9. Eczema & dermatitis

Dermatology Power point slides
Useful, Important & Easy Way To Understand The Chapter

1. DR. BIJAY KR.YADAV Holly vision technical campus Shankhamul , Kathmandu E czema

2. Eczema ' Ekze ', in Greek means “to boil over” but it seems that the skin is “Boiling out” or “Oozing out” in eczema. Erythema, papulo -vesicles, oozing & crusting, lichenification All eczemas are dermatitis, but not all dermatitis are eczemas.

3. The “Itch / Scratch” Cycle The sensation of itch and subsequent scratching is hallmark of most eczemas itch scratch itch scratch

4. Classification Etiology Pattern/morphology Chronicity Endogenous Discoid Acute Exogenous Hyperkeratotic Chronic Combined Lichenified Seborrheic

5. Etiological Classification Eczema Exogenous Endogenous Irritant Contact Derma. Allergic Contact Derma. Photo dermatitis Infective dermatitis Atopic dermatitis Seborrheic dermatitis Nummular eczema Stasis Dermatitis Asteatotic eczema Pompholyx

6. CLASSIFICATION ON THE BASIS OF CHRONICITY Acute eczematous Sub acute eczematous Chronic eczematous Intense itching Intense erythema Oedema Papulovesicles Oozing Erythema (lesser than in acute stage) Crusting and scaling Fissuring Slight to moderate itching Stinging and burning sensation Dryness of skin Excoriation Fissuring Lichenification

7. Clinical features Acute Eczema : Erythematous & edematous plaque, which is ill-defined & surmounted by papules, vesicles, pustules & exudates that dries to form crusts scales Chronic Eczema : Lichenification – Triad of hyperpigmentation, thickening & increased markings of skin Less vesicular & exudative More scaly Flexural lesions may develop fissures

8. Complications : Dermatological : Infection Ide eruption Contact dermatitis Erythroderma Psychosocial : Anxiety Depression Social complications Wage loss Debility Social ostracism

9. Treatment General measures : Remove triggers Hydration & use of Emollients ACUTE PHASE : Topical treatment Acute Eczema of hands & feet : Soaks of potassium permanganate 0.01%, followed by application of steroid lotion or cream is best Larger areas : compresses followed by soothing agents like calamine lotion Systemic treatment Systemic steroids : used in extensive lesions & when Ide eruption develop Immunosuppressive : Azathioprine Antibiotics : used for infected lesions Antihistamines : for itching

10. Chronic phase Steroids : Topical steroids : for localized lesions – t/t of choice, for lichenified lesions, topical steroids may be combined with keratolytic agents like salicyclic acid & urea Systemic steroids : for extensive lesions like in airborne contact dermatitis Antibiotics : for bacterial infection – topical or systemic Topical immunomodulators : for their steroid sparing action

11. Atopic dermatitis It is a chronic or relapsing dermatitis usually beginning in childhood characterized by marked pruritus and rash Seen in 3% of all infant Increased between 3-6 months of age Increased worldwide incidence because of P ollutants I ndoor allergen (house dust mite ) D ecline in breast feeding

12. Etiopathogenesis : Exact cause of atopic dermatitis is unknown It is genetic predisposition ( due to excessive I.e. hypersensitivity) Increased histamine release from basophils may lead to persistent pruritus Produce IL-4 and IL-13 , which promote IgE production by B cells

13. Triggering factors Anxiety; emotional stress Temperature change and sweating Decreased humidity Excessive washing Contact with irritants Allergens Foods Microbial agents

14. Clinical features Itching : Due to - contact - trauma - T emperature changes - Psychic stress Chronic thickening of skin Dry skin Hyperlinear palm

15. Oozing , crusted, erythematous, scaly plaques on the scalp and face, sparing the diaper area. When baby begins to crawl, the extensor extremities become more involved. INFANTILE ATOPIC DERMATITIS (2m—2y)

16. CHILDHOOD ATOPIC DERMATITIS: (2-12 yrs.) Lesions become prominent on the hands, posterior neck, antecubital and popliteal fossae

17. Adult phase (12 years onwards) Commonly involves flexural areas. The disease may be diffuse or patchy. Dermatitis of the upper eyelids and blepharitis

18. Criteria for diagnosis ( Hanifin and Rajka ) Major criteria : Pruritus Typical morphology and distribution Facial and ext. involvement in infant. Flexural lichenification in adults and children. Chronic and chronically relapsing dermatitis Personal or family H/o atopy

19. Minor criteria : Cataract Cheilitis Ichthyosis Xerosis Orbital darkening Wool intolerance P. alba Dennie - Morgan fold Palmer hyperlinearity Itching when sweating

20. Management of Atopic dermatitis INVESTIGATIONS Patch test : ( Type IV hypersensitivity) Prick test : ( Type I hypersensitivity ) Bacteria & viral swabs for microscopy & culture.

21. TREATMENT First-line treatment General measures - Avoid scratching Avoid frequent use of soap, contact woollen clothes Measure to avoid house dust mite Topical treatments - Moisturizer ; Emollients; Humectants Corticosteroids Calcineurin inhibitors: Pimecrolimus ; tacrolimus

22. Oral treatment - Antihistamines Sedative antihistamines preferred Promethazine; trimeprazine ; hydroxyzine Antibiotics Systemic steroids (in severe cases)

23. 2. Second-line treatment Intensive topical therapy Wet wrap technique 3. Third-line treatment Phototherapy Oral immunosuppresants Cyclosporine Azathrioprine Thymopentin α - Interferon

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