ECZEMA

Dr. Zahra Shoaib

 CONTENT
I. Definition
II. Classification
III. Clinical Features
IV. Investigations
V. Management

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1. DEFINITION

• The term eczema

derives from the Greek
word ‘to boil’
• It describes a group of
inflammatory skin
conditions that are
characterized by itchy,
dry or scaly skin.
• The hallmark of
eczema is pruritis

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II. CLASSIFICATION
Types of Eczema

Endogenous

Atopic, Seborrheic

Exogenous

Irritant, Allergic, Photo-Allergic, Chronic Actinic Dermatitis

Characteristic patterns and morphology

Asteatotic, Discoid, Gravitational, Pompholyx

Atopic Dermatitis Contact Dermatitis Nummular eczema Asteatotic Eczema

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III. CLINICAL FEATURES

Clinical Morphology of Eczema

• Erythma
• Edema
Acute • Vesicles
• exudative

• Less oedema, vesiculation and exudate.

• Lichenification
Chronic • Fissures, excoriations
• scaling
• Dyspigmentation

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Acute Eczema Subacute Eczema Chronic Eczema

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IV. INVESTIGATIONS

 Clinical diagnosis

 Patch Tests (If contact allergic dermatitis is suspected)

 Total and specific Ig E Level (May be raised in atopic dermatitis)

 Bacterial Swab (If secondary bacterial infection is suspected)

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V. MANAGEMENT

 Avoidance of irritants and allergans

 Moisturizing soap substitutes.

 Emollients can be used as soap substitutes,

bath additives and directly applied to skin

 Emollients and topical glucocorticoids

are mainstays of treatment for all eczema

types.

SAMPLE FOOTER TEXT 20XX 9

 Steroids in an ointment base are preferred for chronic eczema and occlusion with a

paste bandage can be done to ease itching or scratching.

 Hydrocortisone 1% or clobetasone butyrate is generally used on face while more

potent glucocorticoids(betamethasone) are restricted to trunks and limbs. Strength of

glucocorticoid depends on severity of the condition.

 Cream or lotion based treatment is more appropriate in acute eczema.

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 Topical calcineurin inhibitors such as tacrolimus and pimecrolimus

 Antihistamines for pruritis

 Oral antibiotis if secondary bacterial infection is present

 Systemic steroids(prednisolone 1mg/kg/day) for severe cases.

SAMPLE FOOTER TEXT 20XX 11

Therapeutic Agent Acute Subacute Chronic
Rest, Sedation ++ + +/-
Wet dressings and soaks ++ +/- -
Wet wrap bandaging ++ + +/-
Paste bandages +/- + ++
Sedative antihistamines ++ ++ +
Emollients ++ ++ ++
Croticosteroids, local + ++ +
Pimecrolimus(topical) + ++ ++
Tacrolimus(topical) + ++ ++
Tar, icthamol,etc +/- + ++
Polythene occlusion +/- + +
Intralesional steroids - +/- +
Habit reversal therapy - +/- +
X-ray therapy - - +/-
UVB phototherapy - + +
PUVA phototherapy - + +
UVA1 phototherapy - + +
Systemic corticosteroids + + +/-
Ciclosporin + + +/-
Azathioprine - + +
Methotrexate - + +
Alitretinoin (hand eczema) - + + 12
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