Dermatitis and eczema

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

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

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

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

Atopic Eczema
• Interaction of genetics and environmental
factors results in development of atopic
eczema.
• Both IgE mediated and cell mediated
hypersensitivity reactions are involved
6

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

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

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

Diagnostic Criteria
Hanifin diagnostic criteria:
Major
– Pruritus
– Typical and age-specific changes:
– Chronic and relapsing course
– Family Hx
10

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

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
12

Atopic Eczema
• Are particularly prone to
I. Cutaneous Infections/Infestations
• Bacterial
• Viral
• Fungal
• Scabies
27

Atopic Eczema
• Are particularly prone to
II. Localized eczemas
31

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

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

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

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.
40

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
47

Contact Dermatitis
 Avoid the agent.
 Topical steroids and if severe
systemic
for a short time.
 Antipruritics
 Treat the complications. 57

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

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

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
66

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

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

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

Seborrhoeic
Dermatitis
Has two pick ages of onset:
Infancy, and Puberty
73

Selenium sulfide shampoo
Ketoconazole shampoo
Topical steroids
Systemic azoles
UV radiation
Recurrences and remissions are
common 78

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

Pityriasis Alba
 1 % Hydrocortisone ointment, is effective
 Avoid frequent washing with soap
 Self limiting conditions that disappears
with age
81

Dermatitis and eczema

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