This document discusses various types of dermatitis and eczema. It begins with an introduction noting that dermatitis and eczema refer to inflammation of the skin. Eczema progresses through acute, subacute, and chronic stages. Prevalence in the US is 10-12% in children and 0.9% in adults, rising internationally. Atopic eczema is a chronic pruritic inflammation affecting the epidermis and dermis, commonly presenting in infants and children. Contact dermatitis results from allergic or irritant reactions to substances touching the skin. Other conditions discussed include lichen simplex chronicus, discoid eczema, seborrhoeic dermatitis, and

1. Dermatiti
s anD
eczema
1

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 2

3. Epidemiology
Prevalence
– In the US:
– 10-12% in children
– 0.9% in adults.
– Internationally: as high as 18% and is rising,
especially in developed countries.
Race, Age, Sex, Income
3

4. Atopic Eczema
• Acute, subacute, but usually chronic pruritic
inflammation of the epidermis and dermis
• It affects 5-10% of children below 5 years
– 60 % of patients present by first year;
– 30 % are seen for the first time by age 5, and
– only 10 % develop AD between 6 and 20 years of
age
4

5. Atopic Eczema
• Patients with AD:
–30% develop asthma
–35% have Allergic Rhinitis.
5

6. Atopic Eczema
• Interaction of genetics and environmental
factors results in development of atopic
eczema.
• Both IgE mediated and cell mediated
hypersensitivity reactions are involved
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7. Atopic Eczema
• Pruritus is the sine qua non of atopic
dermatitis.
• There is no fever or other constitutional
symptoms.
• Lichenification because of repeated scratching
is commonly seen.
• Other atopic diathesis may present at the same
time.
• Sparing of the diaper area is more common in
7

8. Atopic Eczema
Has three phases:
I. Infantile AD
– tends to primarily involve the face, scalp and torso.
II. Childhood AD
– involves the extensor extremities
III. Adulthood AD
– Flexural surface
– More generalized… 8

9. Atopic Eczema
• The exact cause of the condition is UK:
– Most patients have
• marked xerosis and
• inability to retain moisture in the skin.
• Environmental triggers
– heat, humidity, detergents/soaps;
– abrasive clothing, chemicals, and smoke and stress
9

10. Diagnostic Criteria
Hanifin diagnostic criteria:
Major
– Pruritus
– Typical and age-specific changes:
– Chronic and relapsing course
– Family Hx
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11. Diagnostic Criteria
Hanifin diagnostic criteria:
Minor
– Early age of onset
– Atopy (IgE reactivity)
– Xerosis
– Keratosis pilaris/ichthyosis/palmar hyperlinearity
– Atypical vascular responses
– Perifollicular changes
– Ocular/periorbital changes
– Perioral/periauricular lesions
Diagnosis 11

12. Atopic Eczema
The presence of the 1 major and at least 3 minor
features is diagnostic of AD
– Major Feature
• An itchy skin condition
– Minor Features:
• Onset below age 2 years
• History of skin crease involvement
• History of a generally dry skin
• Personal history of other atopic disease
• Visible flexural dermatitis
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14. Atopic Eczema
•
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27. Atopic Eczema
• Are particularly prone to
I. Cutaneous Infections/Infestations
• Bacterial
• Viral
• Fungal
• Scabies
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31. Atopic Eczema
• Are particularly prone to
II. Localized eczemas
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37. Management
Eduacation on prophylactic
measures
Bathing and soaps
 Recommend non-soap cleansers such as Cetaphil or
moisturizing soaps such as Dove.
Clothing,
Emollients
 Ichthammol and coal tar,
 Make sure a humid household environment is
37

38. Management
 Topical Corticosteroids,
 Antihistamines, ???
 Antibiotics
 Topical immuno-modulators
 Tacrolimus ointment 0.03%, 0.1% bid.
OR
 Pimecrolimus 1% cream bid.
Long term prognosis generally good
38

39. Contact Dermatitis [ CD ]
–Acute or chronic inflammatory reactions to
substances that come in contact with the
skin.
–Two forms of CD exist
• Irritant Contact Dermatitis (ICD)
• Allergic Contact Dermatitis (ACD)
39

40. Contact Dermatitis [ CD ]
• Common allergen-containing products include
• cosmetics
• Soaps
• dyes and
• jewelry.
• The most frequent sensitizers are
• fragrance
• nickel, neomycin
• formaldehyde, lanolin, and
• a host of other common environmental chemicals.
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41. Contact Dermatitis
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47. The distribution of the rash should drive the
examiner's history to possible allergen exposures.
• Facial distributions
– suggest a personal skin care product.
• Ear lobes
– suggest nickel allergy from earrings.
• Hand dermatitis
– should provoke questions regarding
• occupation, hobbies, and habits
• especially those working in hair or nail salons
• There are photo-dependent allergic reactions
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57. Contact Dermatitis
 Avoid the agent.
 Topical steroids and if severe
systemic
for a short time.
 Antipruritics
 Treat the complications. 57

58. Lichen Simplex Chronicus
Thickening of the skin with variable
scaling that arises secondary to
repetitive scratching or rubbing.
It is not a primary process.
occur mainly at the nuchal area. 58

59. Lichen Simplex
Chronicus
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65. Lichen Simplex Chronicus
 Break the itch-scratch-itch cycle with
 Antihistamines
 Potent topical steroids and
 Treat lichenification with keratolytics
 Advice patients not to scratch the
area
 Trim nails 65

66. Discoid Eczema
 Nummular or Microbial 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
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70. Discoid Eczema
 Skin hydration and application of
potent steroid with or with out
antihistamines.
 Usually recurs.
70

71. Seborrhoeic Dermatitis
 Very common chronic dermatosis
characterized by redness and scaling.
 Occurs in regions where the sebaceous
glands are most active.
 Affects 4 – 5 % of the population
 Mild form in the scalp is Called
dandruff 71

72. Seborrhoeic Dermatitis
 Cause not fully inderstood
 Associated factors:
Genetics
Immunosupression
Pityrosporon ovale
72

73. Seborrhoeic
Dermatitis
Has two pick ages of onset:
Infancy, and Puberty
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78. Seborrhoeic Dermatitis
Selenium sulfide shampoo
Ketoconazole shampoo
Topical steroids
Systemic azoles
UV radiation
Recurrences and remissions are
common 78

79. Pityriasis Alba
 A common disfiguring hypomelanosis of
the face presenting as
 White area (alba)
 Mild scaling (pityriasis)
 Cause is not known
 Atopic state may be present:
 A forerunner of AD 79

80. Pityriasis Alba
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81. Pityriasis Alba
 1 % Hydrocortisone ointment, is effective
 Avoid frequent washing with soap
 Self limiting conditions that disappears
with age
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86. Exercise
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105. Discoid Eczema
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