2. 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 exogenous
7. Introduction
• Atopy (Gk. atopos = out of place) is the
general medical term for allergic conditions
such as hay fever, asthma or this type of
eczema.
• People with a tendency to suffer from allergic
conditions are said to be atopic.
8. Definition
• Atopic dermatitis (ie, eczema) is a
chronic pruritic skin condition due
to hereditary predisposition to react
for sensitizers usually beginning in
infancy.
9. Epidemiology
• Atopic eczema affects about 15 per cent of
children and up to 5 per cent of adults in
Western countries.
• The exact prevalence is not known in our
country.
• There is no predilection of sex for
occurrence however, females have a
worse prognosis.
• Approximately 60% of patients experience
their first outbreak by age 1 year and 90%
by age 5 years.
10. Immune Abnormalities
• Primary Defect - ?synthesis of IgE rather than IgG
Syndrome Presumed immune mechanism
Rhinitis Immediate hypersensitivity
Asthma Immediate hypersensitivity
+/- T cell involvement
Eczema ? T cell - mediated hypersensitivity
11. • Precise etiology is unknown, but current theories
center on a disordered immune response,
especially an imbalance of cytokines.
• The immune system of people with atopic eczema
is active in a particular way.
• Serum levels of IgE are elevated in 80% of cases.
• There is also dysregulation of the immune system
with over activity of TH2 helper cells.
• High blood level of IL-4 & IL-5 with low level of
gamma interferon is observed.
Etio-pathogenesis
12. • The disease also appears to have a
hereditary component; family history is
positive for atopy (i.e., asthma, allergic
rhinitis, atopic dermatitis) in two thirds of
patients.
• The exact mode of inheritance is
obscure. It is thought to be autosomal
dominance with variable penetrance.
• Defective gene is found around 11q13 for
respiratory atopy.
13. • Several triggers have been identified.
• Anything that could dry the skin may
exacerbate atopic dermatitis. Potential
triggers include excessive bathing, hand
washing, lip licking, sweating, or
swimming.
• Contact with solvents, detergents,
deodorants, cosmetics, and soaps can
exacerbate the disease. Loose or poorly
fitting clothing that constantly rubs the skin
also can cause problems.
14. • Excessive or prolonged heat may trigger a
flare-up.
• General Risk factors
– Skin infections
– Emotional stress
– Irritating clothes and chemicals
– Excessively hot or cold climate
– Food allergy in children (controversial)
– Exposure to tobacco smoke
15. CLINICAL PICTURE
• Although the first episode of atopic eczema
can be delayed to adulthood the majority of
people have a history that goes back to
their childhood.
• The most common presentation is that of
infants, usually younger than 6 months,
brought in by their parents for a persistent
rash
16. • The predominant symptom is intense
pruritus. Atopic dermatitis typically is
not associated with fever or other
constitutional symptoms.
• Distribution of lesions
–Infants: Symmetric lesions over cheeks,
forehead, scalp, trunk, and the extensor
surfaces. Lesions may extensively involve
the flexural surfaces, sparing only the
diaper area. Scalp involvement may be
severe enough to cause alopecia.
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18.
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21. –Children:
•Symmetric lesions on wrists,
ankles, and flexor areas of the
extremities. Generalized
eruptions also may occur in this
age group.
31. Other manifestations
• Ichthyosis vulgaris - Observed in one
third of patients. Characterizing features
are hyperlinear palms and soles and
polygonal fishlike scales, especially on
the lower legs.
• Keratosis pilaris - Characterized by
asymptomatic horny follicular papules
on the extensor surfaces of the upper
arms, buttocks, and anterior thighs
32. • Hand and foot dermatitis may be the only
manifestation in adults and adolescents.
Fissuring of the palms, soles, and fingers
often occurs.
• Keratoconus is observed in severe cases. A
cone-shaped cornea (requiring corneal
transplant) may develop in the second or
third decade of life.
33. Associated features
• Facial erythema
• Perioral pallor
• Infraorbital fold (ie, Dennie-Morgan line)
• Dry skin
• Increased palmar linear markings
• Pityriasis alba
• Pilaris
42. The UK refinement of Hanifin and
Rajka's diagnostic criteria.
Scabies should be excluded.
• In order to qualify as a case of atopic
dermatitis with the UK diagnostic
criteria, the child must have:
– An itchy skin condition (or parental report
of scratching or rubbing in a child)
43. • Plus three or more of the following
1) Onset below age 2 years (not used if child is
under 4 years)
2) History of skin crease involvement (including
cheeks in children under 10 years)
3) History of a generally dry skin
4) Personal history of other atopic disease (or
history of any atopic disease in a first degree
relative in children under 4 years)
5) Visible flexural dermatitis (or dermatitis of
cheeks/forehead and outer limbs in children
under 4 years)
45. First line treatment
• General advice
– Enthusiastic social relationship
– Advice on prognosis, available treatments,
triggers, complications etc.
• Reduction of triggers
– Avoid irritants
– Cool the room
– (Dietary manipulation)
– Avoid stress.
48. Second line treatment
• Intensive topical treatment
• Wet-wrap technique
• Allergy management
• UV radiation
49. Third line treatment
• Topical immunomodulators
–Tacrolimus, Ascomycin
• Systemic treatment
–Cyclosporin
–Methotrexate
–Prednisolone
• Desensitization
50. Contact Dermatitis
–Acute or chronic inflammatory reactions to
substances that come in contact with the skin.
–Two forms of CD exist
• Irritant Contact Dermatitis
• Allergic Contact Dermatitis
51. Contact Dermatitis
ICDlesions are confinedto the area of exposure and
previous exposure is not the prerequisite
ACDoccurs in previously sensitizedindividuals and
eczematous pruriticlesions occur even apart from the
contact site
The agent causing ACDcan be identified using patch
testing
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65. Contact Dermatitis
Avoid the agent,
Topical steroids and if severe systemic
for a short time,
Antipruritics
Treat the complications.
66. Lichen Simplex Chronicus
Thickening of the skin with variable scaling that
arises secondary to repetitive scratching or
rubbing. It is not a primary process.
occurs mainly at the nuchal area.
Hyperpigmentation and lichenific-ation is the
feature.
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73. Lichen Simplex Chronicus
Break the itch-scratch-itch cycle with
antihistamines, potent topical steroids and treat
lichenificatin by keratolytics
Advice patients not to scratch the area
74. Discoid 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
75. Discoid Eczema
Coin shaped plaques formed by confluent
papules and vesicles are seen mainly on the
extremities.
Pruritis is common
79. Seborrhoeic Dermatitis
Very common chronic dermatosis characterized
by redness and scaling occurring in regions
where the sebaceous glands are most active
Called dandruff in the scalp
Affects 4 – 5 % of the population
81. Seborrhoeic Dermatitis
Has two pick ages of onset: Infancy, and
Puberty.
The infantile type commonly presents as
“cradle cap”.
Yellowish red, often greasy, or white dry
scaling macules and papules of varying
size (5 to 20 mm), rather sharply
marginated occurs.
The seborrhoeic areas are primarily
affected.
88. Pityriasis Alba
A common disfiguring hypomelanosis of the face
presenting as white area (alba) with scaling
(pityriasis)
Cause is not known
Atopic state may be present
Asympromatic or mildly pruritic
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90.
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92. Pityriasis Alba
Hydrocortisone cream or ointment 1%, is
effective
Avoid frequent washing with soap
Self limiting conditionsthat disappears with age
