Ekze, in Greek means “to boil over”. Eczema is an inflammatory condition of the skin that is characterized by erythema, papulo-vesicles, oozing & crusting in the acute stages & lichenification in the chronic stages
Exogenous eczemasMediated by external trigger factors; inherited tendenciesmay play a part. Endogenous eczemasMediated by internal factors; that is, processes originatingwithin the body. Combined EczemasSome types of eczema are precipitated by both externaland internal factors.
CLINICAL FEATURES The inflammatory changes of eczema evolve through two stages: ◦ Acute eczematous inflammation ◦ Chronic eczematous inflammation
DIAGNOSIS OF ECZEMAS Diagnosis in most cases, is clinical and based on a carefully taken history. Total IgE level to assess if the individual is atopic. Swabs for culture and sensitivity (Bacterial resistance) Microscopy: to rule out dermatophyte infection/ scabies
PATCH TEST Relies on the principle of a type IV hypersensitivity reaction. Method used to determine if a specific substance causes allergic inflammation of the skin. Commonest antigen used-Nickel. TECHNIQUE- Antigens in standardised dilutions applied to the back and occluded. Patches removed after 48hrs;read after half hour. Another reading at 96hr detects delayed reaction.
INFANTILE PHASE 3 months-2years. Itchy papules and vesicles,becoming exudative. Begins on face;can involve rest of body. Spares diaper area.
CHILDHOOD PHASE 2-12 years. Dry,leathery and itchy plaques. Charecteristic feature-Lichenification. Site-elbow and knee flexors. Pallor of the face is common; erythema and scaling occur around the eyes
ADULT PHASE 12 years onwards. Lesions become more diffuse with an underlying background of erythema. Face and flexural areas are commonly involved and is dry and scaly. Xerosis is prominent. Lichenification may be present.
POMPHOLYX Dyshydrotic eczema/acute vesiculobullous hand eczema It is a skin condition that is characterized by small blisters on the hands or feet.
CLINICAL FEATURES Summer aggravation. Recurrent episode of deep seated,bland looking vesicles(blisters) Vesicles resolve gradually in 3 to 4 weeks, and may be followed by chronic eczematous changes. Sites-fingers,palms and soles.
TREATMENT Saline soaks followed by topical steroids. Antibiotics in bacterial infection.
CLINICAL FEATURES Spectrum of features ranging from dryness,redness or chapping to an acute caustic burn. Acute Exudative Lesions- Exposure to a strong irritant. Dry Dermatic Lesions- Chronic repeated exposure to a weak irritant.
PATHOGENESIS Chemical directly injures skin without involving immunologic pathway. Develops in patients exposed to chemicals and develop with 1st exposure itself.
ALLERGIC CONTACTDERMATITIS Allergic contact dermatitis (ACD) is a delayed type of induced sensitivity (allergy) resulting from cutaneous contact with a specific allergen to which the patient has developed a specific sensitivity. This allergic reaction causes inflammation of the skin manifested by varying degrees of erythema, edema, and vesiculation.
PATHOGENESIS Type IV hypersensitivity reaction to exogenous antigens. Antigen Processed by antigen presenting cells Processed antigen+Sensitised lymphocytes Multiplication of lymphocytes Release cytokines Skin injury(inflammation,itching and rashes)
CLINICAL FEATURESMORPHOLOGY ACUTE ECZEMAo Progress from erythema to edema to papulovesiculation.o Manifest as edema in eyelids and genitalia. CHRONIC ECZEMAo Itchy lichenified plaques.
PHOTOCONTACTDERMATITIS Eczematous condition triggered by an interaction between an unharmful or less harmful substance on the skin and ultraviolet light. Distribution typically on the light exposed areas of the skin. Two types:1. Phototoxic2. Photoallergic
PHOTOTOXIC PHOTOALLERGIC Common Less CommonNon immunological TYPE IV Hypersensitivity Sunburn Eczematous
CLINICAL FEATURES Seen around discharging wounds and ulcers Presents as an area of advancing erythema sometimes with microvesicles at the edge around the lesion
DERMATOPHYTID Eczematous reaction that occurs as an allergic response to a dermatophyte infection elsewhere on the skin Most common dermatophytid is an inflammation in the hands resulting from a fungus infection of the feet.
Diagnostic criteria A proven focus of dermatophyte infection. A positive skin test to a group-specific trichophytin antigen. Absence of fungi in the dermatophytid lesion. Clearing of the dermatophytid after the eradication of the primary fungal infection.
Seborrheic dermatitis is a papulosquamous disorder patterned on the sebum-rich areas of the scalp, face, and trunk. SITES- Scalp,eyebrows,nasolabial folds,retroauriculararea presternal and interscapular regions. EPIDEMIOLOGY- Age- Onset at puberty;peaks at 40yrs. Gender- Common in males
ETIOLOGY Microbial- Overgrowth of Malassezia furfur Genetic Predisposition Immunodeficiency Associated with psoriasis and Parkinson‟s disease.
CLINICAL FEATURES INFANTILE SEBORRHEIC DERMATITIS Commonly affects within first 3 months of life; affects both sexes equally. Begins as cradle cap. Lesions comprise tiny papules covered with yellow, greasy scales; and redness in the diaper area and axillae.
CLINICAL FEATURES ADULTS Affects hairy areas; mostly men (30 to 60 years). Scalp: Earliest sign is dandruff; later followed by greasy scales and retroauricular fissuring. Face: Scaling; erythema of eyebrows, nasolabial folds; and squamous blepharitis may occur. Trunk: Papules, greasy scales, petaloid pattern. Flexural areas: Marginated erythema, greasy scaling and secondary infection.
TREATMENT Topical therapy Systemic Therapy1. Topical antifungals In extensive lesions and HIV+ve patients. Topical ketoconazole,selenium Include antibiotics and sulphide and ciclopirox. antifungal agents(fluconazole/itraco2. Topical steroids nazole) Combined with antifungal agents in flexural and exudative lesions. Combined with salicylic acid in recalcitrant lesions of scalp.
LICHEN SIMPLEXCHRONICUS Neurodermatitis. Skin disorder characterized by chronic itching and scratching
CLINICAL FEATURES Symptoms-extremely itchy MORPHOLOGY-Single/multiple lichenified plaques Lesion reappear after treatment is stopped Commonly affects adults (30 to 50 years); often in atopics SITES-Nape of neck in women,legs in men,anogenital area in both.
ETIOLOGY Scratching in predisposed individuals. Atopy.
STASIS ECZEMA Gravitational eczema/Venous eczema Refers to the skin changes that occur in the leg as a result of "stasis" or blood pooling from insufficient venous return. ETIOLOGY: Secondary to venous hypertension. Late sequel of previous deep vein thrombosis. SITE-Lower third of leg(medial malleolus)
CLINICAL FEATURES Begins with pedal edema around ankles. Over period of time,brownish pigmentation appears(punctate initially and later confluent) LIPODERMATOSCLEROSIS- Long standing case presents with ivory whitesiderotic plaques with dilated capillary loops.
Management Leg elevation; weight reduction in obese patients. Compression by regular use of firm elastic bandage or well fitting stockings. Sedative antihistamines Topical steroids. Systemic antibiotics for secondary bacterial infection.
NUMMULAR ECZEMA Discoid eczema. Name comes from the Latin word “nummus," which means "coin.“ Characterized by round or oval-shaped itchy lesions
ETIOLOGY Unknown in many case. Frequent association with atopy Reaction to bacterial antigens has been suspected. Can also be worsened by stress and caffeine, which dehydrates the body and thus the skin
PITYRIASIS ALBA Common skin condition mostly occurring in children and usually seen as dry, fine-scaled, pale patches on the face. Characterized by asymptomatic, slightly elevated, hypopigmented, scaly patches; indistinct borders.
ETIOLOGY Unknown. Public swimming pools could be a factor.
Affects children (3 to 16 years) and disappears in early adulthood; may be a manifestation of atopic dermatitis. SITES:Face, perioral area, chin and cheeks; lateral aspect of the upper arm; and thighs. Hypopigmentation appears prominent in dark skinned patients and during summer as it stands out against the tanned skin
CLINICAL FEATURES Individual lesions develop through 3 stages and sometimes are itchy: Raised and red - although the redness is often mild and not noticed by parents Raised and pale. Smooth flat pale patches.
TREATMENTManagement Self-limiting condition; hypopigmentation is not due to vitiligo. Emollients to control scaling. Sunscreens. Short course of a topical steroid for actively inflammed lesions.
ASTEATOTIC ECZEMA Eczema craquelé Form of eczema that is characterized by changes that occur when skin becomes abnormally dry, itchy, and cracked. Common in old people.
ETIOLOGY Old age. Dry skin Low humidity Hypothyroidism Malignancy
CLINICAL FEATURES Extremely itchy. Skin is dry with fine reticulate red supericial fissures
Management Advise to live in a warm room; avoid exposure to cold winds. Wear woollen clothing over the cottons, avoid direct contact with wool. Restrict bathing with very hot water; and use of soaps and detergents. Application of emollient, immediately after bathing frequently thereafter to keep the skin moisturized. Substituting aqueous cream for soap prevent recurrence.
PSORIASIS ECZEMAModerately itchy.Scratching Very itchy.Scratching resultsresults in bleeding in oozing.Well defined indurated Not so well defined and notplaques. indurated.Surmounted with silvery Scale-crust.scales.Nail changes-Typical Variable.Auspitz sign-Positive Negative
SCABIES IN INFANTS INFANTILE ECZEMABurrows PapulovesiclesOn palms and soles;genitalia Spares palms and solesFamily history-positive Positive for atopic diathesis