differential diagnosis of eczema

DIFFERENTIAL

DIAGNOSIS OF ECZEMA

Dr Diana Purvis

Paediatric Dermatologist

Eczema can be mimicked by:

• Inflammatory dermatoses

• Infections

• Infestations

• Metabolic disorders

• Genetic disorders

• Immunological disorders

• Malignancies

Quiz slide A

Quiz slide B

Quiz slide C

Quiz slide D

Quiz slide E

Inflammatory dermatoses

• Seborrhoeic dermatitis

• Psoriasis

• Lip lickers dermatitis

• Perioral dermatitis

• Pityriasis lichenoides

• Pityriasis alba

• Keratosis pilaris

• Contact dermatitis

Seborrhoeic dermatitis

Seborrhoeic dermatitis

• Infantile seborrhoeic dermatitis overlaps with eczema

• Adult seborrhoeic dermatitis overlaps with psoriasis

• Management: often not very responsive to treatment

• Prognosis: most improve but increased risk of eczema

Psoriasis

Psoriasis - treatment

• Emollients

• Topicals

• Calcipotriol

• Steroids

• Tars

• Phototherapy

• Systemic therapy

• Methotrexate, acitreti, cyclosporin, biologics

Pustular psoriasis

• Rare inflammatory form

• Can be life-threatening

• Often precipitated by

withdrawal from steroids

Lip lickers dermatitis

Perioral dermatitis

Pityriasis alba

Keratosis pilaris

Pityriasis lichenoides

Contact or phytophotodermatitis

Infections and infestations

• Bacterial

• Viral

• Fungal

• Other

• Infestations

Staphylococcal scalded skin syndrome

Scarlet fever

Pityriasis rosea

Tinea corporis

Scabies

Metabolic, genetic, immunologic,

malignant

• Metabolic

• Nutritional deficiencies, acrodermatitis enteropathica, PKU…

• Genetic

• Ichthyoses, Netherton’s, Ectodermal dyplasias…

• Immunologic

• Omenn’s syndrome, primary immunodeficiencies, Wiskott- Aldrich…

• Malignant

• Langerhan’s cell histiocytosis….

Zinc deficiency

Ichthyosis

Netherton’s syndrome

Hypohidrotic ectodermal dysplasia

Omenn’s syndrome

Langerhan’s cell histiocytosis

Erythroderma in the neonate

• >90% body surface affected by erythema

• Causes • Infections - SSSS, candida

• Drugs - vancomycin, ceftriaxone, TEN

• Dermatoses - atopic dermatitis, seborrhoeic dermatitis, psoriasis, pityriasis rubra pilaris - usu after first 6w of life

• Immunodeficiencies - Omenn’s syndrome, SCID

• Ichthyoses - Netherton’s syndrome, bullous / non-bullous ichthyosiform erythroderma

• Require immunological work up, skin biopsy, specific investigations eg hair, genetics

Quiz slide A

Quiz slide B

Quiz slide C

Quiz slide D

Quiz slide E

Quiz answers

• A – Zinc deficiency

• B – Tinea corporis

• C – Perioral dermatitis

• D – Pityriasis lichenoides

• E – Scabies