dermatitis and eczema
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TRANSCRIPT
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Dermatitis and eczema
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Introduction•Inflammation of the skin
•The terms 'ECZEMA' and 'DERMATITIS' are regarded as synonymous
•Eczema has three clinical stages of development
•Acute, Subacute, or Chronic
•Endogenous, or exogenous2
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Epidemiology
Prevalence– In the US:
– 10-12% in children – 0.9% in adults.
– Internationally: as high as 18% and is rising, especially in developed countries.
Race, Age, Sex, Income
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Atopic Eczema
• Acute, subacute, but usually chronic pruritic inflammation of the epidermis and dermis
• It affects 5-10% of children below 5 years – 60 % of patients present by first year;
– 30 % are seen for the first time by age 5, and
– only 10 % develop AD between 6 and 20 years of age
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Atopic Eczema
• Patients with AD: –30% develop asthma –35% have Allergic Rhinitis.
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Atopic Eczema
• Interaction of genetics and environmental factors results in development of atopic eczema.
• Both IgE mediated and cell mediated hypersensitivity reactions are involved
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Atopic Eczema
• Pruritus is the sine qua non of atopic dermatitis.
• There is no fever or other constitutional symptoms.
• Lichenification because of repeated scratching is commonly seen.
• Other atopic diathesis may present at the same time.
• Sparing of the diaper area is more common in AD.
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Atopic Eczema Has three phases:
I. Infantile AD– tends to primarily involve the face, scalp and torso.
II. Childhood AD – involves the extensor extremities
III. Adulthood AD – Flexural surface– More generalized…
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Atopic Eczema
• The exact cause of the condition is UK:– Most patients have
• marked xerosis and • inability to retain moisture in the skin.
• Environmental triggers – heat, humidity, detergents/soaps; – abrasive clothing, chemicals, and smoke and stress
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Diagnostic CriteriaHanifin diagnostic criteria:
Major– Pruritus
– Typical and age-specific changes:
– Chronic and relapsing course
– Family Hx10
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Diagnostic CriteriaHanifin diagnostic criteria:
Minor– Early age of onset – Atopy (IgE reactivity) – Xerosis– Keratosis pilaris/ichthyosis/palmar hyperlinearity – Atypical vascular responses – Perifollicular changes – Ocular/periorbital changes – Perioral/periauricular lesions
Diagnosis11
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Atopic Eczema
The presence of the 1 major and at least 3 minor features is diagnostic of AD
– Major Feature•An itchy skin condition
– Minor Features: •Onset below age 2 years •History of skin crease involvement •History of a generally dry skin•Personal history of other atopic disease•Visible flexural dermatitis
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Atopic Eczema
•
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Atopic Eczema
• Are particularly prone to
I. Cutaneous Infections/Infestations• Bacterial• Viral• Fungal• Scabies
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Atopic Eczema
• Are particularly prone to
II. Localized eczemas
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Management Eduacation on prophylactic
measures Bathing and soaps
Recommend non-soap cleansers such as Cetaphil or moisturizing soaps such as Dove.
Clothing, Emollients Ichthammol and coal tar,
Make sure a humid household environment is maintained. 37
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Management Topical Corticosteroids, Antihistamines, ??? Antibiotics Topical immuno-modulators
Tacrolimus ointment 0.03%, 0.1% bid. OR
Pimecrolimus 1% cream bid.
Long term prognosis generally good
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Contact Dermatitis [ CD ]
–Acute or chronic inflammatory reactions to substances that come in contact with the skin.
–Two forms of CD exist•Irritant Contact Dermatitis (ICD)•Allergic Contact Dermatitis (ACD)
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Contact Dermatitis [ CD ]
• Common allergen-containing products include • cosmetics • Soaps• dyes and • jewelry.
• The most frequent sensitizers are • fragrance• nickel, neomycin• formaldehyde, lanolin, and • a host of other common environmental chemicals.
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Contact Dermatitis
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The distribution of the rash should drive the examiner's history to possible allergen exposures.
• Facial distributions – suggest a personal skin care product.
• Ear lobes – suggest nickel allergy from earrings.
• Hand dermatitis – should provoke questions regarding
• occupation, hobbies, and habits • especially those working in hair or nail salons
• There are photo-dependent allergic reactions47
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Contact Dermatitis
Avoid the agent. Topical steroids and if severe systemic for a short time. Antipruritics Treat the complications.
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Lichen Simplex Chronicus
Thickening of the skin with variable scaling that arises secondary to repetitive scratching or rubbing.
It is not a primary process.
occur mainly at the nuchal area.
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Lichen Simplex Chronicus
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Lichen Simplex Chronicus
Break the itch-scratch-itch cycle with Antihistamines Potent topical steroids and Treat lichenification with
keratolytics
Advice patients not to scratch the area Trim nails
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Discoid Eczema
Nummular or Microbial eczema A chronic, pruritic, inflammatory
dermatitis occurring in the form of coin-shaped plaques.
Unknown cause. Unrelated to atopic diathesis IgE levels are normal Commonly seen in the lower leg
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Discoid Eczema
Skin hydration and application of potent steroid with or with out antihistamines.
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Seborrhoeic Dermatitis
Very common chronic dermatosis characterized by redness and scaling.
Occurs in regions where the sebaceous glands are most active.
Affects 4 – 5 % of the population Mild form in the scalp is Called
dandruff Up to 20% of population affected71
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Seborrhoeic Dermatitis
Cause not fully inderstood
Associated factors:GeneticsImmunosupressionPityrosporon ovale
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Seborrhoeic Dermatitis
Has two pick ages of onset: Infancy, and Puberty
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Seborrhoeic Dermatitis
Selenium sulfide shampooKetoconazole shampooTopical steroidsSystemic azolesUV radiationRecurrences and remissions are common
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Pityriasis Alba
A common disfiguring hypomelanosis of the face presenting as White area (alba) Mild scaling (pityriasis)
Cause is not known
Atopic state may be present: A forerunner of AD
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Pityriasis Alba
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Pityriasis Alba
1 % Hydrocortisone ointment, is effective
Avoid frequent washing with soap
Self limiting conditions that disappears with age 81
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Exercise
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Discoid Eczema
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