ECZEMA AND DERMATITIS

1. DR. Pranami Kashyap
SRD, Deptt of Dermatology
NEIGRIHMS.
ECZEMA ANDDERMATITIS

2. ECZEMA
⚫'Ekze', in Greek means “toboil over” but it seems that theskin is
“Boiling out” or “Oozing out” in eczema.
Erythema, papulo-vesicles, oozing &crusting, lichenification
⚫All eczemas are dermatitis, but not all dermatitis are eczemas.

3. THE“ITCH/ SCRATCH” CYCLE
The sensation of itch and subsequent scratching is hallmark of most eczemas
itch
scratch
itch
scratch

4. CLASSIFICATION
Etiology Pattern/morphology Chronicity
Endogenous Discoid Acute
Exogenous Hyperkeratotic Chronic
Combined Lichenified
Seborrheic

5. ETIOLOGICAL CLASSIFICATION
Eczema
Exogenous Endogenous
•Irritant Contact Derma.
•Allergic Contact Derma.
•Photo dermatitis
•Infective dermatitis
•Atopic dermatitis
•Seborrheic dermatitis
•Nummular eczema
•Stasis Dermatitis
•Asteatotic eczema
•Pompholyx

6. CLASSIFICATIONONTHEBASISOFCHRONICITY
Acute eczematous Sub acute eczematous Chronic eczematous
⚫Intense itching
⚫Intense erythema
⚫Oedema
⚫Papulovesicles
⚫Oozing
⚫Erythema (lesser than
in acute stage)
⚫Crusting and scaling
⚫Fissuring
⚫Slight to moderate
itching
⚫Stinging and burning
sensation
⚫Dryness of skin
⚫Excoriation
⚫Fissuring
⚫Lichenification

7. CLINICALFEATURES
 AcuteEczema:
• Erythematous&edematousplaque,whichisill-defined &surmountedby
papules, vesicles, pustules &exudates that dries to form crusts
• scales
 Chronic Eczema :
• Lichenification – Triad of hyperpigmentation, thickening &increased
markings of skin
• Less vesicular &exudative
• Morescaly
• Flexural lesions may develop fissures

8. COMPLICATIONS:
1. Dermatological :
 Infection
 Ide eruption
 Contact dermatitis
 Erythroderma
2. Psychosocial :
 Anxiety
 Depression
 Social complications
 Wage loss
 Debility
 Social ostracism

9. TREATMENT
 General measures:
• Removetriggers
• Hydration&useof Emollients
ACUTEPHASE:
1. Topical treatment
 AcuteEczemaofhands&feet: Soaksofpotassiumpermanganate0.01%,followedby
applicationof steroidlotionor creamis best
 Larger areas : compresses followed by soothing agents like calaminelotion
2. Systemic treatment
 Systemic steroids : used in extensivelesions &whenIde eruption develop
 Immunosuppressive: Azathioprine
 Antibiotics : usedfor infectedlesions
 Antihistamines: for itching

10. CHRONICPHASE
1. Steroids :
 Topicalsteroids: forlocalizedlesions– t/t ofchoice,for
lichenified lesions, topical steroids may be combined with
keratolytic agents like salicyclic acid &urea
 Systemic steroids : for extensive lesions like in airborne contact
dermatitis
2. Antibiotics : for bacterial infection – topical or systemic
3. Topical immunomodulators : for their steroid sparing action

11. ATOPICDERMATITIS
It is a chronic or relapsing dermatitis usually beginning in childhood
characterized by marked pruritus and rash
⚫Seen in 3% of all infant
⚫Increased between 3-6 months of age
⚫Increased worldwide incidence because of
 Pollutants
 Indoor allergen (house dust mite )
 Decline in breast feeding

12. ETIOPATHOGENESIS:
• Exact cause of atopic dermatitis is unknown
• It is genetic predisposition ( due to excessive I.e. hypersensitivity)
• Increased histamine release from basophils maylead to persistent
pruritus
• Produce IL-4and IL-13, which promote IgEproduction by Bcells

13. Triggeringfactors
⚫Anxiety; emotional stress
⚫Temperaturechange and sweating
⚫Decreased humidity
⚫Excessive washing
⚫Contact with irritants
⚫Allergens
⚫Foods
⚫Microbial agents

14. CLINICALFEATURES
1. Itching : Due to - contact
- trauma
- Temperaturechanges
- Psychic stress
2. Chronic thickening of skin
3. Dry skin
4. Hyperlinear palm

15. Oozing, crusted, erythematous,
scaly plaques on the scalp and
face, sparing the diaper area.
When baby begins to crawl, the
extensor extremities become
more involved.
INFANTILE ATOPIC DERMATITIS (2m—2y)

16. CHILDHOOD ATOPIC DERMATITIS: (2-12 yrs.)
 Lesions become prominent on the hands, posterior
neck, antecubital and popliteal fossae

17. ADULT PHASE (12 YEARS ONWARDS)
Commonly involves flexural areas.
⚫The disease may be diffuse
or patchy.
⚫Dermatitis
of
theupper eyelids
and blepharitis

18. CRITERIAFORDIAGNOSIS(HANIFINANDRAJKA)
1. Major criteria :
 Pruritus
 Typical morphology and distribution
 Facial and ext. involvement in infant.
 Flexural lichenification in adults and children.
 Chronic and chronically relapsing dermatitis
 Personal or family H/o atopy

19. 2. Minor criteria :
 Cataract
 Cheilitis
 Ichthyosis
 Xerosis
 Orbital darkening
 Wool intolerance
 P
. alba
 Dennie- Morgan fold
 Palmer hyperlinearity
 Itching when sweating

20. MANAGEMENTOFATOPICDERMATITIS
INVESTIGATIONS
1. Patch test : ( TypeIV hypersensitivity)
2. Prick test : ( TypeI hypersensitivity )
3. Bacteria &viral swabs for microscopy &culture.

21. TREATMENT
1. First-linetreatment
General measures -
⚫Avoidscratching
⚫Avoidfrequent useof soap, contact woollen clothes
⚫Measuretoavoidhousedust mite
T
opical treatments-
◦ Moisturizer ; Emollients; Humectants
◦ Corticosteroids
◦ Calcineurin inhibitors: Pimecrolimus; tacrolimus

22.  Oral treatment -
◦ Antihistamines
🞄 Sedative antihistamines preferred
🞄 Promethazine; trimeprazine; hydroxyzine
◦ Antibiotics
◦ Systemic steroids (in severe cases)

23. 2. Second-line treatment
⚫Intensive topical therapy
⚫Wet wraptechnique
3. Third-line treatment
⚫Phototherapy
⚫Oral
immunosuppresants
◦ Cyclosporine
◦ Azathrioprine
◦ Thymopentin
◦ α- Interferon

24. CONTACT DERMATITIS
–Acuteorchronicinflammatoryreactions
to
substancesthatcomeincontactwithth
e skin.
–TwoformsofCDexist
• IritantContactDermatitis(ICD)
• AlergicContactDermatitis(ACD)

25. • Common allergen-containing products
include
• cosmetics
• Soaps
• dyes and
• jewellery.
• The most frequent sensitizers are
• fragrance
• nickel, neomycin
• formaldehyde, lanolin, and
• a host of other common environmental chemicals.

26. Contact Dermatitis
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30. TREATMENT OF CONTACT DERMATITIS
▪ Avoid the agent.
▪ Topical steroids and if severe
systemic steroids can be considered
for a short time.
▪ Antipruritics
▪ Treat the complications.

31. DISCOID ECZEMA
▪ Nummular or Microbial eczema
▪ A chronic,pruritic,inflammatory
dermatitis occuring in the form of coin-
shaped plaques.
▪ Unknown cause.
▪ Unrelated to atopic diathesis
▪ IgE levels are normal
▪ Commonly seen in the lower limbs

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35. TREATMENT OF DISCOID ECZEMA
▪ S kin hydration and application of
potent steroids with o r with o u t
antihistamines.
▪ Usualy recurs.

36. SEBORRHOEIC DERMATITIS
▪ V ery common chronic dermatosis characterized by redness
and scaling.
▪ O c c u r s i n r e g i o n s w h e r e t h e sebaceous glands are
most active.
▪ Affects 4 – 5 % of the population
M i l d e r f o r m s i n t h e s c a l p r e f e r r e d t o a s
d a n d r u f f o r p i t y r i a s i s
s i c c a . 71

37. SEBORRHOEIC DERMATITIS
▪ Cause not understood
▪ Associatedfactors:
▪ Genetics
▪ Immunosupresion
▪ Pityrosporum ovale(
Malassezia furfur)

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40. TREATMENT OF SEBORRHOEIC DERMATITIS
▪ S e l e n i u m sulfide shampoo
▪ Ketoconazole shampoo
▪ Topical steroids
▪ Systemic azoles
▪ UV radiation
▪ Recurrences and remissions are
common