ECZEMA

SANAULLAH SHAIKH

HOUSE OFFICER

DERMATOLOGY DEPARTMENT

INTRODUCTION• ECZEMA IS A GROUP OF SKIN

DISEASES CHARACTERIZED BY IRRITATION AND INFLAMMATION OF THE SKIN.

• ECZEMA IS A GREEK WORD MEANING ‘TO BOIL’

• SYNONYMOUS WITH DERMATITIS

• INCREDIBLY COMMON

• CAUSE UNKNOWN

• WAXING AND WANING NATURAL HISTORY

CLINICAL TYPESACUTE STAGE

ERYTHEMA

SWELLING

OOZING VESICLES

CHRONIC STAGE

LICHENIFICATION

HYPER/HYPO PIGMENTATION

EXCORIATION MARKS

SUBACUTE STAGE

FEATURES OF BOTH

HISTOLOGIC PICTURE IN ECZEMA

• IN THE ACUTE STAGE, INTERCELLULAR EPIDERMAL (SPONGIOSIS) IS MOST PROMINENT.

• IN THE SUBACUTE STAGE, SPONGIOSIS

DIMINISHES BUT (ACANTHOSIS) STARTS TO

INCREASE.

• IN THE CHRONIC STAGE ACANTHOSIS IS THE

DOMINANT FEATURE.

SIGNS & SYMPTOMS

• ITCHING. THE ITCHING CAN BE INTENSE. THE DAMAGE TO THE SKIN DURING ECZEMA IS OFTEN DUE TO SCRATCHING.

• SCALING. THE SURFACE OF THE SKIN CAN FLAKE OFF, GIVING THE SKIN A ROUGH, SCALY APPEARANCE.

• REDNESS. THE AFFECTED SKIN MAY BLEED AND APPEAR BLOTCHY.

• FLUID-FILLED BLISTERS . THESE CAN OOZE AND FORM CRUSTS.

• CRACKING. SEVERELY AFFECTED SKIN MAY DEVELOP PAINFUL, DEEP CRACKS, ALSO CALLED FISSURES.

• LICHENIFICATION

TWO MAJOR CLASSIFICATION IN ECZEMA

• ECZEMA MAY BE INDUCED BY A WIDE RANGE OF EXTERNAL AND INTERNAL FACTORS ACTING SINGLY OR IN COMBINATION. TWO MAIN CLASSIFICATION ARE:

• ENDOGENOUS ECZEMA: BASED ON AN INHERENT POTENTIALITY TO HAVE ECZEMA. NO CONTACT WITH A STIMULUS NEEDED. RECURRENT, SELF ABATING

• EXOGENOUS ECZEMA : CONTACT WITH OUTSIDE STIMULANT NEEDED. CONTACT IRRITANT AND CONTACT ALLERGIC TYPES

ATOPIC DERMATITIS CONTACT DERMATITIS

SEBORRHIC DERMATITIS

MAJOR TYPES OF ECZEMA

ENDOGENOUSECZEMA

ATOPIC DERMATITIS

• COMMONEST OF ALL FORMS

• ENDOGENOUS

• USUALLY INHERITED

• FLEXURAL IN DISTRIBUTION

• HISTORY OF ATOPIC DISEASE (ASTHMA RHINITIS ECZEMA) IN FIRST DEGREE RELATIVE

• ONSET UNDER 2 YRS

• THE CHIEF CHARACTERISTIC OF ATOPIC ECZEMA IS THE ‘ITCH’

• ELEVATED SERUM IGE LEVELS

AGGRAVATING FACTORS FOR ATOPIC DERMATITIS

• DRY SKIN

• SWEATING

• HEAT

• SEASONAL CHANGES

• INFECTIONS

• STRESS

• HARSH SOAPS, DETERGENTS, WOOL

Atopic dermatitis (AD) is a chronic, highly pruritic, eczematous skin disease that follows patients from early childhood into puberty and sometimes adulthood.

INFANTILE PHASE CHEEKS ,DORSUM OF HANDS AND FEET ARE INVOLVED

CHILDHOOD PHASE ANTECUBITAL FOSSA AND POPPLITEAL FOSSA ARE INVOLVED

ADULT PHASE DISTRIBUTION IS SIMILAR TO INFANTILE PHASE

SEBORRHOEIC ECZEMA• SEBORRHOEIC ECZEMA IS ASSOCIATED WITH

MALASSEZIA YEAST, WHICH NORMALLY LIVES ON THE SKIN.

• IT AFFECTS SEBACEOUS PRODUCING AREAS IN ADULTS

• KETOCONAZOLE COMPOUNDS, 2% SELENIUM SULPHIDE SHAMPOO ARE EFFECTIVE

• INFANTILE SEBORRHOEIC ECZEMA IS COMMON IN BABIES UNDER ONE AND INVOLVES THE SCALP, NECK AND NAPPY AREA.

• THE GREASY RASH USUALLY STARTS ON THE SCALP AS MILD DANDRUFF (SOMETIMES CALLED CRADLE CAP IN BABIES).

SEBORRHIC ECZEMA

Flaky, white to yellowish scales form on oily areas

EXOGENOUS ECZEMA

IRRITANT CONTACT DERMATITIS• CAN OCCUR IN ANY INDIVIDUAL

• REPEATED EXPOSURE TO IRRITANTS

• COMMON IN HOUSEWIVES, HAIRDRESSERS, NURSES

• COMMON SITES FOR IRRITANT CONTACT DERMATITIS ARE THE HANDS AND FACE,

• IRRITANT CONTACT DERMATITIS IS A REACTION TO FREQUENT CONTACT WITH EVERYDAY THINGS WHICH IRRITATE THE SKIN

• OCCUPATIONS AT GREATEST RISK OF DEVELOPING IRRITANT CONTACT DERMATITIS INCLUDE: CHEFS, HAIRDRESSERS, METAL WORKERS, NURSES, CLEANERS AND CONSTRUCTION WORKERS.

ALLERGIC CONTACT DERMATITIS

• OCCURS AFTER REPEATED EXPOSURE BUT ONLY IN SUSCEPTIBLE INDIVIDUALS

• ALLERGIC REACTION

• ALLERGIC CONTACT DERMATITIS IS MUCH LESS COMMON THAN IRRITANT CONTACT DERMATITIS.

• COMMON CULPRITS – NICKEL, CHROMATES, LATEX ETC

• PATCH TESTING

COMPLICATIONS

oSecondary bacterial infection

oEczema herpeticum

oLichen simplex

oHyper /hypo pigmentation

RARE FORMS OF DERMATITIS• STASIS DERMATITIS (VENOUS ECZEMA)

• ASTEATOTIC DERMATITIS

• DISCOID DERMATITIS (NUMMULAR ECZEMA)

• POMPHOLYX (DYSHYDROTIC ECZEMA)

• JUVINILE PLANTAR DERMATOSIS

HOW TO TREAT

STEP 1

counselling

STEP 2

Emollients

STEP 3

TOPICAL STERIODS

STEP 4

PHOTOTHERAPY

STEP 5

SYSTEMIC IMMUNOSUPPRESSANTS &TOPICAL IMMUNOMODULATORS

ALWAYS BE THANKFUL TO GOD FOR EVERYTHING

THANKS