Dermatitis and Eczema

Ailing Zou （邹爱玲） 2021.10.18

Department of Dermatology, Huangshi Central Hospital,
Affiliated Hospital of Hubei Polytechnic College.

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contents

01
Contact Dermatitis

02
Atopic Dermatitis

03
Eczema

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definition

01
Contact Dermatitis

Contact dermatitis is an inflammatory

reaction of the skin resulting from direct
contact with particular external substances.
It presents with erythemas, swelling,
papules, vesicles, and even bullae.

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Etiology and Pathogenesis

(1)Irritant contact dermatitis(ICD): this

accounts for the majority of contact
dermatitis cases. The skin lesions are
caused by the direct effect of an irritant
substance on the skin, which
presumably would affect anybody
under similar circumstance.
(2)Allergic contact dermatitis (ACD): here
the causative substances are less
irritating in general, and the condition
only occurs in specific individuals who
are allergic to these substances.

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Etiology and Pathogenesis

Irritant contact dermatitis(ICD): The contact itself is strongly irritant

(e.g. by exposure to chemicals such as strong acids and bases) or
toxic. The common characteristics are as follows.
(1)It can occur after contact by anyone.
(2)No certain incubation period.
(3)Skin lesions are mostly confined to the direct contact parts, with
clear boundary.
(4)After discontinuation of contact, lesions may subside.

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Etiology and Pathogenesis

Allergic contact dermatitis (ACD):

A typical type IV hypersensitivity reaction
The contact is a sensitizer (hapten) and has no irritation or toxicity
of its own.
The initial reaction stage (induction period) lasts about 4 days, and
the second reaction stage (excitation period) lasts 24 to 48 hours.

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Etiology and Pathogenesis

The common characteristics:

(1)There is a certain incubation period. After the first contact,
there is no reaction, after 1 to 2 weeks if again contact with
the same allergens, it will occur.
(2)The skin lesions are generally distributed symmetrically.
(3)Prone to recurrent attacks.
(4)Skin patch test is positive.

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 Clinical Manifestations

Acute contact dermatitis Chronic contact dermatitis

An acute contact dermatitis may present with erythema, edema, bullae and even necrosis ,with
intense burning and stinging sensations. However, in mild cases of chronic contact dermatitis
hyperkeratosis, lichenification and fissure are more likely to occur.

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Diagnosis and differential Diagnosis

The diagnosis is based on a history of exposure to the

suspected irritant(s) and clinical examination.
After removal of the etiology and appropriate treatment, skin
lesions will quickly subside.
The patch test is the simplest and most reliable method of
diagnosing contact dermatitis.
Furthermore, other forms of dermatoses such as atopic
dermatitis, palmar psoriasis, tinea manus and pedis, and
erythema multiforme should be differentiated from contact
dermatitis.

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Treatment

It is important to identify and avoid the

substances that are shown to cause the
dermatitis. If contact is not completely
avoidable, one should wash the skin
thoroughly and immediately with cool water
after contact to a known allergen or irritant.
Treatment usually consists of medications that
help with symptomatic improvement and
healing of any rash. Glucocorticoids and
antihistamines are the most commonly used
medications for contact dermatitis and should
be prescribed according to the type of
eruption.

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definition

02
Atopic Dermatitis

Atopic Dermatitis is a chronic inflammatory skin

disease associated with hereditary allergic diathesis.

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Etiology and Pathogenesis

• Allergens
contact with allergens
• Gene susceptibility
inhale allergens
• Skin barrier dysfunction
food allergens
• Stimulus
• Season
• Skin infection
• Air pollution
• Smoking
• Lifestyle

Gene Environment
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Clinical Manifestations

Atopic is an itchy, chronic, relapsing dermatitis.

The features and distribution of the eruptions vary with age.
There are three phases for this disease:
• The infantile phase
• The childhood phase
• The adolescent and adult phase

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Clinical Manifestations

The infantile phase(0~2 years old):

 The lesions most frequently start on the face, particularly on
the cheeks, forehead or scalp, but may occur anywhere on
the body, including the trunk and limbs.
 Rash features:
• Erythemas, papules, vesicles
• The boundary is not clear
• After scratching and rubbing, it can form erosion, exudation
and scab.

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The infantile phase

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Clinical Manifestations

The childhood phase(2~12 years old):

 Skin lesions involving the flexion or extension side of limbs,
often limited to the elbow, popliteal fossa, etc., followed by
eyelids, face and neck.
 Skin damage is dark red, exudation is lighter than infantile
period, often accompanied by scratch, and lichenification.
 In this period itching is still very severe, forming itch-scratch
- itchy vicious cycle.

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The childhood phase

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Clinical Manifestations

The adolescent and adult phase(>12 years old):

 It usually occurs around the eye, neck, elbow, popliteal
fossa, limb and trunk.
 Skin lesions are often manifested as localized lichen-like
changes.
 Sometimes can be presented as acute, subacute eczema-
like changes.
 Sometimes are manifested as extensive and dry papules.
 Blood scabs, scales, pigmentation and other secondary skin
lesions occur, when intense itching and scratching.
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The adolescent and adult phase

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Diagnosis

The diagnosis of atopic dermatitis is usually based on history

and clinical findings. Williams’diagnostic criteria are often
adopted.
 Requirement
• An itchy skin condition(or parents complain of scratching or
rubbing history).
 Supplementary condition
1. Onset earlier than 2 years of age(not used if child is under 4
years).
2. A history of skin crease involvement(including cheeks in
children under 10 years old).

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Diagnosis

 Supplementary condition
3. Personal history of other atopic disease such as asthma or
hay fever(or a history of any atopic disease in a first-degree
relative in children under 4 years).
4. A history of generally dry skin.
5. Visible flexural dermatitis(or dermatitis of cheeks/forehead
and outer aspects of limbs in children under 4 years).

The diagnosis requires necessary conditions and at least

three supplementary conditions

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Differential Diagnosis

 Seborrheic dermatitis(especially in infants)

 Contact dermatitis
 Nummular eczema
 Scabies
 Psoriasis

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 Treatment

General management
In order to alleviate the clinical symptoms, trigger factors should be avoided. Keeping for the patient away from
surrounding irritants. Avoiding scratching or scraping, avoidance of excessive cleaning, keeping away from environmental
allergens. Promptly use of moisturizers after bathing.

Systemic therapy
In order to alleviate itching and anaphylaxis, oral therapy is sometimes necessary. Antihistamines are usually applied ,and
different types of antihistamines may be alternatively applied for patients with long-term therapy.

Topical therapy
Topical glucocorticoids—first line drugs
Topical calcineurin inhibitors such as 0.03%-0.1% tacrolimus and 1% pimecrolimus ointments

Phototherapies
These include UVB, narrow-band UVB, UVA1 and PUVA light.

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definition

03
Eczema

Eczema is a kind of superficial dermal and

epidermal inflammation caused by various
internal and external factors. Clinically, the acute
stage of skin lesions are mainly herpetic and
prone to exudation. The chronic stage is mainly
lichenoid and prone to recurrent episodes.
It can be divided into acute, subacute and chronic
eczema.

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Etiology and Pathogenesis

• Chronic infections(such as chronic

Interior
cholecystitis, tonsillitis, intestinal parasitic
factor
diseases).
• Endocrine and metabolic changes(such as
menstrual disorders, pregnancy, etc.).
• Disturbance of blood circulation(such as
varicose leg veins, etc.) .
• Neuropsychiatric factors, genetic factors, etc.

Food (such as fish, shrimp, beef, mutton, etc.),

External inhalation (such as pollen, house dust mite, etc.), living
factor environment (such as hot, dry, etc.), animal fur and
various chemicals (such as cosmetics, soap, synthetic
fiber, etc.) can induce or aggravate.

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 Clinical Manifestations

Acute eczema Subacute eczema Chronic eczema

• Papules, papulovesicle on the basis • Redness and exudation are • The infiltrating dark erythema has
of erythema.
reduced, but there may still papules, scratches, scales, local
• Small blisters may appear in severe
be papules and a small hypertrophic skin and rough
cases.
amount of papulovesicles. surface.
• Often spreading over a large area, • The skin is dark red and • There are different degrees of
without distinct borders.
may be slightly scaly and lichen-like change, pigmentation
• Often due to scratch, there is a
infiltrated. or hypopigmentation.
punctate erosion surface and
obvious serous exudation.
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Clinical Manifestations

A Acute eczema, B subacute eczema, C Chronic eczema.

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Clinical Manifestations

Acute eczema Subacute eczema Chronic eczema

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Diagnosis and differential Diagnosis

Diagnosis
The typical clinical manifestations were as
follows: severe pruritus with polymorphous
symmetrical skin lesion, exudative tendency in
acute phase, lichen-like skin lesion in chronic
phase, etc.

Differential Diagnosis
• Acute eczema should be distinguished from
acute contact dermatitis.
• Chronic eczema should be distinguished
from chronic simple lichen.
• Eczema of hands and feet should be
distinguished from tinea pedis.
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Treatment

Identify the triggers of the eczema, carefully investigate

General the patients’work environment, lifestyle, diet, habits,
management etc. The next step is to remove the triggers.

Antihistamines are effective in management of

Treatment Systemic itching. If necessary, two kinds of antihistamines
can be used together or alternately.
therapy

The principles for treatment of eczema are similar to those of

Topical contact dermatitis, drug selection depend on the exact type of
therapy eruption and available drug formulations. Moist compress is
needed in cases with edema and erythema or erosion and
exudation. But for subacute eruptions, occlusion with zinc oxide
paste can be used.
Topical glucocorticoids are almost always the first line.
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THANK YOU
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