Atopic dermatitis is a chronic, highly pruritic skin disease that is common in childhood. It involves the cheeks, hands, feet and flexural areas. Seborrheic dermatitis affects sebaceous areas in adults and commonly presents as flaky, greasy scales on the scalp. Eczema has endogenous and exogenous forms. Endogenous eczema includes atopic dermatitis while exogenous eczema includes irritant and allergic contact dermatitis caused by external triggers. Proper treatment of eczema focuses on moisturization, reducing irritation and treating secondary infections.

1. ECZEMA
SANAULLAH SHAIKH
HOUSE OFFICER
DERMATOLOGY DEPARTMENT

2. INTRODUCTION
• ECZEMA IS A GROUP OF SKIN DISEASES
CHARACTERIZED BY IRRITATION AND
INFLAMMATION OF THE SKIN.
• ECZEMA IS A GREEK WORD MEANING ‘TO
BOIL’
• SYNONYMOUS WITH DERMATITIS
• INCREDIBLY COMMON
• CAUSE UNKNOWN
• WAXING AND WANING NATURAL HISTORY

3. CLINICAL TYPES
ACUTE STAGE
 ERYTHEMA
 SWELLING
 OOZING VESICLES
CHRONIC STAGE
 LICHENIFICATION
 HYPER/HYPO PIGMENTATION
 EXCORIATION MARKS
SUBACUTE STAGE
 FEATURES OF BOTH

5. HISTOLOGIC PICTURE IN ECZEMA
• IN THE ACUTE STAGE, INTERCELLULAR
EPIDERMAL (SPONGIOSIS) IS MOST
PROMINENT.
• IN THE SUBACUTE STAGE, SPONGIOSIS
DIMINISHES BUT (ACANTHOSIS) STARTS TO
INCREASE.
• IN THE CHRONIC STAGE ACANTHOSIS IS THE
DOMINANT FEATURE.

6. SIGNS & SYMPTOMS
• ITCHING. THE ITCHING CAN BE INTENSE. THE DAMAGE TO THE SKIN DURING ECZEMA IS OFTEN
DUE TO SCRATCHING.
• SCALING. THE SURFACE OF THE SKIN CAN FLAKE OFF, GIVING THE SKIN A ROUGH, SCALY
APPEARANCE.
• REDNESS. THE AFFECTED SKIN MAY BLEED AND APPEAR BLOTCHY.
• FLUID-FILLED BLISTERS . THESE CAN OOZE AND FORM CRUSTS.
• CRACKING. SEVERELY AFFECTED SKIN MAY DEVELOP PAINFUL, DEEP CRACKS, ALSO CALLED
FISSURES.
• LICHENIFICATION

7. TWO MAJOR CLASSIFICATION IN ECZEMA
• ECZEMA MAY BE INDUCED BY A WIDE RANGE OF EXTERNAL AND INTERNAL
FACTORS ACTING SINGLY OR IN COMBINATION. TWO MAIN CLASSIFICATION
ARE:
• ENDOGENOUS ECZEMA: BASED ON AN INHERENT POTENTIALITY TO HAVE
ECZEMA. NO CONTACT WITH A STIMULUS NEEDED. RECURRENT, SELF ABATING
• EXOGENOUS ECZEMA : CONTACT WITH OUTSIDE STIMULANT NEEDED.
CONTACT IRRITANT AND CONTACT ALLERGIC TYPES

8. ATOPIC DERMATITIS CONTACT DERMATITIS SEBORRHIC DERMATITIS
MAJOR TYPES OF ECZEMA

9. ENDOGENOUS
ECZEMA

10. ATOPIC DERMATITIS
• COMMONEST OF ALL FORMS
• ENDOGENOUS
• USUALLY INHERITED
• FLEXURAL IN DISTRIBUTION
• HISTORY OF ATOPIC DISEASE (ASTHMA RHINITIS ECZEMA) IN
FIRST DEGREE RELATIVE
• ONSET UNDER 2 YRS
• THE CHIEF CHARACTERISTIC OF ATOPIC ECZEMA IS THE
‘ITCH’
• ELEVATED SERUM IGE LEVELS

11. AGGRAVATING FACTORS FOR ATOPIC DERMATITIS
• DRY SKIN
• SWEATING
• HEAT
• SEASONAL CHANGES
• INFECTIONS
• STRESS
• HARSH SOAPS, DETERGENTS, WOOL

12. Atopic dermatitis (AD) is a chronic, highly pruritic,
eczematous skin disease that follows patients from early
childhood into puberty and sometimes adulthood.
INFANTILE PHASE CHEEKS ,DORSUM OF HANDS
AND FEET ARE INVOLVED
CHILDHOOD PHASE ANTECUBITAL FOSSA AND
POPPLITEAL FOSSA ARE INVOLVED
ADULT PHASE DISTRIBUTION IS SIMILAR TO
INFANTILE PHASE

13. SEBORRHOEIC ECZEMA
• SEBORRHOEIC ECZEMA IS ASSOCIATED WITH MALASSEZIA YEAST, WHICH
NORMALLY LIVES ON THE SKIN.
• IT AFFECTS SEBACEOUS PRODUCING AREAS IN ADULTS
• KETOCONAZOLE COMPOUNDS, 2% SELENIUM SULPHIDE SHAMPOO ARE
EFFECTIVE
• INFANTILE SEBORRHOEIC ECZEMA IS COMMON IN BABIES UNDER ONE AND
INVOLVES THE SCALP, NECK AND NAPPY AREA.
• THE GREASY RASH USUALLY STARTS ON THE SCALP AS MILD DANDRUFF
(SOMETIMES CALLED CRADLE CAP IN BABIES).

14. SEBORRHIC ECZEMA
Flaky, white to yellowish scales form on oily areas

15. EXOGENOUS ECZEMA

16. IRRITANT CONTACT DERMATITIS
• CAN OCCUR IN ANY INDIVIDUAL
• REPEATED EXPOSURE TO IRRITANTS
• COMMON IN HOUSEWIVES, HAIRDRESSERS, NURSES
• COMMON SITES FOR IRRITANT CONTACT DERMATITIS ARE THE HANDS AND FACE,
• IRRITANT CONTACT DERMATITIS IS A REACTION TO FREQUENT CONTACT WITH EVERYDAY THINGS
WHICH IRRITATE THE SKIN
• OCCUPATIONS AT GREATEST RISK OF DEVELOPING IRRITANT CONTACT DERMATITIS INCLUDE:
CHEFS, HAIRDRESSERS, METAL WORKERS, NURSES, CLEANERS AND CONSTRUCTION WORKERS.

17. ALLERGIC CONTACT DERMATITIS
• OCCURS AFTER REPEATED EXPOSURE BUT ONLY IN SUSCEPTIBLE INDIVIDUALS
• ALLERGIC REACTION
• ALLERGIC CONTACT DERMATITIS IS MUCH LESS COMMON THAN IRRITANT
CONTACT DERMATITIS.
• COMMON CULPRITS – NICKEL, CHROMATES, LATEX ETC
• PATCH TESTING

19. COMPLICATIONS
oSecondary bacterial
infection
oEczema herpeticum
oLichen simplex
oHyper /hypo pigmentation

20. RARE FORMS OF DERMATITIS
• STASIS DERMATITIS (VENOUS ECZEMA)
• ASTEATOTIC DERMATITIS
• DISCOID DERMATITIS (NUMMULAR ECZEMA)
• POMPHOLYX (DYSHYDROTIC ECZEMA)
• JUVINILE PLANTAR DERMATOSIS

21. HOW TO TREAT

22. STEP 1

23. STEP 2

24. STEP 3

25. STEP 4

26. STEP 5

27. ALWAYS BE THANKFUL TO GOD FOR EVERYTHING