Eczema dermatitis

• ECZEMA :- it is manifestated as pruritus ,

erythema , edema , papules , scaling and
lichenification.
 Classification of eczema
According to aetiology
• Endoenous eczema –where the constitution of
the patient predisposes the patient to develop
an eczema.
• Exogenous eczema – when patient develops
an eczema due to external stimuli.
• Combined eczema – when combination of
extrinsic and constitutional factors work.
According to duration
Acute eczema – it is characterised by
• Ill defined erythematous and edematous
surrounded by papules and vesicles which rupture
to give exudate then dried to form crust .
Chronic eczema – it is chracterised by
• Less exudative scaling with lichenification
(triad of hyperpigmentation , thickening of skin
and increase skin markings)
 Complication of eczema
• Infection
• Contact dermatitis
• Erythrodema
• Ide eruption
 Differential diagnosis
• Psoriasis
• Scabies
• Dermatophytic infections
 Investigation
• Patch test – for allergic dermatitis
• Photopatch test –photoallergic contact
dermatitis
• Prick test –atopic dermatitis
• Serological test
• Total serum IgE and IgE antibodies
• Radioallergosorbent test (RAST)
 Treatment
• Remove common allergen / irritants in contact
dermatitis
• Aggravating factor in atopic dermatitis
• Hydration of skin by application of emollients.
Topical treatment
• Calamine lotion with steroid cream .
• Potassium permagnate 0.01% or aliminium acetate
0.65% followed by application of corticosteroid
lotion or cream.
Systemic treatment
• Steroid combined with salicylic acid or urea
• Antihistamines
• Antibiotics
 Atopic dermatitis
• It is an endogenous eczema triggered by
exogenous agents
• It is characterised by – pruritic , recurrent ,
symmetric eczematous lesions.
• Personal or family history of allergic rhinitis
,asthma or atopic dermatitis.
• Increase ability to form IgE to common
environment allergen.
 Clinical features
• It begins at the age of 3 month
• Exudative, itchy papules and vesicles .
• Dry , leathery and extremely itchy plaques .
• Itchy and lichenified .
• Asthma
• Hay fever (allergic rhinitis)
• Urticaria
 Investigation
• Prick test
• IgE level – more than 200IU/ml
 Treatment
• Avoid scratching , woollen clothes , chemicals , excessive
dress and house dust mite
• Avoid milk ,eggs
Topical therapy
• Hydration of skin
• Emollients
• Corticosteroids
• Calcineurin inhibitors- tacrolimus 0.03%and 0.15% ointment .
Systemic steroid
Systemic antibiotics
Antihistamines
 Irritant contact dermatitis
Aetiology
• Occupation as industrial contact or household
contact .
Clinical features
• Exudative lesion
Treatment
• Corticosteroids
• Emollients
 Allergic contact dermatitis
 It is type IV delayed hypersensitivity reaction
Aetiology
• Air borne exposure
• Costume jewellery , clips
• Chromium plating
• Cement
• Leather
• Hair dyes
• Cosmetics , perfumes , shampoo
Clinical features
• As acute or chronic eczema
Investigation
• Patch testing
Treatment
• Avoid contact with antigen
• Topical corticosteroid
• Oral corticosteroid
• Antihistamines
 Infectious eczematoid dermatitis
Aetiology
• Bacterial or viral
Clinical features
• Seen around dicharging wounds and ulcers
• Erythema with micro vesicles
Treatment
• Topical steroid and antibiotics combination
• Oral antibiotics