ECZEMATOUS DISORDERS

JI Cortez, Arianne M.

 A general term for pruritic rash is a skin disease that is characterized by:
erythematous vesicular, weeping, and crusting patches.

Itching is a characteristic symptom Epidermal intercellular edema (spongiosis) is a characteristic histopathologic nding of eczematous conditions. The term eczema is also commonly used to refer to atopic dermatitis

ATOPIC DERMATITIS
common chronic inammatory dermatosis that generally begins in infancy. The term atopy was coined in the early 1920s to describe the associated triad of asthma, allergic rhinitis, and dermatitis follows the remitting/recurrent course that may continue through life

In 80% of patients with AD, however, serum immunoglobulin IgE is elevated, sometimes markedly.

Types of Atopic dermatitis:

Infantile Age of onset Areas Affected 2mos 2 years cheeks forehead extensors forearm Childhood 2-6 years old antecubital and popiteal areas wrists eyelids face neck Adolescent/ Adult > 6 years old whole body flexural

ACUTE LESIONS OF AD
eczematouserythematous, scaling, and papulovesicular. Weeping and crusted lesions may develop. Scratching results acutely in linear excoriations, presenting as erosions or a hemorrhagic crust.

In extremely severe cases, exfoliative dermatitis (erythroderma) may occur, with generalized redness, scaling, weeping, and crusting.

Treatment:
Anti-histamines (H1 Blockers) Corticosteroids Tar bath preparation UVL for severe pruritus Therapeutic baths, compress and cleansers Moisturizers Cyclosporine if generalized and severe Interferon gamma

CHRONI LESIONS OF AD
Tend NOT to be eczematous Instead, lichenied plaques or nodules predominate. Lichenication denotes areas of thickened skin divided by deep linear furrows. Lichenied plaques result from repeated rubbing or scratching and thus often occur in areas of predilection, such as the popliteal and antecubital fossae.

CONTACT DERMATITIS
can be either allergic or irritant in etiology. Clinical Presentation: Pruritic, erythematous, edematous papules, and plaques Sharp margins Geometric or linear configuration Conforms to area of contact Vesicles and bullae common Linear lesions or pattern of contact Toxicodendron species (poison ivy, oak, sumac) common culprits

 Patch testing may be required to conrm the diagnosis. The manifestations of irritant contact dermatitis are similar to those of allergic contact dermatitis in the irritant form, however, the mechanism is not immunologic. Given sufcient concentration and duration of contact, offending agents will induce irritation in anyones skin. Detergents, acids, alkalis, solvents, formaldehyde, and berglass are common causes

Treatment:
Identify and remove irritants and allergens Lukewarm baths Apply lubricant immediately following the bath Learn to recognize skin infections and seek treatment promptly

SEBORRHEIC DERMATITIS
Clinically, may exist without vesicle formation. Lesional morphology is usually a greasy scale on erythematous patches; however, the scale may be dry, and the patches may have an orange hue. Typical Areas of Involvement:
Scalp, eyebrows, mustache area, nasolabial folds, and chest

Psoriasis may be part of the differential diagnosis.

Treatment:
Selenium Sulfide (Selsun Blue) Ketoconazole (Nizoral) Zinc Pyrithionate (Guard, Head & Shoulders) Resorcin Tar Corticosteroid creams

DIAPER DERMATITIS
An erythematous and papulovesical dermatitis distributed over the lower abdomen, genitals, thigh and the convex surfaces of the buttocks Complications: a. punched-out ulcers or erosions with elevated borders (Jacquets erosive diaper dermatitis) b. pseudoverrucous papules and nodules c. 0.5 to 4 cm violaceous plaques and nodules (granuloma gluteal infantum)

Treatment:
Prevention is the best treatment Zinc oxide paste or other ointments such as 1-23 ointment are excellent: Burrows solution -1part Anhydrous lanolin -2 parts Lassars paste w/o -3 parts salicylic acid Equal parts Nystatin ointment and 1% hydrocortisone ointment

NUMMULAR DERMATITIS
well-demarcated, coin-shaped eczematous patches that are usually 2 to 4 cm (rarely more than 10 cm) in diameter. May be vesicular, but more often with scale and crust. Lower extremities commonly involved in men The lesions are quite pruritic.

Treatment:
Requires potent topical steroids, antihistamines, and, occasionally, intralesional or systemic corticosteroids for treatment.

DYSHIDROTIC DERMATITIS
Pruritic deep-seated vesicles involving lateral aspects of digits, palms, and soles, maybe accompanied by hyperhidrosis. Typically, 1 to 2 mm vesicles appear on the sides of ngers, although more extensive involvement can occur.

Treatment:
with compresses and soaks, antipruritics, topical steroids, and, in severe recalcitrant cases, systemic corticosteroids. Photochemotherapy with topical psoralen and ultraviolet A irradiation (PUVA) may also be effective.

OTHERS
Stasis Dermatitis:
pruritic erythematous and hyperpigmented papules and lichenified plaques in lower legs

Eczematous drug eruption

Nonspecific dermatitis that is usually widespread and pruritic

Autoeczematezation reaction
Poorly defined papular eruption that follows an acute dermatitis of the hands or feet

DIAGNOSIS
The list of medical tests mentioned in various sources as used in the diagnosis of Eczema includes: Physical exam Skin scratch/prick tests need careful interpretation. Blood tests for airborne allergens often not very useful for diagnosis. Eosinophil levels IgE levels Food diary to watch for food allergies

 Patch Test - used to detect hypersensitivity to a substance that is in contact with the skin so that the allergen may be determined and corrective measures taken - confirmatory and diagnostic - application to the intact uninflammed skin, in nonirritating concentration, of substances suspected to be causes of the contact dermatitis

MAJOR CRITERIA
Personal or family history of atopy (atopic dermatitis, allergic rhinitis, allergic conjunctivitis, allergic blepharitis, or asthma) Characteristic morphology and distribution of lesions Chronic or chronically recurring dermatosis Pruritus

MINOR CRITERIA
Hyperimmunoglobulinemia E Food intolerance Intolerance to wool and lipid solvents Recurrent skin infections Xerosis Sweat-induced pruritus White dermatographism Ichthyosis Chronically scaling scalp Accentuation of hair follicles Recurrent conjunctivitis Anterior subcapsular cataracts and keratoconus

HOME REMEDIES
Changing your laundry detergent Prevent dry skin by taking warm (not hot) showers rather than baths. Use a mild soap or body cleanser. Dry yourself very carefully and apply moisturizing skin lotions all over your body. Avoid lotions with fragrances or other irritating substances. Avoid wearing tight-fitting, rough, or scratchy clothing. Avoid scratching the rash. Anything that causes sweating can irritate the rash. Avoid strenuous exercise during a flare. Cold compress

NUT SCRUB
Walnuts contain essential fatty acids that help to soften the skin. They are widely used to treat skin conditions such as fungal infections, warts, eczema and psoriasis.

OATMEAL SCRUB
Oats contain beta-glucan, which is often found in the cellulose of plants. It creates a film on the surface of the skin, allowing the skin to retain its moisture, which makes it very valuable in the treatment of eczema.

ALOE VERA
anti-fungal, healing, cooling and anti-inflammatory properties.

 Coconut oil applied to portions with eczema, helps the the skin to remain soft. 1 tbsp of turmeric powder and bitter neem leaves Papaya seeds mashed and applied on areas to prevent itching of the skin with eczema

TREATMENT
Reduction of Trigger Factors
Reduction of trigger factors (harsh chemicals, detergents, and wool) and avoidance of occupations that require contact with trigger factors (hairdressing, and construction) can be helpful. Appropriate behaviors should be taught to patients and parents early during life, when habits are more easily formed.

 Bland Emollients The use of mild, nonalkali soaps and frequent use of emollients are important elements in the long-term management of AD.

Corticosteroids Application immediately after bathing improves cutaneous penetration. Long-term use of inadequately potent topical corticosteroids may pose a greater risk of adverse effects than brief use of more potent agents followed by a rapid taper to bland emollients.

 Antihistamines
can sometimes be helpful in breaking the itchscratch cycle in AD. Sedating antihistamines, such as hydroxyzine and diphenhydramine, are particularly usefulespecially when itching prevents sleep

 Antidepressants
Doxepin, a tricyclic antidepressant known to have antihistaminic effects, can be benecial when applied topically in a 5% cream.

Phototherapy
Virtually every phototherapy regimen has been reported to ameliorate AD.

 Antimicrobials
are obviously important for patients with infection. Less clear is whether antimicrobial agents can directly treat AD by reducing bacterial products thought to exacerbate the condition.

THANK YOU

Arianne M. Cortez