ECZEMA

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 ECZEMA
Reaction pattern of skin secondary to various external / internal stimuli
Classification of Eczema
1. Morphologic classification

Acute Sub acute Chronic

•Erythema •Erythema •Lichenification

•Edema •Scaling •Hyper pigmented thick

skin
•Vesicles
•Exaggerated skin
• Oozing Crease [Due to chronic
itching
• Crusting

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 ECZEMA
Histopathology of acute eczema: Spongiosis

Intra-epidermal
Intercellular edema

2. Etiologic classification

Exogenous Endogenous
•- Contact dermatitis
•Phyto dermatitis
•Photo dermatitis

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 Contact Dermatits
Allergic contact dermatitis Irritant contact dermatitis
•Predisposition All who are exposed Genetically predisposed

•Mechanism Non immunologic Immunologic

[Direct tissue damage] [Type iv hypersensitivity]

•Distribution Restricted to the site of Contact Tends to disseminate beyond the

site of contact

•Examples Detergents, acids alkali burns, - Most common metal:

diaper dermatitis Nickel
- Most common in cement:
Potassium dichromate
- Most common topical Antibiotic :
Neomycin
- In bindi dermatitis

Paratertiary butyl phenol

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 Phyto dermatitis
Phyto Dermatits
• Related to plants

• ABCD → Air borne contact dermatitis

• Most common plant in India : Parthenium hysterophorus

Allergen: Sesquiterpene lactone (SQL)

• Treatment

Systemic steroids Non steroidal Immunosuppressive

(main)
Azathioprine

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 Allergic dermatitis
•Diagnosed by patch test [Type IV Hypersensitivity]

Allergens applied over the back

Read at 48 hrs (a days)

Best read at 96hrs (4 days)

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 Endogenous eczema
1. Seborrheic dermatitis

Inflammatory response to malassezia yeast

Scales: Greasy yellow
Sites : Nasolabial fold, retroauricular region.
Severe form parkinson's disease
HIV

Infantile seborrheic dermatitis

Cradle cap

2. Varicose eczema / stasis eczema / gravitational eczema.

• Associated with chronic venous insufficiency

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 Endogenous eczema
3. Asteatotic eczema [ winter itch]
• In old age → ↓Skin surface lipids dry,
Xerotic skin.

4.Pityriasis alba
↓ ↓
Scaling White
• Multiple hypopigmented macules
• Site : face
• DD Indeterminate Hansen's disease.
↓
Endermic region : Bihar, UP, Tamil Nadu
No scaling, surface → minimal atrophy.

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 Endogenous eczema
5. Nummular eczema [ Discoid eczema ]
Coin shaped lesion.

6. Pompholyx / Dyshidrotic eczema:

Multiple deep seated tense vesicles

Sago grain appearance.

Sites: palms, sides of the fingers.

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 Atopic Dermatitis
• Endogenous eczema
• Chronic relapsing inflammatory skin disease
• Atopy : Localised type hypersensitivity reaction
• Atopic triad Allergic rhinitis (upper respiratory tract)
Bronchial asthma lower respiratory tract) Atopic
Atopic dermatitis(recurrent skin allergy asthma

Atopic
Triad

Atopic Allergic
dermatitis rhinitis

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