2. 'Ekze', in Greek means “to boil over”.
Eczema is an inflammatory condition of
the skin that is characterized by
erythema, papulo-vesicles, oozing &
crusting in the acute stages &
lichenification in the chronic stages
4. Exogenous eczemas
Mediated by external trigger factors; inherited tendencies
may play a part.
Endogenous eczemas
Mediated by internal factors; that is, processes originating
within the body.
Combined Eczemas
Some types of eczema are precipitated by both external
and internal factors.
5. CLINICAL FEATURES
The inflammatory changes of eczema
evolve through two stages:
◦ Acute eczematous inflammation
◦ Chronic eczematous inflammation
10. DIAGNOSIS OF
ECZEMAS
Diagnosis in most cases, is clinical and based on a
carefully taken history.
Total IgE level to assess if the individual is atopic.
Swabs for culture and sensitivity (Bacterial
resistance)
Microscopy: to rule out dermatophyte infection/
scabies
11. PATCH TEST
Relies on the principle of a type IV hypersensitivity
reaction.
Method used to determine if a specific substance
causes allergic inflammation of the skin.
Commonest antigen used-Nickel.
TECHNIQUE-
Antigens in standardised dilutions applied to the
back and occluded.
Patches removed after 48hrs;read after half hour.
Another reading at 96hr detects delayed reaction.
20. INFANTILE PHASE
3 months-2years.
Itchy papules and vesicles,becoming exudative.
Begins on face;can involve rest of body.
Spares diaper area.
21.
22.
23. CHILDHOOD PHASE
2-12 years.
Dry,leathery and itchy plaques.
Charecteristic feature-Lichenification.
Site-elbow and knee flexors.
Pallor of the face is common; erythema and scaling
occur around the eyes
24.
25. ADULT PHASE
12 years onwards.
Lesions become more diffuse with an underlying
background of erythema.
Face and flexural areas are commonly involved and
is dry and scaly.
Xerosis is prominent.
Lichenification may be present.
34. POMPHOLYX
Dyshydrotic eczema/acute vesiculobullous hand
eczema
It is a skin condition that is characterized by
small blisters on the hands or feet.
35.
36. CLINICAL FEATURES
Summer aggravation.
Recurrent episode of deep seated,bland looking
vesicles(blisters)
Vesicles resolve gradually in 3 to 4 weeks, and
may be followed by chronic eczematous changes.
Sites-fingers,palms and soles.
48. CLINICAL FEATURES
Spectrum of features ranging from dryness,redness or
chapping to an acute caustic burn.
Acute Exudative Lesions-
Exposure to a strong irritant.
Dry Dermatic Lesions-
Chronic repeated exposure to a weak irritant.
49. PATHOGENESIS
Chemical directly injures skin without involving
immunologic pathway.
Develops in patients exposed to chemicals and
develop with 1st exposure itself.
51. ALLERGIC CONTACT
DERMATITIS
Allergic contact dermatitis (ACD) is a delayed type of
induced sensitivity (allergy) resulting from cutaneous
contact with a specific allergen to which the patient has
developed a specific sensitivity.
This allergic reaction causes inflammation of the skin
manifested by varying degrees of erythema, edema, and
vesiculation.
55. PATHOGENESIS
Type IV hypersensitivity reaction to exogenous antigens.
Antigen
Processed by antigen presenting cells
Processed antigen+Sensitised lymphocytes
Multiplication of lymphocytes
Release cytokines
Skin injury(inflammation,itching and rashes)
56. CLINICAL FEATURES
MORPHOLOGY
ACUTE ECZEMA
o Progress from erythema to edema to
papulovesiculation.
o Manifest as edema in eyelids and genitalia.
CHRONIC ECZEMA
o Itchy lichenified plaques.
58. PHOTOCONTACT
DERMATITIS
Eczematous condition triggered by an interaction
between an unharmful or less harmful substance
on the skin and ultraviolet light.
Distribution typically on the light exposed areas of
the skin.
Two types:
1. Phototoxic
2. Photoallergic
59. PHOTOTOXIC PHOTOALLERGIC
Common Less Common
Non immunological TYPE IV
Hypersensitivity
Sunburn Eczematous
65. CLINICAL FEATURES
Seen around discharging wounds and ulcers
Presents as an area of advancing erythema
sometimes with microvesicles at the edge around
the lesion
66.
67. DERMATOPHYTID
Eczematous reaction that occurs as an
allergic response to a dermatophyte infection
elsewhere on the skin
Most common dermatophytid is an
inflammation in the hands resulting from a
fungus infection of the feet.
69. Diagnostic criteria
A proven focus of dermatophyte infection.
A positive skin test to a group-specific trichophytin
antigen.
Absence of fungi in the dermatophytid lesion.
Clearing of the dermatophytid after the eradication
of the primary fungal infection.
72. Seborrheic dermatitis is a papulosquamous
disorder patterned on the sebum-rich areas of the
scalp, face, and trunk.
SITES-
Scalp,eyebrows,nasolabial folds,retroauricular
area presternal and interscapular regions.
EPIDEMIOLOGY-
Age-
Onset at puberty;peaks at 40yrs.
Gender-
Common in males
73. ETIOLOGY
Microbial-
Overgrowth of Malassezia furfur
Genetic Predisposition
Immunodeficiency
Associated with psoriasis and Parkinson‟s disease.
74. CLINICAL FEATURES
INFANTILE SEBORRHEIC DERMATITIS
Commonly affects within first 3 months of life; affects
both sexes equally.
Begins as cradle cap.
Lesions comprise tiny papules covered with yellow,
greasy scales; and redness in the diaper area and axillae.
75.
76. CLINICAL FEATURES
ADULTS
Affects hairy areas; mostly men (30 to 60 years).
Scalp: Earliest sign is dandruff; later followed by greasy
scales and retroauricular fissuring.
Face: Scaling; erythema of eyebrows, nasolabial folds;
and squamous blepharitis may occur.
Trunk: Papules, greasy scales, petaloid pattern.
Flexural areas: Marginated erythema, greasy scaling and
secondary infection.
77.
78. TREATMENT
Topical therapy Systemic Therapy
1. Topical antifungals In extensive lesions and
HIV+ve patients.
Topical
ketoconazole,selenium Include antibiotics and
sulphide and ciclopirox. antifungal
agents(fluconazole/itraco
2. Topical steroids nazole)
Combined with
antifungal agents in
flexural and exudative
lesions.
Combined with salicylic
acid in recalcitrant
lesions of scalp.
80. CLINICAL FEATURES
Symptoms-extremely itchy
MORPHOLOGY-Single/multiple lichenified plaques
Lesion reappear after treatment is stopped
Commonly affects adults (30 to 50 years); often in
atopics
SITES-Nape of neck in women,legs in men,anogenital
area in both.
84. STASIS ECZEMA
Gravitational eczema/Venous eczema
Refers to the skin changes that occur in the leg as
a result of "stasis" or blood pooling from
insufficient venous return.
ETIOLOGY:
Secondary to venous hypertension.
Late sequel of previous deep vein thrombosis.
SITE-Lower third of leg(medial malleolus)
85. CLINICAL FEATURES
Begins with pedal edema around ankles.
Over period of time,brownish pigmentation
appears(punctate initially and later confluent)
LIPODERMATOSCLEROSIS-
Long standing case presents with ivory white
siderotic plaques with dilated capillary loops.
88. Management
Leg elevation; weight reduction in obese patients.
Compression by regular use of firm elastic bandage
or well fitting stockings.
Sedative antihistamines
Topical steroids.
Systemic antibiotics for secondary bacterial
infection.
89. NUMMULAR ECZEMA
Discoid eczema.
Name comes from the Latin word “nummus,"
which means "coin.“
Characterized by round or oval-shaped itchy
lesions
90. ETIOLOGY
Unknown in many case.
Frequent association with atopy
Reaction to bacterial antigens has been suspected.
Can also be worsened by stress and caffeine, which
dehydrates the body and thus the skin
95. PITYRIASIS ALBA
Common skin condition mostly occurring in
children and usually seen as dry, fine-scaled,
pale patches on the face.
Characterized by asymptomatic, slightly
elevated, hypopigmented, scaly patches;
indistinct borders.
97. Affects children (3 to 16 years) and disappears in
early adulthood; may be a manifestation of atopic
dermatitis.
SITES:Face, perioral area, chin and cheeks; lateral
aspect of the upper arm; and thighs.
Hypopigmentation appears prominent in dark
skinned patients and during summer as it stands
out against the tanned skin
98. CLINICAL FEATURES
Individual lesions develop through 3 stages and
sometimes are itchy:
Raised and red - although the redness is often mild
and not noticed by parents
Raised and pale.
Smooth flat pale patches.
99.
100.
101. TREATMENT
Management
Self-limiting condition; hypopigmentation is not due
to vitiligo.
Emollients to control scaling.
Sunscreens.
Short course of a topical steroid for actively
inflammed lesions.
102. ASTEATOTIC ECZEMA
Eczema craquelé
Form of eczema that is characterized by changes that
occur when skin becomes abnormally dry, itchy, and
cracked.
Common in old people.
105. Management
Advise to live in a warm room; avoid exposure to
cold winds.
Wear woollen clothing over the cottons, avoid direct
contact with wool.
Restrict bathing with very hot water; and use of
soaps and detergents.
Application of emollient, immediately after bathing
frequently thereafter to keep the skin moisturized.
Substituting aqueous cream for soap prevent
recurrence.
108. PSORIASIS ECZEMA
Moderately itchy.Scratching Very itchy.Scratching results
results in bleeding in oozing.
Well defined indurated Not so well defined and not
plaques. indurated.
Surmounted with silvery Scale-crust.
scales.
Nail changes-Typical Variable.
Auspitz sign-Positive Negative
109. SCABIES IN INFANTS INFANTILE ECZEMA
Burrows Papulovesicles
On palms and soles;genitalia Spares palms and soles
Family history-positive Positive for atopic diathesis
