1. Eczema
Dr. Majdy Naim

2. Eczematous Diseases Contact Dermatitis Atopic Dermatitis
Seborrheic Dermatitis
Dyshidrotic Dermatitis
Nummular Dermatitis
Stasis Dermatitis
Majdy Naim Eczema

3. Contact Dermatitis
A pruritic, epidermal and dermal inflamatory reaction caused or aggravated by items in contact with the skin.
Majdy Naim Eczema

4. Contact Dermatitis Irritant contact dermatitis
Allergic contact dermatitis
Phototoxic photoallegic contact dermatitis
Majdy Naim Eczema

5. Irritant Contact dermatitis
Acute
chronic
Majdy Naim Eczema

6. 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

7. Factors that determine the response (Irritant Dermatitis)
Individual factors
Time of exposure
Region of the skin exposed
Majdy Naim Eczema

8. Strong- ICD chemical burn ( ACIDS; ALKALIS) thermal burn sun burn
Majdy Naim Eczema

9. Acute dermatitis from turpentine
Majdy Naim Eczema

10. Cement ulcerations
Majdy Naim Eczema

11. Acute bullous contact dermatitis from a scabicide
Majdy Naim Eczema

12. 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

13. W-napkin dermatitis
Majdy Naim Eczema

14. Napkin dermatitis under the plastic part of the diaper
Majdy Naim Eczema

15. ICD in a mechanic – caused by oil
Majdy Naim Eczema

16. Irritant dermatitis due to licking
Majdy Naim Eczema

17. Common agents that produce irritant contact dermatitis
Water
Cleansers
Alkalis
Acids
Oils
Organic solvents
Oxidants
Plants
Animal substances
Majdy Naim Eczema

18. Most commonly located in the hands, forearms, face and legs
Majdy Naim Eczema

19. Laboratory investigations: patch testing
Diagnosis:
History
Examination
Laboratory investigations: patch testing
Majdy Naim Eczema

20. Differential diagnosis: Atopic eczema Discoid eczema
Allergic contact dermatitis
Fungal infection
Majdy Naim Eczema

21. - 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

22. 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

23. 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

24. Contact Allergens poison ivy, poison oak Nickel sulfate Rubber
Formaldehyde and related preservatives
Para-phenylenediamine
Fragrance
Neomycin
Majdy Naim Eczema

25. Poison Ivy/Oak Dermatitis
Presentation: acute pruritic dermatitis with linear grouping of vesicles
Confirmation: history of exposure
Majdy Naim Eczema

27. Nickel Dermatitis
Presentation: areas in contact with jewelry or metal clothing fasteners
Confirmation: skin patch testing
Majdy Naim Eczema

28. Majdy Naim Eczema

29. Majdy Naim Eczema

30. Nickel dermatitis from brassiere clasps
Majdy Naim Eczema

31. Nickel dermatitis from spectacle frames
Majdy Naim Eczema

32. 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

33. Majdy Naim Eczema

34. Majdy Naim Eczema

35. Chromate dermatitis from leather in work shoes
Majdy Naim Eczema

36. Allergic contact dermatitis from thiuram in latex gloves
Majdy Naim Eczema

37. Allergic contact dermatitis from fragrance in a cosmetic
Majdy Naim Eczema

38. Allergic contact dermatitis from glue in sticking plaster
Majdy Naim Eczema

39. Allergic contact dermatitis from plants in the compositae
Majdy Naim Eczema

40. Allergic contact dermatitis from toluenesulfonyl urea in nail varnish
Majdy Naim Eczema

41. Allergic contact dermatitis from toluenesulfonyl urea in nail varnish
Majdy Naim Eczema

42. Allergic contact dermatitis caused by garlic
Majdy Naim Eczema

43. Allergic contact stomatitis caused by the mercury in amalgam dental fillings in a mercury-sensitive person
Majdy Naim Eczema

44. Phototoxic contact dermatitis
Striped and bullous dermatitis of the legs after exposure to plant juices on a sunny day
Majdy Naim Eczema

45. Bullous dermatitis caused by squeezing lime on a sunny day
Majdy Naim Eczema

46. Laboratory investigations: patch testing
Diagnosis:
History
Examination
Laboratory investigations: patch testing
Majdy Naim Eczema

47. A positive patch test to the perfume-mixture
Majdy Naim Eczema

48. Identification of Contact Allergens
Patch Testing
Finn Chamber

49. Patch Test
Majdy Naim Eczema

50. Atopic Dermatitis
Majdy Naim Eczema

51. 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

52. Atopic Dermatitis
Majdy Naim Eczema

53. Environmental Suspects???
urbanization
outdoor pollution
indoor pollution/insulated homes
fewer infections/infestations
changes in food processing
NOBODY KNOWS FOR SURE
Majdy Naim Eczema

54. 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

55. 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

56. 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

57. 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

58. 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

59. 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

60. Treatment Skin care and emollients Treatment of infection
Topical anti-inflammatory agents
STEROIDS
NEW NON-STEROID TOPICAL IMMUNOMODULATORS
Antihistamines
Majdy Naim Eczema

61. 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

62. Treatment
Antibiotics, topical steroids, baths and emollients are safe and effective therapy
Majdy Naim Eczema

63. 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

64. 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

65. 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

66. Quality of Life
Majdy Naim Eczema

67. Atopic Dermatitis
Aim of treatment is to improve the child’s quality of life and that of the family
Majdy Naim Eczema

68. “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

69. Seborrheic dermatitis
Dr. Majdy Naim

70. 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

71. Majdy Naim Eczema

72. Majdy Naim Eczema

73. 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

74. Pathophysiology
normal levels of Malassezia but an abnormal immune response
Majdy Naim Eczema

75. 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

76. 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

77. 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

78. Majdy Naim Eczema

79. Majdy Naim Eczema

80. Majdy Naim Eczema

81. Majdy Naim Eczema

82. Majdy Naim Eczema

83. 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

84. Thank you for your attention!
Majdy Naim Eczema