2. 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 2
3. 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
3
4. 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
4
6. Atopic Eczema
• Interaction of genetics and environmental
factors results in development of atopic
eczema.
• Both IgE mediated and cell mediated
hypersensitivity reactions are involved
6
7. 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
7
8. 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… 8
9. 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
9
11. Diagnostic Criteria
Hanifin 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
Diagnosis 11
12. 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
12
37. 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
37
38. 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
38
39. 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)
39
40. 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.
40
47. 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 reactions
47
57. Contact Dermatitis
Avoid the agent.
Topical steroids and if severe
systemic
for a short time.
Antipruritics
Treat the complications. 57
58. 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. 58
65. 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 65
66. 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
66
70. Discoid Eczema
Skin hydration and application of
potent steroid with or with out
antihistamines.
Usually recurs.
70
71. 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 71
72. Seborrhoeic Dermatitis
Cause not fully inderstood
Associated factors:
Genetics
Immunosupression
Pityrosporon ovale
72
78. Seborrhoeic Dermatitis
Selenium sulfide shampoo
Ketoconazole shampoo
Topical steroids
Systemic azoles
UV radiation
Recurrences and remissions are
common 78
79. 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 79
81. Pityriasis Alba
1 % Hydrocortisone ointment, is effective
Avoid frequent washing with soap
Self limiting conditions that disappears
with age
81
