Pharmacotherapeutics of Eczema

1. ECZEMA
Dr. V. S. Swathi
Assistant Professor

2. DEFINITION
• It is defined as an itchy erythematous eruption consisting of ill defined erythematous
plaques or papules

3. EPIDEMIOLOGY
• In the world, atopic eczema affects 15-20% of children and 1-3% of adults
worldwide
• In India, Prevalence of eczema is ranges from 0.44 -2.8%

4. ATOPIC ECZEMA
• It is common skin disorder in childhood
• Main reasons for this are:
• Genetic factors
• Environmental factors
• Immunological factors
Characterised by:
• Chronic itchy skin
• Flexural involvement of skin creases
• Dry skin
• Presence of other atopic diseases
• Onset in first 2 years of life

5. ALLERGIC CONTACT DERMATITIS
• It is example for delayed Type IV hypersensitivity
reactions
• Symptoms rarely develops on initial exposure to stimulus
and manifests months/ years later following repeated
exposures
Allergens include:
• Metals- Nickel and cobalt
• Topical antibiotics – Neomycin
• Fragrance ingredients
• Rubber compounds
• Hair dyes
• Plant pollen
• Characterised by localised or generalised erythematous
rash
Common locations of Allergic contact dermatitis:
• Periorbital region
• Umbilicus
• Neck
• Hair line
• Hands

6. IRRITANT CONTACT DERMATITIS
• Most common form of occupational dermatitis
• It mostly affects hands
Risk factors include:
• Builders
• Hair dressers
• Gardeners
• Health care workers
• Chefs
• Irritants include:
• Detergents
• Oil
• Water
• Inorganic acids
• Alcohol
• Plastics

7. DISCOID ECZEMA
• Also known as Nummular dermatitis
• It is a form of chronic eczema
• Characterised by disseminated coin shaped eczematous lesion of the extremities
• It affects middle aged males

8. STATIS ECZEMA
• Also known as Statis dermatitis or Gravitational dermatitis or Varicose Eczema
• It occurs in chronic venous insufficiency

9. ASTEATOTIC ECZEMA
• Also known as Eczema craquele
• It affects lower legs
• Characterised by dry and cracked skin
Risk factors include:
• Increase age
• Low humidity
• Frequent bathing

10. RISK FACTORS
• Exposure to allergens
• Exposure to irritants
• Exposure to extreme temperatures
• Age
• Occupation
• Lack of moisturizing after bathing
• Co morbid conditions like:
• HIV infection
• Parkinson’s disease
• Chronic venous insuffiency

11. ETIOLOGY
• Allergens
• Irritants
• Household dust mites
• Molds
• Foods
• Chemicals
• Metals
• Water
• Extreme temperatures
• Abnormal functioning of person’s own immune system

14. CLINICAL PRESENTATION
• Xerosis
• Pruritis
• Plaques
• Vesicles
• Spongiosis
• Oozing from ruptured vesicles
• Crusting at ruptured vesicles
• Lichenification
• Hyperkeratosis
• Cradle cap
• Cracked paving
• Localised or generalised erythematous rash
• Pink yellow greasy patches with bran like appearance
• Disseminated coin shaped lesion at lower extremities

15. COMPLICATIONS
• Erythema
• Excoriation
• Skin infections
• Sleep disorders
• Depression
• Erythroderma
• Eye problems
• Asthma exacerbations

16. DIAGNOSIS
• Based upon history
• Based upon clinical presentation
• Patch test
• IgE levels

17. NON PHARMACOLOGICAL
TREATMENT
• Avoidance of exposure to risk factors
• Use of emollients
• Phototherapy
• Bandaging
• Counselling

18. TREATMENT ALGORITHM

19. DRUGS USED IN TREATMENT OF
ECZEMA
Drug Category Mode of action Dose Adverse effects
Hydrocortisone Topical
corticosteroid
Decreases
proliferation of
epidermal cells
2.5-0.5% ointment
twice daily
 Striae
 Telangiectasia
 Epidermal thinning
 Purpura
 Acne
Ketoconazole Topical shampoo Decreases count
of Pityosporum
ovale on skin
2% shampoo twice
for week for 6
weeks
 Irritation
 Hair loss
 Abnormal hair texture
 Dry skin
 Scalp pustules
Prednisolone Oral corticosteroid Controls rate of
T -Cell proliferation
20mg/day for 7
days
 Acne
 Diabetes
 Hypertension
 Osteoporosis
 Delayed wound healing

20. Cetrizine Antihistamine Sedation 5-10mg-PO-at
night
 Somnolence
 Head ache
 Fatigue
 Dry mouth
 Malaise
Tacrolimus Calcineurin
Inhibitor
Decreases
T-lymphocyte
proliferation
0.03-0.5%
ointment
 Burning sensation
 Flu like symptoms
 Skin Erythema
 Head ache
 Application site oedema
Ciclosporin Systemic immune
suppressant
Block activation
of T
lymphocytes
2.5 to
5 mg/kg/day
 Tremor
 Nephrotoxicity
 Hypertension
 Infection
 Hirsutism
Azathioprine Systemic immune
suppressant
Block activation
of T
lymphocytes
2mg/kg/day  Leukopenia
 Infection
 Lymphoma
 Alopecia

21. Methotrexate Systemic immune
suppressant
Inhibit
proliferation of T
cells and B cells
10-25mg once per
week
 Reddening of skin
 Hyperurecemia
 Glossitis
 Stomatitis
 Gingivitis
Mycophenolate
Mofetil
Systemic immune
suppressant
Inhibit
proliferation of T
cells and B cells
500mg-BD-PO  Hyperglycaemia
 Hypercholesterolemia
 Hypomagnesaemia
 Dyspnoea
 Leukopenia
Phototherapy Narrow band UVB Calms
inflammation
2/3 times per week  Burning of skin
 Premature ageing of skin
 Increase risk of skin cancer
 Photosensitivity
 Cataract

22. RESOURCES
• https://doi.org/10.1016/j.abd.2018.10.004
• https://doi.org/10.1016/j.jaad.2019.09.073
• https://sci-hub.tw/https://doi.org/10.1111/bjd.16717
• https://www.bmj.com/content/bmj/361/bmj.k1332.full.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790711/pdf/BJD-181-707.pdf