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Eczema

It is a non- infectious, inflammatory condition

of the skin characterized by vesicles, oedema

and erythema in acute stage, plaque with scale

and crust in sub acute stage and lichenificationand hyperpigmentation in its chronic stage.

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Classification

Extrinsic

Allergic

contactdermatitis

Irritantcontact

dermatitis

Intrinsic

Atopicdermatitis

Seborrhoeicdermatitis

Discoid

dermatitis

Pompholyx

Lichen simplex

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Investigations

CBC

Skin biopsy for histopathology

Patch test

Prick test Serum IgE

RAST

Blinded food challenge

Eosinophilic cationic protein Food specific IgE

Photo patch test

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Treatment

Avoidance of the offending agent

Anti-histamine

Topical and systemic steroids

Topical tacrolimus, moisturizer, emollients.

Methotrexate, cyclosporin.

Phototherapy.

Any other treatment according to the type ofeczema.

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Complications

Lichenification

Hyperpigmention

Fissuring Erythroderma

Secondary infection

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Atopic dermatitis

It is a genetically predisposed IgE mediated

Inflammatory condition of skin.

More than 50% of children of atopic mother

develop the disease.

It rises up to 79% if both the parents are

involved.

Rate is 86% in monozygotic twins.

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Stages

Infantile atopic dermatitis - 2months to 2 yrs of

age.

Childhood atopic dermatitis2 to 10 yrs of age.

Adult atopic dermatitis

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CriteriaMajor criteria

PruritusFlexural involvement inadults, facial andextensor involvement ininfants.

Chronic and chronicallyrelapsing.

Personal or familyhistory of asthma,rhinitis.

Three major and three

minor criteria need to

be present for

diagnosis

Minor criteria

XerosisIchthyosis

Elevated IgE

Nipple eczema

ConjunctivitisLip eczema

Cataract

Facial pallor

Food, wool, environmental,emotional hypersensitivity

Hand and foot dermatitis

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Pathogenesis

Genetic factor

Thelper cell mediated immunity

Hyperactive IgE & IgE receptor Neuropeptide

Infections

Disturbance in skin barrier function

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Investigations

CBC Skin biopsy for histopathology

Patch test

Prick test

Serum IgE RAST

Blinded food challenge

Eosinophilic cationic protein

Food specific IgE

Photo patch test

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Treatment

Avoidance of predisposing factor including dust, housemite, specific food and other inciting factor.

Topical emollients like white petrolatum, urea and lactic

acid. Topical steroids

Topical tacrolimus

Topical coal tar

Systemic steroids, immuosuppresive agents, IVIG andphototherapy.

Anti-histamine

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Complications

Exfoliative dermatitis

Secondary bacterial and viral infections

Growth retardation

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Seborrhoeic dermatitis

It is a chronic, superficial, inflammatory disease

characterized by yellow, greasy scale on

erythematous base and caused byPityrosporum

ovale.

Epidemiology: 2% to 5% population get

affected. Men and women get involved in same

proportion. Infants also are affected

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Aetiopathogenesis

Unknown

Pityrosporum ovale

Immunological

Diabetes

Parkinsonism

Epilepsy

AIDS

Antiepileptic drug

Arsenic

Stroke

malabsorption

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Clinical feature

Site: scalp, eyebrow, eye lid, nasolabial crease, auditorycanal, postauricular region, presternal area,inframammary fold, axilla, umbilicus, groin and glutealcrease

There is yellowish, moist, greasy scale on anerythematous base.

Sometimes there is thick crust and fissuring

May be associated with folliculitis and severe itching

In rare cases there can be exfoliative dermatitis It often is limited to scalp known as dandruff or

pityriasis sicca.

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Investigation

Skin scrapping for fungus microscopic

examination in KOH preparation and culture in

SDA media

Skin biopsy for histopathology

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Treatment

Topical

Corticosteroid

TacrolimusKetoconazole

Selenium sulfide

Systemic

Antifungal

TetracyclineAntihistamine

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Exfoliative dermatitis

Also known as exfoliative dermatitis.

It is a condition characterized by exfoliation ofmore than 90% of BSA and characterized by

erythema, pruritus and scale.

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Aetiology

Idiopathic Dermatoses

Psoriasis

Seborrhoeic

debmatitisAtopic

dermatitis

PRP

Mycosisfungoides

Bollous disease

Systemic

disease

Leukemia

LymphomaSolid organ

malignancy

Nutritional

deficiency

Drugs

Antiepileptic

NSAID

SulfasalazinePiroxicam

Antihypertens

ive

20% 52% 23% 5%

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Clinical feature

Symptom

Fever with chill

Shivering pruritus

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Clinical feature continued

Sign

Exfoliation of more than 90% of BSA

Erythema, scale,

Papule, vesicle Loss of hair

Lymphadenopathy

Erosion, crust, exudation

Tachycardia, tachypnia

Low BP,

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Investigation

Routine

CBC

Urine R/E

CXR

Specific

Skin biopsy for histopathology and DIF

PBF

S. electrolyte S. creatinine, BUN

SGPT

USG, CT and other relevant tests to find out the cause

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Treatment

Avoidance of any offending dug

Correction of fluid and electrolyte imbalance

Maintenance of airway if necessary

Maintenance of temperature

Proper nutrition

Antihistamine

Broad spectrum antibiotic

Specific treatment according to the cause

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Complication

Hypothermia

Hypovolemia

Electrolyte imbalance High output cardiac failure

Infection with septicemia

Renal failureARDS