Nurse 530B Week 7 Dermatitis

Nurse 530B Week 7 Dermatitis

 

Dermatitis

Dermatitis is the general term that delineates skin irritation (Kapur et al., 2018). Dermatitis can manifest in a variety of forms correlated to diverse etiologies. The purpose of this paper is to explore the various forms of dermatitis including atopic dermatitis, tinea capitis, thrush, molluscum contagiosum, and impetigo highlighting the pathophysiology, clinical manifestations, evaluation, and treatment.

Atopic Dermatitis

Atopic dermatitis is a chronic, highly pruritic inflammatory skin condition that is more common in children. Approximately 12% of the children in the US are affected (Kapur et al., 2018). The pathophysiology of the condition although not well understood is complex and involves an interaction between immune dysregulation, defects in skin barrier function, and environmental and infectious agents (Kapur et al., 2018). Additionally, skin barrier defects are related to mutations within or rather impaired expression of the filaggrin gene while Staphylococcus aureus is the most common implicated infectious agent. The interplay of the aforementioned factors results in T helper cell responses with resultant production of proinflammatory cytokines that promote I_gE production and systemic inflammatory responses with resultant pruritic inflammation of the skin.

Clinical manifestations include intense pruritus and dry skin. Infantile atopic dermatitis presents as eczema involving the head, face, and extensor surfaces of the extremities sparing the diaper area while childhood, adolescent, and adulthood atopic dermatitis presents with flexural creases and lichenified lesions of flexor surfaces of the extremities. Common associations include asthma and allergic rhinitis. Diagnosis requires a criterion composed of eczema, pruritus, and exclusion of other causes. Further evaluation includes severity assessment, allergy testing, and histopathology which reveals spongiotic dermatitis. Treatment includes nonpharmacological approaches such as patient education and skin care as well as pharmacological approaches such as topical corticosteroids, topical calcineurin inhibitors, and topical antimicrobial therapy(Kapur et al., 2018). Systemic corticosteroids and systemic immunosuppressive agents are indicated for severe disease.

Tinea Capitis

The pathophysiology of this dermatophyte infection of the head and scalp lies in the ability of the acquired dermatophyte species (Microsporum and Trichophyton acquired through direct contact) to infect keratin and keratinized tissue (Leung et al., 2020). Predisposing factors include diabetes, prolonged steroid use, cancer, immunosuppressant medications, and anemia. Clinically, round, pruritic scaly plaques with broken hair shafts or alopecia are seen in the affected areas mostly in children. Evaluation involves potassium hydroxide preparation, fungal culture, and wood light. Leung et al. (2020) recommend treatment with systemic antifungal agents such as terbinafine, itraconazole, fluconazole and griseofulvin.

Thrush

Refers to the infection of the oral cavity by Candida albicans. The pathophysiological process of this condition emanates from impaired host immunity which can be due to local disruption or secondary to antimicrobial use, corticosteroid use, and HIV resulting in overgrowth of the fungus and formation of pseudomembrane (Taylor & Raja, 2021). Clinically,Cottony feeling in the mouth, loss of test, angular cheilitis, and a white plaque is visible on the tongue, buccal mucosa, soft or hard palates which when scraped off reveal painful red, inflamed or bleeding areas. Diagnosis is clinical and may be supported by KOH wet mount preparation, blood, or tissue culture. Taylor and Raja (2021) recommend the use of topical nystatin or oral fluconazole for 7 to 14 days as first-line and other azoles or echinocandins as alternatives.

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Impetigo

This is a highly contagious skin infection of superficial layers of the epidermis mostly by Staphylococcus aureus and Group A beta-hemolytic streptococcus. Classified as primary or secondary correlating to infection on healthy skin or preexisting skin lesions respectively. Conditions that interfere with the integrity of the skin barrier (trauma, atopic dermatitis, cuts, burns, varicella, etc.) expose fibronectin receptors required for colonization by the aforementioned organisms (Nardi & Schaefer, 2022). Clinically, the non-bullous type presents as papules on the face and extremities, and later small vesicles surrounded by erythema or pustules that can rupture releasing oozing secretions that dries forming honor-colored crusts that heal without scarring. Meanwhile, bullous impetigo presents as vesicles that coalesce to form large bullae on the trunk and extremities and is positive for the Nikolsky sign (Nardi & Schaefer, 2022). Diagnosis is based on clinical presentation and microbiological cultures.

Treatment involves general measures such as wound cleansing with antibacterial washes and pharmacological treatment. Mild non-bullous impetigo is treated with topical antibiotics such as mupirocin while the remaining forms of impetigo are treated with beta-lactamase resistant antibiotics such as cephalosporins, amoxicillin-clavulanate, and dicloxacillin (Nardi & Schaefer, 2022). Suspected/confirmed MRSA is managed by clindamycin, doxycycline, or trimethoprim-sulfamethoxazole.

Molluscum Contagiosum

A localized skin infection caused by the molluscum contagiosum virus. Most common in childhood. Following transmission (through direct skin contact and autoinoculation) and an incubation period from 2 weeks to 6 months, the virus produces proteins that impair human antiviral immunity thus interfering with the development of innate immunity response(Badri & Gandhi, 2021). However, the virus infects only the keratinocytes and is thus limited to the epidermis. Risk factors include immunosuppression, overcrowding, atopic dermatitis, hot and humid climates. Clinically, single or multiple lesions, non-tender, skin-colored, pearly, dome-shaped papules, 2-5mmin diameter with central umbilication typically on trunk, face, and genitalia. Lesions are worse in immunocompromised (Badri & Gandhi, 2021).

The condition is a clinical diagnosis although HIV testing, as well as biopsy, may be required. Histopathology reveals acanthosis, molluscum bodies, and cup-shaped invaginations. Spontaneous resolution occurs within a few months. However, treatment if indicated involves cryotherapy, curettage, topical cantharidin, podophyllotoxin, and topical imiquimod (Badri & Gandhi, 2021). Finally, immunocompromised with severe or refractory disease can be treated with cidofovir or interferon-alpha.

References

Badri, T., & Gandhi, G. R. (2021). Molluscum Contagiosum. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441898/

Kapur, S., Watson, W., & Carr, S. (2018). Atopic dermatitis. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 52. https://doi.org/10.1186/s13223-018-0281-6

Leung, A. K. C., Hon, K. L., Leong, K. F., Barankin, B., & Lam, J. M. (2020). Tinea capitis: An updated review. Recent Patents on Inflammation & Allergy Drug Discovery, 14(1), 58–68. https://doi.org/10.2174/1872213X14666200106145624

Nardi, N. M., & Schaefer, T. J. (2022). Impetigo. https://pubmed.ncbi.nlm.nih.gov/28613693/

Taylor, M., & Raja, A. (2021). Oral Candidiasis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK545282/

 

Describe the pathophysiology, clinical manifestations, evaluation, and treatment of atopic dermatitis, impetigo contagiosum, tineacapitis, thrush, and molluscumcontagiosum.