EczemaEczema (eczematous inflammation) is the most common inflammatory

skin disease . Although the term dermatitis is often used to refer to an

eczematous eruption, the word means inflammation of the skin and is

not synonymous with eczematous processes.

Stages of eczema(path.&clinical): جدا مهم

acute, subacute, and chronic.

Each represents a stage in the evolution of a dynamic inflammatory

process. Clinically, an eczematous disease may start at any stage and

evolve into another.

Most eczematous diseases, if left alone (i.e., neither irritated,

scratched, nor medicated), resolve in time without complication.

This ideal situation is almost never realized; scratching, irritation,

or attempts at topical treatment are almost inevitable.

Some degree of itching is a cardinal feature of eczematous inflammation.

1.Acute: Vesicles, blisters, intense redness. Intense itch.

Contact allergy (poison ivy), severe irritation, id reaction, acute

nummular eczema, stasis dermatitis, pompholyx (dyshidrosis).

2.Subacute: Redness, scaling, fissuring, parched appearance, scalded

appearance. Slight to moderate itch, pain, stinging, burning.

Contact allergy, irritation, atopic dermatitis, stasis dermatitis, nummular

eczema, asteatotic eczema, fingertip eczema.

3.Chronic: Thickened skin, skin lines accentuated (lichenified skin),

excoriations, fissuring.Moderate to intense itch.

Atopic dermatitis, habitual scratching, lichen simplex chronicus, chapped

fissured feet, nummular eczema, asteatotic eczema, fingertip eczema,

hyperkeratotic eczema.

Hand Eczema

Inflammation of the hands is one of the most common problems

encountered by the dermatologist .Hand dermatitis causes discomfort

and embarrassment and, because of its location, interferes significantly

with normal daily activities .Hand dermatitis is common in industrial

occupations: it can threaten job security if inflammation cannot be

controlled.

Treatment Options for Hand Eczema

1.Skin protection:

Gloves

Barrier creams

Bland emollients

Lifestyle changes

Workers’ education

2.Topical treatments:

Corticosteroid: creams, ointments, emollient foams

Tacrolimus, pimecrolimus

Coal tar and derivatives

Irradiation with UV light

Irradiation with x-rays

3.Systemic treatments:

Antihistamines

Azathioprine

Methotrexate (MTX)

Cyclosporine

Oral corticosteroids in short treatment course

Irritant And Allergic Contact Dermatitis جدا مهم

Seborrheic Dermatitis

Seborrheic dermatitis is a common, chronic, inflammatory disease with a

characteristic pattern for different age groups.

The yeast Malassezia ovalis probably is a causative factor, but both

genetic and environmental factors seem to influence the onset and

course of the disease. Many adult patients have an oily complexion, the

so-called seborrheic diathesis.

In adults seborrheic dermatitis tends to persist, but it undergoes

periods of remission and exacerbation.The extent of involvement among

patients varies widely.

Infants (Cradle Cap) : Infants commonly develop a greasy adherent

scale on the vertex of the scalp.

Minor amounts of scale are easily removed by frequent shampooing

with products containing sulfur, salicylic acid, or both (e.g., Sebulex

shampoo, T/Gel shampoo).

Scale may accumulate and become thick and adherent over much of the

scalp and may be accompanied by inflammation. Secondary infection can

Derma-Smoothe/FS lotion (peanut oil, mineral oil, fluocinolone

acetonide 0.01%) to the scalp and washing several hours later.

Remissions possibly can be prolonged with frequent use of salicylic

acid or tar shampoos.

Ketoconazole is another option for the treatment of infantile

seborrheic dermatis, to avoid the side effects of topical corticosteroid

in long-term use and on large surface areas of treatment.

Adolescents and Adults (Classic Seborrheic Dermatitis):

Most individuals periodically experience fine, dry, white scalp scaling

with minor itching; this is dandruff. They tend to attribute this condition

to a dry scalp and consequently avoid hair washing. Avoidance of

washing allows scale to accumulate and inflammation may occur.

Patients with minor amounts of dandruff should be encouraged to wash

every day or every other day with antidandruff shampoos.

Fine, dry, white or yellow scale may occur on an inflamed base.

The distribution of scaling and inflammation may be more diffuse and

occur in the seborrheic areas: scalp and scalp margins, eyebrows, base of

eyelashes, nasolabial folds, external ear canals, posterior auricular fold,

and presternal area

Treatment:

Frequent washing with Shampoos (ketoconazle 2%)

Topical Steroids (foams and solutions)

Oral antifungals (itraconazole capsules 100mg)