ECZEMA

DEFINITION
Hypersensitivity reaction of the skin
Endogenous / exogenous factors
 TYPES OF ECZEMA

• Endogenous
• Exogenous
 STAGES

• Acute
• Chronic
• Sub acute
 CLINICAL HALLMARK
Pruritis
Mild
Moderate
Severe
 CLINICAL SIGNS
Six classical signs
• Erythema
• Exudation
• Vesiculation
• Excoriation
• Cracking
• Lichenification
 PATHOGENESIS
• Direct toxicity
• Irritation
• Immune mediated
• Type 1 hypersensitivity i.e. atopy
• Anaphylaxis
• Disturbed T cell function
• Disturbed B cell function
• Disturbed function of immune of immune cells
• Type 4 hypersensitivity
 EXOGENOUS ECZEMA
• Irritant contact dermatitis
• Infective dermatitis
• Allergic contact dermatitis
• Photodermatitis
• Phytodermatitis
• Pseudophytophotodermatitis
 Irritant contact dermatitis
Cumulative Irritant contact dermatitis
Soaps
Detergents
Water
Dettol
Acute insult Irritant contact dermatitis
Acids, Alkalis
 Allergic contact dermatitis

• Delayed hypersensitivity
• SALT
• MALT
• GALT
• Sensitizers
 Photodermatitis

• UVB
• Delayed hypersensitivity
• SALT
 Phytodermatitis

• Poison ivy
• Poison oak
• Chrysanthemum
• Rutacae
• Moracae
• Crustacae
 Pseudophytophotodermatitis

• Fungicides
• Arsenicals
• Insecticides
 ENDOGENOUS ECZEMAS
• Atopic dermatitis
• Seborrhoeic dermatitis
• Asteototic dermatitis
• Neurodermatitis
• Nummular dermatitis
• Pompholyx
• Pityriasis alba
• Lip licking dermatitis
 Atopic dermatitis

• Type 1 hypersensitivity i.e. atopy

• Anaphylaxis
• Disturbed T cell function
• Disturbed B cell function
• Disturbed function of immune of immune
cells
• Type 4 hypersensitivity
 Clinical features

THREE PHASES
• Infantile phase
• Childhood phase
• Adulthood phase
 Seborrhoeic dermatitis
TWO PHASES
• Infantile phase
• Adult phase
• Sites
• Craddle cap
• Dandruff
 Asteototic dermatitis

• Old age
• Excessive use of soaps
• Limbs
• Crazy pavement appearance
 Neurodermatits

• Readily approachable sites

• Mentally disturbed patients
 Nummular dermatitis

• Disc like lesions

• Limbs
• Bilaterally symmetrical
 Pompholyx

• Vesicles
• Sago grain appearance
• Sides of hands and fingers
 Lip licking dermatitis

• Habitual lip licking

• Perioral eczema
• Young subjects
 Pityriasis alba

• Young subjects
• Face
• White patches
• Scaly
 MANAGEMENT

• NONSPECIFIC
Antibiotics
Antiallergics
Antipyretics
Antianalgesics
 SPECIFIC

• ACUTE
Local
Saline soaks
Potassium permanganate soaks
Steroid creams
Systemic
Systemic steroids
• CHRONIC
Local
Tar
Salicylic acid
Dithranal
Resorcinol
Steroid ointments
Emollients
UVB
Systemic
Steroids
Azathioprine
Cyclosporin A
Local / Systemic
PUVA
Psoralien + UVA