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ECZEMA
ECZEMA
ECZEMA
OUTLINES
1.
2.
3.
4.
DEFINITION
Eczema
in fl a m m a tor y epiderm a l r a sh,
acute or chronic,
characterized by vesicles (acute
stage), redness, weeping, oozing,
crusting, scaling and itch.
Eczema and dermatitis are synonymous.
PATHOPHYSIOLOGY
Hyperproliferation causes
epidermis to thicken
(acanthosis) and to scale.
Ig
E
CAUSES/TRIGGERING FACTORS OF
ECZEMA
Dust mite (common)
Sweating
Extreme of hot and cold
Chlorinated water
Infection
Allergy
Stress/emotional factors
Skin irritants: wool, detergents
Perfumes
Foodstuff s: cows milk, beef, eggs
TYPES OF DERMATITIS
Exogenous
1. ATOPIC DERMATITIS
Term atopic refers to a hereditary
background
OR
Tendency to develop one or more group
of conditions such as allergic rhinitis,
asthma, eczema, skin sensitivities and
uticaria
Distribution:
Infants : cheeks of
the face, fold of the
neck, scalp, extensor
surface of limb.
Children: cubital &
popliteal fossa.
Adult: upper arms,
back, wrists, hands,
fi ngers, feet, toes.
MANAGEMENT
( NON PHARMACOLOGICAL)
Advice to parents of aff ected children
Avoid soap and perfumed products use bland bath
oil & aqueous cream, cleanser and shampoo with
low pH ( 4.5-6.0)
Emollient soon after bathing
Short and tepid shower
Avoid rubbing & scratching use gauze bandange
Avoid sudden change in temp or overheating
Wear light, soft loose cotton clothes
Dust mite covers for bedding
Wash linen in hot water >55C
MANAGEMENT
(PHARMACOLOGICAL)
Note : corticosteroid creams (acute) & ointments
(chronic)
Mild
soap substitutes aqueous cream
Emollients
Moderate
As for mild
Topical corticosteroid (twice daily)
Severe
As for mild and moderate eczema
Potent topical corticosteroid to worse areas
Consider hospitalisation
Systemic corticosteroid (rarely used)
Allergy assessment if unresponsive
EDUCATION AND REASSURANCE
Explanation , reassurance, and support are very
important
Emphasise that atopic dermatitis is superfi cial
disorder and will not scar and disfi gure
Counselling indicated where family stress and
psychological factor
Infection is common.
2. NUMMULAR (DISCOID)
DERMATITIS
Chronic, red, coinshaped plaques
Crusted, scaling and
itchy
Mainly on legs, also
buttocks and trunk
Often symmetrical
Common in middle age
patients
Maybe related to stress
Persists for months
Treatment as for classic
atopic dermatitis
3. PITYRIASIS ALBA
White patches on the face of children and adolescents
Very common mild condition
Common around mouth and on cheeks
Can occur on neck, upper limbs, occasionally trunk
Subacute form of atopic dermatitis
Full repigmentation occurs eventually
Treatment :
Reassurance
Simple emollient
Restrict use of soap and washing
May prescribe hydrocortisone ointment (rarely
necessary)
4. DYSHIDROTIC DERMATITS
(POMPHOLYX)
Typically in patients aged
20-40 years
Itching vesicles on fi ngers
Commonly aff ects sides of
digits and palms
Last for few weeks and can
recur
Related to stress
Treatment : wet dressings,
as for atopic dermatitis
5. ASTEATOTIC DERMATITIS
Asteatotic means without
moisture
Common, very itchy dermatitis
Occur in elderly especially during winter
Dry crazy paving pattern
Commonly occur on legs
Treatment :
Take short bath with low water temperature
Eliminate use of soap in involved areas
Apply emollients after bath
Apply topical steroid ointment
EXOGENOUS DERMATITIS
CONTACT DERMATITIS
Contact dermatitis is a type of eczema triggered by contact with
a particular substance.
source: www.nhs.uk
2 types
Irritant (ICD)
Allergic (ACD)
70% have irritant cause.
Presence of irritant dermatitis increases the risk of
developing a contact allergy
Features:
Itchy, infl amed skin
Red and swollen
Papulovesicular (papules & vesicles)
May be dry and fi ssured
IRRITANT CONTACT
DERMATITIS (ICD)
Caused by primary irritant such as :
Acids
Alkalis
Detergent
Soaps
Oils
Solvent
Common allergen:
Fragrances
Topical antibiotics,
anaesthetic, antihistamines
Metal salts ( nickel sulphate,
chromate)
Clothing dyes
Rubber/latex
Diagnosis
Careful history / examination
Consider occupation, family
history, vacation/ travel,
clothes, topical application
Refer dermatologist for
patch testing
PATCH TESTING
MANAGEMENT
Determine the cause and remove it
Wash with water only and pat dry
(avoid soap)
If acute with blistering, apply
Burows compresses
Oral prednisolone for severe cases
Topical corticosteroid cream
Oral antibiotic if secondary
infection
Chronic phase : use fragrant- free
moisturiser
Glycerol 10% in sorbolene cream
Paraffi n
Emollient
SEBORRHOEIC
DERMATITIS
Very common skin infl ammation
Aff ects areas abundant in sebaceous glands
Common in :
Scalp
Face
Neck
Axilla
Groins
Eyelids
eyebrows
External auditory meatus
Nasolabial folds
Presternal area
Features:
Not itchy
Greasy and yellowish
SEBORRHOEIC DERMATITIS OF
INFANCY
Known as cradle cap
Aff ects scalp, nappy rash (napkin area)
Diffi cult to diff erentiate from atopic dermatitis but
seborrhoeic tends to appear very early 1 s t month
of life / within 1 s t 3 months (androgen activity is
most prevalent)
Appears red patches/ blotches with scaling
Flaky, scurf-like dandruff appears 1 s t yellowish
then greasy, scaly crust forms and associated with
reddening of skin
Can become infected
Cradle cap and nappy rash may meet in the
middle
Pro g n o s i s
C l e a r b y 1 8 m o n t h s ( ra re a ft e r 2
years)
N o n p h a r ma c o l o g i c a l t r e a t m e n t
Ke e p a re a c l ea n a nd d r y
B a t h e i n wa rm w a t er , p a t d r y
w i t h s o ft c l o t h
S k i n ex p o s ed t o a i r
Av o i d t o i l e t s o a p f o r wa s h i n g e m u l s i fy i n g o i n t m en t
Ru b s c a l es wi t h b a b y o i l , t h e n
w a s h a wa y l o o s e s c a l es
C h a n g e we t a nd s o i l ed n a p p y
o ft en
M i l d a rea s , a p p l y t h i n s m ea r o f
zi n c c re a m
Pharmacological treatment
Scalp
Infants
1-2% sulphur and 1-2% salicylic acid in aqueous cream with 2%
liquor picis carbonis added:
Apply overnight to scalp, shampoo off next day (3 times a week)
Egozite cradle cap lotion (6% salicylic acid)
Older children and adults
Zinc pyrithione 1% / selenium sulphide 2.5% shampoo/ ketoconazole
or miconazole shampoo
Face, fl exures an d trunk
Ketaconazole cream
Sorbolene cream
Hydrocortizone 1%
Betamethasone 0.02-0.05%
Desonide 0.05% lotion for face/eyelids and weeping area
Napkin area
Mix equal 1% hydrocortisone with nystatin/ ketoconazole/
clotrimazole cream
LET US RECALL
ATOPIC DERMATITIS
SEBORRHOEIC DERMATITIS
PITYRIASIS ALBA
DISCOID DERMATITIS
DYSHIDROTIC DERMATITIS
ALLERGIC CONTACT
DERMATITIS
http://patient.info/health/topical-steroids-foreczema
REFERENCE
John Murtaghs General Practice 6 t h Edition.
Clinical Dermatology 4 t h Edition, Blackwell Publishing
Websites:
http://www.epiceram.ca/physician/inside_out.php
http://www.treatallergicdisorder.com/atopic-eczema/
http://www.everythingforeczema.com/blog/2014/01/29/unde
rstanding-eczema-what-happens-to-the-skin-in-eczema
/
http://
emedicine.medscape.com/article/1049085-overview?
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pU%2FRKPMVvK4nGsI2Vmg6nKL9Qd%2FsGPYa%2BToEoLjuhF
nUEHw%3D%3D#a5