Generalized pruritus Dermatologic (arising from diseases of the skin)

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Presentation transcript:

Generalized pruritus Dermatologic (arising from diseases of the skin) Xerosis Atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid Dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized pruritus Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis contact dermatitis Urticaria bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Winter Itch Xerosis (dry skin)

Generalized Pruritus Winter itch Xerosis (dry skin) Aggravated by low ambient humidity, repeated exposure to water Great frequency in elderly patients

Generalized Pruritus Winter itch Xerosis (dry skin) Aggravated by low ambient humidity, repeated exposure to water Great frequency in elderly patients Physical exam Dry, cracked and scaly skin on the lower leg

Generalized Pruritus Winter itch Xerosis (dry skin) Aggravated by low ambient humidity, repeated exposure to water Great frequency in elderly patients Physical exam Dry, crackednand scaly skin on the lower leg Treatment

Generalized Pruritus Winter itch Xerosis (dry skin) Aggravated by low ambient humidity, repeated exposure to water Great frequency in elderly patients Physical exam Dry, crackednand scaly skin on the lower leg Treatment Limiting frequency, duration and water temperature of bathing

Generalized Pruritus Winter itch Xerosis (dry skin) Aggravated by low ambient humidity, repeated exposure to water Great frequency in elderly patients Physical exam Dry, crackednand scaly skin on the lower leg Treatment Limiting frequency, duration and water temperature of bathing Use superfatted soaps or syndet bars

Generalized Pruritus Winter itch Xerosis (dry skin) Aggravated by low ambient humidity, repeated exposure to water Great frequency in elderly patients Physical exam Dry, crackednand scaly skin on the lower leg Treatment Limiting frequency, duration and water temperature of bathing Use superfatted soaps or syndet bars Use emollients immediately after bath of shower

Generalized Pruritus Winter itch Xerosis (dry skin) Aggravated by low ambient humidity, repeated exposure to water Great frequency in elderly patients Physical exam Dry, crackednand scaly skin on the lower leg Treatment Limiting frequency, duration and water temperature of bathing Use superfatted soaps or syndet bars Use emollients immediately after bath of shower Oral antihistamins

Generalized pruritus Dermatologic (arising from diseases of the skin) Xerosis Atopic dermatitis contact dermatitis Urticaria bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion)

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile (2 mo to 2y) Cheeks

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile (2 mo to 2y) Cheeks Face

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile (2 mo to 2y) Cheeks Face Ext surface of extremities

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile Childhood (3 to 11y) Flex surface of extremities

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile Childhood (3 to 11y) Flex surface of extrimities Buttocks

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile Childhood (3 to 11y) Flex surface of extrimities Buttocks Back of thighs

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile Childhood Adults Mostly hands

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile Childhood Adults Mostly hands Sometimes face and neck

Generalized pruritus Atopic Dermatitis Diagnostic criteria for atopic dermatitis Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis Presentation Infantile Childhood Adults Mostly hands Sometimes face and neck Rarely diffuse area

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors Scrubbing

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors Scrubbing Bathing > 10 min

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors Scrubbing Bathing > 10 min Hot water bathing

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors Scrubbing Bathing > 10 min Hot water bathing Temperature extreme, …

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors Scrubbing bathing > 10 min hot water bathing temperature extreme, … Applying moisturizing

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors Scrubbing bathing > 10 min hot water bathing temperature extreme, … Applying moisturizing Containing ceramid and vaselin

Generalized pruritus Atopic Dermatitis Treatment Avoid provoking factors Scrubbing bathing > 10 min hot water bathing temperature extreme, … Applying moisturizing containing ceramid and vaselin whitin 3 min of bathing Keep humidity between 35-40%

Generalized Pruritus Atopic Dermatitis Treatment Subacute and Chronic lesions

Generalized Pruritus Atopic Dermatitis Treatment Subacute and Chronic lesions Topical CS

Generalized Pruritus Atopic Dermatitis Treatment Subacute and Chronic lesions Topical CS Once daily use Application in the evening more effective than morning

Generalized Pruritus Atopic Dermatitis Treatment Subacute and chronic lesions Topical CS Once daily use Application in the evening more effective than morning Acute and weeping lesion

Generalized Pruritus Atopic Dermatitis Treatment Subacute and chronic lesions Topical CS Once daily use Application in the evening more effective than morning Acute and weeping lesion Wet to dry compress

Generalized Pruritus Atopic Dermatitis Treatment Subacute and chronic lesions Topical CS Once daily use Application in the evening more effective than morning Acute and weeping lesion Wet to dry compress Role of antihistamins is minimal

Generalized Pruritus Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Bullouse Pemphigoid BP is the disease of the elderly (after 60y)

Generalized Pruritus Bullouse Pemphigoid BP is the disease of the eldery (after 60y) In non-bullouse phase sign and symptoms may be nonspecific

Generalized Pruritus Bullouse Pemphigoid BP is the disease of the eldery (after 60y) In non-bullouse phase sign and symptoms may be nonspecific Mild to severe pruritus

Generalized Pruritus Bullouse Pemphigoid BP is the disease of the eldery (after 60y) In non-bullouse phase sign and symptoms may be nonspecific Mild to severe pruritus Eczematous lesions

Generalized Pruritus Bullouse Pemphigoid BP is the disease of the eldery (after 60y) In non-bullouse phase sign and symptoms may be nonspecific Mild to severe pruritus Eczematous lesions Papular lesions

Generalized Pruritus Bullouse Pemphigoid BP is the disease of the eldery (after 60y) In non-bullouse phase sign and symptoms may be nonspecific Mild to severe pruritus Eczematous lesions Papular lesions Urticarial lesions

Generalized pruritus Bullouse pemphigoid BP is the disease of the eldery (after 60y) In non-bullouse phase sign and symptoms may be nonspecific Mild to severe pruritus Eczematous lesions Papular lesions Urticarial lesions Persist for several weeks to months

Generalized pruritus Bullouse pemphigoid BP is the disease of the eldery (after 60y) In non-bullouse phase sign and symptoms may be nonspecific Mild to severe pruritus Eczematous lesions Papular lesions Urticarial lesions Persist for several weeks to months May remain the only sign of the disease

Generalized Pruritus Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid Dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Dermatitis Herpetiformis Cutaneous manifestation of celiac disease

Generalized Pruritus Dermatitis Herpetiformis Cutaneous manifestation of celiac disease Associated with gluten sensitivity in all cases

Generalized Pruritus Dermatitis Herpetiformis Cutaneous manifestation of celiac disease Associated with gluten sensitivity in all cases Symmetric distribution of skin lesions

Generalized Pruritus Dermatitis Herpetiformis Cutaneouse manifestation of celiac disease Associated with gluten sensitivity an all cases Symmetric distribution of skin lesions Elbows

Generalized Pruritus Dermatitis Herpetiformis Cutaneouse manifestation of celiac disease associated with gluten sensitivity an all cases Symmetric distribution of skin lesions Elbows Ext forearms

Generalized Pruritus Dermatitis Herpetiformis Cutaneouse manifestation of celiac disease associated with gluten sensitivity an all cases Symmetric distribution of skin lesions Elbows Ext forearms Back

Generalized Pruritus Dermatitis Herpetiformis Cutaneouse manifestation of celiac disease associated with gluten sensitivity an all cases Symmetric distribution of skin lesions Elbows Ext forearms Back Buttocks Knees

Generalized Pruritus Dermatitis Herpetiformis Cutaneouse manifestation of celiac disease associated with gluten sensitivity an all cases Symmetric distribution of skin lesions Elbows Ext forearms Back Buttocks Knees

Generalized Pruritus Non-dermatologic Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Non-dermatologic Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Non-dermatologic Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)

Generalized Pruritus Non-dermatologic Dermatologic (arising from diseases of the skin) Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … Non-dermatologic Systemic (liver, kidney, blood and drugs) Neurologic (MS, brain tumor and …) Psychogenic (depression, anxiety, OCD,,,)