2. ECZEMA
▪ Greek term “To boil over”
▪ Usually refers to severely inflamed dermatitis,
and the signs and symptoms associated with
such an acute process (itching, sting, burning of
the skin with drainage from lesions)
3. Cause
▪ The cause of eczema is unknown but is presumed
to be a combination of genetic and environmental
factors.
▪ The failure of the body to metabolize linoleic acid
into y-linoleic acid (GLA) may be a cause of
eczema, and administration of GLAs has been
demonstrated to alleviate symptoms. Eczema may
be in some cases caused by an inherited
abnormality of essential fatty acid metabolism.
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7. Distribution
▪ In infants, the face is often affected first, then the
hands and feet; dry red patches may appear all
over the body.
▪ In older children, the skin folds are most often
affected, especially the elbow creases and behind
the knees.
▪ In adults, the face and hands are more likely to be
involved.
9. Pathophysiology
▪ There are two phases
Acute phase
Chronic phase
▪ In acute stage, fluid escapes from dialated dermal
blood vessels to produce edema in epidermis
▪ This collects into tiny vesicles or blisters, particularly
where the skin is thick, as on the palms and soles.These
vesicles coleasce into larger blisters.
▪ Where the skin is thinner they lead to rupture onto the
skin surface, causing exudation, and crusting.
10. ▪ The chronic stage shows less edema and
vesiculation and more thickening of the epidermis
and horny layers, produced by prolonged rubbing
and scratching by the sufferer.
▪ Both stages are accompanied by a heavy
inflammatory cell infilteration of dermis and
epidermis
11. Acute eczema
▪ It is cherecterized by progression through number
of diseases
¥ Red, hot, swollen and itchy skin
¥ Papules and tiny blisters
¥ Exudation and crusting
¥ scaling
blistering
12. Chronic eczema
▪ In addition to features listed in acute
eczema, chronic eczema may show
¥ Drier skin, becoming more scaly
¥ Lichenification
¥ Painful fissures
13.
14. MainTypes Of Dermatitis:
Atopic dermatitis
▪ Atopic dermatitis (AD) is a chronic, highly
pruritic, eczematous skin disease that follows
patients from early childhood into puberty and
sometimes adulthood.
▪ This allergic disease is believed to have a
hereditary component and often runs in families
whose members also have asthma or hay fever.
▪ Itchy rash is particularly noticeable on head and
scalp, neck, inside of elbows, behind knees, and
buttocks. It is very common in developed
countries, and rising.
15.
16. ATOPIC DERMATITIS:
SIGNS AND SYMPTOMS
▪ Pruritus (itching)
▪ Dry, scaly skin
▪ Crusted rashes on
face, scalp, hands, arms feet or
legs
▪ Small bumps that open and weep
when scratched
▪ Redness and swelling of the skin
▪ Thickening of the skin (with
chronic dermatitis)
17. Exacerbating factors
▪ Anxiety/stress
▪ Climatic factors
▪ Temperature
▪ Humidity
▪ Irritants
▪ Detergents/solvents
▪ Wool or other rough material
▪ Perspiration
▪ Allergens (contact, inhalant & food)
▪ Infections (staph and strep)
18. CONTACT DERMATITIS
▪ Two types of CD exist
¥ In the first the rash is caused by an allergen to an
external substance( cell mediated immune or type
IV reaction)
¥ In the second, the cause is caused by wear and tear
and irritation.
¥ It accounts for 30% of all occupational disease
20. COMMON ALLERGENS
▪ Nickel Jewelry
▪ Benzocaine anesthetics
▪ Fragrance perfumes, personal care products
▪ Mercaptomix rubber gloves
▪ Black rubber mix rubber gloves
▪ PPD black hair dye
▪ Potassium dichromate leather, spackling, detergents
▪ Cinammic aldehyde fragrance, toothpaste
▪ Quaternium 15 preservative in personal care products
21. IRRITANT CONTACT DEMATITIS
▪ Non-immunologic inflammatory reaction of the
skin due to an external agent
▪ It is commonly seen in housewifes, nurses,
hairdressers, caterers, and those who work with oil
and grease in industries
22. COMMON IRRITANTS
¥ Water
¥ Skin cleansers
¥ Industrial cleaning agents
¥ Acids and alkalis
¥ Oils and organic solvents
¥ Oxidizing and reducing agents
¥ Plants
¥ Animal products
23.
24. Xerotic eczema
▪ Also known as asteatotic eczema
▪ This means ‘lacking in oil ‘ and is typically found in
elderly, in whom skin becomes over dry, perhaps
aggravated by the use of soap.
25. SEBORRHOEIC ECZEMA
▪ It is a condition sometimes classified as a form of
eczema that is closely related to dandruff.
▪ It causes dry or greasy peeling of the
scalp, eyebrows, and face, and sometimes trunk.
▪ The condition is harmless except in severe cases of
cradle cap.
▪ In newborns it causes a thick, yellow crusty scalp rash
called cradle cap, which seems related to lack
of biotin and is often curable.
26. Vesicular palmoplantar dermatitis
▪ Also known as dyshidrosis, only occurs on
palms, soles, and sides of fingers and toes.
▪ Tiny opaque bumps called vesicles, thickening, and
cracks are accompanied by itching, which gets
worse at night.
▪ A common type of hand eczema, it worsens in
warm weather
27. Discoid eczema
▪ Discoid eczema is characterized by round spots of
oozing or dry rash, with clear boundaries, often on
lower legs. It is usually worse in winter. Cause is
unknown, and the condition tends to come and go
28. Venous eczema
▪ Venous eczema occurs in people with impaired
circulation, varicose veins and edema, and is
particularly common in the ankle area of people
over 50.
▪ There is redness, scaling, darkening of the skin and
itching.
▪ The disorder predisposes to leg ulcers.
32. Moisturizers
▪ Moisturizers or emollients including bath oils, soap substitutes can
be applied to the dermatitis as frequently as required to relieve
itching, scaling and dryness.
▪ Emollients should also be used on the unaffected skin to reduce
dryness.
▪ Emollient therapy helps to restore one of the skin's most important
functions, which is to form a barrier to prevent bacteria and viruses
getting into the body and therefore help to prevent a rash
becoming infected.
▪ MoistureTrapping effectiveness
▪ Best:Oils (e.g. Petroleum Jelly)
▪ Moderate: Creams
▪ Least: Lotions
▪ Apply emollients after bathing and times when the skin is
unusually dry (e.g. winter months).
33. Topical Immunomodulators(calcineurin
ihibitors)
▪ Topical immunomodulators (TIMs) are a new type of
non-steroidal anti-inflammatory drug for the treatment
of eczema.
▪ Mild burning sensations have been reported when
applyingTIMs.
▪ Apply a thin layer of tacrolimus ointment to affected
skin areas twice daily rub in gently and completely.
Treatment should be continued for one week after
clearing sign and symptoms. Should not be used with
occlusive dressing.
▪ e.g.Tacrolimus ointment ( 0.03% & 0.1%). &
Pimecrolimus cream ( 1%)
34. Corticosteroids
▪ According to their duration of action are classified
into:
▪ Short to medium acting: e.g.Hydrocortisone
butyrate 0.1% cream apply thinly 1-2 times daily.
▪ Intermediate acting: e.g.Triamcinolone 0.1%
ointment apply thinly 1-2 times daily.
▪ Long acting : e.g. Betamethasone (as valerate)
0.1% cream apply thinly 1-2 times daily.
▪ Severe cases may be treated with oral
corticosteroids.
35. ▪ Adverse effects
▪ an increase in appetite, weight gain, insomnia,
fluid retention mood changes, such as feeling
irritable, or anxious, osteoporosis, hypertension
(high blood pressure), diabetes, weight gain,
increased vulnerability to infection, cataracts and
glaucoma (eye disorders), thinning of the skin,
bruising easily muscle weakness.
36. Antibiotics
▪ Damaged skin is susceptible to bacterial infection.
People living with eczema tend to develop more skin
infections than others. Antibiotics, topical or oral, may
be required to treat eczema.
▪ Clindamycin dosage and application: Clindamycin
Topical solution(50ml) Each ml contains : 10 mg of
clindamycin Squeeze few drops of the solution on a
small piece of cotton or face pad and apply to affected
area twice daily after cleaning the skin with soap and
rinsing well with water.
▪ Gentamicin Sulfate Cream Each gram contains: 3mg of
gentamicin supplied in 30 gram tubes, a small amount
of gentamicin sulfate cream should be applied gently to
the lesions three or four times daily . If necessary this
may be covered with a dressing.
37. Antifungal agents
▪ Antifungal agents - Indicated for suspected
candidiasis or proven candidal infection by a
medical practitioner.
▪ Commonly used topical antifungal agents are
nystatin cream or ointment and econazole nitrate
cream .
▪ Dosage and Administeration: Nystatin cream-
ointment. Each gram contain: 100,000 units
Nystatin. Supply in atube of 15 gm Apply 2-4 times
daily .
38. Antihistamines
▪ Antihistamines are occasionally prescribed to
control itching and help the eczema sufferer sleep.
▪ Their effectiveness as anti-itch medication is
limited, however, as histamines are not important
components of eczema-associated itching.
▪ Sedating antihistamines such as promethazine
(Phenergan) diphenhydramine (Benadry) are more
effective at relieving itch than the newer,
nonsedating antihistamines.
▪ Dosage and Administration: Diphenhydramine 25-
50 mgTwo times daily or at night.
39. Immunosuppressants
▪ When eczema is severe and does not respond to other
forms of treatment, immunosuppressant drugs are
sometimes prescribed.
▪ These dampen the immune system and can result in
dramatic improvements to the patient's eczema.
▪ E.g. cyclosporin , azathioprine and methotrexate
▪ Dosage and Administration: Methotrexate 2.5mg
tablet. Should be taken 1 hr before or 1-2 hrs after
meal. Generally 7.5-16 mg in a week not exceed 20 mg.
If not effective after 8 weeks with the maximum dose
should discontinued.
▪ ADR: Bone marrow depression Hepatotoxic Hair loss
Skin rash Mouth sore
40. Coal tar
▪ Coal tar- has been used to treat the itching and
inflammation caused by skin conditions for
hundreds of years.
▪ The tar contains chemicals that soothe the skin.
Coal tar is very sticky and messy.
▪ Tar creams and ointments are usually used to treat
discoid eczema which is often resistant to topical
steroids
▪ ADR: photosensitivity, acneform eruptions, etc
41. Phototherapy
▪ It involves the use of light to treat a medical
condition. Ultraviolet light therapy improves
eczema symptoms in some people.
▪ Phototherapy may only use ultraviolet light, or
may combine the use of ultraviolet light with
psoralen , a rug that increases light sensitivity.
▪ PUVA or UVB
▪ ADR:
erythema, blisreing, nausea, lethargy, pruritus
42. ▪ Chinese herbal medicine
Some Chinese herbal preparations contain prescription
medications, including prednisone, and have been associated
with cardiac and liver problems.
▪ Bleach baths-A randomized, investigator-blinded, placebo-
controlled trial including 31 patients showed that intranasal
mupirocin ointment and diluted bleach (sodium
hypochlorite) baths improved atopic dermatitis symptoms in
patients with clinical signs of secondary bacterial infection.
43. Dermatologists recommend the
following for soap use:
• Avoid harsh detergents or drying soaps
• Choose a soap that has an oil or fat base; a "super
fatted" soap is best
• Use an unscented soap
• Patch test your soap choice, by using it only on a
chosen area until you are sure of its results
• Use a non-soap based cleanser
• Bathe in warm water — not hot
• Use soap sparingly
• Avoid using washcloths, sponges, or loofahs
• Use soap only on areas where it is necessary
• Soap up only at the very end of the bath
• Use a fragrance free barrier type moisturizer such as
vaseline or aquaphor before drying off
• Never use any kind of lotion, soap, or fragrance unless
doctor recommended or allergen free
• Don’t rub skin, it removes the natural oils and
moisture
