dermatitis and eczema

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Page 1: Dermatitis and eczema

Dermatitis and eczema

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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

•Endogenous, or exogenous2

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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

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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

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Atopic Eczema

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

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Atopic Eczema

• Interaction of genetics and environmental factors results in development of atopic eczema.

• Both IgE mediated and cell mediated hypersensitivity reactions are involved

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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 AD.

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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…

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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

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Diagnostic CriteriaHanifin diagnostic criteria:

Major– Pruritus

– Typical and age-specific changes:

– Chronic and relapsing course

– Family Hx10

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Diagnostic CriteriaHanifin 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

Diagnosis11

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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

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Atopic Eczema

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Atopic Eczema

• Are particularly prone to

I. Cutaneous Infections/Infestations• Bacterial• Viral• Fungal• Scabies

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Atopic Eczema

• Are particularly prone to

II. Localized eczemas

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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 maintained. 37

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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

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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)

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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.

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Contact Dermatitis

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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 reactions47

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Contact Dermatitis

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

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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.

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Lichen Simplex Chronicus

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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

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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

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Discoid Eczema

Skin hydration and application of potent steroid with or with out antihistamines.

Usually recurs.70

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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 Up to 20% of population affected71

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Seborrhoeic Dermatitis

Cause not fully inderstood

Associated factors:GeneticsImmunosupressionPityrosporon ovale

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Seborrhoeic Dermatitis

Has two pick ages of onset: Infancy, and Puberty

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Seborrhoeic Dermatitis

Selenium sulfide shampooKetoconazole shampooTopical steroidsSystemic azolesUV radiationRecurrences and remissions are common

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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

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Pityriasis Alba

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Pityriasis Alba

1 % Hydrocortisone ointment, is effective

Avoid frequent washing with soap

Self limiting conditions that disappears with age 81

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Exercise

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Discoid Eczema

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