Eczematous Disorders CFM REPORT 2.ppt

7/31/2019 Eczematous Disorders CFM REPORT 2.ppt

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ECZEMATOUSDISORDERS

JI Cortez, Arianne M.


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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 finding ofeczematous conditions.

The term eczema is also commonly used to referto atopic dermatitis


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ATOPIC DERMATITIS

common chronic inflammatory dermatosis thatgenerally begins in infancy.

The term atopy was coined in the early 1920s todescribe the associated triad of asthma, allergicrhinitis, and dermatitis follows theremitting/recurrent course that may continuethrough life

In 80% of patients with AD, however, serumimmunoglobulin IgE is elevated, sometimesmarkedly.


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Infantile Childhood Adolescent/

AdultAge of

onset

2mos 2 years 2-6 years old > 6 years old

Areas

Affected

cheeks

forehead

extensorsforearm

antecubital and

popiteal areas

wristseyelids

face

neck

whole body

flexural

Types of Atopic dermatitis:


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ACUTE LESIONS OF AD

eczematouserythematous, scaling, andpapulovesicular. Weeping and crusted lesions maydevelop. 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.


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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


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CHRONI LESIONS OF AD

Tend NOT to be eczematous Instead, lichenified plaques or

nodules predominate. Lichenification

denotes areas of thickened skin divided

by deep linear furrows. Lichenified plaques result from

repeated rubbing or scratching and

thus often occur in areas of

predilection, such as the popliteal

and antecubital fossae.


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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


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Patch testing may be required to confirm the diagnosis.

The manifestations of irritant contact dermatitis aresimilar to those of allergic contact dermatitis in the irritant

form, however, the mechanism is not immunologic.

Given sufficient concentration and duration of contact,offending agents will induce irritation in anyones skin.Detergents, acids, alkalis, solvents, formaldehyde, and

fiberglass are common causes


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Treatment: Identify and remove irritants and

allergens

Lukewarm baths Apply lubricant immediately following

the bath

Learn to recognize skin infections and

seek treatment promptly


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SEBORRHEIC DERMATITIS

Clinically, may exist without vesicleformation.

Lesional morphology is usually agreasy scale on erythematous

patches; however, the scale may bedry, and the patches may have anorange hue.

Typical Areas of Involvement: Scalp, eyebrows, mustache area,

nasolabial folds, and chest Psoriasis may be part of the

differential diagnosis.


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Treatment: Selenium Sulfide (Selsun Blue)

Ketoconazole (Nizoral)

Zinc Pyrithionate (Guard, Head & Shoulders)

Resorcin

Tar

Corticosteroid creams


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DIAPER DERMATITIS

An erythematous and papulovesical dermatitisdistributed 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)


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Treatment: Prevention is the best treatment

Zinc oxide paste or other ointments such as 1-2-

3 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


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NUMMULAR DERMATITIS

well-demarcated, coin-shapedeczematous 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 commonlyinvolved in men

The lesions are quite pruritic.


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Treatment:

Requires potent topical steroids,

antihistamines, and, occasionally,

intralesional or systemic corticosteroids for

treatment.


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DYSHIDROTIC DERMATITIS

Pruritic deep-seated vesicles involvinglateral aspects of digits, palms, and soles,maybe accompanied by hyperhidrosis.

Typically, 1 to 2 mm vesicles appear onthe sides of fingers, although moreextensive involvement can occur.


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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.


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OTHERS

Stasis Dermatitis: pruritic erythematous and hyperpigmented

papules and lichenified plaques in lower legs

Eczematous drug eruption

Nonspecific dermatitis that is usuallywidespread and pruritic

Autoeczematezation reaction

Poorly defined papular eruptionthat follows an acute dermatitis

of the hands or feet


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DIAGNOSIS

The list of medical tests mentioned in various sources asused in the diagnosis of Eczema includes:

Physical exam

Skin scratch/prick tests need careful interpretation.

Blood tests for airborne allergens often not very usefulfor diagnosis.

Eosinophil levelsIgE levels

Food diary to watch for food allergies


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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 non-irritating concentration, of substances suspected to becauses of the contact dermatitis


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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


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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


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HOME REMEDIES

Changing your laundry detergent

Prevent dry skin by taking warm (not hot) showers ratherthan baths. Use a mild soap or body cleanser. Dryyourself very carefully and apply moisturizing skin lotions

all over your body. Avoid lotions with fragrances or otherirritating 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


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NUT SCRUB

Walnuts contain essential fatty acids that help to soften the skin.

They are widely used to treat skin conditions such as fungalinfections, warts, eczema and psoriasis.

OATMEAL SCRUB

Oats contain beta-glucan, which is often found in the cellulose ofplants. It creates a film on the surface of the skin, allowing the skinto retain its moisture, which makes it very valuable in the treatmentof eczema.

ALOE VERA

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


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Coconut oilapplied 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


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TREATMENT

Reduction of Trigger Factors

Reduction of trigger factors (harsh chemicals,

detergents, and wool) and avoidance of

occupations that require contact with triggerfactors (hairdressing, and construction) can

be helpful.

Appropriate behaviors should be taught topatients and parents early during life, when

habits are more easily formed.


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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.


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Antihistamines

can sometimes be helpful in breaking the itch-scratch cycle in AD. Sedating antihistamines,such as hydroxyzine and diphenhydramine,

are particularly usefulespecially whenitching prevents sleep


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Antidepressants

Doxepin, a tricyclic antidepressant known to

have antihistaminic effects, can be beneficialwhen applied topically in a 5% cream.

Phototherapy

Virtually every phototherapy regimen hasbeen reported to ameliorate AD.


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Antimicrobials

are obviously important for patients with

infection. Less clear is whether antimicrobial

agents can directly treat AD by reducingbacterial products thought to exacerbate the

condition.


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THANK YOU

Arianne M. Cortez

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Eczematous Disorders CFM REPORT 2.ppt