Eczema

Atopic Dermatitis
Dr. Andaç Salman
 DERMATITIS=ECZEMA

■ Seborrheic dermatitis
■ Asteatotic eczema
■ Stasis dermatitis
■ Dyshidrotic dermatitis
■ Contact dermatitis
■ Atopic dermatitis
 DERMATITIS=ECZEMA

■ Seborrheic dermatitis
■ Stasis dermatitis
■ Dyshidrotic dermatitis
■ Contact dermatitis
■ Atopic dermatitis
Seborrheic Dermatitis
■ Common, mild chronic eczema
■ Confined to skin regions with high sebum production (scalp,
ears, face, central chest and intertriginous areas)
■ Pathogenesis; sebum overproduction and the commensal
yeast Malassezia
Infantile Seborrheic Dermatitis

■ Self-limited, first 3 months of life

■ Initially mild greasy adherent scales on vertex,
inflammation, oozing (cradle cap=konak)
■ Axillae, inguinal folds, neck, retroauricular region
acutely inflamed, oozing, sharply demarcated
lesions
■ Candida superinfection
Adult Seborrheic Dermatitis
■ Chronic, peak in 4th to 6th decade
■ Symmetrical involvement of face, forehead-medial portions
of the eyebrows, upper eyelids, nasolabial folds, lateral
aspects of the nose-yellowish red with typical bran-like scale
■ Skin is sensitive to irritation, exposure to heat/sun
■ Chronic relapsing course
■ Extensive and severe disease, HIV??
Differential Diagnosis

■ Infantile Seborrheic Dermatitis

– Atopic dermatitis vs earlier onset, absence of
pruritus
■ Adult Seborrheic Dermatitis
– Psoriasis, difficult to differentiate/sebopsoriasis
overlap/ In psoriasis thicker silvery white scales,
more discrete, less pruritic, additional features of
psoriasis elsewhere
Treatment
■ Infantile ■ Adult
– Bathing and – Topical azoles cream/shampoo
emollients
– Extensive/persistent – Maintenance regimen for
cases, ketoconazole relapses
cream 2% – Emollients
– Low potency topical – Low potency topical CS
CS
– Avoidance of – Zinc pyrithione, Selenium
irritance sulfide shampoos
– Topical calcineurin inhibitors
■ Seborrheic dermatitis
■ Stasis dermatitis
■ Dyshidrotic dermatitis
■ Contact dermatitis
■ Atopic dermatitis
Stasis Dermatitis (Varicose eczema,
Congestion Eczema)
■ Often associated with other signs of venous hypertension
■ Erythema and scaling are most prominent around the inner
malleoli
■ Very pruritic, multiple excoriations
Stasis Dermatitis (Varicose eczema,
Congestion Eczema)
Stasis Dermatitis (Varicose eczema,
Congestion Eczema)
■ Management of venous hypertension
– Compression bandages/stockings
– Surgical therapy
■ Topical CS and emollients
■ Seborrheic dermatitis
■ Stasis dermatitis
■ Dyshidrotic dermatitis
■ Contact dermatitis
■ Atopic dermatitis
Dyshidrotic Eczema (Pompholyx)
■ Symmetric, deep-seated, firm, pruritic vesicles and bullae of
the palms and soles, lateral-medial aspects of fingers and
toes
■ Associated with AD and CD
Dyshidrotic Eczema (Pompholyx)

■ Diff Dx; tinea manuum, scabies, palmoplantar pustular

psoriasis
■ Topical and systemic corticosteroid
■ Topical CI
■ Bath PUVA
■ Underlying ACD or ICD should be considered (nickel
sensitization)
■ Seborrheic dermatitis
■ Stasis dermatitis
■ Dyshidrotic dermatitis
■ Contact dermatitis
■ Atopic dermatitis
Contact Dermatitis
■ Irritant Contact Dermatitis
■ Allergic Contact Dermatitis

■ May occur simultaneously

■ One substance may act as both an irritant and allergen

■ Common irritants: water-soap-industrial cleansers-frictional forces

■ Common allergens: nickel, fragrances, preservatives, topical
antibiotics, nickel
Irritant Contact Dermatitis

■ Most common form of CD

■ 80% of occupational CD
■ Repeated exposure to water and/or soap
– Health care workers, janitorial services, food
industry employees
■ Non-immunologic response, disrupted epidermal
barrier
Irritant Contact Dermatitis

■ Weeks after weak irritants, immediately after strong irritants

■ May affect any individual
■ Those with a history of AD are at higher risk
■ Pruritus, burning, pain
■ Well demarcated with a glazed appearance
■ There may be erythema, swelling, blistering, scaling
■ Hands-forearms-eyelids-face
Irritant Contact Dermatitis
■ Differential Diagnosis
– Allergic CD-positive patch test
– Atopic dermatitis
– Cutaneous fungal infections-annular plaques with scaly
border
■ Identification and removal of irritants
■ Repair of the normal skin barrier
■ Vinyl gloves as a barrier
■ Emollients
■ Mid-potency topical CS
Allergic Contact Dermatitis

■ Metals (nickel, cobalt), fragrances , preservatives, topical

antibiotics
■ Delayed Type IV hypersensitivity reaction
■ Induction phase-sensitization- 10-14 days
■ Elicitation-reexposure-within hours to days

■ Intensely pruritic at the site of contact allergen

Allergic Contact Dermatitis
■ Acute-papules and vesicles on an
erythematous base
■ Chronic-xerosis, fissuring, lichenification

■ Occurs in the site of contact with the allergen

– Nickel-earrings-earlobes
– However especially eyelids and face may
result from contact to allergens on the
hands (nail polish)
■ Patch testing
Allergic Contact Dermatitis
■ Identification of the allergen through patch testing
■ Avoidance of the allergen
■ Repair of the normal skin barrier

■ Emollients
■ Topical CS, CI
■ Acute flares-systemic CS
■ Seborrheic dermatitis
■ Stasis dermatitis
■ Dyshidrotic dermatitis
■ Contact dermatitis
■ Atopic dermatitis
Atopic Dermatitis

■ Very common
■ 20% of children in developed countries
■ 90% of the patients have onset before 5 years of age
■ >75% have a family history of atopy (allergic rhinitis,
asthma)
■ Filaggrin mutations, epidermal barrier dysfunction
Atopic Dermatitis

■ Similar lesion morphology: excoriations, erythematous-scaly papules

and plaques, vesicles, serous drainage, crusts
■ Three distributions
– Infants: Cheeks, trunk and extensor extremities
– Young children: Posterior neck, flexor extremities (antecubital-
popliteal), wrists, ankles, hands
– Older children and adults: Posterior neck, flexor extremities, hand
involvement. Chronic AD features, lichenification, prurigo
nodularis, postinflammatory hypo/hyperpigmentation
Atopic Dermatitis

■ AD patients are frequently colonized with S.aureus

– Erosions, yellow crusting, hemorrhagic crusting on plaques
■ Wart and Molluscum are more common
■ Susceptibility to HSV infection-Eczema Herpeticum
– Oral antiviral therapy is needed
– Multiple widespread discrete erosions with hemorrhagic crusting
■ Elevated serum total IgE
Atopic Dermatitis

■ Differential Diagnosis
– Seborrheic dermatitis: yellow, greasy scale most
commonly on head, face, and neck region. Not as
pruritic as atopic dermatitis.
– Psoriasis: well-demarcated, persistent plaques with
overlying scale. The diaper area in infants is commonly
affected
– Contact dermatitis: well-demarcated eczematous
plaques, usually localized to areas of contact.
Atopic Dermatitis
■ Explain nature of the disease-chronic and relapsing
■ Preventive measures
– Minimising skin irritation
Avoidance of :
■ clothes made of wool
■ Hot baths, harsh soaps
■ Wet house work
– Emollients
■ To relieve dryness and itching
■ To reduce the quantity of topical steroids
Atopic Dermatitis