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Obtain t he diagnosis
PATHOGENESIS OF DERMATITIS
• Refers to an inflammatory response of the skin
• It may follow the stimulus (toxic, infectious, or alergic)
• The central role are T-cell lymphocyte:
• T-helper 1
• T-helper 2
• Releases mediators: cytokine, chemokine, growth factors
• Inflammation process: vasodilatation, edema and accumulations inflammatory cells
DERMATITIS
• an inflammation of
dermis and
epidermis (dermo-
epidermitis):
• Dilated vessels:
• blood cells
extravasations
• Edema, push the
keratinocytes to
cause cleft (blister)
EPIDERMAL THICKENING
Subacute Chronic
DERMATITIS ACUTE-SUBACUTE
papules vesiclesl
plaques crusts
DERMATITIS CHRONIC
dermatophytosis Urticaria
CLASSIFICATION OF DERMATITIS
Classification:
• Burton JL (etiological base)
• exogen
• endogen.
CLASSIFICATION OF DERMATITIS
Eczema exogen Eczema endogen
Dermatitis contact iritan and alergic Dermatitis atopic
Dermatitis photocontact Dermatitis seboroic
Dermatitis numularis
Dermatitis stasis
Dermatitis hand n foot
J.L. Burton
TYPES OF DERMATITIS
• Atopic dermatitis
Chronic, relapsing skin inflammation, with dry
skin and pruritus.
• Allergic contact dermatitis
A delayed hypersensitivity reaction involving
allergens and antibodies.
• Irritant contact dermatitis
Exposure to irritating chemicals or
detergents.
TYPES OF DERMATITIS
• Stasis dermatitis
Occurs on the ankles and lower legs of people with venous insufficiency.
• Nummular dermatitis
Coin shaped patches that occur anywhere on the body in relation to dry
skin.
• Seborrheic dermatitis (cradle cap)
Yellow, greasy scales like dandruff on the scalp and hair-bearing areas of
the head, neck, upper chest, and flexural regions.
• Lichen simplex chronicus
A rash caused by long-term scratching of an area producing thickened skin.
ATOPIC DERMATITIS
childhood
INFANTIL
ADULT
ALLERGIC VS IRRITANT CONTACT
DERMATITIS
ALLERGIC IRRITANT
Examples Nickel, fragrance, hair Water, soap
dye
Number of compounds Fewer Many
Distribution of reactions May spread beyond area Localized
Concentration of agent Can be very small High
needed to elicit reaction
Time course Sensitization in 2 weeks; Immediate to late
elicitation takes 24 – 72h
Immunology Delayed type Rupture of barrier skin
hypersensitivy reaction
Stewart, LA. Contact Dermatitis. In Fitzpatrick JE, Morelli JG editors: Dermatology Secrets in Color. 3rd
ed. Philadelphia, Pa: Elsevier; 2007. p. 77
CONTACT DERMATITIS
PHOTOCONTACT PHOTOTOXIC DERMATITIS
NUMMULAR DERMATITIS
• It has recently been considered a form of adult onset
atopic dermatitis.
• the characteristic round-to-oval erythematous plaques.
• commonly located on the extremities,
http://emedicine.medscape.com/article/1123605-overview
NUMULAR DERMATITIS
SEBHOROIC DERMATITIS
STASIS DERMATITIS
• Skin changes typical for patients with venous insufficiency,
include edema, varicosities, hyperpigmentation,
• Frequently involve the medial ankle, with symptoms
progressing to involve the foot and/or the calf.
• Erythematous, scaling, eczematous patches affecting the
lower extremity.
STASIS DERMATITIS
NEURODERMATITIS
• Chronic itching
• Initial lesion:
mechanic irritant
• Thickening of
epidermal and
upper dermis
• Symptoms in rest
Skin
lesion itch
scratch