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

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

3. 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

4. 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.

5. 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

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

7. Nickel Allergy from Belt Buckle and Jewelry

8. 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

9. Acute stage

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

11. subacute

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

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

17. 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

19. SD of scalp and beard

21. Stasis Dermatitis

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

23. 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.

25. Shoe Leather Dermatitis

26. Atopic dermatitis

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

28. 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

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

30. 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

31. 4-decrease cell mediated immunity
virus herpes ecz. herpeticum, molloscum contagiosum
5- decrease neutrophil & monocyte chemotaxis

32. 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

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

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

35. 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

36. 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

37. White dermographisim

38. Pityriasis alba

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

42. Infected Atopic Dermatitis (Impetiginized)

43. Eczema herpeticum
HSV superinfection

44. Eczema herpeticum

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

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

50. 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

51. 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

52. Newly introduced
Tacrolimus lymhoma risk
Narrow band uvb therapy

53. Any question

54. summary
What is eczema and stages
Types of eczema
Atopic eczema

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

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