Dermatitis and Eczema Practice Questions

Q: Most common metal in contact allergic dermatitis is?

Nickel. ***Nickel*** - **Nickel** is the most frequent cause of **metal-induced contact allergic dermatitis**, affecting a significant portion of the population. - It is commonly found in jewelry, belt buckles, buttons, and other everyday metallic objects. *Gold* - **Gold allergy** can occur but is much less common than nickel allergy. - Reactions typically arise from jewelry and may involve **allergic contact dermatitis**. *Silver* - **Silver allergy** is quite rare and often due to impurities or alloys rather than pure silver itself. - Pure silver is generally considered **hypoallergenic**. *Aluminum* - **Aluminum** is generally not a common cause of **allergic contact dermatitis**. - While it can be an irritant in some products (e.g., antiperspirants), true allergic reactions are infrequent.

Q: Characteristic of chronic eczema?

Lichenification. ***Lichenification*** - **Lichenification** is a hallmark of chronic eczema, characterized by thickening of the epidermis with exaggerated skin markings due to persistent rubbing or scratching. - This response reflects the long-term inflammatory and reparative processes in chronically affected skin. *Erythema* - **Erythema**, or redness, is a common finding in both acute and chronic inflammatory skin conditions, including acute eczema, but is not specifically characteristic of chronicity. - While present, it does not distinguish chronic from acute phases as definitively as other features. *Induration* - **Induration** refers to hardening or firmness of the skin, often due to inflammation or infection, and while it can be present in chronic eczema, it's a more general sign and not as specific as lichenification. - It might also suggest other conditions like cellulitis or deep tissue involvement. *Edema* - **Edema**, or swelling, is more prominent in the acute phase of eczema due to vasodilation and increased vascular permeability leading to fluid extravasation. - While some edema can persist, it's a less defining feature of chronic eczema compared to the epidermal changes observed in lichenification.

Q: Which of the following is NOT a feature of atopic dermatitis?

Darier’s Sign. ***Darier's Sign*** - **Darier's sign** is characteristic of **urticaria pigmentosa** (cutaneous mastocytosis), where rubbing a skin lesion causes the formation of an urticarial wheal due to mast cell degranulation - It is **not associated** with the pathogenesis or clinical presentation of **atopic dermatitis** *Dennie-Morgan fold* - **Dennie-Morgan folds** are extra folds or lines in the skin just below the lower eyelids - They are a common clinical sign observed in patients with **atopic dermatitis**, often linked to chronic inflammation and allergic reactions affecting the skin around the eyes *Hertoghe's sign* - **Hertoghe's sign** refers to the thinning or absence of the lateral third of the eyebrows - This sign is often seen in individuals with **atopic dermatitis**, as well as in other conditions like hypothyroidism *Hyperlinearity of palms* - **Hyperlinearity of palms** refers to the exaggerated creases and lines on the palms of the hands - This is a common **stigmata of atopy** and is frequently observed in patients with **atopic dermatitis**, reflecting the underlying predisposition to skin dryness and altered epidermal barrier function

Q: A primigravida female presented with erythematous skin changes and lesions consistent with a severe allergic reaction. Which of the following should be the most appropriate treatment?

Corticosteroids. ***Corticosteroids*** - **Corticosteroids** are the **first-line therapy** for severe allergic reactions due to their potent **anti-inflammatory** and **immunosuppressive** effects. - They help to stabilize mast cell membranes, reducing the release of inflammatory mediators and suppressing the allergic response. *Acitretin* - **Acitretin** is a **retinoid** primarily used for severe **psoriasis** and is **teratogenic**, making it unsuitable for a primigravida and a severe allergic reaction. - Its mechanism of action involves regulating cell proliferation and differentiation, which is not appropriate for acute allergy management. *Psoralen + PUVA* - **Psoralen** combined with **UVA light (PUVA)** is a **phototherapy** treatment used for severe **psoriasis**, **vitiligo**, and **cutaneous T-cell lymphoma**. - It has a slow onset of action and involves photosensitizers, making it inappropriate for the urgent treatment of a severe allergic reaction. *PUVA* - **PUVA** (Psoralen plus UVA light) is a form of **phototherapy** used for chronic skin conditions, not acute allergic reactions. - The mechanism involves psoralen making the skin more sensitive to UVA light, which then inhibits excessive cell growth and immune activity over time.

Q: Which condition is characterized by perioral pallor and Dennie-Morgan folds?

Atopic dermatitis. ***Atopic dermatitis*** - **Perioral pallor** (paleness around the mouth) and **Dennie-Morgan folds** (infraorbital folds) are classic cutaneous manifestations observed in atopic dermatitis. - These features, along with xerosis, lichenification, and eczema, form part of the diagnostic criteria for this chronic inflammatory skin condition. *Chronic actinic dermatitis* - This condition is characterized by an **eczematous eruption** in **sun-exposed areas**, such as the face, neck, and dorsal hands. - It does not typically present with perioral pallor or Dennie-Morgan folds, which are specific to atopic predispositions. *Blood dyscrasia* - Blood dyscrasias are disorders affecting the blood components and can manifest with various skin findings, like **purpura**, **pallor due to anemia**, or **ulcers**. - However, they do not specifically cause perioral pallor in the characteristic pattern seen with atopic dermatitis or Dennie-Morgan folds. *Perioral contact dermatitis* - This condition is an **inflammatory skin response** to a **topical irritant or allergen** applied around the mouth. - It usually presents with erythema, scaling, and sometimes vesicles in the area of contact, rather than generalized perioral pallor or Dennie-Morgan folds.

Q: Most common precipitant of contact dermatitis is?

Nickel. ***Nickel*** - **Nickel** is the most frequent cause of **allergic contact dermatitis**, commonly found in jewelry, belt buckles, and zippers. - Exposure leads to a **Type IV hypersensitivity reaction**, characterized by erythema, itching, and vesiculation. *Gold* - While gold can cause contact dermatitis, it is **far less common** than nickel allergy. - Reactions to gold are often seen with prolonged skin contact, such as with jewelry. *Silver* - **Silver** is a **rare cause** of allergic contact dermatitis. - Allergic reactions to silver are typically observed in individuals with extensive exposure, such as jewelers. *Iron* - **Iron** is **not a common precipitant** of contact dermatitis. - Allergic reactions to iron are exceedingly rare, as iron is an essential element found naturally in the body.

Q: Which condition is commonly known as cradle cap in infants?

Seborrheic dermatitis. ***Seborrheic dermatitis*** - **Cradle cap** is the common term for **infantile seborrheic dermatitis**, characterized by greasy, scaly patches on the scalp. - It is a common, harmless skin condition in infants, often resolving on its own. *Pemphigus vulgaris* - This is a rare, severe **autoimmune blistering disease** affecting the skin and mucous membranes, not a common infant scalp condition. - It involves the formation of **flaccid bullae** and erosions due to autoantibodies against desmosomal proteins. *Acute sunburn reaction* - An **acute sunburn reaction** is caused by excessive exposure to **ultraviolet (UV) radiation**, leading to skin redness, pain, and blistering. - It is an environmental injury and does not present as chronic scaling on an infant's scalp. *Psoriasis vulgaris* - **Psoriasis vulgaris** is a chronic autoimmune condition causing well-demarcated, erythematous plaques with silvery scales. - While it can occur in children, its typical presentation is different from cradle cap, and it is less common in infants.

Q: Which type of dermatitis is evaluated through patch testing?

Contact dermatitis due to allergens. ***Contact dermatitis due to allergens*** - **Patch testing** is specifically used to identify specific **allergens** that trigger an **allergic contact dermatitis** reaction. - It involves applying suspected allergens to the skin and observing for a localized inflammatory response, indicating delayed type IV hypersensitivity. *Atopic dermatitis* - This is a chronic inflammatory skin condition characterized by **eczematous lesions** and severe **pruritus**, often linked to a genetic predisposition and immune dysfunction. - While allergy testing (e.g., prick tests, blood tests for IgE) might be used to identify triggers, **patch testing** is not the primary diagnostic tool for atopic dermatitis itself. *Irritant contact dermatitis* - This type of dermatitis is caused by direct **damage to the skin barrier** from exposure to caustic substances or irritants, not an immune-mediated allergic reaction. - Diagnosis is usually based on clinical history of exposure and symptom presentation, and **patch testing** is typically negative in these cases. *Discoid eczema* - Also known as **nummular dermatitis**, this condition presents with distinctive **coin-shaped lesions** and is often associated with dry skin or skin trauma. - Its etiology is generally unknown and not attributable to specific allergens detectable by **patch testing**.

Q: A patient who experiences recurrent urticaria during exercise and heat exposure, including sunlight, most likely has:

Cholinergic Urticaria. ***Cholinergic Urticaria*** - Cholinergic urticaria is characterized by the appearance of small, itchy wheals in response to stimuli that raise the **body temperature**, such as **exercise**, **heat**, or **emotional stress**. - The symptoms resolve when the body cools down, aligning with the patient's presentation of recurrent urticaria during exercise and heat exposure. *Chronic Spontaneous Urticaria* - This condition involves daily or almost daily urticaria for **six weeks or more** without an identifiable external cause. - While it is chronic, the specific triggers of exercise and heat exposure point more directly to a physical urticaria like cholinergic urticaria. *Universal Dermographism* - **Dermographism** (or dermatographia) is a type of physical urticaria where hives appear after **firm stroking or scratching** of the skin. - Universal dermographism would imply this reaction over a large body surface area, but it is not typically triggered by systemic heat or exercise. *Photodermatitis* - **Photodermatitis** is a general term for skin inflammation caused by **exposure to light**, especially sunlight, often due to an abnormal reaction to UV radiation. - While sunlight is a trigger for this patient's symptoms, the additional triggers of exercise and general heat exposure make cholinergic urticaria a more encompassing diagnosis than photodermatitis alone.

Question 1

A 25-year-old patient presents with chronic itchy, erythematous skin lesions on the flexural areas that have been recurring since childhood. The patient has a family history of asthma. Which of the following is the most important diagnostic criterion for the most likely diagnosis?

Accepted Answer

Chronic pruritic eczema with typical morphology and distribution

Answer

Personal or family history of atopy

Answer

Elevated serum IgE levels

Answer

Early age of onset (before 2 years)

Question 2

Most common metal in contact allergic dermatitis is?

Accepted Answer

Nickel

Answer

Gold

Answer

Silver

Answer

Aluminum

Question 3

Characteristic of chronic eczema?

Accepted Answer

Lichenification

Answer

Erythema

Answer

Induration

Answer

Edema

Question 4

Which of the following is NOT a feature of atopic dermatitis?

Accepted Answer

Darier’s Sign

Answer

Dennie-Morgan fold

Answer

Hyperlinearity of palms

Answer

Hertoghe’s sign

Question 5

A primigravida female presented with erythematous skin changes and lesions consistent with a severe allergic reaction. Which of the following should be the most appropriate treatment?

Accepted Answer

Corticosteroids

Answer

Psoralen + PUVA

Answer

PUVA

Answer

Acitretin

Question 6

Which condition is characterized by perioral pallor and Dennie-Morgan folds?

Accepted Answer

Atopic dermatitis

Answer

Chronic actinic dermatitis

Answer

Blood dyscrasia

Answer

Perioral contact dermatitis

Question 7

Most common precipitant of contact dermatitis is?

Accepted Answer

Nickel

Answer

Gold

Answer

Silver

Answer

Iron

Question 8

Which condition is commonly known as cradle cap in infants?

Accepted Answer

Seborrheic dermatitis

Answer

Pemphigus vulgaris

Answer

Acute sunburn reaction

Answer

Psoriasis vulgaris

Question 9

Which type of dermatitis is evaluated through patch testing?

Accepted Answer

Contact dermatitis due to allergens

Answer

Atopic dermatitis

Answer

Irritant contact dermatitis

Answer

Discoid eczema

Question 10

A patient who experiences recurrent urticaria during exercise and heat exposure, including sunlight, most likely has:

Accepted Answer

Cholinergic Urticaria

Answer

Chronic Spontaneous Urticaria

Answer

Universal Dermographism

Answer

Photodermatitis

Dermatitis and Eczema — MCQs

Dermatitis and Eczema — MCQs

On this page

Practice by Chapter

Want unlimited practice?