ECZEMA

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ECZEMA

• Lecture fife

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FUNCTIONS OF SKIN

• Protect against infections, chemical toxins and
  physical agents (UV, ionizing radiation)
• Prevent insensible water loss
• Control body temperature (thermoregulation)
• Sensation, communication (psychosocial, sexual,
  endocrine functions)
• Self-regeneration and healing

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ECZEMA

• Usually refers to severely inflamed dermatitis.
• It is a non infectious inflammatory dermatosis
  in which the affected skin is erythematous.
• IT IS NOT ADISEASE, IT IS A SYMPTOM.
• MOST DERMATOLOGISTS WOULD ACCEPT THE DEFINITION
  SKIN INFLAMMATION OF WHATEVER CAUSE
• signs and symptoms associated with such an acute
  process (itching, sting, burning of the skin with
  drainage from lesions)

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TERMINOLOGY

• Dermatitis Dermat itis
• refers to skin means
• inflamed
• (thus, inflamed skin)
• Other examples arthritis, colitis,
• encephalitis, etc.

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CARDINAL FEATURES OF INFLAMMATION

• (warmth) - increased blood flow
• (redness) -dilated blood vessels
• (pain)- irritation of nerves in inflamed tissues

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Classification

• Can either be acute or chronic in nature.
• Acute eczema shows marked inflammation of skin,
  erythema and papules
• .
• Chronic eczema shows lichenification (thickening
  of the skin) from repeated rubbing or scratching,
  post inflammatory hyper- or hypo pigmentation.
• Both types can show excoriations.
• There is commonly a secondary infection, usually
  with Staphylococcus aureus (S. aureus).

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TYPES OF DERMATITIS( ECZEMA)

• IT IS PRECIPITATED BY EXTERNALSOURCES OR INTERNAL
  ONES(ENDOGENOUS
• Exogenous contact DERMATITIS(acute)
• Irritant, allergic and infective.
• Endogenous, chronic Atopic, A steatiOTIC,
  neurodematisTIS,and other types

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IRRITANT CONTACT DERMATITIS

• Non-immunologic inflammatory reaction of the skin
  due to an external agent
• Varied morphology
• Clinical types
• Chemical burns
• Irritant reactions
• Acute irritant contact dermatitis
• Chronic irritant contact dermatitis

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COMMON IRRITANTS

• Water
• Skin cleansers
• Industrial cleaning agents
• Acids and alkalis
• Oils and organic solvents
• Oxidizing and reducing agents
• Plants
• Animal products
• Miscellaneous

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FACTORS INFLUENCING THE DEVELOPMENTOF SKIN
IRRITATION
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• THE SUBSTANCE, IF IT PENETRATE TO THE DERMAL AREA
  WHERE VASCULAR AND LYMPHATIC SUPPLY ARE PRESENT
• DEGREE OF IRRITATION DEPEND ON
• 1- THE INTRINSIC IRRITATION POTENTIAL
• 2-CONCENTRATION
• 3-ABILITY TO REMAIN BOUND TO THE SKIN

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• THE CLIMATE
• MACROWHICH REFERS TO ENVIROMENTAL
  CONDITIONSWHICH WILL AFFECT SKIN TEXTURE
• MICRO CLIMATE DEPENDS ON WETHER THE SKIN IS
  OCCLUDED OR LEFT OPEN TO THE ATMOSPHERE

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• THE HOST
• AGED SKIN IS LESS PRON TO IRRITATION THAN
  YOUTHFUL SKIN, BECAUS E OF GREATER DIFFICULTY IN
  DRUG PENETRATION THTOUGH AGED SKIN

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• Allergic contact dermatitis
• The term contact dermatitis describes an
  inflammation of the skin caused by contact with
  external agents. Allergic contact dermatitis is a
  delayed-type hypersensitivity reaction due to the
  contact with a chemical to which the individual
  has previously been sensitized. Possible
  allergens are found in jewellery, personal care
  products, topical medications, plants and
  work-related materials. Usually, the eczematous
  reaction develops within 24 to 72 hours after
  contact with the causative chemical in a
  sensitized individual.

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Atopic dermatitis

• A chronic problem causing dry skin, intense
  itching, and a raised rash, some children outgrow
  atopic dermatitis, or have milder cases as they
  age. In severe cases, this non-contagious rash
  forms clear, fluid-filled blisters. What causes
  atopic dermatitis isn't clear, but those affected
  may have a personal history of allergies and
  asthma and a sensitive immune system. IT OCCURE
  PRIMARILY DURING CHILDHOOD AND EARLY ADULTHOOD

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• Several treatment options for eczema are
  available. But primarily, it is most important to
  diagnose correctly and to identify the underlying
  etiological factors (e.g. allergens in case of
  allergic contact dermatitis). Avoidance of the a
  etiological factors is one important therapeutic
  approach. Symptomatic treatment includes topical
  and systemic treatment regimens. The treatment
  depends on the underlying type of eczema and on
  its localization.The following general
  guidelines have proved helpful in eczema
  patients

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• Asteatotic eczema this eczema is characterized
  by dry and fissured skin and by absence of
  sebaceous secretions. It occurs mainly during the
  dry weather and in the aged skin.
• Neurodermatitis this is a chronic form of eczema
  found more often in women. It is often localized
  in the nape of the neck, legs,genitoanal region,
  and forearms.
• Emotional stress play a role in this condition.

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Strategy for treatment of eczema

• In some forms of eczema the patient is sensitive
  for a wide variety of agents, and therapeutic
  entities may aggravate already inflamed skin.
• In contact dermatitis, drug therapy is needed for
  only a short time because withdrawal of allergen
  or irritant ameliorates the condition

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TREATMENT OF allergic cotact dermatitis

• Topical glucocorticoids
• Oral antihistamines
• Compresses
• Topical Emollients
• Oral antibiotics
• Oral glucocorticoids

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CHILDHOOD ECZEMA
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OTC products for eczema

• 1- protestants zinc oxide past (lesser)and
  ointment
• 2- astringents soaking in solution of aluminum
  acetate reduces the weeping for a large areas.
  Bathes of local astringents compresses(15-30 ) a
  few time daily help dry the weeping areas. More
  potent astringents should be reserved until
  erythemal inflammation of the acute phase
  subsides in order not aggravate the condition

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• 3- cooling agents to reduce the extent of
  pruritus. In the acute phases of eczema, soothing
  lotions applied as wet compresses are helpful.
• 4- antihistamines orally administered for their
  sedative and antipruritis effects.
• 5- antiseptics these are useful in infective
  dermatitis

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preccautions

• calamin lotion and other powered-based
  preparations that dry weeping through water
  adsorption should be avoided because of their
  tendency to crust.
• Removal of the crust may cause bleeding and
  potential infections

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SUMMARY
Dermatitis is a common type of skin
inflammation There are many causes of
dermatitis Dermatitis disrupts the normal
functions of skin Investigating causes of
dermatitis is as important as using drug therapy
Traditional agents (glucocorticoids,
antihistamines) and newer agents (TIMs) are
available to treat this condition
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Thank you