So what we'll do now is do a couple of
review questions, and feel free to
pause after any of the questions that I ask
to give yourself some time to reflect
on the answer. Let's jump in.
So, which of the following 5 items is true?
Item number 1, poison ivy dermatitis
is a type of allergic
contact dermatitis. Well, that sounds true. So,
let's just go through the other ones to make
sure we're not missing something. Number 2,
irritant contact dermatitis nearly
always presents acutely.
As we've discussed, we know that
irritant contact dermatitis can
present either acutely or chronically,
so that's not correct.
Number 3, the first step in treating
allergic contact dermatitis
is high-potency topical glucocorticoids.
Well, really the first step is to just
take away the offending agent.
Whatever is causing the allergic contact
dermatitis should be removed, and then
things may just improve on their
own, so that's not correct.
Number 4, irritant contact dermatitis
is usually associated with an
atopic history. Instead, it's allergic
might be associated with an atopic
history, and certainly atopic
dermatitis would be, so that
one's not correct.
And then number 5, allergic contact
dermatitis is a type 1
And that's also not true. It's a type
4 hypersensitivity reaction.
So, we're left with our first instinct,
which was item number 1.
Poison ivy dermatitis is a type of
allergic contact dermatitis.
Let's move on to the next question.
What is the "illness script"
for atopic dermatitis? And the
term "illness script"
is used to describe a typical
pattern you might
see on the boards that should prime
you're thinking about this condition.
So, as we've seen in the case that
we've reviewed already today,
the typical illness script for atopic
dermatitis would be a child
with an "atopic" family history,
presenting with a persistent,
intensely pruritic rash in the antecubital
fossae of both arms,
characterized by symmetric, dry, lichenified,
erythematous plaques with scattered papules
and likely to have excoriations, as well.
Last question, which of the following
is true of seborrheic dermatitis?
So, going through each of these
items, one at a time, number 1,
it only occurs in infants. Well, as
we've discussed, it also
occurs in elderly patients,
so that's not correct.
Number 2, preferentially involves
the palms and soles.
Well, we know that seborrheic dermatitis
most commonly affects the face:
the eyebrows, behind the ears,
maybe in the axilla,
but not the palms and soles,
so that's incorrect.
Number 3, it is intensely pruritic. That
would be a classic feature of
atopic dermatitis, but seborrheic
very mildly itchy, if at all.
4, it's best treated with selenium
sulfide or azole shampoos.
And that's correct. We know that
strangely, seborrheic dermatitis
is associated with malassezia forfor. Even
though we're not entirely clear what the
etiology is, we do know that it does respond
to these atypical or antifungal agents.
And lastly, it is less common
in patients with HIV.
In fact, we know it's more common in
patients with HIV, and can be
quite a good deal worse. So, with that,
we've come to the end of our discussion today.