Eczema(dermatitis), atopic dermatitis, seborrhoeic dermatitis and exfoliative dermatitis

Mohammad Asifuzzaman Assistant professor Z.H. Sikder Womens Medical College & hospital

Eczema

It is a non- infectious, inflammatory condition of the skin characterized by vesicles, oedema and erythema in acute stage, plaque with scale and crust in sub acute stage and lichenification and hyperpigmentation in its chronic stage.

Classification
Intrinsic
Extrinsic Allergic contact dermatitis Irritant contact dermatitis Atopic dermatitis Seborrhoeic dermatitis Discoid dermatitis

Pompholyx
Lichen simplex

Investigations

CBC Skin biopsy for histopathology Patch test Prick test Serum IgE RAST Blinded food challenge Eosinophilic cationic protein Food specific IgE Photo patch test

Treatment

Avoidance of the offending agent Anti-histamine Topical and systemic steroids Topical tacrolimus, moisturizer, emollients. Methotrexate, cyclosporin. Phototherapy. Any other treatment according to the type of eczema.

Complications

Lichenification Hyperpigmention Fissuring Erythroderma Secondary infection

Atopic dermatitis

It is a genetically predisposed IgE mediated Inflammatory condition of skin. More than 50% of children of atopic mother develop the disease. It rises up to 79% if both the parents are involved. Rate is 86% in monozygotic twins.

Stages

Infantile atopic dermatitis - 2months to 2 yrs of age. Childhood atopic dermatitis 2 to 10 yrs of age. Adult atopic dermatitis

Criteria
Major criteria Pruritus Flexural involvement in adults, facial and extensor involvement in infants. Chronic and chronically relapsing. Minor criteria Xerosis Ichthyosis

Elevated IgE
Nipple eczema Conjunctivitis Lip eczema Cataract Facial pallor Food, wool, environmental, emotional hypersensitivity Hand and foot dermatitis

Personal or family history of asthma,rhinitis.

Three major and three minor criteria need to be present for diagnosis

Pathogenesis

Genetic factor T helper cell mediated immunity Hyperactive IgE & IgE receptor Neuropeptide Infections Disturbance in skin barrier function

Investigations

CBC Skin biopsy for histopathology Patch test Prick test Serum IgE RAST Blinded food challenge Eosinophilic cationic protein Food specific IgE Photo patch test

Treatment

Avoidance of predisposing factor including dust, house mite, specific food and other inciting factor. Topical emollients like white petrolatum, urea and lactic acid. Topical steroids Topical tacrolimus Topical coal tar Systemic steroids, immuosuppresive agents, IVIG and phototherapy. Anti-histamine

Complications

Exfoliative dermatitis Secondary bacterial and viral infections Growth retardation

Seborrhoeic dermatitis

It is a chronic, superficial, inflammatory disease characterized by yellow, greasy scale on erythematous base and caused by Pityrosporum ovale. Epidemiology: 2% to 5% population get affected. Men and women get involved in same proportion. Infants also are affected

Aetiopathogenesis

Unknown Pityrosporum ovale Immunological Diabetes Parkinsonism Epilepsy AIDS Antiepileptic drug Arsenic Stroke malabsorption

Clinical feature

Site: scalp, eyebrow, eye lid, nasolabial crease, auditory canal, postauricular region, presternal area, inframammary fold, axilla, umbilicus, groin and gluteal crease There is yellowish, moist, greasy scale on an erythematous base. Sometimes there is thick crust and fissuring May be associated with folliculitis and severe itching In rare cases there can be exfoliative dermatitis It often is limited to scalp known as dandruff or pityriasis sicca.

Investigation

Skin scrapping for fungus microscopic examination in KOH preparation and culture in SDA media Skin biopsy for histopathology

Treatment
Topical Corticosteroid Tacrolimus Ketoconazole Selenium sulfide Systemic Antifungal Tetracycline Antihistamine

Exfoliative dermatitis

Also known as exfoliative dermatitis. It is a condition characterized by exfoliation of more than 90% of BSA and characterized by erythema, pruritus and scale.

Aetiology
Idiopathic Dermatoses Psoriasis Seborrhoeic debmatitis Atopic dermatitis PRP Mycosis fungoides Bollous disease 52% Systemic disease Leukemia Lymphoma Solid organ malignancy Nutritional deficiency Drugs Antiepileptic NSAID Sulfasalazine Piroxicam Antihypertens ive

20%

23%

5%

Clinical feature
Symptom Fever with chill Shivering pruritus

Clinical feature continued

Sign Exfoliation of more than 90% of BSA Erythema, scale, Papule, vesicle Loss of hair Lymphadenopathy Erosion, crust, exudation Tachycardia, tachypnia Low BP,

Investigation
Routine CBC Urine R/E CXR

Specific Skin biopsy for histopathology and DIF PBF S. electrolyte S. creatinine, BUN SGPT USG, CT and other relevant tests to find out the cause

Treatment

Avoidance of any offending dug Correction of fluid and electrolyte imbalance Maintenance of airway if necessary Maintenance of temperature Proper nutrition Antihistamine Broad spectrum antibiotic Specific treatment according to the cause

Complication

Hypothermia Hypovolemia Electrolyte imbalance High output cardiac failure Infection with septicemia Renal failure ARDS