ECZEMA Lecture fife

FUNCTIONS OF SKIN Protect against infections, chemical toxins and physical agents (UV, ionizing radiation) Prevent insensible water loss Control body temperature (thermoregulation) Sensation, communication (psychosocial, sexual, endocrine functions) Self-regeneration and healing

ECZEMA Usually refers to severely inflamed dermatitis. It is a non –infectious inflammatory dermatosis in which the affected skin is erythematous. IT IS NOT ADISEASE, IT IS A SYMPTOM. MOST DERMATOLOGISTS WOULD ACCEPT THE DEFINITION: SKIN INFLAMMATION OF WHATEVER CAUSE signs and symptoms associated with such an acute process (itching, sting, burning of the skin with drainage from lesions)

TERMINOLOGY Dermatitis = Dermat+itis refers to skin means “inflamed” (thus, inflamed skin) Other examples: arthritis, colitis, encephalitis, etc.

CARDINAL FEATURES OF INFLAMMATION (warmth) - increased blood flow (redness) -dilated blood vessels (pain)- irritation of nerves in inflamed tissues

Classification Can either be acute or chronic in nature. Acute eczema shows marked inflammation of skin, erythema and papules. Chronic eczema shows lichenification (thickening of the skin) from repeated rubbing or scratching, post inflammatory hyper- or hypo pigmentation. Both types can show excoriations. There is commonly a secondary infection, usually with Staphylococcus aureus (S. aureus).

TYPES OF DERMATITIS ( ECZEMA) IT IS PRECIPITATED BY EXTERNALSOURCES OR INTERNAL ONES(ENDOGENOUS Exogenous: contact DERMATITIS(acute) Irritant, allergic and infective. Endogenous, chronic Atopic, A steatiOTIC, neurodematisTIS,and other types

IRRITANT CONTACT DERMATITIS Non-immunologic inflammatory reaction of the skin due to an external agent Varied morphology Clinical types –Chemical burns –Irritant reactions –Acute irritant contact dermatitis –Chronic irritant contact dermatitis

COMMON IRRITANTS Water Skin cleansers Industrial cleaning agents Acids and alkalis Oils and organic solvents Oxidizing and reducing agents Plants Animal products Miscellaneous

FACTORS INFLUENCING THE DEVELOPMENTOF SKIN IRRITATION

THE SUBSTANCE, IF IT PENETRATE TO THE DERMAL AREA WHERE VASCULAR AND LYMPHATIC SUPPLY ARE PRESENT DEGREE OF IRRITATION DEPEND ON: 1- THE INTRINSIC IRRITATION POTENTIAL 2-CONCENTRATION 3-ABILITY TO REMAIN BOUND TO THE SKIN

THE CLIMATE; MACRO;WHICH REFERS TO ENVIROMENTAL CONDITIONSWHICH WILL AFFECT SKIN TEXTURE MICRO CLIMATE DEPENDS ON WETHER THE SKIN IS OCCLUDED OR LEFT OPEN TO THE ATMOSPHERE

THE HOST; AGED SKIN IS LESS PRON TO IRRITATION THAN YOUTHFUL SKIN, BECAUS E OF GREATER DIFFICULTY IN DRUG PENETRATION THTOUGH AGED SKIN

Allergic contact dermatitis The term “contact dermatitis” describes an inflammation of the skin caused by contact with external agents. Allergic contact dermatitis is a delayed-type hypersensitivity reaction due to the contact with a chemical to which the individual has previously been sensitized. Possible allergens are found in jewellery, personal care products, topical medications, plants and work-related materials. Usually, the eczematous reaction develops within 24 to 72 hours after contact with the causative chemical in a sensitized individual.

Atopic dermatitis A chronic problem causing dry skin, intense itching, and a raised rash, some children outgrow atopic dermatitis, or have milder cases as they age. In severe cases, this non-contagious rash forms clear, fluid-filled blisters. What causes atopic dermatitis isn't clear, but those affected may have a personal history of allergies and asthma and a sensitive immune system. IT OCCURE PRIMARILY DURING CHILDHOOD AND EARLY ADULTHOOD

Several treatment options for eczema are available. But primarily, it is most important to diagnose correctly and to identify the underlying etiological factors (e.g. allergens in case of allergic contact dermatitis). Avoidance of the a etiological factors is one important therapeutic approach. Symptomatic treatment includes topical and systemic treatment regimens. The treatment depends on the underlying type of eczema and on its localization. The following general guidelines have proved helpful in eczema patients:

Asteatotic eczema: this eczema is characterized by dry and fissured skin and by absence of sebaceous secretions. It occurs mainly during the dry weather and in the aged skin. Neurodermatitis: this is a chronic form of eczema found more often in women. It is often localized in the nape of the neck, legs,genitoanal region, and forearms. Emotional stress play a role in this condition.

Strategy for treatment of eczema In some forms of eczema the patient is sensitive for a wide variety of agents, and therapeutic entities may aggravate already inflamed skin. In contact dermatitis, drug therapy is needed for only a short time because withdrawal of allergen or irritant ameliorates the condition

TREATMENT OF allergic cotact dermatitis Topical glucocorticoids Oral antihistamines Compresses Topical Emollients Oral antibiotics Oral glucocorticoids

CHILDHOOD ECZEMA

OTC products for eczema 1- protestants; zinc oxide past (lesser)and ointment 2- astringents ;soaking in solution of aluminum acetate reduces the weeping for a large areas. Bathes of local astringents compresses(15-30 ) a few time daily help dry the weeping areas. More potent astringents should be reserved until erythemal inflammation of the acute phase subsides in order not aggravate the condition

3- cooling agents; to reduce the extent of pruritus. In the acute phases of eczema, soothing lotions applied as wet compresses are helpful. 4- antihistamines ;orally administered for their sedative and antipruritis effects. 5- antiseptics; these are useful in infective dermatitis

preccautions calamin lotion and other powered-based preparations that dry weeping through water adsorption should be avoided because of their tendency to crust. Removal of the crust may cause bleeding and potential infections

SUMMARY Dermatitis is a common type of skin inflammation There are many causes of dermatitis Dermatitis disrupts the normal functions of skin Investigating causes of dermatitis is as important as using drug therapy Traditional agents (glucocorticoids, antihistamines) and newer agents (TIMs) are available to treat this condition

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