, DR. ZONE SUGGESTS WRITING ON THE PRESCRIPTION, I AM STUPID. 98
99 ATOPIC DERMATITIS: GENERALLY FLEXURAL 99
100 STAPHYLOCOCCUS AUREUS GRAM + (BLUE/PURPLE) STAPH IS THE PURPLE PEOPLE EATER.
101 JOHN BEZZANT S HANDS AND FEET THIS WINTER HELPA ME, HELPA ME, HELPA ME! (TOSCANINI S PLEA TO THE NBC ORCHESTRA) I LL SHOW YOU HOW TO HELP ME. 101
102 MY ECZEMATOUS SYMPTOMS: PAIN, BURINGS, ITCHING. I CANNOT PLAY KEYBOARD INSTRUMENTS DURING FLARES. 102
103 TREATMENT FOR JOHN BEZZANT S HAND ECZEMA
104 GREASE FOR PEACE! CETAPHIL DOESN T CAUSE STINGING ON FISSURED SKIN!
105 TREATMENTS GIVEN TO HIM BY HIS INTERNIST 105
106 1. CLOBETASOL 0.05% OINTMENT TWICE DAILY 2. MUPIROCIN 2% TWICE DAILY 3. 40% UREA CREAM TWICE DAILY 4. CETAPHIL OR CERA VE CREAM TWICE DAILY 106
107 PROBLEM
108 SHAMPOOS FOR TREATING SEBORRHEIC DERMATITIS ANTI-YEAST: 1. ZINC 2. SELENIUM 3. KETOCONAZOLE ANTI-INFLAMMATORY: COAL TAR (BROWN) REMOVE SCALE: SALICYLIC ACID (CLEAR)
109 CAN USE INDIVIDUAL SHAMPOOS OR MIX THEM
110 MID TO ULTRAPOTENT STEROID SOLUTIONS OR FOAM FOR SCALP
111 1% HYDROCORTISONE SOLUTION TO EARS & FACE
112 SHAVING DERMATITIS 112
113 SHAVING 113
114 Allergic contact dermatitis usually requires treatment with prednisone 1 mg/kg/day, often in addition to a high potency topical steroid 2X/day
115 115
116 POISON IVY DERMATITIS
117 AUTOECZEMATIZATION
118 Allergic contact dermatitis. Note sparing of the palms. You can clearly see the line where the stratum corneum of the palms thickens and prevents chemical penetration.
119 PREDNISONE
120 ORAL CORTICOSTEROIDS PREDNISONE 1 MG/KG/DAY, TAPERING OVER 3-4 WEEKS BEFORE STARTING ASK ABOUT: 1. DIABETES MELLITUS 2. TUBERCULOSIS 3. COUMADIN (PREDNISONE HAS AN ANTI-COAGULANT EFFECT: IT RAISES THE INR) 4. MENTAL ILLNESS: DEPRESSION, ANXIETY, ETC.
121 WEEKLY INTRALESIONAL INJECTIONS OF KENALOG WERE GIVEN BY A DERMATOLOGIST FOR ONE YEAR--NO IMPROVEMENT, NO DIAGNOSTIC PROCEDURE PERFORMED. NOTE MARKED SKIN ATROPHY!
122 SCABIES, NORWEGIAN (DIFFUSE, LONGSTANDING)
123 Scraping penis left
124 WATCH FOR ANXIETY/DEPRESSION ANTIHISTAMINE: DOXEPIN ADULTS: MG ORALLY AT BEDTIME CHILDREN: 1-5 MG ORALLY AT BEDTIME QUESTIONS: DRUG INFORMATION,
125 LICHEN SIMPLEX CHRONICUS (ANXIETY/DEPRESSION
126
127 COMFORTABLY NUMB
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