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Eczema Dermatology by Dr.vaibhavi parmar.pptx
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- 2. • The term‘eczema’ derives from the Greek word ‘to boil’ and is synonymous with the other descriptive term, ‘dermatitis’. • Eczema describes a clinical and histological pattern, which can be acute or chronic and has several causes. • Acutely, epidermal oedema (spongiosis) and intra-epidermal vesiculation (producing multilocular blisters) predominate, whereas with chronicity there is more epidermal thickening (acanthosis). Vasodilatation and T-cell lymphocytic infiltration of the upper dermis also occur.
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- 5. Eczema reaction Acute- • Rednessand swelling, usually with ill-defined margins. • Papules, vesicles and more rarely, large blisters. • Exudation and cracking • Scaling Chronic • May show all of the above, but usually less vesicular and exudative • Lichenification, a dry leathery thickening and scratching • Fissure
- 6. Classification of eczema 1)Atopic 2) Seborrhoeic 3) Discoid 4) Irritant 5) Allergic 6) Asteatotic 7) Gravitational 8) Lichen simplex 9) Pompholyx
- 7. Atopic Eczema/Dermatitis • Atopyis a genetic predisposition to form excessive IgE, which leads to a generalised and prolonged hypersensitivity to common environmental antigenes such as pollen and house dust mite. • It found in particular families who have strongly other atopic or group of atopic individuals. Aetiology 1. Genetic factors- 86% of monozygotioc but only 21% of dizygotic twins. 2. Environmental factors- such as exposure to allergens either in utero or during childhood. Allergens like food and animal hair.
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- 9. pathogenesis • Decreased barrierfunction of skin • May allow penetration of environmental allergens through epidermis. • So cause stimulation of the immune system in susceptible individuals, precipitating an inflammatory response. • In addition, IgE autoantibody production occurs in some individuals.
- 10. Atopic Eczema- distributionand character of Rash INFANCY- • Often acute and involves the face and trunk • Frequent sparing of the napkin Area CHILDHOOD • Backs of the knees fronts of the eyebrows, wrists and ankles ADULTS • Face and trunk are involved; lichenification is common.
- 11. Diagnostic criteria ofatopic dermatitis Itchy skin and at least three of the following- • History of itch in skin creases (or cheeks if < 4yrs • History of asthma/hay fever (or in a fist-degree relative if <4 yrs • Dry skin (xeroderma) • Visible flexural eczema (cheeks,forehead,outer limbs if <4yrs) • Onset in first 2 yrs of life
- 12. Clinical feature • Thecardinal feature of atopic eczema is itch and scratching accounts for many of signs. • Widespread dryness (felt as roughness) of the skin. • The distribution and character of rash varie with age.
- 13. Complication SUPERINFECTION- Bacterial • Staphy.aureus Viral •Herpes simplex virus causes a widespread severe eruption- eczema herpaticum • Papiloma virus and molluscum contagiousum IRRITANT REACTION • Defective barrier function Sleep disturbance • Loss of schooling and behavioural difficulities Food allergy • Eggs, cow’s milk,protein,fish,wheat and soya may cause and immediate urticarial eruption rather than exacerbation of eczema.
- 14. Seborrhoeic eczema • Thisis characterised by Red scaly rash and classically affects the scalp(dandruff), central face, nasolabial folds, eyebrows and centeral chest. • It is due to pityrosporum ovale infection of skin. • when severe ,it may resemble psoriasis. • Seborrhoeic eczema is feature of AIDS in which case it can be very severe.
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- 16. Discoid eczema • Thiscommon form of eczema is recognised from discrete coin shaped eczematous lesions, particularly on the limbs of young and elderly men. • It can occur in children with atopic eczema and may be difficult to treat.
- 17. Irritant eczema • Strongirritants elicit an acute reaction at the site of contact, whereas weak irritants most often cause chronic eczema, especially of the hands after prolonged exposure. • Detergents, alkalis , acids, solvents and abrasive dusts are common causes . • There is a wide range of susceptibility to weak irritants . • Irritant eczema accounts for the majority of occupational cases and work loss. • The elderly those with fair and dry skin and those with an atopic background are especially vulnerable.
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- 19. Allergic contact eczema •This is due to delayed hypersensitivity reaction following contact with antigens or haptens . • Previous exposure to the allergens is required for sensitisation and the reaction is specific to the allergens or closely related chemicals.
- 20. Common allergens Common AllergenPresent in Nickle Dichromate Rubber chemicals Colophony Paraphenylenediamine Basam of Peru Neomycin, benzocaine Parabens Wool alchols Epoxy resin Jewellery, jean studs, bra clips cement.,leather,matches Clothing,shoes,tyres Sticking plaster, collodin Hair dye, clothing Perfumes, citrus fruits Topical applications Preservative in cosmetics and creams Lanolin, cosmetics, creams Resin adhesives
- 21. • The eczemareaction occurs wherever the allergen is in contact with skin and sensitisation persists indefinitely. • It is important to determine the original site of the rash before secondary spread obscures the picture, as this often provides the best clue to the allergens. • There are many easily recognisable patterns, e.g. eczema of the hands and wrists due to rubber gloves. • Oedema of the lax skin of the eyelids and genitalia is a frequent concomitant of allergic contact eczema.
- 22. Asteatotic eczema • Thisis frequently seen in hospitalised elderly, especially when the skin is dry; low humidity caused by central heating , over washing and diuretics are contributery factors. It occurs most often on the lower legs as a rippled or crazy paving pattern of fine fissuring on a erythematous background.
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- 24. Gravitational (stasis) eczema •This occur on the lower legs and is often associated with signs of venous insufficiency: oedema , red or bluish discoloration, loss of hair induration ,haemosidering pigmentation and ulceration
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- 26. Lichen simplex • Thedescribed a plaque of lichenified eczema due to repeated rubbing or scratching as a habbit or in response to stress . • Common sites include the nape of the neck, the lower legs and the anogenital area .
- 27. Pompholyx • Reccurent vesicaland bullae occurs on the palms, palmer surface of the fingers and soles and are excruciatingly itchy. • This form of eczema can occur in atopic eczema and in irritant and contact allergic dermatitis. • It can be provoked by heat, stress and nickel ingetion in a nickel sensitive patient but is often idiopathic.
- 28. Investigation of eczema •Patch tests are performed in suspected cases of contact allergic dermatitis. • Prick test or IgE in specific IgE test are occassionally performed to support the diagnosis of atopic eczema and to determine specific environmentant allergens . • Bacterial and viral swab for microscopy and culture in suspected secondary infection. • Bacteria are inveriabely present but antibacterial treatment should be reserve for those cases with avidence of clinical infection.
- 29. General management ofeczema • Successful management of dermatitis requires a multipronged approach. Apart from the specific therapy, appropriate general measures are very helpful in treating the eczemas. • Identification of any offending allergen, irritant or triggering factor is very important. Adequate measures to avoid the offenders may help in treating the dermatitis. • Eczemas like atopic dermatitis and asteatotic dermatitis are associated with dry skin and hence increased susceptibility to irritants. Maintaining proper hydration of the skin is important in treating dry eczema.
- 30. Topical Treatment • Wetcompresses with a solution of either potassium permanganate (0.01%/light pink colour) or aluminium sulphate (0.65%) followed by application of steroid lotion/cream is best in the oozing stage of eczema. These compresses help by suppressing inflammation, removal of crusts, have antibacterial action and cause drying of the lesions. • In the subacute stage, wet compresses should be discontinued and only mid-potency topical steroid cream can be prescribed. • Chronic eczema requires potent steroid in ointment base for topical application. In lichenified lesions, a topical steroid can be combined with keratolytic agents like salicylic acid or urea. • For secondary bacterial infection a topical antibiotic can be combined with a steroid.
- 31. Systemic Treatment • Ashort course of systemic steroids may be needed for extensive lesions and when an irritant dermatitis eruption (spread of an acute inflammatory dermatitis to distant sites is termed irritant dermatitis eruption or autosensitisation) develops in acute eczema. • Systemic antibiotics are required for infected lesions. • Oral antihistamines may be prescribed, as and when required
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