Eczema 1 Teaching should be such that what is offered is perceived as a valuable gift and not as a hard duty. Atopic eczema

Severe itching Sudden urticaria food drugs Long standing no skin lesion with skin leisions Scabies eczema lichen planus Dermtitis herpetiformis

Define eczema and determine its prevalence objectives Define eczema and determine its prevalence List stages, types and clinical presentations of eczema Determine Etiological factors and clinical features of atopic dermtitis To develop a management plan for a patient with atopic eczema

Eczema, a term derived from the Greek word ε´κζεμα meaning ‘to boil’, is a clinical and histological pattern of infl ammation of the skin seen in a variety of dermatoses with widely diverse aetiologies.

Inflammatory components erythema scales vesicles Eczema and dermatitis Common inflammatory condition of the skin with peculiar clinical and histopathological picture. Inflammatory components erythema scales vesicles and some degree of itching

Incidence and prevalence 1st in west 2nd in Iraq after infection

Nickel Allergy from Belt Buckle and Jewelry

Acute 3 stages of evolution Stages of eczema 3 stages of evolution Acute Clinical vesicles ,edema ,oozing ,red base sever itch Histopath sever spongiosis uper dermal odema ,mild perivascular infeltrate

Acute stage

Stages Subacute few vesicles,erythema scales Moderat spongiosis hyper parakeratosis Some acanthosis preivascular infeltrate

subacute

Stages Chronic Dry thick scaly itchy Hyperkeratosis acanthosis slight spongiosis Chronic perivascular infiltrate

classifi cation The classifi cation of eczematous dermatoses is based on aetiology exogenous and endogenous. Why

Classification of eczema A-endogenous(constitutional ) 1-atopic dermatitis 2-seborrheic dermatitis 3-discoid eczema 4-Asteatotic 5-gravitational d. 6-pompholyx 7.lichen simplex

SD of scalp and beard

Stasis Dermatitis

“I can’t do anything with my hands like this!”

B. exogenous (environmental ) 1-occupational d. 2-irritant contact d. Classification B. exogenous (environmental ) 1-occupational d. 2-irritant contact d. 3-allergic contact d. 4- infective d. 5-photoallergic d.

Shoe Leather Dermatitis

Atopic dermatitis

Atopic dermatitis Genetically determent Personal or family history of asthma, allergic rhinitis or atopic dermatitis Increase liability to produce IgE antibodies

10-20% among children international 2-3% in developing counteries prevelance 10-20% among children international 2-3% in developing counteries Five fold increase over last 30 years Early exposure to probiotic reduces the icdidence

Aetiology Gentic : +ve family history 75% dizygotic twin 20,mono 70 polygenic (not mendelian ) HLA marking is still not identify

Immunological abnormalities primary or 2ndry or association 1-increase serum IgE not always increase immediate type 2- increase histamin level in skin and blood 3- increase blood eosinophiles

4-decrease cell mediated immunity virus herpes ecz. herpeticum, molloscum contagiosum 5- decrease neutrophil & monocyte chemotaxis

Other inflammatory changes Blood vessels: increase tendency for vasoconstriction Itching threshold is low Easily irritated by soap syntheic clothes Hypersensetivty reaction to normal flora Increase incidence of staph aureus infection

Abnormal epidermal barrier function pathophysiology Imbalance in t lymphocyte th2 predominant resulting in production of interleukins ,increase in IgE production Abnormal epidermal barrier function

Triggering factors Food :egg fish preservative Temp sweating Humidity Staph infection Stress

Clinical features of atopic d. Chronic relapsing infant children adult Personal and family history of atopy Itching Primary lesion is follicular rash ,vesicle ,pustules Distributin of lesions Infant face extensors ,child adult flexures

Clinical features Major criteria continue Major criteria 1-pruritis 2-morphology and distributtion 3-chronicity and relapses 4-personal of family history of atopy Minor criteria high IgE, dry skin ,food and wool,infra orbital fold,orbital darkening ,itchy when sweating, infections (staph, herpes,) white dermogrphisim, pityriasis alba, cataracts

White dermographisim

Pityriasis alba

Three phases of atopic d. Infantile phase: 3m-1y face,forhead,scalp,limbs extensor scaly erythematous oozing or dry skin itchy,bacterial infections

Infected Atopic Dermatitis (Impetiginized)

Eczema herpeticum HSV superinfection

Eczema herpeticum

Childhood phase: 1y-12y flexor surface,neck,elbow,knee hand and feet Dry scaly erythematous

Adult phase: may persist for life flexor ,itchy,lichenefication ,thick skin ,pigmentation

Increase drug and food allergies Associated diorders Icthyosis vulgaris Alopacia areata Increase drug and food allergies Increase incidence of asthma & allergic rhinitis& urticaria Increase incidence of staph,herpes& molloscum cataract

Reassurance of parents Explain Avoid triggering factors Management Reassurance of parents Explain Avoid triggering factors Topical and systemic steroids potency formula and indications Antibiotics and antihistamin humidity, house dust Environment house hospital

Newly introduced Tacrolimus lymhoma risk Narrow band uvb therapy

Any question

summary What is eczema and stages Types of eczema Atopic eczema

Conclusions Eczema is common Wide spectrum of disease Different subtypes Identify cause if possible Emollients and topical steroids

Today task Please write down 4 lines on the important things that you acquired from this lecture. Sabeeh