Eczema and Dermatitis

7/28/2019 Eczema and Dermatitis

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ECZEMA AND DERMATITIS

What Is Dermatitis ?

Dermatitis is the

inflammation of the

skin -that is

characterized bycertain clinical

(erythema, scales &

vesicles) and

histopathologicalchanges (spongiosis)-


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CLASSIFICATION:

1. EXOGENOUS "contact" eczema:

Allergic contact dermatitis

Irritant contact dermatitis Photocontact dermatitis

Infective dermatitis

Dermtophytide


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2. ENDOGENOUS:

Atopic dermatitis

Seborrhoeic dermatitis

Discoid eczema

Pompholyx Gravitational 'stasis' dermatitis

Pityriasis alba.

Asteatotic eczema Neurodermatitis ' Lichen Simplex

chronicus '.

Juvenile plantar dermatosis.


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STAGES OF ECZEMA

ACUTE ECZEMA

SUBACUTE

ECZEMA

CHRONIC ECZEMA


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CONTACT DERMATITIS

Irritant Contact Dermatitis Non-allergic reaction that results from exposure to an

irritating agent ( Physical or chemical ) producing celldamage and an inflammatory reaction

Sufficient amount, concentration and time

occurs in any person, no immunological factors andprevious sensitization.

common causes:

- Chemicals: acids, alkalis, soap, detergent.

- Physical: dusts, gases, heat, cold, humidity.

- Mechanical: Friction, rubbing, scratching.

E.G. Napkin dermatitis, Housewives dermatitis


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Allergic Contact Dermatitis

Delayed type IV hypersensitivity reaction SENSITIZER: - chemical agent with low molecular

weight which is able to sensitize certainindividuals and induce cell mediated immunereaction that end with dermatitis only in previously

sensitized persons. Pathogenesis:

- Induction (sensitization) phase: 18-24 days

- Elicitation phase: 2-4 days

Antigen binds Langerhans cells in the epidermisor macrophages in the dermis

Interaction with CD4+ T lymphyocytes at theregional lymph nodes causes release of

inflammatory cytokines


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Contact Dermatitis

Common causes: nickel,

rubber, potassium

dichromate,

paraphenylenediamine

Contact dermatitis with

Nickel.

Reddish marking and

itching will occur.


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Patch Test


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Atopic Dermatitis

Atopy : -genetically determined

condition characterized by excessive

response to an environmental antigen

by production of large amounts of IgE

anti bodies and these include asthma,hay fever and atopic Dermatitis


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Aetiology: -

1. Genetic tendency: family history of atopy is found in

about 70 % of patients

2. Immunological abnormalities

1. Increased IgE level.

2. Increased immediate anaphylacticreactions to food and drugs.

3. Decreased delayed type hypersensitivity.

4. Increased tendency for vasoconstriction.

5. Increased susceptibility to bacterial,, viral anddermatophyte inf.

6. Decreased function of the monocyte and

neutrophils.

7. Decreased itching threshold.


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Clinical Features

Itching, Chronicity. Xeroderma

I // Infantile phase: -


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II // Childhood

phase: -

Ill // Adulthood

phase: -


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MANAGEMENT: -

1. Explanation and reassurance of the

patient or his parents

2. Avoidance of irritant materials

3. Emollients 4. Mild to moderate topical steroid

ointment

5. Sedative antihistamines 6. Systemic antibiotics

7. Tacrolimus & Pimecrolimus.

8. In very severe and resistant cases systemic

steroids, azathioprime, PUVA and cyclosporine


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SEBORRHOEIC DERMATITIS

1. classical form:

- Infantile seborrheic

dermatitis

- adulthoodseborrheic dermatitis


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Presentations

2. petaloid form

3. Trunk:

pityriasiform

4. Intertriginous or

flexural lesions

5. Severe widespread form

erythroderma.


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Treatment

1. Topical imidazoles are the first line of

treatment.

2. 2% sulpher + 2 % salicylic acid in asolution form especially on hairy areas.

3. Mild to moderate topical steroids.

4. Antibiotics in case of secondary

infection.

5. UVB may be useful in some cases.

6. Systemic antifungal, Systemic steroids

and other immunosuppressive drugs


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DISCOID ECZEMA


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POMPHOLYX

Aetiology: the exact aetiology is unknown but

may be due to:

1. Severe irritant or allergic contact dermatitis.

2. Ingested metals. Nickel, Chromate or Cobalt.

3. Ide reaction to the presence of active

T. pedis, T. capitis, severe irritated dermatitis. 4. Emotional stress.


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Clinical features


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Treatment: -

1. Avoidance and treatment of the

precipitating factors. 2. Potassium permanganate soaks and

very potent corticosteroid creams.

3. Systemic steroids may be needed insevere cases.

4. Antibiotics in the presence of

infection.


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Gravitational or Stasis

Dermatitis

Treatment: -

1. Elimination of

the oedema by

elevation andpressure bandage.

2. Moderately

potent topicalsteroids.

3. Antihistamines

and antibiotics


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Asteatotic Eczema


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Localized Neuro Dermatitis

(Lichen Simplex Chronicus)

Eczema and Dermatitis

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