eczema
Definition Pruritic papulovesicular dermatitis characterised by erythema, oedema and a serous exudate in the epidermis.
Pathogenesis Two hypotheses: 1) Immunological disturbance causes IgE-mediated sensitisation, epithelial barrier dysfunction is secondary (Endogenous Eczema) 2) Epidermal barrier dysfunction allows irritants and allergens into the skin, with immunological disturbance secondary (Exogenous Eczema)
classified by pathogenesis Contact dermatitis Housewives hand eczema Keratodermia tylodes palamaris progressiva(Hand eczema) Diaper dermatitis Atopic dermatitis Seborrheic dermatitis Nummular eczema Lichen simplex chronicus Lichen Vidal autosensitisation dermatitis Stasis dermatitis
Staging of eczema Acute eczema Subacute eczema Chronic eczema
1- Acute eczema It is accompanied by exocytosis of lymphocytes and spongiotic bulla.
clinical feature Exudative erythema Oedema Vesicles (sometimes) Intercellular oedema (spongiosis), intense dermal oedema, and inflammation occur. Acanthosis usually does not
Skin care: moisturizing the skin AND avoid irritant. treatment Education! Skin care: moisturizing the skin AND avoid irritant. Topical corticosteroids.
2- Subacute eczema Subacute eczema has a severity between that of acute and that of chronic
clinical feature Erythema Oedema, and it is slightly lichenoid. Mild oedema is produced in the epidermis. Acanthosis Parakeratosis are observed
3- Chronic eczema Hyperkeratosis Parakeratosis Irregular acanthosis, and elongation of rete ridges are observed. Spongiosis and spongiotic bulla are less severe in chronic eczema than in acute eczema more than one week after onset
clinical feature Lichenification Dry, sensitive skin Red, inflamed skin Scaly areas Recurring rash Rough, leathery patches Swelling Dark-colored patches of skin
treatment Choose the correct steroid for the site and activity of disease. Remove the causative agents if it is contact dermatitis. Treat the dryness (Emollients). Use keratolytics if it is seborrhoeic eczema. Antihistamines (Itching).