Eczema

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Eczema dermatitis Occupationals dermatosis

• Libuše Mardešicová
• Dpt. Of Dermatovenerology FNKV and 3.LF UK

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Eczema - dermatitis

• most frequent skin disease (1/4)
• a group of skin diseases with complicated,
  different and sometimes unknown pathogenesis
• but with the identical clinical picture

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Eczema - dermatitis

• Definition superfitial non-infectious
  inflamation of skin frequently of allergic origin
  which is provoked by different external and
  internal factors
• Histopathological marks are located in epidermis
  and upper corium
• Healing of acute forms without scars ( red
  macules, hypo- or hyperpigmentations), healing of
  chronical form sometimes with lichenification
• provoking factors are usually unknown

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Eczema - dermatitis

• Different types
• - atopic eczema or dermatitis
• - seborrhoic eczema or dermatitis
• - microbic eczema
• - contact alergic eczema
• -contact irritant dermatitis
• The unique morfology is typical!!!

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Clinical picture ofeczema -dermatitis

• Acute stadium
• red papules(grouped)
• edematous swelling
• small vesicles
• weeping of moisture
• crusting
• scaling

• Chronical disease
• thickening of skin
• rough skin
• creation of fissures

Different treatment!!!
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Predilection

• Eczema can be located at any place of the body
• but some of them are more often present

• Hands
• Face

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Eczema acutum
ekdzein to spring to the surface
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Eczema chronicum
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Eczema atopicum
White dermografism, pruritus, capricious course
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Seborrhoic eczema
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Microbic eczema
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Main differences between contact dermatitis and
eczema

• dermatitis
• cause irritant
• occures in all individuals contacting irritant
• burning sensations, pain
• symptoms are restricted just on the place of
  contact
• toxical provo factors

• eczema
• cause alergen
• a patient is only genetically predisposed person
• itching
• spreading from the place of contact
• alergy of the VIth type

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Irritant contact dermatitis

• - due to a nonspecific reaction
• - contact with irritans for a sufficient lenght
  of time
• - irritant in sufficient high concentration -

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Main irritants

• Defatting, degreasing agents, damage of the skin
  by cytotoxic action
• - detergents
• - solvents
• - cleaners
• (- strong acids and alkalis acute severe
  dermatitis)

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Acute contact allergic eczema
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Acute contact irritant dermatitis
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Chronical dermatitis x chronical eczema
dryness, some fissuring, thickening
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Most frequent allergens

• Metals (Ni, Co, Hg, Cr, Pt.)
• Rubber (additives)
• Cosmetics (emulgators, antimicrobials, perfumes)
• Organic dyes
• Formaldehyde
• Parabens and lanolin
• Plastics and resins (epoxy resin, acrylates)
• Topically used medicaments
• Plants (needles, tulips, chrysantems, poisson
  ivy..)

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Epi- tests

• Alergy of the IV th type
• Preparation of the patient
• Anamnesis
• Concentration of allergen
• Vehicle

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Occupational skin diseases

• List of occupational diseases-law
• 60-80
• the rules for reporting are strictly done
• specialised dpts. - assessment
• reporting of occupational diseases
• legal consequences retraining, financial profit
• eczema contactum allergicum, dermatitis contacta
  irritativa, occupational acne (picea, oleosa,
  chlorina), skin tumors, skin infections
  (medicals, farmers, ! teachers x sisters)

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Chronical contact irritative dermatitis(house
wife dermatitis)

• Detergents,soaps, cleansers, frequent washing,
  polishes, waxes, bleaches
• weak acids
• cement
• dezinficients
• organic solvents
• (petrol, turpentyne...)

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Allergy -Chromium in leather gloves
Typical protective necessity among workers
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Occupationals skin infections

• farmers (no tinea pedum)
• forrest workers (borreliosis)
• medicals (scabies x teachers pedikulosis) tbc
  cutis verrucosa
• poultry farms (candidiasis)
• flesh processing (butchers, cookers)-erysipeloid

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Occupational skin infections
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Acne venenata

• venenatio, -onis f. l. poisoning

• Acne contacta

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Acne chlorina

• rare
• occupational or non-
• through skin, ingescion, inhalation
• Chlorated hydrocarbons (importance of position of
  Cl in the molecule)

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Chlorated hydrocarbons

• Polychlorated naftalens
• Polychlorated difenyls (PCB)
• Polychlorated dibenzofurans (PCDF)
• Polychlorated dibenzodioxins
• Azobenzens a azoxybenzens

Chemical industry, halowax, herbicids Prevention,
accidents
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Toxicity

• hepatotoxic hepatitis - cirrhosis
• neurotoxic
• kancerogenic
• teratogenic

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Clinical picture of acne chlorina

• commedons small cysts with black centres,
  cysts, scaring
• predilection all places with skin folliculs
  (face except nose, axils, scrotum, penis)

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Acne oleosa

• Products made from crude oil- petroleum
• Other oils (from plants)
• Metall working fluids mineral oils, grease,
  technological fluids, oils, diesel

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Acne oleosa

• Personaly disposition
• Clinical picture is polymorph a picture of
  keratosis pilaris ?comedons ?papules ? pustules ?
  absces. Never cysts.
• Predilection dorsal part of fingers, forearms,
  thighs, abdomen, back, face (among young patients)

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Prevention of acne oleosa

• Cleanliness of dress
• Cleanliness of skin during work and after it
  (warm! Water, soaps)

Cleanliness is next to godliness
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Acne picea

• asfalts, bitumens (mede f.i. from coal)
• many professions (contact with asfalt
  construction of roads, industry of petroleum)
• Clinical picture open commedons, without
  inflammation of surrounded skin, whenever on the
  skin (also on the face)
  hyperpigmentations

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Prevention of acne picea

• Ventilation in workrooms
• Personaly hygienic habits
• Persons with seborrhoic type of skin
• (fotoprotection)

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Occupationals tumors

• Spinalioma
• - fingers of physicians (x-rays)