ECZEMA

Lecture fife

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

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)

TERMINOLOGY
Dermatitis =

Dermat

itis

refers to skin
means
inflamed
(thus, inflamed skin)
Other examples: arthritis, colitis,
encephalitis, etc.

CARDINAL FEATURES
OF INFLAMMATION
(warmth) - increased blood flow
(redness) -dilated blood vessels
(pain)- irritation of nerves in inflamed
tissues

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).

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

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

COMMON IRRITANTS

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

FACTORS INFLUENCING THE

DEVELOPMENTOF SKIN
IRRITATION

 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

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

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

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.

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

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:

 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.

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

TREATMENT OF allergic cotact

dermatitis

Topical glucocorticoids
Oral antihistamines
Compresses
Topical Emollients
Oral antibiotics
Oral glucocorticoids

CHILDHOOD ECZEMA

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

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

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

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

Thank you