Eczema.

1. ECZEMAS

2. “All eczemas are dermatitis, but not all dermatitis are eczemas.”

3. Classification
Exogenous eczemas
▪ Irritant dermatitis
▪ Allergic contact
dermatitis
▪ Photodermatitis
▪ phytodermatitis
Endogenous eczemas
▪ Atopic dermatitis
▪ Pityriasis alba
▪ Seborrhoeic dermatitis
▪ Discoid eczema
▪ Hand eczema
▪ Asteatotic eczema
▪ Gravitational eczema
▪ Lichen simplex chronicus
▪ Prurigo nodularis

4. Clinical stages

5. Acute Eczema
▪ Intense itching
▪ Intense erythema
▪ Oedema
▪ Papulovesicles
▪ Oozing
▪ HPE

6. Subacute eczema
▪ Erythema (lesser than in
acute stage)
▪ Crusting and scaling
▪ Fissuring
▪ Slight to moderate itching
▪ Stinging and burning
sensation

7. Chronic eczema
▪ Dryness of skin
▪ Excoriation
▪ Fissuring
▪ Lichenification -
▪ HPE-

8. Exogenous Eczemas

9. Irritant Contact Dermatitis
▪ Non-immunologic inflammatory reaction of the skin
▪ due to an external agent.
▪ non sensitized

10. • Types:
• Symptomatic responses:-chloroform, methanol
• Burns: Acid, Alkali
• ICD- acute/chronic

11. • Acute Irritant Dermatitis:
• nature of substance
• amount of substance
• acid, alkali, solvents
• erythema, edema, vesiculation, pruritus, tenderness
• occupational in nature

12. • Chronic Irritant Dermatitis:
• patient characteristics + nature of substance
• detergents- housewife dermatitis
• oil mechanics-cutting oil

13. Paedrous Dermatitis
• Dermatitis linearise/ whiplash dermatitis
• organism:
• irritant:
• Season:
• overnight onset

16. Allergic Contact Dermatitis
• immunological-type IV

18. • Clinical Features:
• Acute
• Chronic

19. • Allergens:
• metals
• cosmetics
• medicines
• clothings

21. • Cosmetics:
• fragrances and preservatives
• lipsticks
• hair gels
• nail polish

23. Allergens Sources
Nickel, cobalt Artificial jewellery, jean buttons
Chromium Cement, Painting
Potassium dichromate Leather, detergents, paint
Epoxy resins, phenols Plastics
Parthenium Plants
Propylene glycol Cosmetics, medicaments
PPD Hair dyes
Neomycin, gentamycin Topical medications
Latex/ rubber gloves, shoes, belts
PTBP Bindi

24. • MC metal allergen:
• MC allergen in India:
• MC topical medicine causing ACD:

26. Phytodermatitis:
• MC cause in India:
• Allergen:Sesquiterpene lactones
• Population:

27. ABCD
subacute eczema

29. • Course:
• Chronic relapsing
• more in summers and monsoons
• Treatment:
• Occupation change, reduce exposure
• CS, AZA

30. Systemic contact dermatitis:

31. •PENICILLIN
•STREPTOMYCIN
•NEOMYCIN
•NICKEL

32. Photodermatitis:
• phytotoxic
• photoallergic
• PMLE

33. Phototoxic Photoallergic
Incidence Common Less Common
Mechanism Non immunological TYPE IV Hypersensitivity
Onset on UV exposure Minutes to days 24-28hrs
Morphology of the lesion Sunburn Eczematous
Diagnosis Clinically diagnosed Photo patch testing

34. Sparfloxacin
quinolones

35. PMLE
• MC form of immunologically mediated
photosensitivity dermatoses.
• DTH to an endogenous antigen expressed after
exposure to UVA
• typically appears after first exposure to intense
sunlight in spring or summer
• tends to recur annually

38. Patch Test:
• Principle:
• HS:
• Indications:
• site

39. reading: 48hrs (best reading at 96 hrs)

40. • Photopatch: • Antigens applied in duplicate
• covered with opaque
material.
• Onset is then irradiated with
UVA At 48 hrs

42. • Management:
• avoid irritants
• topical steroids
• oral steroids
• AZA , cyclosporine
• No retinoids

43. ENDOGENOUS
ECZEMA

44. Atopic Dermatitis
• Definition: itchy, chronic or chronically relapsing
inflammatory skin condition
• Itch That Rashes/ itch is a disease

45. • Atopic Triad:
Asthma
Allergic
Rhinitis
(Hay fever)
Atopic
Dermatitis

46. • Pathogenesis:

47. • Defective Barrier:
• defect in fillagrin and locirin
• decrease ceramides/lipids
• increased TEWL

48. • Genetic Factors:
• FLG gene
• immune genes- IL4, IL13

49. • Immunological Factors:
• TH2

50. • Environmental factors:

52. • Hygiene Hypothesis:

53. • Clinical Features:
Infantile-3 mnths-2 years
adolescent-2yrs-12 yrs

54. • Infantile phase:

55. • Childhood Phase:

56. • Adult Phase:

57. • hertoghe sign
• allergic shiners-darkening
beneath eyes
• denny morgan fold

59. • headlight sign-perioral pallor

62. • Diagnosis:
• Clinical
• High IgE
• Criteria

64. • Management:
• Remove triggers
• Hydration
• Pharmacological treatment

65. • 1st line:
• Control of flare factors
• Topicals
• systemic

66. • Second line:I
• Intensive topical therapy- step up to potent steroid
▪ Wet wrap technique
▪ Allergy management
• Third line:
▪ Phototherapy
▪ Oral immunosuppresants
• Cyclosporine
• Azathriopine
• Thymopentine
• α- Interferon
▪ Desensitization

67. • Newer agents:
• CRISABOLE-PDE 4 INHIBITOR-TOPICAL
• DUPILUMAB: interleukin-4 (IL-4) receptor alpha
antagonist- Systemic

68. Pityriasis Alba
vs indeterminate hansen-
endemic area, solitary lesion,
no scaling, not episodic

70. Seborrheic Dermatitis
• chronic, inflammatory papulosquamous disease
• Organism:malassezia
• Age: infants, adolescents, adults
• Pathogenesis: increased sebum

71. • Other Associated Disorders: Parkinson’s , HIV
• Sites:

73. < 3 months
cradle cap
maternal androgens

78. • Management:
• no oil
• Medicated shampoos : selenium sulphide or ketaconazole,
ciclopirox olamine, tar and salicylic lotions.
• Mild topical steroid or antifungals
• antifungals
• antihistamines

79. Discoid Eczema

80. Hand Eczema
• endogenous or exogenous
• ACD
• ICD
• focal peeling
• hyperkeratotic
• pompholyx

82. Pompholyx
endogenous type
B/L symmetrical
sago grain deep seated vesicles
itchy
relapsing remitting

84. Asteatotic eczema
NO FAT RASH)
(Eczema craquele, winter eczema)
Elderly, topics
winters
shins
cracked porcelain or ‘crazy paving’
pattern, dried riverbed)

86. Venous Eczema
• Gravitational/ stasis eczema
• varicose veins
• medial end of limbs

87. atrophie blanchae
hemosiderin deposition

89. Neurodermatitis