This document summarizes different types of dermatitis (eczema), including their causes, symptoms, and treatments. It discusses atopic dermatitis (eczema) in depth, covering its pathogenesis and presentation in infants, children, and adults. Other types summarized include contact dermatitis (allergic and irritant), seborrheic dermatitis, stasis dermatitis, neurodermatitis, and dishydrotic eczema. Diagnosis and general management principles are also outlined.
This document summarizes different types of dermatitis (eczema), including their causes, symptoms, and treatments. It discusses atopic dermatitis (eczema) in depth, covering its pathogenesis and presentation in infants, children, and adults. Other types summarized include contact dermatitis (allergic and irritant), seborrheic dermatitis, stasis dermatitis, neurodermatitis, and dishydrotic eczema. Diagnosis and general management principles are also outlined.
This document summarizes different types of dermatitis (eczema), including their causes, symptoms, and treatments. It discusses atopic dermatitis (eczema) in depth, covering its pathogenesis and presentation in infants, children, and adults. Other types summarized include contact dermatitis (allergic and irritant), seborrheic dermatitis, stasis dermatitis, neurodermatitis, and dishydrotic eczema. Diagnosis and general management principles are also outlined.
Department of dermatovenereology Faculty of medicine YARSI University DERMATITIS -Eczema A common type of inflamation of skin ( epidermo- dermatitis ) which is not caused by micro- organism. Itching is the most symptom
Some types appear to be due to as yet unidentified constitutional abnormalities, while others are more obviously the result of some external set of circumstance
Constitutional : eg Atopic dermatitis
External : eg Contact dermatitis Eflorescense of Dermatitis-Eczema Erythem Papule Vesicle Pustule Oozing Crust Squama Several types of Derm- ecz
Atopic dermatitis Contact dermatitis Seborrhoic dermatitis Statis dermatitis Neurodermatitis Nummular eczema Dishidrosis Infective Eczematoid Dermatitis Atopic dermatitis/ Eczema Def : Acute, subacute, or chronic relapsing skin disorder that usually begins in infancy and is characterized principally by dry skin and pruritus. Often associated with personal or family history of atopy such as allergic rhinitis, asthma, and atopic dermatitis (AD) A.D may divided into three stages, namely : Infantile ( 2 months 2 years) Childhood ( 2 years 10 years) Adult Pathogenesis : ??? Complex interaction of skin barrier, genetic, environmental, pharmacologic and immunologic factors Infantile Usually begins as an itchy erythema of cheeks followed by development of vesicle, rupture and produce moist crusted areas
The eruptions may rapidly extend to other parts of the body, chiefly the scalp, the neck, the forehead, the wrist and the extremities
The buttocks and diaper area are often involved
The eruption may become generalized with erythroderma Infantil AD Childhood AD The lesion to be less exudative, drier, and more papular
The classic locations are the antecubital, and the popliteal spaces, the wrist, eyelids, and the face and in collarette about the neck
The other area, however, are frequently affected
Itching
There is a decrease in the frequency of sensitization to egg, wheat and milk, but an increase in sensitization to nonigested substances, particulary wool, cat hair, dog hair, and pollens Childhood AD Adolescent and adult AD Usually the eruption involves the antecubital and popliteal fossae, the front and sides of the neck, the forehead and the are about the eyes Hands dermatitis occurs more frequently in atopic individuals, and eczematous lessions of the dorsum are usual Pruritus : paroxysm, nocturnal, triggered by acute emotional stress Trigger factors : rough clothing, wool irritation, foods or tension. Adolescent and Adult AD Associated features Cutaneous stigmata : Dennie-Morgan fold, Keratosis pilaris, and Hertoghes sign Vascular stigmata : White dermographism Personality traits : Nervous tension Ophthamologic abnormalities : cataracts, keratoconus. Susceptibility to infection : S.aureus, generalized Herpes simplex or vaccinia virus infections to produce Kaposis varicelliform eruption
Hanifin & Rajka criteria : Major criteria 1. Pruritus 2. Typical morphology and distribution 3. Tendency toward chronics or chronically relapsing dermatitis 4. Personal or family history of atopic diseases (asthma, allergic rhinitis, AD) Minor criteria : 1. Xerosis / ichthyosis/ hyperlinear palms 2. Pityriasis alba 3. Keratosis pilaris 4. Facial pallor / infraorbital darkening 5. Elevated serum IgE 6. Keratoconus 7. Tendency to non spesific hand eczema 8. Tendency to repeat cutaneous infections Differential diagnosis
Nummular Dermatitis Seborrhoic Dermatitis Contact Dermatitis Psoriasis Scabies General management 1. In infancy and childhood a. It should be avoided : External irritation Sudden change of temperature, excessive bathing, insufficient cleanless especially in the diaper region, local infections
b. Food elimination ( with special attention)
b. Antihistamin systemically
c. Olive oil on absorbent cotton may used with gentle patting for cleansing to avoide rubbing the affected patrs. Particular attention should be given the genitals and buttocks and the diapers should be changed
d. Weak topical corticosteroid. 2. In adults : a. The emosional stress should be controlled b. Avoid extremes cold and heat c. Hydrated xerotic skin d. Antihistamin e. Topical steroid ( be ware of the potentiallity) f. Antiobiotics ( if nedded) Contact Dermatitis (CD) An exogenous dermatitis which develops as a reaction of the skin to contact with a foreign substance / an environmental agent, either a primary irritant ( Irritant CD) or an allergen (allergic CD) It may be affected by exposure to UV-light, resulting into two variant reaction : Photoallergic & Phototoxic CD Allergic Contact Dermatitis (ACD) Occur in predisposed individual Sensitization occurs within a week after contact with a substance (allergen), but there are no visible skin changes Subsequent contact with allergen, even in small amounts, causes an dermatitis Once established, sensitivity may persists for months, years, or even a lifetime
Symptom : intense pruritus
Physical exam acute : erythema & edema subacute : plaques of mild erythema, dry scales chronic : plaque of lichenification
Lab : patch test (+)
PATCH TEST Irritant Contact Dermatitis Occure in any individual provided the chemical irritant is applied in a potent enough concentration for a sufficient length of time
Inflamation of the skin develops at the site of contact
There is non allergic mechanism involved, the damage result from direct chemical action
Irritants: strong irritant severe inflamation at the first contact Weak irritants: less toxic substances which require repeated or prolinged contact to cause inflamation (detergent, organic solvents, excessive exposure to water)
Incidence: The incidence of cases of ICD (each type) depending mainly on the degree of exposure and the causative agent In patients with atopic dermatitis there is a relatively high incidence of ICD
Treatment Preventive : Once the causative agent has been identified, further contact should be avoided Topical therapy : in acute state : wet dressing : Burowi solution 1/20 1/40, Permanganate 1/10.000, followed by topical steroid. in chronic state : moderate topical steroid Systemic therapy : Antihistamin (severe pruritus) and steroid (severe / extensive eruption Contact Dermatitis Seborrhoic dermatitis Two distinct subset of patients : * The Infantile form * Characterized by large yellowish scale mainly on the scalp, face, axilla and napkin rash May cause confusion with Infantile Atopic Dermatitis No link between the infantile and adult form No pruritus eat & sleep well Infantil form Seborrhoeic Dermatitis Cradle Cap * The adult form * Affect the face, scalp, anterior chest, axilla, sub mammary fold, groins, external ear Facial lesion, particularly in the nasolabial fold, in men, maybe very persistent the scalp is frequently involved presenting complaint, esp severe and persistent dandruff Eyebrow/ eyelid stickness of the eyelid in early morning Differential diagnosis : Contact dermatitis, psoriasis and Pityriasis versicolor
Treatment : Tends to recure whatever treatment is chosen Topical : imidazol antifungal ketokonazol (cream/shampoo) , weak potency topical steroid Adult form Seborrhoeic Dermatitis Stasis dermatitis dermatitis on the lower legs, commonly seen in association with venous insufficiency many cases seen in obese, female patients have a degree of venous insufficiency inner aspects of boths lower legs above and around the medial malleous are chiefly involved the skin is shinny, atrophic and large numbers of small blood vessels clearly visible, purpura, pigmentation (due to haemosiderin) pruritus may be severe and cause scratch marks which are slow to heal
Treatment : treatment of underlying varicose veins, topical steroid (weak) be ware of side effects atrophy Stasis Dermatitis Neurodermatitis (liken simplex chronicus)
a well demarcated are of chronic lichenified dermatitis which is not due to either external irritants or identified allergens In predisposed persons, the lesions are induced by continual scratching or rubbing of a localized area of itching skin stress / emotional disturbance pruritic stimulus scratch itch-scratch-itch cycle stimulate a reactive hyperplasia, recognized clinically as lichenification clinically, neurodermatitis are seen as a well-circumscribe, lichenified, slightly elevated plaque, seen on the nape of neck, forearm, or the legs
a very characteristic pattern of intensely itchy vesicles of the skin of the hands and occasionally the feet and also the side of finger Deep-seated vesicle ; often easier to feel than to see The cause is not understood ( contact dermatitis / stress? ) Treatment ; systemic antihistamins ( control the need to scratch) prevent secondary infection, potent topical steroid ( a short time) ; for the moist lesion calamine lot. Dishydrotic Nummular or Discoid dermatitis a chronic, recurrent pattern of dermatitis with discrete coin-shape lesions tending to to involve the limbs Usually affects adults (many of whom will have a past history of AD) ; The aetiology is unknown Clinically : subacute with erythema, edema, vesiculation; the surface may be moist and appear infected bacterial eczema Pruritus is variable Treatment : topical steroid + antibiotic Nummular or Discoid Dermatitis INFECTIVE ECZEMATOID DERMATITIS IED is exogen in nature, can be defined as fluid/ exudate which originates from inflammation or disorders such as: OMP, sinusitis, chronic ulcers, etc IED is thought as autosensitisation dermatitis which occurs from skins sensitivity toward chemical substances originating from tissues/ bacteria in the bodys own exudate Clinical appearances : Erythema & exudation In a dry state, there is crust. If crust is peeled, we would see erythema & often pustules on the edges Examples : The earlobes of children suffering from OMP. The area around the nose of maxilaris sinusitis sufferers
Therapy : Rivanol 1/1000, Betadine dressing When cleared Hidrocortisone 1 % or combination with antibiotic Infective Eczematoid Dermatitis URTICARIA & AGIOEDEMA Def : * URTICARIA is compoused of wheals (transient edematous papules & plaques, usually pruritic and due to edema of papilary body). The wheals are superficial, well defined. * ANGIODEMA is a large edematous area that involves the dermis and subcutaneous tissue, is deep and ill defined Therapy Antihistamin : H1, H1 + H2 Systemic corticosteroid Adrenalin inj subcutis/ ephedrin tab
urticaria angioedema Vasculitis A heterogeneous group of clinical synd characterized by inflammation of blood vessels The clinical picture is essensially dependent of size and extent of vessel involvement purpura Test : diaskopi