This document provides information on dermatitis and eczema. It discusses the characteristics of different types of dermatitis including atopic, seborrheic, discoid, dyshidrotic, and contact dermatitis. Potential triggers are identified like irritants, allergens, and infections. Treatment options are outlined from conservative therapies using emollients and topical steroids to phototherapy. Prevention strategies focus on moisturizing, identifying triggers, and avoiding harsh soaps, wool or tight clothes.

1. DERMATITIS ECZEMA
Department of dermatology
Name-Hari Shankar Meena
424b
7 feb 2021
Aktobe

2. Any itchingrash
Any red itchingrash
Any red itching rash that hasscalesor is
dry
The itch thatrashes
Any rash that cannot otherwise be
identified

3. An acute, subacute but usually
chronic pruritic inflammation of the
epidermis and the dermis, often
occurring in association with a
personal family history of hay fever,
asthma, allergic rhinitis or atopic

4. Historically
Endogenous (occurring from within)
dermatitis was given the name
“eczema”
Exogenous dermatitis (occurring from
without) was termed“dermatitis”

5. Endogenou
s
Atopic orIgE
Seborrheic
Discoid ornummular
Pompholyx
Venous
Asteatotic
Juvenileplantar
Erythoderma
Exogenous
Allergic
Toxicirritant
contact
Photosensitive

6. Well demarcated plaques of erythema
and edema on which are superimposed
and closely spaced small vesicles filled
with clear fluid with punctate erosions
and crusting
Distribution may be isolatedand
localized orgeneral

7. Term dyshidrotic is amisnomer as
sweat glands are notinvolved
Also known aspompholyx

9. Plaques of mild erythema with small dry
scales and or superficial desquamation,
sometimes associated with small red,
pointed or roundpapules
Distribution may be isolated and localized or
general

10. Note erythema, swelling and
desquamation

12. Plaques of lichenification with
deepening of the skin lines with satellite,
small, firm flat or round top papules,
excoriations and pigmentations or mild
erythema
Distribution–isolatedand
localizedor generalized

13. Note lichenification, scaling and
fissuring

14. Commonly misdiagnosed aspsoriasis

15. Swellingand
erythema
Punctateerythema,
desquamation Lichenification

16. 10-20% of
population
Primary
symptom: itch
Location, location,
location
Associated with
atopic background
Periorbital pallor

17. Characteristics:
60%haveonset in the first year of life
Influenced by geneticsand environmental
factors
More common in males that females
Ethnicity may be afactor –lesscommon in
Asians; more common in Westerners and
higher socioeconomicfamilies
Theory is - manifestation of well nourished
immune system rarely challenged by infection
Raretohave adult onset
2/3of patients havefamily history of
asthma, hay fever or allergic rhinitis

18. May persist months to years
All patients havedry skin
Exacerbations caused by allergens,
stress, hormones, climate, skin
dehydration
Physical characteristicmay include all
phases
DistinctiveCharacteristics:
Lesions are usuallybilateral
Located frequently in skin folds/creases
and flexor surfaces

19. Note:
•Bilateral
•Skin foldsand
flexor surfaces

20. Triggers:
Irritants
Dry skin; bathing without moisturizing
Harsh/perfumed soaps,detergents
Disinfectants
Contact withwool, occupational chemicals/fumes
Allergens
Dust mites
Pet dander (cat more allergenic than dog)
Pollens, seasonal andmolds
Foods- strawberries, carrots

21. Infections
Bacteri
al Viral
1. Cold and otherURIviruses
2. GIviruses
Fungal
Environmental
Extremesin temperature and/or humidity
Perspiration
Stress

22. Confusedwith:
Scabies, seborrhea, psoriasisand,
contact dermatitis

25. Eruptionmay becomegeneralized,inmost casesitfirstmanifestswith
severe“cradlecap”orsevereintertriginousrashes(groin,neck,axillae).
As the patientapproaches age 2years, the flexorcreasesbecome involved.
Lesions consist of scaly, red,and occasionally oozing plaques that tendto be
symmetric.
Occurs onthe
 scalp
 face, particularlycheeks
 neck
 chest
 extensor extremities

26. These patients tend to be less acuteand lesions less exudativethan those seenin
infancy.
Inflamed lesions become lichenified (especially inAsian andAfrican-American
patients)
secondaryto chronic rubbing and scratching.
Lesions tendto occursymmetrically,with characteristic distribution in the
flexuralfolds.
Occurs onthe:
Antecubital and poplitealfossae
Neck, wrists, andankles
May occuron the eyelids, lips, scalp, and
postauricularareas

27. Post inflammatoryhyperorhypopigmentedchangestendto beseen.
Theappearanceof atopicdermatitismay changeto a morepoorlydefined,
itchy, erythematous rash, possibly with papules and/or plaques.
Lichenified plaques of atopic
dermatitis are typically less well
demarcated than arethe plaques
seen in psoriasis. These plaques
tend to blend into surrounding
normal skin.

28. Characteristics:Positive family history is common
Seenin all age groups equally
May occur on presternal areaand mid upper back
Stress may increasesymptoms
Pityrosporum ovale may be causative factor
DistinctiveCharacteristics:
Redgreasy scaling rashconsists of patches and plaques with
indistinct margins and an underlying red glazed look to the
skin
Most commonly located in the hairy areas,nasolabial folds,
retroauriclar folds
Excoriations from scratching arerare

29. Rednessand flakes
appear in thehead.
Eruptions onscalp
may appear.
Treated with
shampoos containing
ketokonazole or
hydrocortisone

33. Characteristic
: Delayed, cell mediatedhypersensitivity
Strong sensitizer results in reaction soon after
exposure
Weaksensitizer my take months or years to develop
reaction
Age does not influence capacity for sensitization but
more common inadults
Black skin is lesssusceptible
Important causeof disability in industry
Non seasonal

34. Characteristics:
usually clearsquite rapidly on withdrawal of
offending agent
may appearaserythematous papules,vesicles
or bullous
more common where epidermis is thinner
DistinctiveCharacteristics:
Initial lesions usually limited to contact area
not bilateral
lesions with sharpborders or angles are
pathognomonic

35. Metals- nickel, platinum (10%of women)
Detergents
Plants andfibers
Chemicals anddyes
Polyethylene glycol andpolysorbate 60
Topical antibiotics andmedications
Animal keratin

38. Note:
distribution

39. Note:
Linear
distribution
with
satellite
lesions

40. Poison
Ivy/Oak/Sumac
linearity

41. Potassium
Dichromate in
Leather

42. Latex
Cleaning
products
Cosmetics
Occupational
exposures
Check the feetand nails!!!

44. Contact dermatitiswith
Nickel.
Reddish markingand
itching will occur.

45. Prevention is
key!

48. Coin shaped patches
and plaques
Secondary to xerosis
cutis
Primary symptomitch
Notice thesurrounding xerosis

49. Characteristics:
usually -personal or family history of allergy,
especially asthma, hay fever, and childhood
eczema
Distinctive Characteristics - Coin-shaped
papulovesicular patches that develop in to
scaling andcrusting lesions;lesions may be as
large as4-5cm in diameter with distinct
margins, initial eruptions on arms and legs;
intense itching; tends to be chronic

50. Characteristics:
Most severeduring winter; may be aggravated
by systematic administration of iodine or
bromine; secondary bacterial infections are
common
Treatment: skin hydration, topical
corticosteroids, intralesional injection, coal tar
ointments, UVB treatment, treat secondary
infection

51. Note:
•Coinshaped
lesions
•dorsal
surfacearms
•bilateral

52. Extreme case
of xerosis
Riverbed type
cracking

53. Characteristics:
Seen mainly inelderly
Worse in thewinter
Precipitated by excessivewashing
Treatment:
Avoid excessive washing and use of soap
Emollients
Increase humidity in the environment
Topical steroids for a short periods of time

54. Venoushypertension
Full spectrum oftiming
Id reactioncommon
Complicated byulceration

55. Venousulceration
Dispigmentation (chronic)

56. Do: 1)dry weepinglesions
2) cover forinfection
Don’t: 1)applyneosporin
2) just hopesteroids
will fixit

57. Characterisitcs:
Origin often small patch of dermatitis or insect bite starting
the itch –scratch- itch cycle
Condition unrelated to allergies or family history
More common inwomen
Nonseasonal
aggravated bystress
worse at night
may be secondary to atopic eczema, contactdermatitis,
lichen planus, psoriasis, or insect bite

58. DistinctiveCharacteristics:
Lesions lichenified orexcoriated
usually limited to a single patch at hairline of
nape of neck or on wrists, ankles, ears, or anal
area
Not bilateral
Llichenification of dark skin develops a
“follicular pattern”

60. Butterflysign
PrurigoNodularis
Considerscreening

61. ConservativeTherapy
1. Education - prevention
2. Useof astringents and
emollients/moisturizer
s
3. OTCproducts (hydrocortisone,
Benadryl, Calamine, etc.)
Low to mid potency steroid creams
High potencysteroid creams
CoalTar
PUVA therapy(phototherapy)

62. Moisturize daily
Wearcotton, avoid wool and tight clothes
Takelukewarm showers,using mild soapor
nonsoapcleansers
Pat dry –do not rub
Apply moisturizer within 3min. to “lock in”
moisture
Avoid extremes of heat / humidity and
perspiration
Learn triggers andhow to avoid them
Keep fingernailsshort
Remove carpets andpets from the home

63. Irritants:
 Recommend non-irritant fabric,
such as cotton. Wool mayinduce
itching
 Overheating andsweating:
Excess dryness orhumidity should be
avoided.
An air conditioner or humidifier in a
child’s bedroom may help to avoid
the dramatic changes in climate that
may triggeroutbreaks.
Allergens:
 Environmental elimination of
airborne substances may bring lasting
relief.

64. Cetaphil
Aquanil
Aveeno Daily Mositurizer
EucerinGentle HydratingCleanser
Lobana BodyShampoo
Moisturel
pHisoderm
Indications:
For use in those eczema patients who may be
sensitive to one or more of the various potential
sensitizers in soapsandshampoos.
To cleanse, reduce irritation (if sensitive to soaps),
and reduce dryness (thereby increase absorption of
other topicals).

65. Aquaphor
Balmex Daily
AmLactin
Cutemol
DMLForte
EucerinOriginal
Hydrisinol
Lanolor
Indication: Tosoften and soothe rough, dry skin
and increase absorbability of topical medications
Directions: Apply asnecessary or asprescribed;
generally after showering/bathing and pat drying;
apply liberally to affected areas
Neutrogena NorwegianFormula
Lac-Hydrin
Aveeno
Pen-Kera
Curel
LubridermAdvancedTherapy
Minerin

66. Astringents –reduce secretions (bycausing
contraction of tissues) and are antibacterial
Best used in eczema where vesicular or draining
lesions arepresent
AceticAcid 5%(white vinegar)–especially useful in
Pseudomonas infections
Burow’s Solution(Domeboro and others)
Potassium Permanganate

67. Topical Steroids should be applied only to
inflamed skin (active disease).
immediately after bathing
When T
opical Steroids are applied
their
penetrationand potency are increased.
Low-potency topical steroids are
recommended for use on the face and in
skin folds.

68. Tegrin cream andlotion
Medotar ointment
PsoriGel gel
Polytar andTegrinsoaps
Tegrin,T/Gel, andother shampoos
Indication: to relieve and control itching, and
flaking skin associated with psoriasis and
seborrhea aswell aseczema
Directions: Depending on product 1-4 times
daily

69. Contraindications:
Hypersensitivity
Precautions:
Do not useon broken skin, genital or rectal area
except on the advise of your health careprovider.
Photosensitivity x 24hr afterapplication
May stain lightcolored hair
Warning:
High concentrations of some chemicals in coal tar
may causecancer. Concentrations of 0.5% to 5%
appear to besafe.

70. Indications: Psoriasis, eczema, pruritic rashes
of othercauses
Consists of psoralen (photosensitizing agent)
followed byUVAphototherapy
Must avoid sunlight for 24h after psoralen
Sessions are 3d/wk, may be from 12-30
sessions, increasing induration
Side effects are redness, burning, occasional
nausea

71. thanks
made by Dr. HARI SHANKAR MEENA 424B