Dermatitis and eczema

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Introduction•Inflammation of the skin

•The terms 'ECZEMA' and 'DERMATITIS' are regarded as synonymous

•Eczema has three clinical stages of development

•Acute, Subacute, or Chronic

•Endogenous, or exogenous2

Epidemiology

Prevalence– In the US:

– 10-12% in children – 0.9% in adults.

– Internationally: as high as 18% and is rising, especially in developed countries.

Race, Age, Sex, Income

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Atopic Eczema

• Acute, subacute, but usually chronic pruritic inflammation of the epidermis and dermis

• It affects 5-10% of children below 5 years – 60 % of patients present by first year;

– 30 % are seen for the first time by age 5, and

– only 10 % develop AD between 6 and 20 years of age

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Atopic Eczema

• Patients with AD: –30% develop asthma –35% have Allergic Rhinitis.

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Atopic Eczema

• Interaction of genetics and environmental factors results in development of atopic eczema.

• Both IgE mediated and cell mediated hypersensitivity reactions are involved

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Atopic Eczema

• Pruritus is the sine qua non of atopic dermatitis.

• There is no fever or other constitutional symptoms.

• Lichenification because of repeated scratching is commonly seen.

• Other atopic diathesis may present at the same time.

• Sparing of the diaper area is more common in AD.

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Atopic Eczema Has three phases:

I. Infantile AD– tends to primarily involve the face, scalp and torso.

II. Childhood AD – involves the extensor extremities

III. Adulthood AD – Flexural surface– More generalized…

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Atopic Eczema

• The exact cause of the condition is UK:– Most patients have

• marked xerosis and • inability to retain moisture in the skin.

• Environmental triggers – heat, humidity, detergents/soaps; – abrasive clothing, chemicals, and smoke and stress

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Diagnostic CriteriaHanifin diagnostic criteria:

Major– Pruritus

– Typical and age-specific changes:

– Chronic and relapsing course

– Family Hx10

Diagnostic CriteriaHanifin diagnostic criteria:

Minor– Early age of onset – Atopy (IgE reactivity) – Xerosis– Keratosis pilaris/ichthyosis/palmar hyperlinearity – Atypical vascular responses – Perifollicular changes – Ocular/periorbital changes – Perioral/periauricular lesions

Diagnosis11

Atopic Eczema

The presence of the 1 major and at least 3 minor features is diagnostic of AD

– Major Feature•An itchy skin condition

– Minor Features: •Onset below age 2 years •History of skin crease involvement •History of a generally dry skin•Personal history of other atopic disease•Visible flexural dermatitis

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Atopic Eczema

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Atopic Eczema

• Are particularly prone to

I. Cutaneous Infections/Infestations• Bacterial• Viral• Fungal• Scabies

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Atopic Eczema

• Are particularly prone to

II. Localized eczemas

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Management Eduacation on prophylactic

measures Bathing and soaps

Recommend non-soap cleansers such as Cetaphil or moisturizing soaps such as Dove.

Clothing, Emollients Ichthammol and coal tar,

Make sure a humid household environment is maintained. 37

Management Topical Corticosteroids, Antihistamines, ??? Antibiotics Topical immuno-modulators

Tacrolimus ointment 0.03%, 0.1% bid. OR

Pimecrolimus 1% cream bid.

Long term prognosis generally good

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Contact Dermatitis [ CD ]

–Acute or chronic inflammatory reactions to substances that come in contact with the skin.

–Two forms of CD exist•Irritant Contact Dermatitis (ICD)•Allergic Contact Dermatitis (ACD)

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Contact Dermatitis [ CD ]

• Common allergen-containing products include • cosmetics • Soaps• dyes and • jewelry.

• The most frequent sensitizers are • fragrance• nickel, neomycin• formaldehyde, lanolin, and • a host of other common environmental chemicals.

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Contact Dermatitis

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The distribution of the rash should drive the examiner's history to possible allergen exposures.

• Facial distributions – suggest a personal skin care product.

• Ear lobes – suggest nickel allergy from earrings.

• Hand dermatitis – should provoke questions regarding

• occupation, hobbies, and habits • especially those working in hair or nail salons

• There are photo-dependent allergic reactions47

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Contact Dermatitis

Avoid the agent. Topical steroids and if severe systemic for a short time. Antipruritics Treat the complications.

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Lichen Simplex Chronicus

Thickening of the skin with variable scaling that arises secondary to repetitive scratching or rubbing.

It is not a primary process.

occur mainly at the nuchal area.

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Lichen Simplex Chronicus

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Lichen Simplex Chronicus

Break the itch-scratch-itch cycle with Antihistamines Potent topical steroids and Treat lichenification with

keratolytics

Advice patients not to scratch the area Trim nails

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Discoid Eczema

Nummular or Microbial eczema A chronic, pruritic, inflammatory

dermatitis occurring in the form of coin-shaped plaques.

Unknown cause. Unrelated to atopic diathesis IgE levels are normal Commonly seen in the lower leg

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Discoid Eczema

Skin hydration and application of potent steroid with or with out antihistamines.

Usually recurs.70

Seborrhoeic Dermatitis

Very common chronic dermatosis characterized by redness and scaling.

Occurs in regions where the sebaceous glands are most active.

Affects 4 – 5 % of the population Mild form in the scalp is Called

dandruff Up to 20% of population affected71

Seborrhoeic Dermatitis

Cause not fully inderstood

Associated factors:GeneticsImmunosupressionPityrosporon ovale

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Seborrhoeic Dermatitis

Has two pick ages of onset: Infancy, and Puberty

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Seborrhoeic Dermatitis

Selenium sulfide shampooKetoconazole shampooTopical steroidsSystemic azolesUV radiationRecurrences and remissions are common

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Pityriasis Alba

A common disfiguring hypomelanosis of the face presenting as White area (alba) Mild scaling (pityriasis)

Cause is not known

Atopic state may be present: A forerunner of AD

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Pityriasis Alba

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Pityriasis Alba

1 % Hydrocortisone ointment, is effective

Avoid frequent washing with soap

Self limiting conditions that disappears with age 81

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Exercise

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Discoid Eczema

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