Usually begins as an itchy erythema of cheeks followed
by development of vesicle, rupture and produce moist crusted areas
The eruptions may rapidly extend to other parts of the
body, chiefly the scalp, the neck, the forehead, the wrist and the extremities
The buttocks and diaper area are often involved
The eruption may become generalized with erythroderma
Infantil AD
Childhood AD
The lesion to be less exudative, drier, and more papular
The classic locations are the antecubital, and the popliteal
spaces, the wrist, eyelids, and the face and in collarette about the neck
The other area, however, are frequently affected
Itching
There is a decrease in the frequency of sensitization to egg,
wheat and milk, but an increase in sensitization to nonigested substances, particulary wool, cat hair, dog hair, and pollens
Childhood AD
Adolescent and adult AD
Usually the eruption involves the antecubital and popliteal
fossae, the front and sides of the neck, the forehead and the are about the eyes Hands dermatitis occurs more frequently in atopic individuals, and eczematous lessions of the dorsum are usual Pruritus : paroxysm, nocturnal, triggered by acute emotional stress Trigger factors : rough clothing, wool irritation, foods or tension.
cells, decreased chemotaxis and activations of PMN leucocyte.
Diagnosis Hanifin & Rajka , Svenson, SCORAD criterias Hanifin & Rajka criteria : Major criteria 1. Pruritus 2. Typical morphology and distribution 3. Tendency toward chronics or chronically relapsing dermatitis 4. Personal or family history of atopic diseases (asthma, allergic rhinitis, AD)
Minor criteria : 1. Xerosis / ichthyosis/ hyperlinear palms 2. Pityriasis alba 3. Keratosis pilaris 4. Facial pallor / infraorbital darkening 5. Elevated serum IgE 6. Keratoconus 7. Tendency to non spesific hand eczema 8. Tendency to repeat cutaneous infections
a. It should be avoided : External irritation Sudden change of temperature, excessive bathing, insufficient cleanless especially in the diaper region, local infections b.
Food elimination ( with special attention)
b.
Antihistamin systemically
c.
Olive oil on absorbent cotton may used with
gentle patting for cleansing to avoide rubbing the affected patrs. Particular attention should be given the genitals and buttocks and the diapers should be changed
d.
Weak topical corticosteroid.
2.
In adults : a. The emosional stress should be controlled b. Avoid extremes cold and heat c. Hydrated xerotic skin d. Antihistamin e. Topical steroid ( be ware of the potentiallity) f. Antiobiotics ( if nedded)
Contact Dermatitis (CD)
An exogenous dermatitis which develops as a reaction
of the skin to contact with a foreign substance / an environmental agent, either a primary irritant ( Irritant CD) or an allergen (allergic CD) It may be affected by exposure to UV-light, resulting into two variant reaction : Photoallergic & Phototoxic CD
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Allergic Contact Dermatitis (ACD)
Occur in predisposed individual
Sensitization occurs within a week after contact with a substance (allergen), but there are no visible skin changes Subsequent contact with allergen, even in small amounts, causes an dermatitis Once established, sensitivity may persists for months, years, or even a lifetime
Irritant Contact Dermatitis
Occure in any individual provided the chemical irritant
is applied in a potent enough concentration for a sufficient length of time
Inflamation of the skin develops at the site of contact
There is non allergic mechanism involved, the damage
result from direct chemical action
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Irritants: strong irritant severe inflamation at the first contact Weak irritants: less toxic substances which require repeated or prolinged conatact to cause inflamation (detergent, organic solvents, excessive exposure to water)
Incidence: The incidence of cases of ICD (each type) depending mainly on the degree of exposure and the causative agent In patients with atopic dermatitis there is a relatively high incidence of ICD
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Sign Allergic dermatitis Based on erythematous skin there are : edema, papules, vesicles and occasionally bullae. Patches are single / multiple, and of various size and shape. Strong irritant burns, ulcer and necrosis
Patch Test
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Treatment
Preventive : Once the causative agent has been identified, further contact should be avoided Topical therapy : in acute state : wet dressing : Burowi solution 1/20 1/40, Permanganate 1/10.000, followed by topical steroid. in chronic state : moderate topical steroid Systemic therapy : Antihistamin (severe pruritus) and steroid (severe / ex tensive eruption
Contact Dermatitis
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Seborrhoic dermatitis Two distinct subset of patients :
* The Infantile form *
Characterized by large yellowish scale mainly on the scalp, face, axilla and napkin rash May cause confusion with Infantile Atopic Dermatitis No link between the infantile and adult form No pruritus eat & sleep well
Infantil form Seborrhoeic Dermatitis
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Cradle Cap
* The adult form *
Affect
the face, scalp, anterior chest, axilla, sub
mammary fold, groins, external ear Facial lesion, particularly in the nasolabial fold, in men, maybe very persistent the scalp is frequently involved presenting complaint, esp severe and persistent dandruff Eyebrow/ eyelid stickness of the eyelid in early morning
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Differential diagnosis : Contact dermatitis, psoriasis and Pityriasis versicolor Treatment : Tends to recure whatever treatment is chosen Topical : imidazol antifungal ketokonazol (cream/shampoo) , weak potency topical steroid
Adult form Seborrhoeic Dermatitis
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Stasis dermatitis
dermatitis on the lower legs, commonly seen in association
with venous insufficiency many cases seen in obese, female patients have a degree of venous insufficiency inner aspects of boths lower legs above and around the medial malleous are chiefly involved the skin is shinny, atrophic and large numbers of small blood vessels clearly visible, purpura, pigmentation (due to haemosiderin) pruritus may be severe and cause scratch marks which are slow to heal
Treatment : treatment of underlying varicose veins, topical steroid (weak) be ware of side effects atrophy
Stasis Dermatitis
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Neurodermatitis (liken simplex chronicus)
a well demarcated are of chronic lichenified dermatitis which is
not due to either external irritants or identified allergens In predisposed persons, the lesions are induced by continual scratching or rubbing of a localized area of itching skin stress / emotional disturbance pruritic stimulus scratch itch-scratch-itch cycle stimulate a reactive hyperplasia, recognized clinically as lichenification clinically, neurodermatitis are seen as a well-circumscribe, lichenified, slightly elevated plaque, seen on the nape of neck, forearm, or the legs
Treatment : Reduce pruritus, topical steroid (ointment/ intra lesion)
Neurodermatitis
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Asteatotic aczema (eczema craquele)
The dry irritable skin seen mainly on the limbs of
elderly patients.
The skin is dry and has large scale with a crazypaving appearance.
Treatment : - lubrication - steroid topical should be avoided (skin is already thin and fragile)
Asteatotic Eczema
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Dishydrotic (eczema dishydrosticum)
a very characteristic pattern of intensely itchy vesicles
of the skin of the hands and occasionally the feet and also the side of finger Deep-seated vesicle ; often easier to feel than to see The cause is not understood ( contact dermatitis / stress? ) Treatment ; systemic antihistamins ( control the need to scratch) prevent secondary infection, potent topical steroid ( a short time) ; for the moist lesion calamine lot.
Dishydrotic
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Nummular or Discoid dermatitis
a chronic, recurrent pattern of dermatitis with discrete
coin-shape lesions tending to to involve the limbs Usually affects adults (many of whom will have a past history of AD) ; The aetiology is unknown Clinically : subacute with erythema, edema, vesiculation; the surface may be moist and appear infected bacterial eczema Pruritus is variable Treatment : topical steroid + antibiotic
Nummular or Discoid Dermatitis
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INFECTIVE ECZEMATOID DERMATITIS
IED is exogen in nature, can be defined as fluid/ exudate
which originates from inflammation or disorders such as: OMP, sinusitis, chronic ulcers, etc IED is thought as autosensitisation dermatitis which occurs from skins sensitivity toward chemical substances originating from tissues/ bacteria in the bodys own exudate
Clinical appearances : Erythema & exudation In a dry state, there is crust. If crust is peeled, we would see erythema & often pustules on the edges Examples : The earlobes of children suffering from OMP. The area around the nose of maxilaris sinusitis sufferers
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Therapy : Rivanol 1/1000, Betadine dressing When cleared Hidrocortisone 1 % or combination with antibiotic
