Eczema Dr. Majdy Naim
Eczematous Diseases Contact Dermatitis Atopic Dermatitis Seborrheic Dermatitis Dyshidrotic Dermatitis Nummular Dermatitis Stasis Dermatitis Majdy Naim Eczema 2010
Contact Dermatitis A pruritic, epidermal and dermal inflamatory reaction caused or aggravated by items in contact with the skin. Majdy Naim Eczema 2010
Contact Dermatitis Irritant contact dermatitis Allergic contact dermatitis Phototoxic photoallegic contact dermatitis Majdy Naim Eczema 2010
Irritant Contact dermatitis Acute chronic Majdy Naim Eczema 2010
Irritant Contact Dermatitis It is the most common injury of the skin Irritant Responses include: Wheals erythema Blistering Erosions Hyperkeratosis or thickening of the skin Pustules and skin dryness Majdy Naim Eczema 2010
Factors that determine the response (Irritant Dermatitis) Individual factors Time of exposure Region of the skin exposed Majdy Naim Eczema 2010
Strong- ICD chemical burn ( ACIDS; ALKALIS) thermal burn sun burn Majdy Naim Eczema 2010
Acute dermatitis from turpentine Majdy Naim Eczema 2010
Cement ulcerations Majdy Naim Eczema 2010
Acute bullous contact dermatitis from a scabicide Majdy Naim Eczema 2010
Weak- ICD Prolonged contact Multiple exposure In skin that too wet or too dry Bleaches, cleansers, detergents, plants, soaps, solvents, weak acids, weak alkalis Majdy Naim Eczema 2010
W-napkin dermatitis Majdy Naim Eczema 2010
Napkin dermatitis under the plastic part of the diaper Majdy Naim Eczema 2010
ICD in a mechanic – caused by oil Majdy Naim Eczema 2010
Irritant dermatitis due to licking Majdy Naim Eczema 2010
Common agents that produce irritant contact dermatitis Water Cleansers Alkalis Acids Oils Organic solvents Oxidants Plants Animal substances Majdy Naim Eczema 2010
Most commonly located in the hands, forearms, face and legs Majdy Naim Eczema 2010
Laboratory investigations: patch testing Diagnosis: History Examination Laboratory investigations: patch testing Majdy Naim Eczema 2010
Differential diagnosis: Atopic eczema Discoid eczema Allergic contact dermatitis Fungal infection Majdy Naim Eczema 2010
- Removal of the offending contact - Restore a protective lipid layer Treatment: - Removal of the offending contact - Restore a protective lipid layer - Topical steroid may be necessary Majdy Naim Eczema 2010
Allergic contact dermatitis It is a form of cell-mediated, antigen-antibody immune reaction. Sensitization phase (1 week or longer) Elicitation phase (follows) affect few workers; many skin sensitizers are also irritants (chromates, nickel salts, and epoxy resin hardeners) cross-sensitivity Majdy Naim Eczema 2010
Allergic Contact Dermatitis Presentation: erythematous and edematous or vesicular skin in the pattern of contact Mechanism: cell-mediated immune response to antigens (contact allergens) Majdy Naim Eczema 2010
Contact Allergens poison ivy, poison oak Nickel sulfate Rubber Formaldehyde and related preservatives Para-phenylenediamine Fragrance Neomycin Majdy Naim Eczema 2010
Poison Ivy/Oak Dermatitis Presentation: acute pruritic dermatitis with linear grouping of vesicles Confirmation: history of exposure Majdy Naim Eczema 2010
Nickel Dermatitis Presentation: areas in contact with jewelry or metal clothing fasteners Confirmation: skin patch testing Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Nickel dermatitis from brassiere clasps Majdy Naim Eczema 2010
Nickel dermatitis from spectacle frames Majdy Naim Eczema 2010
Rubber Dermatitis Presentation: sites of exposure to… shoes (adhesive), elastic in clothing, surgical gloves, etc. Confirmation: patch test to accelerators and antioxidants Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Chromate dermatitis from leather in work shoes Majdy Naim Eczema 2010
Allergic contact dermatitis from thiuram in latex gloves Majdy Naim Eczema 2010
Allergic contact dermatitis from fragrance in a cosmetic Majdy Naim Eczema 2010
Allergic contact dermatitis from glue in sticking plaster Majdy Naim Eczema 2010
Allergic contact dermatitis from plants in the compositae Majdy Naim Eczema 2010
Allergic contact dermatitis from toluenesulfonyl urea in nail varnish Majdy Naim Eczema 2010
Allergic contact dermatitis from toluenesulfonyl urea in nail varnish Majdy Naim Eczema 2010
Allergic contact dermatitis caused by garlic Majdy Naim Eczema 2010
Allergic contact stomatitis caused by the mercury in amalgam dental fillings in a mercury-sensitive person Majdy Naim Eczema 2010
Phototoxic contact dermatitis Striped and bullous dermatitis of the legs after exposure to plant juices on a sunny day Majdy Naim Eczema 2010
Bullous dermatitis caused by squeezing lime on a sunny day Majdy Naim Eczema 2010
Laboratory investigations: patch testing Diagnosis: History Examination Laboratory investigations: patch testing Majdy Naim Eczema 2010
A positive patch test to the perfume-mixture Majdy Naim Eczema 2010
Identification of Contact Allergens Patch Testing Finn Chamber
Patch Test Majdy Naim Eczema 2010
Atopic Dermatitis Majdy Naim Eczema 2010
What is the Cause? nobody has identified a single “cause” atopic dermatitis is a genetic disorder atopic children or their relatives may also have asthma allergic rhinoconjunctivitis food allergies urticaria Majdy Naim Eczema 2010
Atopic Dermatitis Majdy Naim Eczema 2010
Environmental Suspects??? urbanization outdoor pollution indoor pollution/insulated homes fewer infections/infestations changes in food processing NOBODY KNOWS FOR SURE Majdy Naim Eczema 2010
Pathophysiology specific gene abnormality not yet identified may be more than one disease down regulation of TH1 lymphocytes (TH1 cells activate IFN- which inhibits IgE synthesis) upregulation of TH2 lymphocytes (TH2 cells activate IL-4 which inhibits IFN-) Majdy Naim Eczema 2010
Is it a Food Allergy? no conclusive evidence that eczema is “a food allergy” atopic children have a higher incidence of urticaria or anaphylaxis to peanuts, eggs, fish, milk certain foods cause contact irritation and erythema eg. tomato sauce Majdy Naim Eczema 2010
What about milk? breast-feeding does not protect against atopic dermatitis “allergen-free” diets in lactating women can compromise nutrition of the baby and mother Effect of cow’s milk formula or soy formula in infants with eczema difficult to evaluate Majdy Naim Eczema 2010
What about Allergy Testing? negative tests may be helpful 80% of atopic children have positive prick and RAST tests often leads to unnecessary food and lifestyle restrictions with consequences for child’s emotional and nutritional well-being parents must be told that positive tests are < 20% predictive of clinical allergy Majdy Naim Eczema 2010
Eczema – Psychological Issues How does it affect sleep? How does it impact on the patient’s behavior and family life? Is the patint’s diet or lifestyle restricted? Are there psychosocial factors that cause anxiety eg. At home, at school Majdy Naim Eczema 2010
Atopic Dermatitis There is no “cure” Eczema can be controlled 60% of children “outgrow” eczema by 11 years of age Treatment better than searching for the “cause” Majdy Naim Eczema 2010
Treatment Skin care and emollients Treatment of infection Topical anti-inflammatory agents STEROIDS NEW NON-STEROID TOPICAL IMMUNOMODULATORS Antihistamines Majdy Naim Eczema 2010
Is the eczema infected? STREPTOCOCCUS, HERPES SIMPLEX most cases of eczema are colonized by Staphylococcus Aureus - staphylococcal superantigens may play a pathogenetic role consider antistaphylococcal antibiotic therapy in all cases of weeping, crusted or very excoriated eczema also consider STREPTOCOCCUS, HERPES SIMPLEX Majdy Naim Eczema 2010
Treatment Antibiotics, topical steroids, baths and emollients are safe and effective therapy Majdy Naim Eczema 2010
Eczema Checklist 1 do parents have a basic understanding of the disease what have they been told by other health care professionals, pharmacists, naturopaths, family and friends do they have realistic expectations Majdy Naim Eczema 2010
Eczema – Checklist 2 is skin care adequate Baths and emollients is topical therapy optimal Topical steroids/steroid-free agents is the eczema infected Antibiotics oral/topical Majdy Naim Eczema 2010
Eczema Checklist 3 Are other measures necessary? Wet wraps Higher potency topical steroids for short periods Phototherapy Psychological evaluation/counselling for child, parents, parent/child interaction Cyclosporin, Azathioprine Majdy Naim Eczema 2010
Quality of Life Majdy Naim Eczema 2010
Atopic Dermatitis Aim of treatment is to improve the child’s quality of life and that of the family Majdy Naim Eczema 2010
“Compassion without competence is dangerous” “Patients aren’t as concerned about how much you know until they know how much you care” “Compassion without competence is dangerous” Majdy Naim Eczema 2010
Seborrheic dermatitis Dr. Majdy Naim
Seborrheic dermatitis a papulosquamous disorder patterned on the sebum-rich areas of the scalp, face, and trunk In addition to sebum, this dermatitis is linked to Malassezia, immunologic abnormalities, and activation of complement Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
The severity varies from mild dandruff to exfoliative erythroderma. Commonly aggravated by changes in humidity, changes in seasons, trauma (eg, scratching), or emotional stress. The severity varies from mild dandruff to exfoliative erythroderma. Majdy Naim Eczema 2010
Pathophysiology normal levels of Malassezia but an abnormal immune response Majdy Naim Eczema 2010
Age The usual onset occurs with puberty. It peaks at age 40 years and is less severe, but present, among older people. In infants, it occurs as cradle cap or, uncommonly, as a flexural eruption or erythroderma. Majdy Naim Eczema 2010
Frequency :3-5 %, dandruff 15-20% Race: Seborrheic dermatitis occurs in persons of all races. Sex: The condition is slightly worse in males than in females. Majdy Naim Eczema 2010
Skin lesions manifest as greasy scaling over red, inflamed skin Scalp appearance varies from mild, patchy scaling to widespread, thick, adherent crusts Skin lesions manifest as greasy scaling over red, inflamed skin Distribution follows the oily and hair-bearing areas of the head and the neck, such as the scalp, the forehead, the eyebrows, the lash line, the nasolabial folds, the beard, and postauricular skin. Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Majdy Naim Eczema 2010
Treatment Topical corticosteroids Dandruff responds to more frequent shampooing Selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs Majdy Naim Eczema 2010
Thank you for your attention! Majdy Naim Eczema 2010