Eczema and Atopic dermatitis

Prof/ Rasha El Shawaf ,MD

 Eczema
Eczema is one of the
commonest skin diseases
with incidence of
15-20% of all
dermatologic diseases.
 Eczema
Acute eczema charactrized by :
a)There is lichenification, thickening of the skin, scaling,
dryness & fissuring
b)Erythema, vesicles, exudation and crusts.√
c)Less erythema,
d)Less vesicles& papules
 Eczema

Chronic eczema charactrized by :

a)There is lichenification, thickening of the skin, scaling,
dryness & fissuring√
b)Erythema, vesicles, exudation and crusts.
c)Less erythema,
d)Less vesicles& papules
 Eczema

Classification:
1- Exogenous eczema: 2- Endogenous eczema:
Contact dermatitis Atopic dermatitis.
Discoid eczema.
Seborrheic dermatitis
Pityriasis alba.

.
 Eczema

Exogenous eczema occurs in:

a) Contact dermatitis. √
b) Atopic dermatitis.
c) Discoid eczema.
d) Seborrheic dermatitis.
e) Pityriasis alba.
 Eczema
female patient 30 y presented with
this lesion after use of henni what
is your diagnosis ?
a) Irritant Contact dermatitis.
b) Allergic Contact dermatitis√
c) Atopic dermatitis.
d) Discoid eczema.
e) Seborrheic dermatitis.
 Eczema
Female patient 25 years old
presented with this lesion after
use of henna( topical cosmotic).
What is the best treatment for
such case?
a)Topical and Systemic steroid√
b) Systemic acyclovir
c)Isotretinoid
d)Systemic antifungal
 Eczema
Male patient 40 y presented with
this lesion in both hands after use
of strong acids what is your
diagnosis ?
a) Irritant Contact dermatitis. √
b) Allergic Contact dermatitis
c) Atopic dermatitis.
d) Discoid eczema.
e) Seborrheic dermatitis.
 Eczema
What is the best treatment for
such case?
a)Topical and Systemic steroid√
b) Systemic acyclovir
c)Isotretinoid
d)Systemic antifungal
 Eczema

Treatment:
1- Removal of the cause.
2- Topical steroid & emollient
3- Oral antihistamines.
4- Systemic steroids in extensive cases.
 Eczema
Treatment:
2- Topical steroid & emollient
 Eczema

Topical steroid can be used in the treatment of:

a) Scabies
b) Herpes zoster
c) Bullous impetigo
d) Contact dermatitis√
 Eczema

Classification:
1- Exogenous eczema: 2- Endogenous eczema:
Contact dermatitis Atopic dermatitis.
Discoid eczema.
Seborrheic dermatitis
Pityriasis alba.

.
 Atopic Dermatitis

Clinical picture: The cardinal symptom is pruritus.

Atopic dermatitis types according to the age group
affected:
A. Infantile atopic dermatitis.
B. Childhood atopic dermatitis.
C. Adulthood atopic dermatitis.
 Atopic Dermatitis

Diagnostic criteria of Atopic dermatitis:

1- Pruritus.
2- Personal or family history of atopy.
3- Chronic or relapsing nature.
4- Typical morphology and distribution.
 Atopic Dermatitis

The cardinal symptom of atopic dermatitis is

a) Pruritus√
b) Hair loss
c) Pityriasis alba
d) Pompholyx
 Atopic Dermatitis

Itching is a manifestation of the following

diseases EXCEPT:
a) Scabies
b)Atopic dermatitis
c) Pediculosis
d)Vitiligo√
e) Eczema
 Instructor information

▪Contact:01000364909
▪Department.Dermatology
▪Official email:Dermadrrasha@yahoo.com
▪Dr /Rasha abd elgawad El Shawaf
Urticaria, Papular urticaria

Prof/ Rasha El Shawaf ,MD

 Urticaria

1) Urticaria
2) Papular urticaria
Urticaria
 primary lesion of urticaria is:
a)wheal √
b)Papule
c) Nodule
d)comedone
 Urticaria

Physical urticaria is caused by :

a) sun, cold, water &heat. √
b) Foods(.fish, egg, strawberries)Food additives
c) Drugs e.g., Aspirin, morphine, sulfa&
penicillin
d) Neoplasms: lymphoma, leukemia & internal
malignancy.
 Urticaria
Course:
• In acute urticaria the lesions
usually disappear within a few
hours or days.

• In chronic urticaria the disease

persists for more than 6 weeks.

Spontaneous improvement may

occur even in absence of diagnosis
or treatment.
 Urticaria

In acute urticaria the disease may persists for less

than:
a) 3 weeks.
b) 6 months.
c) 1 month.
d) 6 weeks. √
 Urticaria

In chronic urticaria the disease persists for more than:

a) 3 weeks.
b) 6 months.
c) 1 month.
d) 6 weeks. √
 Treatment of urticaria by :
a) Topical &Systemic steroids√
b) Topical &Systemic antibacterial
c) Topical &Systemic antiviral
d) Topical &Systemic antifungal
Papular Urticaria (Prurigo
simplex)
Hypersensitivity to insect
bites such as fleas and
mosquitoes.
papular urticaria is caused by:
a)Foods
b)Drugs
c)Insect bites √
d)Inhalants
e)Emotional stress
Male child patient 9 y presented with
itchy small red papules 1-5mm. arise
on top of wheals or independently on
normal skin. And occurs after insect
bite reaction .what is your diagnosis:
a) Atopic dermatitis
b) Papular urticaria√
c) Erthyma multiform
d) Drug eruption
What is treatment of this case all
except ?

a) Disinfestations.
b) Oral antihistamines.
c) Short course of systemic steroids in
extensive cases.
d) Local soothing lotion or topical
steroids.
e) Topical and systemic antiviral√
 Instructor information

▪Contact:01000364909
▪Department.Dermatology
▪Official email:Dermadrrasha@yahoo.com
▪Dr /Rasha abd elgawad El Shawaf
Prof/ Rasha El Shawaf ,MD
 Psoriasis vulgaris
Elbows and knees are common sites
Most common causes of psorasis are:
a) Viral infection
b) Bacterial infection
c) Fungal infection
d) Chronic , immune-mediated disorder√
Male 32y old patient
presented with thick
adherent silvery white
scales in the trunk and
elbow what is your
diagnosis?
a) Psoriasis √
b) Lichen planus
c) Vitiligo
d) Chicken pox
Topical treatment of this case?
Topical antibiotics
Topical acyclovir
Topical antifungal
Topical steroid and salicylic acid√
Male 32y old patient
presented with thick
adherent silvery white
scales in the knee and
elbow what is your
diagnosis?
a) Psoriasis vulgaris√
b) Lichen planus
c) Vitiligo
d) Chicken pox
Topical treatment of
this case?
a)Topical antibiotics
b)Topical acyclovir
c)Topical antifungal
d)Topical steroid and
salicylic acid√
■ Examples of köbner reaction
1. Psoriasis
2. Plane wart
3. Lichen planus
4. Vitiligo
5. MC
 Kobner phenomenon in psoriasis

Psoriasis lesions at sites of trauma of scratching (kobnerization)

■ Q- Enumerate examples of köbner reaction ???
■ Answer:
1. Psoriasis
2. Plane wart
3. Lichen planus
4. Vitiligo
5. MC
Treatment of psoriasis

Topical

NbUVB-PUVA

Systemic (traditional)

Systemic (biologic therapy)

Indications of NbUVB

Psoriasis
Vitiligo

Atopic Dermatitis (AD)

 Phototherapy

1. Narrowband UVB
2. PUVA
Q-Indications of NbUVB phototherapy are
used in treatment of:
a)Acne vulgaris
b)Imptigo
c)Herpes simplex
d)Psoriasis√
 3-Systemic Treatment

■ Methotrexate
– Once weekly
– Hepatotoxic, myelotoxic.
■ Etretinate (acitretin)
– Vitamin A derivative.
– Teratogenic .
■ Cyclosporine
– Nephrotoxic .
Systemic corticosteroids are absolutely
contraindicated in psoriasis vulgaris
 Systemic corticosteroids are absolutely
contraindicated in psoriasis vulgaris:
1-True√
2-False

20
 Instructor information

▪Contact:01000364909
▪Department.Dermatology
▪Official email:Dermadrrasha@yahoo.com
▪Dr /Rasha abd elgawad El Shawaf
Prof/ Rasha El Shawaf ,MD
 Papulosquamous Diseases
1- Psoriasis.
2- Lichen planus.
3- Pityriasis rubra pilaris.( PRP)
4- pitryasis rosea
 2-Lichen Planus
LP ‫الحزاز‬

3
The surface of the
papule may show
white fine dots and
lines known as
Wickham's striae.

Violaceous papules and plaques with white scale and

Wickham striae on the dorsal foot
Wickham's striae is present in
a) Lichen planus√
b) Psorasis
c) Atopic dermatitis
d) Eczema
Positive(Koebner
phenomenon)
 ‫‪PR‬النخالة الوردية‪4-‬‬

‫‪7‬‬
 HERALD
PATCH

• It is well-defined, oval or rounded patch with a rosy-red edge

• Covered with collaret of scales.
.
Single large patch(herald patch) is present in
a) Lichen planus
b) Psorasis
c) Pitryasis rosea√
d) Acne
 Description of classic PR
■ Two types of lesion
2-Multiple small lesions:
* Similar but smaller than herald
patch
■ Inverted christmas tree
pattern distribution .
Inverted christmas tree pattern distribution
is characteristic of the following disease:
a) Lichen planus
b) Psorasis
c) Pitryasis rosea√
d) Acne
 Acne Vulgaris
Acne vulgaris is a chronic inflammatory disorder of
the pilosebaceous apparatus, characterized by
formation of comedones.
Clinical picture:
Age: adolescence of both
sexes.
Lesions: The primary lesion is
comedone (black and white
heads). Inflammatory lesions
are papules, pustules, nodules
and cysts.
Sites: face, back, chest,
shoulders.
The primary lesion of acne is :
a) Papule
b) Nodule
c) Cyst
d) comedone√
 female patient 20y old presented
with these lseions 2 months ago
what is your diagnosis?
a) Black heads of acne vulgaris√
b) White heads of acne vulgaris
c) Chicken pox
d) Impetigo
What is topical treatment of this case?
a)Topical antifungal
b)Topical antiviral
c)Topical steroid
d)Topical Retinoic acid (0.05-0.1%) √
What is primary lesion of this case?
a)Papules
b)pustules
c)wheals
d)comedon√
 female patient 20y old presented
with these lseions 2 months ago
what is your diagnosis?
a) Black heads of acne vulgaris
b) White heads of acne vulgaris
c) Impetigo
d) Inflammatory type of acne
vulgaris√
What is topical treatment of
this case?
a)Topical antifungal
b)Topical antiviral
c)Topical steroid
d) Benzoyl peroxide 5%(
Antibacterial agents) √
What is systemic treatment of this
case?
a) systemic antifungal
b) systemic antiviral
c) systemic steroid
d) Isotretinoin√
1-Topical treatment:
1- Comedonolytic agent ( Retinoic acid (0.05-0.1%)
is used in gradually increasing concentration and left
on the skin for 1-2 hours in the start of treatment,
then the duration is increased gradually until it can
be left over night. The response appears after 8
weeks. It may cause contact dermatitis.
2-Antibacterial agents:
A- Benzoyl peroxide 5% alone or
in combination with retinoic acid
is highly effective in acne. It may
cause contact dermatitis.
2-Antibacterial agents:
B- Topical antibiotics:
erythromycin, clindamycin are
effective in pustular lesions.
- Comedonolytic agent ( Retinoic acid (0.05-
0.1%) used in treatment of:
a) Imptigo
b) Leprosy
c) Scabies
d) Acne √
-Benzoyl peroxide 5%( Antibacterial agents)
used in treatment of:
a) Imptigo
b) Leprosy
c) Scabies
d) Acne√
-Topical antibiotics,erythromycin and
clindamycin used in treatment of:
a) Imptigo
b) Leprosy
c) Scabies
d) Acne √
Systemic treatment:
Systemic treatment:
A.Antibiotics:
1. Doxycycline: 100mg/day is the
antibiotic of choice in acne. This
dose is given until acne clears then
decrease the dose gradually for 6
months.
Systemic treatment:
A.Antibiotics:
2-Erythromycin: 1gm/ day with gradual
decreasing the dose to 250mg/day
It can be used in patient intolerant to
doxycycline.
Systemic treatment:
A.Antibiotics:
3- Azithromycin 500 tablet
B-Isotretinoine:
(It  sebum secretion,  P.acne. 
follicular hyperkeratosis and has
anti-inflammatory effect).
BUT Teratogenic drug with
serious side effects, so it is used
only in severe acne.
Systemic treatment:
C-Antiandrogens: used only in
females with severe
nodulocystic acne.
-Doxycycline is the antibiotic of choice in
a) Acne vulgaris√
b) Erysipelas
c) Erythrasma
d) Nonbullous impetigo
In adult male with acne, the following medications
could be used Except:
a) systemic retinoids.
b) Oral Doxycycline
c) Oral Erythromycin.
d )systemic antiandrogens. √
 Instructor information

▪Contact:01000364909
▪Department.Dermatology
▪Official email:Dermadrrasha@yahoo.com
▪Dr /Rasha abd elgawad El Shawaf
Diseases of Sebaceous Glands
Prof/ Rasha El Shawaf ,MD
 Seborrhoeic Dermatitis
common erythematous
scaling eruption that is
localized to seborrhoeic
sites.
Aetiology:Pityrosporum-
ovale(Malassezia) may play
a role.
Treatment: SD though easily
suppressed is not curable disease.
• Scalp lesion: shampoo containing
selenium sulphide, zinc pyrithione,
tar or ketoconazole.
• Skin lesions: topical imidazole& mild
steroid combination cream.
Shampoo containing selenium sulphide, zinc
pyrithione, tar or ketoconazole are used in :
a) Imptigo
b) Scabies
c) Chicken pox
d) Seborrheoic dermatitis