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  1. 1.  AD - multifactorial allergic skin disease that develops in people with genetically deterministic anomalous orientation of the immune response the effect of factors external and internal environment.  The main pathogenetic link its development is IgE-mediated mechanism induced by allergen-specific Th2-lymphocytes
  2. 2.  Endogenous risk factors for AD :  - heredity  - hyperreactivity  Exogenous risk factors for AD ( Union of pediatricians of Russia , 2001)  1. Causal factors ( triggers)  allergenic :  - food  - household  - epidermal  - fungal  - Bacterial  - vaccinal
  3. 3. non-allergenic :  Psycho-emotional stress  Change meteosituations  Smokind  Food additives  strong,  constant itching  pollutants
  4. 4.  2 . Factors contributing to the action triggers  - climatogeographic factor  - Violation of the nature of power  - Foul mode and skincare  - Living conditions  - vaccination  - Psychological stress  - Acute viral infection
  5. 5. Development stage and phase of the disease:  initial  Pronounced changes (during an exacerbation): acute phase  chronic phase  Remission - incomplete (subacute period)  full  Clinical recovery
  6. 6. Clinical forms (age periods):  - Infant (I)  - Children (II)  - Teenage Adults (III). Prevalence:  - Bounded process  - Widespread (disseminated and diffuse) process. Severity:  - easy  - Medium-heavy  - Heavy. Clinic-etiological options:  - Food  - tick  - fungal  - Pollen and other allergies
  7. 7.  At this age, blood pressure manifested severe inflammatory phenomena with erythema, exudation, edema.  Process occurs primarily at protruding parts of the face (cheeks, forehead, chin area).  Nasolabial triangle remains intact. further inflammation apply on the scalp, neck, extensor surfaces of the limbs, trunk, in folds. Itching is different intensity.  Erosion, excoriation often infected.
  8. 8.  This is a form of child AD.  For her characteristic are: flushing (erythema), swelling, lichenification, papular rash, plaque formation, erosion, excoriation, hemorrhagic crust cracks.  Integuments presented dry, covered with a large number of pityriasis scales.  Localization - flexor surfaces of the extremities, the anterolateral surface neck, elbow and popliteal fossa, back of hands.
  9. 9.  During this period, dominated shiny skin, dry, lichenoid papules, infiltration of skin lesions, excoriation, hemorrhagic crusts.  Process is localized both in flexion, so and on the extensor surfaces of the limbs, face, extends to the skin of the trunk.
  10. 10.  exudative,  erythematous-squamous,  erythematous-squamous with lihenifikation,  lichenoid
  11. 11.  Most often seen in children  first year of life up to 2 - 3 years (I age phase; infant period) is characterized by the first manifestations of the face in the form of redness, swelling, exudation (мокнутие), followed by crusts.  Nasolabial triangle usually remains free from rashes.  In the future, the eruption spreads on other areas of skin.  Dermographism red or mixed.  Subjectively - itchy skin different intensity
  12. 12.  Erythematous-squamous form is manifested by hyperemia, small swelling, rash papular, vesicular, erosions in place opening vesicles pronounced desquamation.  Itching significant as consequence - multiple scratches, hemorrhagic crusts.  Moisture is not typical.  Can be observed in the I, II and in age periods
  13. 13.  Erythematous- squamous form with lihenifikation ( arises from 2 years old, holds up to 10-12 years - II age period ) is characterized by erythematous- squamous foci with small ( miliary , lenticular ) hemispherical and gabled , follicular papules .  Skin thickens liheninification, becomes dry . Itching strong. Number scratching a lot .  Peeling scaly , finely - lamellar .  Skin rashes occur mainly in flexion of the legs , front and side of the neck , rear brushes , and on the face.  Dermographism mixed or white resistant
  14. 14.  Lichenoid form is characteristic of atopic dermatitis, especially teenagers, may persist after a period of sexual maturing adults.  It is characterized by dryness and underlined pattern of the skin, swelling and infiltration.
  15. 15.  erythema,  papules,  microvesicles,  multiple exoriations,  crusts,  scaling,  itching of varying degrees of intensity.
  16. 16.  Remission may be complete or incomplete.  In incomplete remission, there is a significant reduction in the symptoms of the disease, with infiltration, lichenification, dryness and skin flaking, hyper- or hypopigmentation in the lesions.  Complete remission is characterized by the absence of all clinical symptoms of the disease
  17. 17.  In a limited localized process, the area affected does not exceed lesion area does not exceed 10% of the skin.  With a generalized process, the area affected is more than 10% of the skin. skin.  The most severe manifestation of AD is atopic Erythroderma
  18. 18.  A mild stage of the disease is characterized by predominantly limited localized manifestations of the skin process, minor skin itching, rare exacerbations (less than once or twice a year), and relapses lasting up to 1 month, mainly during the cold season.  Duration of remission is 8-10 months or more. There is a good effect of the therapy.
  19. 19.  Medium-heavy course is generalized skin process.  The frequency of exacerbations is 3-4 times a year with increasing  Their duration increases.  The duration of remissions is 2-3 months.  The process becomes persistent and torpid, with negligible effect of the therapy. The treatment has minimal effect.
  20. 20.  In severe stage AD, the skin process is generalized or diffuse, with prolonged exacerbations and infrequent and short-lived remissions (frequency of exacerbations: 5 times per year; duration of remission: 1-1.5 months).  frequency of flare-ups five times a year or more, relapse intervals of 1-1.5 months). Treatment brings  a short-term, limited improvement. Severe itching, leading to sleep disturbances
  21. 21.  Pseudo-Hertoge symptom (flattening of the lateral eyebrows due to constant rubbing and scratching),  Morgan's folds (additional lower eyelid crease),  Denis lines (deep creases on the lower eyelids),  swelling and blueness of the lower eyelids,  scaling of the upper and lower eyelids,  pale face or congestive reddening with edema,  perioral lichenification and cheilitis.
  22. 22. Basic (mandatory / major) diagnostic criteria for AD: ─ itching of the skin; ─ skin lesions: in children during the first years of life - rash on the face and extensor surfaces of the limbs, in older children and adults - lichenification and scratching at the limb bends; ─ a chronic recurrent course; ─ presence of atopic diseases in the patient or his relatives; ─ Early onset in childhood (up to 2 years of age).
  23. 23. ─ seasonality of exacerbations (worsening during the cold season and - exacerbation (worsening during the cold season and improvement during the summer); ─ exacerbation due to triggering factors (allergens, irritants, foodstuffs, emotional stress, etc.); ─ Increase in total and specific IgE in the blood serum; ─ peripheral blood eosinophilia; ─ hyperlinarity of the palms ("creased") and soles; ─ follicular hyperkeratosis ("horny" papules on lateral side surfaces of shoulders, forearms, elbows); ─ itching with increased sweating; ─ dry skin (xerosis); - White dermographism;
  24. 24. - tendency to skin infections; ─ localization of the skin process on the hands and feet; - Eczema of the nipples; - recurrent conjunctivitis; - Hyperpigmentation of the per orbital area; ─ creases on the anterior surface of the neck; ─ Denier-Morgan's symptom; ─ cheilitis; - keratoconus.
  25. 25.  To make a diagnosis of AD, a combination of the three main criteria and at least three additional at least three additional criteria
  26. 26.  symptom of "dirty neck" (creasing of the anterior surface of the neck skin, reticular pigmentation),  Symptom of "winter foot "(moderate infiltration, hyperemia, cracking and peeling of the soles),  Pseudo-Hertog's syndrome (thinning of the hair, first in the outer third and then in other parts of the eyebrows, presumably due to frequent scratching),  Andogsky's syndrome (appearance of a bilateral catarrhal hypertrophy of the eyebrows) bilateral cataracts with radial adhesions ("dermatogenic cataract") in a patient with AD,  with severe itching - symptom of polished nails (smoothness, absence of striation, maximally abraded nail edge).
  27. 27.  Seborrheic dermatitis,  allergic contact dermatitis,  scabies,  psoriasis vulgaris,  Ichthyosis vulgaris,  microbial eczema,  dermatophytosis,  circumscribed neurodermatitis (Vidal lich),  actinic reticuloid,  phenylketonuria,  enteropathic acrodermatitis
  28. 28.  to achieve clinical remission of the disease,  eliminate or reduce inflammation and skin itching,  moisturise and soften the skin, restore its protective  prevent or eliminate secondary infections,  prevent the development of severe AD,  the restoration of lost ability to work; improvement of the quality of life of patients.
  29. 29.  In limited skin lesions (<20% surface area), in mild to moderate AD, predominantly external therapies are indicated to control the exacerbation: strong to moderate topical corticosteroids and/or topical calcineurin inhibitors, without excluding basic therapies
  30. 30.  In the case of intermediate severity of AD, phototherapy and detoxification agents may be administered in addition to the above, Detoxifying agents may be prescribed when indicated.  In severe AD, treatment includes external therapy, as well as systemic pharmacotherapy or phototherapy.  It is possible to Cyclosporine and/or systemic glucocorticosteroids may be used in short courses.
  31. 31.  Topical corticosteroids.  Topical calcineurin inhibitors.  Topical antihistamines, antipruritic and reducing agents.  Antibacterial, antiviral, antifungal agents.  Permanent basic skin care products (both during exacerbation and remission).
  32. 32.  In the case of an acute, wet inflammatory process, soaks, sprays and wet-dry dressings are used.  In acute inflammatory process without mucous - lotions, aerosols, water poultices, poultices, pastes, creams.  In sub-acute inflammatory process - creams, pastes, powders.  In chronic non-specific inflammatory process - ointments, warming compresses. 5.  In pronounced infiltration in foci - ointments and creams with keratolytic properties.  At the stage of regression of the skin process - ointments, balms and creams with supplements and vitamins.
  33. 33.  Bacterial, fungal, viral skin infections;  Rosacea, perioral dermatitis, acne;  Local reactions to vaccinations;  Hypersensitivity;  Significant skin trophic changes
  34. 34.  atrophy  skin atrophy,  stretch marks,  hirsutism,  steroid acne,  rosacea,  perioral dermatitis,  infectious complications,  pigmentation disorders,  telangiectasia
  35. 35.  The use of emollients leads to reduction of dry and itchy skin, moisturising the epidermis, improving microcirculation and restoring the function of the epidermal the function of the epidermal barrier (root therapy).  The use of basic care products for AD is recommended at all times.  It is important for patients with AD to ensure a protective regime that excludes as much as possible skin irritants (irritants) and allergens, as well as trigger factors
  36. 36.  Topicrem  Dardia  Emolium  Lipobase  Lipobase Baby….
  37. 37.  Antihistamines.  Membrane stabilising drugs.  Drugs that improve or restore digestive function.  Drugs that regulate the function of the nervous system.  Drugs containing unsaturated fatty acids.  Detoxifying, desensitizing drugs.  In infectious complications - antibiotics, antiviral, antifungal drugs.  Systemic corticosteroids.  Cyclosporine A.
  38. 38.  Eczema (from Greek ekzeo - boil) - a chronic, relapsing, polietiological, acute inflammation skin disease presented polymorphism morphological elements (true and evolutionary), which formed as a result of a complex set of etiological and pathogenic factors.
  39. 39.  true eczema (idiopathic, dyshidrotic, pruriginous, horny (tylothic);  Microbial eczema (nuchal, paratraumatic, mycotic, intertriginous, varicose, sycosiform, eczema of the nipples and the mammary circle of women);  seborrheic eczema;  children's eczema;  occupational eczema
  40. 40.  Adrift eczema is divided into: • acute, • subacute, • chronic
  41. 41.  erythematous and oedematous skin with vesicles, pinpoint erosions with mucous  ("serous wells" ), serous crusts, exoriations, less frequently papules and pustules (with sterile contents).  pustules (with sterile contents). Along with the involution of the rash  new lesions form, therefore, the polymorphic character of eczema is typical.  a polymorphic rash is typical. Depending on the evolution of the  of the morphological elements in eczema a number of stages are distinguished: erythematous (erythematosa), papular (papulosa), vesical (vesikulosa), discharge (madidans) and cortical (crustosa).
  42. 42.  The sub acute stage is characterized by erythema, lichenification, scales and excoriations.  The chronic stage of the disease is characterized by infiltration and enhancement of the cutaneous pattern of the affected area, post-inflammatory hypo- and hyperpigmentation.
  43. 43.  TRUE ECZEMA - symmetric inflammatory process , often often affects the skin of hands , arms , face, legs and feet. • long-term course of the disease , a chronic, relapsing, or undulation . • Clinic true eczema manifests as acute inflammation, edematous erythema , against which developed the smallest seropapules and microvesicles . • Microvesicles quickly opened on-site revealed the seropapul or microvesicles , exposed point erosion ( serous wells) , of which stands a hearty serous exudate , forming a weeping surface. • Moisture eczema abundant , drip, or solid. The liquid dries to form a grayish yellow crusts under which epithelialization occurs.
  44. 44.  Clinic: miliary , lenticular papules, vesicular elements on compacted based on the extensor surfaces of the extremities, elbow with popliteal areas , face, groin folds .  Items can not be opened , do not form a soak.  The disease is chronic, accompanied by a pronounced itching ; appears resistant white dermographizm due involvement of the sympathetic nervous system .  The skin of the affected area dry, thickened , lihenification, cracks , peeling , skin pigmentation .
  45. 45.  When dyshidrotic eczema in the palms, soles, on the side finger surfaces appear small vesicles.  They are dense with palpation, grouped or placed in isolation, without tend to be opened.  Bubbles may appear on apparently intact skin or background mild erythema.  With increasing inflammation formed multi- chambered bubbles.
  46. 46.  If bubbles are still opened, then formed erosion polycyclic edges, bright enough bottom, serous or sero-purulent (moist surface).  In the future erosion of crusted (hemorrhagic and yellowish-greyish).  By apostasy struck the surface crusts flaky, often annular peeling, cracks may appear.
  47. 47.  Eczema of the morns (tylothic) is manifested by hyperkeratosis of the palms of the hands, sometimes with deep, painful cracks. and soles, sometimes with deep, painful cracking.  The course Chronic, often resistant to treatment.
  48. 48.  Microbial eczema develops as sensitization to microbial antigen (streptococci, staphylococci) on the background of changes neuroendocrine and immune systems, dysfunction of the gastrointestinal tract.  Inflammation initially asymmetric in the future rash may appear symmetric, including remote.
  49. 49.  Localization - skin shins, dorsum of the hands, sides of the trunk, scalp.  Lesions solid, acute inflammation character, without layers of healthy skin, have sharply defined clear scalloped border, with rejects stratum corneum on the periphery.  Outbreaks presented eczematous reactions, such as erythema, seropapules, microvesicles.  On the periphery of the main focus may be so-called screenings -individual small inflammatory papules, dry, scaly lesions
  50. 50.  Coin-like eczema (numular eczema) is a type of microbial eczema, which is almost always round and has clear boundaries. They are usually present on the upper and lower extremities,  Less commonly on the trunk.  The plaques are an accumulation of Small papules, vesicles, serous pus crusts and scaling on a background of erythema.
  51. 51.  Paratraumatic (peri-wound) eczema develops in the area of Postoperative scars, bone fractures, osteosynthesis, sites of Plaster casts have not been applied correctly.  It is characterized by  Erythema osteoinflammatoryis, exudative papules and/or pustules. Pustules and crusts formation. Superficial sclerosing  Superficial sclerosis of the skin and deposition of haemosiderin in the tissue.
  52. 52.  Varicose eczema is caused by a background of varicose veins.  Injuries, maceration of the skin, and inadequate external treatment of varicose ulcers contribute to the development of the disease.  Lesions are usually located on the lower extremities.  On the lower extremities, mostly in the lower third of the lower leg, often in the vicinity of varicose ulcers, sclerosing areas. sclerosis of the skin.
  53. 53. 1 Antihistamines 2 Glucocorticosteroids (intense inflammation) 3 Tranquillisers with antihistamine effect (hydroxyzine for severe itching) 4 Detoxification therapy (for exudation)
  54. 54.  Depends on the stage of the eczema 1 Dischage stage - antiseptic lotions 2 Glucocorticosteroids locally 3 Aniline dyes 4 Combination medicines (ointments, creams)