dermatitis dr citra 260907.ppt

8/10/2019 Dermatitis dr citra 260907.ppt

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DERMATITIS - EczemaDr. Citra Cahyarini, SpKK

Department of dermatovenereologyFaculty of medicine YARSI University


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DERMATITIS -Eczema

A common type of inflamation of skin( epidermo- dermatitis ) which is not caused by micro-organism. Itching is the most symptom

Some types appear to be due to as yet unidentifiedconstitutional abnormalities, while others are moreobviously the result of some external set of circumstance

Constitutional : eg Atopic dermatitis

External : eg Contact dermatitis


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Eflorescense of Dermatitis-Eczema

Erythem

Papule

Vesicle

PustuleOozing

Crust

Squama


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Several types of Derm- ecz

Atopic dermatitisContact dermatitis

Seborrhoic dermatitisStatis dermatitisNeurodermatitisNummular eczemaDishidrosisInfective Eczematoid Dermatitis


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Atopic dermatitis/ EczemaDef :

Acute, subacute, or chronic relapsing skin

disorder that usually begins in infancy and ischaracterized principally by dry skin andpruritus.Often associated with personal or familyhistory of atopy such as allergic rhinitis,asthma, and atopic dermatitis (AD)


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A.D may divided into three stages, namely : Infantile ( 2 months 2 years) Childhood ( 2 years 10 years) Adult

Pathogenesis : ???

Complex interaction of skin barrier, genetic,environmental, pharmacologic and immunologic factors


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InfantileUsually begins as an itchy erythema of cheeks followedby development of vesicle, rupture and produce moistcrusted areas

The eruptions may rapidly extend to other parts of thebody, chiefly the scalp, the neck, the forehead, the wristand the extremities

The buttocks and diaper area are often involved

The eruption may become generalized with erythroderma


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Childhood AD


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Adolescent and adult AD

Usually the eruption involves the antecubital and poplitealfossae, the front and sides of the neck, the forehead andthe are about the eyes

Hands dermatitis occurs more frequently in atopicindividuals, and eczematous lessions of the dorsum areusualPruritus : paroxysm, nocturnal, triggered by acute emotionalstressTrigger factors : rough clothing, wool irritation, foods ortension.


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Adolescent and Adult AD


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Associated features

Cutaneous stigmata : Dennie-Morgan fold, Keratosis pilaris,and Hertoghes sign

Vascular stigmata : White dermographismPersonality traits : Nervous tensionOphthamologic abnormalities : cataracts, keratoconus.


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Susceptibility to infection :S.aureus, generalized Herpes simplex or vaccinia virusinfections to produce Kaposis varicelliform eruption

Immunology : elevated serum IgE, decreased T-supressorcells, decreased chemotaxis and activations of PMNleucocyte.


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Diagnosis

Hanifin & Rajka , Svenson, SCORAD criterias

Hanifin & Rajka criteria :Major criteria1. Pruritus2. Typical morphology and distribution

3. Tendency toward chronics or chronically relapsing dermatitis4. Personal or family history of atopic diseases (asthma, allergic

rhinitis, AD)


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Minor criteria :1. Xerosis / ichthyosis/ hyperlinear palms2. Pityriasis alba

3. Keratosis pilaris4. Facial pallor / infraorbital darkening5. Elevated serum IgE6. Keratoconus

7. Tendency to non spesific hand eczema8. Tendency to repeat cutaneous infections


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Differential diagnosis

Nummular Dermatitis

Seborrhoic Dermatitis

Contact Dermatitis

Psoriasis

Scabies


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General management

1. In infancy and childhooda. It should be avoided :

External irritationSudden change of temperature, excessivebathing, insufficient cleanless especially in thediaper region, local infections

b. Food elimination ( with special attention)


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b. Antihistamin systemically

c. Olive oil on absorbent cotton may used withgentle patting for cleansing to avoide rubbing the

affected patrs. Particular attention should be giventhe genitals and buttocks and the diapers shouldbe changed

d. Weak topical corticosteroid.


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Contact Dermatitis (CD)

An exogenous dermatitis which develops as a reactionof the skin to contact with a foreign substance / an

environmental agent, either a primary irritant ( IrritantCD) or an allergen (allergic CD)It may be affected by exposure to UV-light, resultinginto two variant reaction : Photoallergic & PhototoxicCD


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A llerg ic Con tact Derm at i t is (ACD)

Occur in predisposed individualSensitization occurs within a week after contact with asubstance (allergen), but there are no visible skin changesSubsequent contact with allergen, even in small amounts,causes an dermatitisOnce established, sensitivity may persists for months,

years, or even a lifetime


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Symptom : intense pruritus

Physical examacute : erythema & edema

subacute : plaques of mild erythema,dry scales

chronic : plaque of lichenification

Lab : patch test (+)


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PATCH TEST


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Ir r i tant Con tac t Derm atit is

Occure in any individual provided the chemical irritantis 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 damageresult from direct chemical action


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Irritants:strong irritant severe inflamation at the first

contactWeak irritants: less toxic substances which require

repeated or prolinged contact tocause inflamation (detergent, organicsolvents, excessive exposure to water)


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Incidence:

The incidence of cases of ICD (each type)

depending mainly on the degree of exposure andthe causative agentIn patients with atopic dermatitis there is arelatively high incidence of ICD


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acute ICD

Symptom :- subjective : burning, stinging, smarting

Physical exam :- < 24 h- erythema vesiculation

* acute : sharply demarcated erythema &superficial edema

vesicles/ blisters


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chronic ICD

Cumulative ICD: slowly after repeated additiveexposure to mild irritan

Symptom : stinging & itching, fissure pain

Physical exam :dryness chapping erythema -

hyperkeratosis & scaling fissure &crusting


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Treatment

Preventive : Once the causative agent has been identified, furthercontact 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 /

extensive eruption


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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 rashMay cause confusion with Infantile Atopic DermatitisNo link between the infantile and adult form

No pruritus eat & sleep well


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Cradle Cap


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* The adult form *

Affect the face, scalp, anterior chest, axilla, submammary fold, groins, external earFacial lesion, particularly in the nasolabial fold, in

men, maybe very persistentthe scalp is frequently involved presentingcomplaint, esp severe and persistent dandruff

Eyebrow/ eyelid stickness of the eyelid inearly 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


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dult form Seborrhoeic Dermatitis


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Stasis dermatitis

dermatitis on the lower legs, commonly seen in associationwith venous insufficiencymany cases seen in obese, female patients have a degree ofvenous insufficiency

inner aspects of boths lower legs above and around the medialmalleous are chiefly involvedthe skin is shinny, atrophic and large numbers of small bloodvessels clearly visible, purpura, pigmentation (due tohaemosiderin)pruritus may be severe and cause scratch marks which are

slow to heal

Treatm ent :treatment of underlying varicose veins, topical steroid (weak)be ware of side effects atrophy


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Stasis Dermatitis


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Neurodermatitis

(liken simplex chronicus)a well demarcated are of chronic lichenified dermatitis which isnot due to either external irritants or identified allergensIn predisposed persons, the lesions are induced by continual

scratching or rubbing of a localized area of itching skinstress / emotional disturbance pruritic stimulus scratchitch-scratch-itch cycle stimulate a reactive hyperplasia,recognized clinically as lichenificationclinically, 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)


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Neurodermatitis


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Dishydrotic(eczema dishydrosticum)

a very characteristic pattern of intensely itchy vesiclesof the skin of the hands and occasionally the feet andalso the side of fingerDeep-seated vesicle ; often easier to feel than to seeThe cause is not understood ( contact dermatitis /stress? )

Treatment ; systemic antihistamins ( control the needto scratch) prevent secondary infection, potenttopical steroid ( a short time) ; for the moist lesioncalamine lot.


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Dishydrotic


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Nummular or Discoid dermatitis

a chronic, recurrent pattern of dermatitis with discretecoin-shape lesions tending to to involve the limbsUsually affects adults (many of whom will have a pasthistory of AD) ; The aetiology is unknownClinically : subacute with erythema, edema,vesiculation; the surface may be moist and appearinfected bacterial eczemaPruritus is variableTreatment : topical steroid + antibiotic


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Nummular or Discoid Dermatitis


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INFECTIVE ECZEMATOID DERMAT

IED is exogen in nature, can be defined as fluid/ exudatewhich originates from inflammation or disorders such as:OMP, sinusitis, chronic ulcers, etcIED is thought as autosensitisation dermatitis which occursfrom skins sensitivity toward chemical substancesoriginating from tissues/ bacteria in the bodys own exudate


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Clinical appearances :Erythema & exudationIn a dry state, there is crust. If crust is peeled, we would

see erythema & often pustules on the edgesExamples :

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 dressingWhen cleared Hidrocortisone 1 % or combination with

antibiotic


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Infective Eczematoid Dermatitis


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URTICARIA AGIOEDEMADef:* URTICARIA

is compoused of wheals (transient edematous papules &plaques, usually pruritic and due to edema of papilarybody). The wheals are superficial, well defined.

* ANGIODEMA is a large edematous area that involves the dermis andsubcutaneous tissue, is deep and ill defined


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Therapy Antihistamin : H1, H1 + H2Systemic corticosteroid Adrenalin inj subcutis/ ephedrin tab


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urticaria

angioedema


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CC Sept- 2007

dermatitis dr citra 260907.ppt

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