Eczema is one of those chronic relapsing conditions that one has to live with and with its majorly early onset, it is important to diagnose it early in order to improve one's quality of life.

1. 7/28/2022 1
By Yvonne N.
Nyatundo

2.  Definition:
 A non specific inflammation of
the skin in response to a
variety of external and internal
factors .
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3.  Different types of eczema may be recognized
either by
 Morphology
◦ Acute _ edema, vesicle, erythema
◦ Chronic _dryness, lichenification
 Site

 Cause
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4. Exogenous eczema
Due to external contact
agent
Endogenous eczema
Due to internal factors
1. Contact dermatitis
2. Napkin dermatitis
1. Atopic dermatitis
2. Seborrheic eczema
3. Discoid eczema
4. Pityriasis alba
5. Stasis eczema
“varicose”
6. Asteotetic eczema
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5.  This is caused by contact of the skin with
either an:
◦ Irritant contact
◦ Allergic contact
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6.  It is manifestation of delayed “cell
mediated” hypersensitivity type IV
 Result from exposure of sensitized
individuals to contact allergens
“sensitizers”
 Acute- pruritic papules and vesicles
on an erythematous base. Lichenified
pruritic plaques indicate chronic
allergic contact dermatitis. 7/28/2022 6

7. The most common allergen
Nickel:_ ”commonest contact allergen” metal contact
jewelers- scissors- instrument
Chromate:_ ”cement”
Cobalt_: ”paint_ ink”
Rubber _”tires_ boots shoes _belts _condoms _gloves_latex
Paraphenyle diamine_:
Hair dye
Clothing dye
Plants: poison ivy- garlic
Medicament :
Chlormaphenicol
Local anesthetic
Neomycin
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8. Investigation in allergic contact
dermatitis:
 Patch test
 Repeat open application test (ROAT)
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9. Treatment
 Avoid irritants
 Topical steroid
 Topical IMNs - contact eyelid dermatitis
 Emollients (eg, white petrolatum, Eucerin)
may be beneficial in chronic cases.
 Sedating oral antihistamines may help
diminish pruritus via a central effect.
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10.  Irritant contact
 Deff.
 It is a non allergic reaction of the skin
 Occurring in all individuals
 Caused by exposure to irritating substances
◦ Chemicals :
 Acids
 Alkalis
◦ Solvent
◦ Detergents
◦ Water
Note: Individuals with a history of atopic dermatitis are more
susceptible to irritant contact dermatitis.
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13. Atopic eczema
 a chronic, pruritic inflammatory skin condition that
typically affects the face (cheeks), neck, arms, and
legs but usually spares the groin and axillary regions.
 starts in early infancy <5yrs, but also affects Adults
 It is a chronic relapsing skin disorder
 Characterized by:
- marked pruritus
-rubbing scratching
-leads to lichenification
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14.  Pruritus
 Early age of onset
 Family history
 igE reactivity
 Peripheral eosinophilia
 Staph aureus superinfection
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15.  Associated with personal or family history of
◦ AD
◦ Br Asthma
◦ hay fever (allergic rhinitis)
◦ food allergy
 IgE levels.
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17.  Clinically there are 3 phases
◦ Infantile AD
◦ Childhood
◦ Adult hood
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18. ◦ Infantile AD
 Lesions most frequently start on the face (mainly the cheeks)
 But may occur any where on the skin surface
 Erythema, oozing, and crusting are characteristics
 Secondary infection and lymph-adenopathy are common
 Child is irritable with poor sleep
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21. 2-child hood AD
 Characteristic sites :-
◦ Antecubital
◦ Popliteal fossa
◦ Side of necks
◦ Wrist and ankles
 Less vesicular
 Papules tend to be replaced by lichenification
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24. 3-adulthood AD
 Chronic, lichenified, dry plaques
 May be ,
◦ Localized to one area
◦ Or disseminated
◦ Scabies
R: Emollients
Topical steroids
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25.  CBC -? Atopic pattern
 Skin swab
 Allergy and radioallergosorbent testing is of
little value
 Biopsy shows an acute, subacute, or chronic
spongiotic dermatitis pattern that is
nonspecific but can be helpful to rule out
other conditions (eg, cutaneous T-cell
lymphoma)
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26.  Potential trigger factors should be identified,
including irritants (eg, soaps and detergents),
skin infections, contact allergens, food allergens,
and inhalant allergens.
 Food allergy should be considered in children
with eczema in whom immediate symptoms
developed after they ingest a certain food. Food
allergy should also be considered in infants and
young children in whom moderate or severe
uncontrolled eczema persists despite optimum
management, particularly if there is associated
gut dysmotility (colic, vomiting, or changes in
bowel habits) or failure to thrive
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27.  Manage flares -seasonal changes, stress,
activity, staphylococcal infection, or contact
allergy.
 Mainstay – topical steroids
 Moisturizers – emulsifying oil
 Frequent baths with the addition of
emulsifying oils (1 capful added to lukewarm
bath water) for 5-10 minutes hydrate the
skin. The oil keeps the water on the skin and
prevents evaporation to the outside
environment. – 3xa day
 Do not dry after bathing
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28.  Initial therapy consists of hydrocortisone 1%
powder in an ointment base applied 2 times
daily to lesions on the face and in the folds.
 A midstrength steroid ointment
(triamcinolone or betamethasone valerate) is
applied 2 times daily to lesions on the trunk
until the eczematous lesions clear.
 Steroids are discontinued when lesions
disappear and are resumed when new
patches arise.
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29.  Tacrolimus is an ointment and is indicated for
moderate-to-severe AD.
 It is indicated for children older than 2 years.
 available in 2 strengths, 0.1% for adults and
0.03% for children
 Apply on dry skin to minimize burning
sensation.
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30.  Superinfection with S aureus may require
topical and/or systemic antibiotic treatment
with antistaphylococcal agents.
 Superinfection with herpes simplex virus,
referred to as eczema herpeticum, can
require admission for systemic treatment
with acyclovir and evaluation of other
complications such as herpes keratitis.
 https://www.contemporarypediatrics.com/vie
w/eczema-herpeticum
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32.  It is
◦ a chronic
◦ Scaly
◦ Inflammatory eruption
 Usually affects seborrhoeic areas
◦ Scalp
◦ Face –
 paranasal area
 eye brows
 external ears
◦ Upper trunk
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33.  Lesions are :-
 Covered with fine scaly
 Red
 Often well demarcated
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34.  Scalp psoriasis:
(well demarcated) in psoriasis
 SLE, systemic lupus erythematosis:
(affect malar areas not paranasal).
R
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35. Discoid eczema (nummular)
 Coined shaped or nummular eczematous patches
 Sites:
 Usually
◦ On the back of hands
◦ Extensor of the forearms, or legs
 Guttate psoriasis:
◦ (Lesions smaller)
 Tinea corporis:
◦ Usually no vesicles
◦ Distinct borders
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36.  Is a common acquired hypo-melanosis
 Characterized by:-
◦ Poorly circumscribed
◦ Fine scaly macules
 Site:
◦ face
◦ Sometimes ,trunk and arms
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37.  Tinea versicolor
 Post inflammatory hypo-pigmentation
 Vitiligo
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38.  Eczema secondary to venous hypertension
 Site:
◦ Lower leg (inner aspect)
 Pigmentation (hemosiderine deposition)
 Atrophy
 Oedema
 Purpura
Stasis eczema
|(Varicose eczema, Gravitation eczema)
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40. Asteotatic Eczema
 Eczema caused by excessive loss of skin lipid
 Occurs specially in elderly
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41.  Thank you.
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