Eczema 1 Teaching should be such that what is offered is perceived as a valuable gift and not as a hard duty.
Atopic eczema
Severe itching Sudden urticaria food drugs Long standing no skin lesion with skin leisions Scabies eczema lichen planus Dermtitis herpetiformis
objectives
Define eczema and determine its prevalence List stages, types and clinical presentations of eczema Determine Etiological factors and clinical features of atopic dermtitis To develop a management plan for a patient with atopic eczemaEczema
Eczema, a term derived from the Greek word εґκζεμα meaning ‘to boil’, is a clinical and histological pattern of infl ammation of the skin seen in a variety of dermatoses with widely diverse aetiologies.Eczema and dermatitis
Common inflammatory condition of the skin with peculiar clinical and histopathological picture. Inflammatory components erythema scales vesicles and some degree of itchingIncidence and prevalence
1st in west 2nd in Iraq after infectionNickel Allergy from Belt Buckle and Jewelry
Stages of eczema3 stages of evolution Acute Clinical vesicles ,edema ,oozing ,red base sever itch Histopath sever spongiosis uper dermal odema ,mild perivascular infeltrate
Acute stage
StagesSubacute few vesicles,erythema scales Moderat spongiosis hyper parakeratosis Some acanthosis preivascular infeltrate
subacute
StagesChronic Dry thick scaly itchy Hyperkeratosis acanthosis slight spongiosis Chronic perivascular infiltrate
classifi cation
The classifi cation of eczematous dermatoses is based on aetiology exogenous and endogenous. WhyClassification of eczema
A-endogenous(constitutional ) 1-atopic dermatitis 2-seborrheic dermatitis 3-discoid eczema 4-Asteatotic 5-gravitational d. 6-pompholyx 7.lichen simplexSD of scalp and beard
Stasis Dermatitis“I can’t do anything with my hands like this!”
ClassificationB. exogenous (environmental ) 1-occupational d. 2-irritant contact d. 3-allergic contact d. 4- infective d. 5-photoallergic d.
Shoe Leather Dermatitis
Atopic dermatitisAtopic dermatitis
Genetically determent Personal or family history of asthma, allergic rhinitis or atopic dermatitis Increase liability to produce IgE antibodies
prevelance
10-20% among children international 2-3% in developing counteries Five fold increase over last 30 years Early exposure to probiotic reduces the icdidenceAetiology
Gentic : +ve family history 75% dizygotic twin 20,mono 70 polygenic (not mendelian ) HLA marking is still not identifyImmunological abnormalities primary or 2ndry or association 1-increase serum IgE not always increase immediate type 2- increase histamin level in skin and blood 3- increase blood eosinophiles
4-decrease cell mediated immunity virus herpes ecz. herpeticum, molloscum contagiosum 5- decrease neutrophil & monocyte chemotaxis
Other inflammatory changes Blood vessels: increase tendency for vasoconstriction Itching threshold is low Easily irritated by soap syntheic clothes Hypersensetivty reaction to normal flora Increase incidence of staph aureus infection
pathophysiology
Imbalance in t lymphocyte th2 predominant resulting in production of interleukins ,increase in IgE production Abnormal epidermal barrier function
Triggering factors
Food :egg fish preservative Temp sweating Humidity Staph infection StressClinical features of atopic d.
Chronic relapsing infant children adult Personal and family history of atopy Itching Primary lesion is follicular rash ,vesicle ,pustules Distributin of lesions Infant face extensors ,child adult flexuresClinical features
Major criteria 1-pruritis 2-morphology and distributtion 3-chronicity and relapses 4-personal of family history of atopy Minor criteria high IgE, dry skin ,food and wool,infra orbital fold,orbital darkening ,itchy when sweating, infections (staph, herpes,) white dermogrphisim, pityriasis alba, cataractscontinue
White dermographisim
Pityriasis albaThree phases of atopic d.
Infantile phase: 3m-1y face,forhead,scalp,limbs extensor scaly erythematous oozing or dry skin itchy,bacterial infections
Infected Atopic Dermatitis (Impetiginized)
Eczema herpeticumHSV superinfection
Eczema herpeticum
Childhood phase: 1y-12y flexor surface,neck,elbow,knee hand and feet Dry scaly erythematousAdult phase: may persist for life flexor ,itchy,lichenefication ,thick skin ,pigmentation
Associated diorders
Icthyosis vulgaris Alopacia areata Increase drug and food allergies Increase incidence of asthma & allergic rhinitis& urticaria Increase incidence of staph,herpes& molloscum cataractManagement
Reassurance of parents Explain Avoid triggering factors Topical and systemic steroids potency formula and indications Antibiotics and antihistamin humidity, house dust Environment house hospitalNewly introduced
Tacrolimus lymhoma risk Narrow band uvb therapyAny question
summaryWhat is eczema and stages Types of eczema Atopic eczema
Conclusions
Eczema is common Wide spectrum of disease Different subtypes Identify cause if possible Emollients and topical steroidsToday task
Please write down 4 lines on the important things that you acquired from this lecture. Sabeeh