Eczema

2.  AD - multifactorial allergic
skin disease that develops in people with
genetically deterministic anomalous orientation
of the immune response
the effect of factors external and internal
environment.
 The main pathogenetic link its development
is IgE-mediated mechanism induced by
allergen-specific Th2-lymphocytes

4.  Endogenous risk factors for AD :
 - heredity
 - hyperreactivity
 Exogenous risk factors for AD ( Union of
pediatricians of Russia , 2001)
 1. Causal factors ( triggers)
 allergenic :
 - food
 - household
 - epidermal
 - fungal
 - Bacterial
 - vaccinal

5. non-allergenic :
 Psycho-emotional stress
 Change meteosituations
 Smokind
 Food additives
 strong,
 constant itching
 pollutants

6.  2 . Factors contributing to the action triggers
 - climatogeographic factor
 - Violation of the nature of power
 - Foul mode and skincare
 - Living conditions
 - vaccination
 - Psychological stress
 - Acute viral infection

7. Development stage and phase of the disease:
 initial
 Pronounced changes (during an
exacerbation): acute phase
 chronic phase
 Remission - incomplete (subacute period)
 full
 Clinical recovery

8. Clinical forms (age periods):
 - Infant (I)
 - Children (II)
 - Teenage Adults (III).
Prevalence:
 - Bounded process
 - Widespread (disseminated and diffuse)
process.
Severity:
 - easy
 - Medium-heavy
 - Heavy.
Clinic-etiological options:
 - Food
 - tick
 - fungal
 - Pollen and other allergies

10.  At this age, blood pressure manifested severe
inflammatory phenomena with erythema,
exudation, edema.
 Process occurs primarily at protruding parts of
the face (cheeks, forehead, chin area).
 Nasolabial triangle remains intact. further
inflammation apply on the scalp, neck, extensor
surfaces of the limbs, trunk, in folds. Itching is
different intensity.
 Erosion, excoriation often infected.

12.  This is a form of child AD.
 For her characteristic are: flushing (erythema),
swelling, lichenification, papular rash, plaque
formation, erosion, excoriation, hemorrhagic
crust cracks.
 Integuments presented dry, covered with a
large number of pityriasis scales.
 Localization - flexor surfaces of the extremities,
the anterolateral surface neck, elbow and
popliteal fossa, back of hands.

15.  During this period, dominated shiny skin, dry,
lichenoid papules, infiltration of skin lesions,
excoriation, hemorrhagic crusts.
 Process is localized both in flexion, so
and on the extensor surfaces of the limbs,
face, extends to the skin of the trunk.

16.  exudative,
 erythematous-squamous,
 erythematous-squamous with lihenifikation,
 lichenoid

17.  Most often seen in children
 first year of life up to 2 - 3 years (I age phase; infant
period) is characterized by the first manifestations of
the face in the form of redness, swelling, exudation
(мокнутие), followed by crusts.
 Nasolabial triangle usually remains free from
rashes.
 In the future, the eruption spreads
on other areas of skin.
 Dermographism red or mixed.
 Subjectively - itchy skin different intensity

18.  Erythematous-squamous form is manifested
by hyperemia, small swelling, rash papular,
vesicular, erosions in place opening vesicles
pronounced desquamation.
 Itching significant as consequence - multiple
scratches, hemorrhagic crusts.
 Moisture is not typical.
 Can be observed in the I, II and in age
periods

19.  Erythematous- squamous form with lihenifikation (
arises from 2 years old, holds up to 10-12 years - II
age period ) is characterized by erythematous-
squamous foci with small ( miliary , lenticular )
hemispherical and gabled , follicular papules .
 Skin thickens liheninification, becomes dry . Itching
strong. Number scratching a lot .
 Peeling scaly , finely - lamellar .
 Skin rashes occur mainly in flexion of the legs ,
front and side of the neck , rear brushes , and on
the face.
 Dermographism mixed or white resistant

20.  Lichenoid form is characteristic of atopic
dermatitis, especially teenagers, may persist
after a period of sexual maturing adults.
 It is characterized by dryness and
underlined pattern of the skin, swelling and
infiltration.

21.  erythema,
 papules,
 microvesicles,
 multiple exoriations,
 crusts,
 scaling,
 itching of varying degrees of
intensity.

22.  Remission may be complete or incomplete.
 In incomplete remission, there is a significant
reduction in the symptoms of the disease,
with infiltration, lichenification, dryness and
skin flaking, hyper- or hypopigmentation in
the lesions.
 Complete remission is characterized by the
absence of all clinical symptoms of the
disease

23.  In a limited localized process, the area
affected does not exceed lesion area does
not exceed 10% of the skin.
 With a generalized process, the area
affected is more than 10% of the skin. skin.
 The most severe manifestation of AD is
atopic Erythroderma

25.  A mild stage of the disease is characterized
by predominantly limited localized
manifestations of the skin process, minor
skin itching, rare exacerbations (less than
once or twice a year), and relapses lasting
up to 1 month, mainly during the cold
season.
 Duration of remission is 8-10 months or
more. There is a good effect of the therapy.

26.  Medium-heavy course is generalized skin
process.
 The frequency of exacerbations is 3-4 times
a year with increasing
 Their duration increases.
 The duration of remissions is 2-3 months.
 The process becomes persistent and torpid,
with negligible effect of the therapy. The
treatment has minimal effect.

27.  In severe stage AD, the skin process is
generalized or diffuse, with prolonged
exacerbations and infrequent and short-lived
remissions (frequency of exacerbations: 5
times per year; duration of remission: 1-1.5
months).
 frequency of flare-ups five times a year or
more, relapse intervals of 1-1.5 months).
Treatment brings
 a short-term, limited improvement. Severe
itching, leading to sleep disturbances

28.  Pseudo-Hertoge symptom (flattening of the
lateral eyebrows due to constant rubbing and
scratching),
 Morgan's folds (additional lower eyelid crease),
 Denis lines (deep creases on the lower eyelids),
 swelling and blueness of the lower eyelids,
 scaling of the upper and lower eyelids,
 pale face or congestive reddening with edema,
 perioral lichenification and cheilitis.

29. Basic (mandatory / major) diagnostic criteria for AD:
─ itching of the skin;
─ skin lesions: in children during the first years of life
- rash on the face and extensor surfaces of the limbs,
in older children and adults
- lichenification and scratching at the limb bends;
─ a chronic recurrent course;
─ presence of atopic diseases in the patient or his
relatives;
─ Early onset in childhood (up to 2 years of age).

30. ─ seasonality of exacerbations (worsening during the cold
season and
- exacerbation (worsening during the cold season and
improvement during the summer);
─ exacerbation due to triggering factors (allergens, irritants,
foodstuffs, emotional stress, etc.);
─ Increase in total and specific IgE in the blood serum;
─ peripheral blood eosinophilia;
─ hyperlinarity of the palms ("creased") and soles;
─ follicular hyperkeratosis ("horny" papules on lateral
side surfaces of shoulders, forearms, elbows);
─ itching with increased sweating;
─ dry skin (xerosis);
- White dermographism;

31. - tendency to skin infections;
─ localization of the skin process on the hands
and feet;
- Eczema of the nipples;
- recurrent conjunctivitis;
- Hyperpigmentation of the per orbital area;
─ creases on the anterior surface of the neck;
─ Denier-Morgan's symptom;
─ cheilitis;
- keratoconus.

32.  To make a diagnosis of AD, a combination of
the three main criteria and at least three
additional at least three additional criteria

33.  symptom of "dirty neck" (creasing of the anterior surface of
the neck skin, reticular pigmentation),
 Symptom of "winter foot "(moderate infiltration, hyperemia,
cracking and peeling of the soles),
 Pseudo-Hertog's syndrome (thinning of the hair, first in the
outer third and then in other parts of the eyebrows,
presumably due to frequent scratching),
 Andogsky's syndrome (appearance of a bilateral catarrhal
hypertrophy of the eyebrows) bilateral cataracts with radial
adhesions ("dermatogenic cataract") in a patient with AD,
 with severe itching - symptom of polished nails
(smoothness, absence of striation, maximally abraded nail
edge).

35.  Seborrheic dermatitis,
 allergic contact dermatitis,
 scabies,
 psoriasis vulgaris,
 Ichthyosis vulgaris,
 microbial eczema,
 dermatophytosis,
 circumscribed neurodermatitis (Vidal lich),
 actinic reticuloid,
 phenylketonuria,
 enteropathic acrodermatitis

36.  to achieve clinical remission of the disease,
 eliminate or reduce inflammation and skin
itching,
 moisturise and soften the skin, restore its
protective
 prevent or eliminate secondary infections,
 prevent the development of severe AD,
 the restoration of lost ability to work;
improvement of the quality of life of patients.

37.  In limited skin lesions (<20% surface area),
in mild to moderate AD, predominantly
external therapies are indicated to control
the exacerbation: strong to moderate topical
corticosteroids and/or topical calcineurin
inhibitors, without excluding basic therapies

38.  In the case of intermediate severity of AD,
phototherapy and detoxification agents may
be administered in addition to the above,
Detoxifying agents may be prescribed when
indicated.
 In severe AD, treatment includes external
therapy, as well as systemic
pharmacotherapy or phototherapy.
 It is possible to Cyclosporine and/or systemic
glucocorticosteroids may be used in short
courses.

39.  Topical corticosteroids.
 Topical calcineurin inhibitors.
 Topical antihistamines, antipruritic and
reducing agents.
 Antibacterial, antiviral, antifungal agents.
 Permanent basic skin care products (both
during exacerbation and remission).

40.  In the case of an acute, wet inflammatory process, soaks,
sprays and wet-dry dressings are used.
 In acute inflammatory process without mucous - lotions,
aerosols, water poultices, poultices, pastes, creams.
 In sub-acute inflammatory process - creams, pastes,
powders.
 In chronic non-specific inflammatory process - ointments,
warming compresses. 5.
 In pronounced infiltration in foci - ointments and creams
with keratolytic properties.
 At the stage of regression of the skin process - ointments,
balms and creams with supplements and vitamins.

41.  Bacterial, fungal, viral skin infections;
 Rosacea, perioral dermatitis, acne;
 Local reactions to vaccinations;
 Hypersensitivity;
 Significant skin trophic changes

42.  atrophy
 skin atrophy,
 stretch marks,
 hirsutism,
 steroid acne,
 rosacea,
 perioral dermatitis,
 infectious complications,
 pigmentation disorders,
 telangiectasia

43.  The use of emollients leads to reduction of dry
and itchy skin, moisturising the epidermis,
improving microcirculation and restoring the
function of the epidermal the function of the
epidermal barrier (root therapy).
 The use of basic care products for AD is
recommended at all times.
 It is important for patients with AD to ensure a
protective regime that excludes as much as
possible skin irritants (irritants) and allergens,
as well as trigger factors

44.  Topicrem
 Dardia
 Emolium
 Lipobase
 Lipobase Baby….

45.  Antihistamines.
 Membrane stabilising drugs.
 Drugs that improve or restore digestive function.
 Drugs that regulate the function of the nervous
system.
 Drugs containing unsaturated fatty acids.
 Detoxifying, desensitizing drugs.
 In infectious complications - antibiotics, antiviral,
antifungal drugs.
 Systemic corticosteroids.
 Cyclosporine A.

46.  Eczema (from Greek ekzeo - boil) - a
chronic, relapsing, polietiological, acute
inflammation skin disease presented
polymorphism morphological elements (true
and evolutionary), which formed as a result
of a complex set of etiological and
pathogenic factors.

47.  true eczema (idiopathic, dyshidrotic,
pruriginous, horny (tylothic);
 Microbial eczema (nuchal, paratraumatic,
mycotic, intertriginous, varicose, sycosiform,
eczema of the nipples and the mammary
circle of women);
 seborrheic eczema;
 children's eczema;
 occupational eczema

48.  Adrift eczema is divided into:
• acute,
• subacute,
• chronic

49.  erythematous and oedematous skin with vesicles, pinpoint
erosions with mucous
 ("serous wells" ), serous crusts, exoriations, less frequently
papules and pustules (with sterile contents).
 pustules (with sterile contents). Along with the involution of
the rash
 new lesions form, therefore, the polymorphic character of
eczema is typical.
 a polymorphic rash is typical. Depending on the evolution
of the
 of the morphological elements in eczema a number of
stages are distinguished: erythematous (erythematosa),
papular (papulosa), vesical (vesikulosa), discharge
(madidans) and cortical (crustosa).

50.  The sub acute stage is characterized by
erythema, lichenification, scales and
excoriations.
 The chronic stage of the disease is
characterized by infiltration and
enhancement of the cutaneous pattern of the
affected area, post-inflammatory hypo- and
hyperpigmentation.

51.  TRUE ECZEMA - symmetric inflammatory process , often
often affects the skin of hands , arms , face, legs and feet.
• long-term course of the disease , a chronic, relapsing, or
undulation .
• Clinic true eczema manifests as acute inflammation,
edematous erythema , against which developed the smallest
seropapules and microvesicles .
• Microvesicles quickly opened on-site revealed the seropapul or
microvesicles , exposed
point erosion ( serous wells) , of which stands a hearty
serous exudate , forming a weeping surface.
• Moisture eczema abundant , drip, or solid.
The liquid dries to form a grayish yellow crusts under which
epithelialization occurs.

52.  Clinic: miliary , lenticular papules, vesicular
elements on compacted based on the extensor
surfaces of the extremities, elbow with popliteal
areas , face, groin folds .
 Items can not be opened , do not form a soak.
 The disease is chronic, accompanied by a
pronounced itching ; appears resistant white
dermographizm due involvement of the sympathetic
nervous system .
 The skin of the affected area dry, thickened ,
lihenification, cracks , peeling , skin pigmentation .

53.  When dyshidrotic eczema in the palms, soles,
on the side finger surfaces appear small
vesicles.
 They are dense with palpation, grouped or
placed in isolation, without tend to be opened.
 Bubbles may appear on apparently intact skin
or background mild erythema.
 With increasing inflammation formed multi-
chambered bubbles.

54.  If bubbles are still opened, then formed
erosion polycyclic edges, bright enough
bottom, serous or sero-purulent (moist
surface).
 In the future erosion of crusted
(hemorrhagic and yellowish-greyish).
 By apostasy struck the surface crusts flaky,
often annular peeling, cracks may appear.

55.  Eczema of the morns (tylothic) is manifested
by hyperkeratosis of the palms of the hands,
sometimes with deep, painful cracks. and
soles, sometimes with deep, painful
cracking.
 The course Chronic, often resistant to
treatment.

56.  Microbial eczema develops as sensitization
to microbial antigen (streptococci,
staphylococci) on the background of
changes neuroendocrine and immune
systems, dysfunction of the gastrointestinal
tract.
 Inflammation initially asymmetric in the
future rash may appear symmetric, including
remote.

57.  Localization - skin shins, dorsum of the
hands, sides of the trunk, scalp.
 Lesions solid, acute inflammation character,
without layers of healthy skin, have sharply
defined clear scalloped border, with rejects
stratum corneum on the periphery.
 Outbreaks presented eczematous reactions,
such as erythema, seropapules,
microvesicles.
 On the periphery of the main focus may be
so-called screenings -individual small
inflammatory papules, dry, scaly lesions

58.  Coin-like eczema (numular eczema) is a
type of microbial eczema, which is almost
always round and has clear boundaries.
They are usually present on the upper and
lower extremities,
 Less commonly on the trunk.
 The plaques are an accumulation of Small
papules, vesicles, serous pus crusts and
scaling on a background of erythema.

59.  Paratraumatic (peri-wound) eczema develops in
the area of Postoperative scars, bone fractures,
osteosynthesis, sites of Plaster casts have not
been applied correctly.
 It is characterized by
 Erythema osteoinflammatoryis, exudative
papules and/or pustules. Pustules and crusts
formation. Superficial sclerosing
 Superficial sclerosis of the skin and deposition
of haemosiderin in the tissue.

60.  Varicose eczema is caused by a background of
varicose veins.
 Injuries, maceration of the skin, and inadequate
external treatment of varicose ulcers contribute
to the development of the disease.
 Lesions are usually located on the lower
extremities.
 On the lower extremities, mostly in the lower
third of the lower leg, often in the vicinity of
varicose ulcers, sclerosing areas. sclerosis of
the skin.

61. 1 Antihistamines
2 Glucocorticosteroids (intense inflammation)
3 Tranquillisers with antihistamine effect
(hydroxyzine for severe itching)
4 Detoxification therapy (for exudation)

62.  Depends on the stage of the eczema
1 Dischage stage - antiseptic lotions
2 Glucocorticosteroids locally
3 Aniline dyes
4 Combination medicines (ointments, creams)