DERMATITIS/ECZEMA

Def: term that are used

interchangeably,
denoting a
polymorphic inflamatory reaction
pattern involving the
epidermis and
dermis

 Acute dermatitis :
- pruritus
- erythema
- vesiculation
Chronic dermatitis :
- pruritus
- xerosis
- lichenification
- hyperkeratosis
- fissuring (sometime)

Atopic Dermatitis
Def : acute, subacute, or chronic
relapsing skin disorder that
usually begins in infancy and is
characterized principally by dry
skin and pruritus. Often
associated with personal or
family history of atopy such as
allergic rhinitis, asthma, and
atopic dermatitis (AD)

 Epid :
- Age of onset : first 2 M of life(60%)
age 5 Y (30%)
age 6-20Y (10%)
Patogenesis : ???
complex interaction of skin barrier, genetic,
environmental, pharmacologic and immunologic
factors.
*Genetic factors : immunologic defisiency
abnormal function
IgE & limfocyte T
*Type I (IgE mediated) hypersensitivity reaction

mast cells and basophil cells

antigen >< IgE

 Physical exam:
* infantile AD :
- age : 2M-2Y
- loc : face, neck, upper trunk
- eff : red skin, tiny vesicles on
puffy surface, scalling,
exudation wet crusts
* childhood-type AD :
- age : 2 Y-10Y
- loc : ante cubiti fossae (esp),
popliteal fossae, wrist, face,
and neck
- eff : dry skin, erythema, papules,
lichenification plaques, erosion,
crusts

*adult-type AD
- loc : cubiti fossae, popliteal fossae,
neck & wrist
- eff : papules, vesicles, lichenification,
exoriation.
Eliciting factors :
- inhalantsdust mite & pollens
- microbial : staphylococ aereus
exotoxin
- food : milk, eggs, peanuts, fish,
wheat, and soya beans

 Dx : 3 mayor + 3 minor J.M. Hanifin &

G Rayka :
- Mayor : pruritus, characteristic
morphology & distribution, chronic &
residive, atopy history
- Minor : xerosis, ichtyosis, IgE, white
dermographisme, wool intolerance,
cheilitis, pityriasis alba, Dennie
Morgan infra orbital fold, infraorbital
darkness, skin infection

 DD : seborheic dermatitis, contanct

dermatitis, numular dermatitis, Darier
disease, Wiscott-Aldrich
syndrome
Management :
- Education : avoid exacerbating
factors, rubbing & scratching
- Topical : antipruritic lot, emolient,
steroid, acutewet dressing
- Syst : anthistamine, AB, steroid

Contact Dermatitis
Def : contact dermatitis (CD) a
generic term applied to acute to
chronic inflamatory reactions to
substances that come in contact
with skin
2 types : - Irritant CD (ICD)
- Allergic CD (ACD)

Irritant Contact
Dermatitis
Def : dematitis is caused by exposure of the skin to
chemical or other physical agents that are capable of
irritating the skin, acutely or chronically
*Severe irritants toxic reaction
Response of the skin :
- Subjectively irritancy
- Transient irritant reactions
- Persistent irritant reactions
- Toxic (caustic) burn

Acute ICD
Symptom :
- subjective : burning, stinging, smarting
Physical exam :
- 24h
- erythema vesiculation
* acute : sharply demarcated erythema &
superficial edema

vesicles/ blisters

Chronic ICD
Cumulative ICD: slowly after repeated
additive exposure to mild irritan
Symptom : stinging & itching, fissure
pain
Physical exam :
dryness chapping erythemahyperkeratosis & scaling fissure &
crusting
Lab : patch test (-)

 Management :
- avoid irritant or caustic chemical
- wash with water/weak neutralizing sol
- acute : wet dressing, topical steroid
class 1, severe syst steroid
prednison 60mg tapering 10mg
- subacute/chronic : potent topical
steroid healing lubricant

ALLERGIC CD

Def : an eczematous (papules, vesicles, pruritic)

dermatitis due to reexposure to a substances to which

the individual is sensitized

Pathogenesis :
- delayed cell-mediated hypersensitivity
reaction.
strong sensitizer 1w/> sensitization
weak sensitizer moths-years sensitization
antigen>< Langerhan cell
lymph nodes
MCHC class II T cells
proliferate
cytokin realese

 Symptom : intense pruritus

Physical exam :
acute :erythema & edema
subacute :plaques of mild
erythema, dry scales
chronic : plaque of
lichenification
Lab : patch test (+)
Dx : history & clinical finding
Tx : = ICD

NUMULAR DERMATITIS
(discoid eczema)
Def ; is a chronic, pruritic,
inflamatory dermatitis occuring in
the form coin shape plaques
composed of grouped small papules,
vesicles on an erythematous base
DD : psoriasis, epidermal
dermatophytosis, ICD & ACD
Tx : = CD

LICHEN SIMPLEX
CHRONICUS

Def : is a special localizide form of lichenification,

occuring in circumscribed plaques, it results
from repetitive rubbing & scratching
Physical exam :
- a solid plaque of lichenification, arising from
the confluence of small papules.
DD : psoriasis vulgaris, dermatophytosis, ICD,
ACD
Dermatopath : hyperplasia of all components of
epidermis
Tx : steroid or tar preparation combination 5%
crude coal tar in zinc oxide paste + cs class II

URTICARIA & AGIOEDEMA

Def :
* urticaria is compoused of wheals
(transient edematous papules &
plaques, usually pruritic and due to
edema of papilary body). The wheals
are superficial, well defined.
* angioedema is a large edematous
area that involves the dermis and
subcutaneous tissue, is deep and ill
defined