Download MBBS Dermatology PPT 7 Endogenous Eczema Lecture Notes

--- Content provided by​ FirstRanker.com ---

a)

Crusts

--- Content provided by‌ FirstRanker.com ---

b) Excoriation
c)

Ulcer

--- Content provided by‌ FirstRanker.com ---

d) Scale

? The best maintenance therapy in atopic dermatitis is
a)

--- Content provided by FirstRanker.com ---

Emol ients.

b) Topical tacrolimus
c)

--- Content provided by‍ FirstRanker.com ---

Topical glucocorticoids

d) Oral and topical antibiotics

? Infantile atopic dermatitis present as red skin topped by tiny vesicles over face

--- Content provided by FirstRanker.com ---

a)

At birth

--- Content provided by​ FirstRanker.com ---

b) After 1 week of age
c)

After 3 months of age

--- Content provided by​ FirstRanker.com ---

d) After 1 year of age

? A 15 year old child presented with sudden onset of many deep-seated pruritic, clear "sago grain-

like"vesicles in both hands associated with severe itching. The probable diagnosis is

--- Content provided by FirstRanker.com ---

a)

Scabies

--- Content provided by⁠ FirstRanker.com ---

b) Pompholyx
c)

Herpes zoster

--- Content provided by⁠ FirstRanker.com ---

d) Irritant dermatitis
? A 29 year old female presents with dandruff and a rash on her face. On examination there is evidence

of areas of erythema with fine greasy scaling over her nasal bridge, around her nasolabial fold and
eyebrows and ears and on scalp. What is the most likely diagnosis?

--- Content provided by FirstRanker.com ---

a)

Psoriasis

--- Content provided by​ FirstRanker.com ---

b) Contact dermatitis
c)

Seborrheic dermatitis

--- Content provided by‍ FirstRanker.com ---

d) Pityriasis versicolor

? A patient presents with papules which are greasy and brown over her chest. She also complains of

greasy scales on scalp. She is otherwise wel . What is the most likely diagnosis?

--- Content provided by‍ FirstRanker.com ---

a)

Seborrheic dermatitis

--- Content provided by FirstRanker.com ---

b) Atopic dermatitis
c)

Pityriasis rosea

--- Content provided by‌ FirstRanker.com ---

d) Guttate psoriasis

FEW BASIC CONCEPT

? The terms `eczema' and `dermatitis' used interchangeably

--- Content provided by​ FirstRanker.com ---

? Denotes a polymorphic inflammatory reaction pattern involving the

epidermis and dermis.

? Wide range of etiologies of `Eczema'. Distribution of lesions differ acc. to

--- Content provided by​ FirstRanker.com ---

the etiology

? Basic morphology of lesions in all etiologies remain same

--- Content provided by⁠ FirstRanker.com ---

ACUTE ECZEMA

? Erythema
? Edema

--- Content provided by⁠ FirstRanker.com ---

? Oozing
? Papulovesicular eruptions

SUB ACUTE ECZEMA

--- Content provided by FirstRanker.com ---

? Erythema
? Edema
? Oozing
? Scaling and crusting

--- Content provided by​ FirstRanker.com ---

CHRONIC ECZEMA

? Xerosis,
? Lichenification,

--- Content provided by‌ FirstRanker.com ---

? Hyperkeratosis/Scaling,
? ?Fissuring.

HISTOPATHOLOGY

--- Content provided by⁠ FirstRanker.com ---

? SPONGIOSIS : an intercellular epidermal oedema that leads to stretching

and eventual rupture of the intercellular attachments, with the formation of

vesicles

--- Content provided by‍ FirstRanker.com ---

? ACANTHOSIS: increase in thickness of epidermis ? regular/ irregular
? HYPERKERATOSIS: increase in thickness of Stratum corneum
? PARAKERATOSIS : retention of nucleated cells in Stratum corneum

--- Content provided by‌ FirstRanker.com ---

HISTOPATHOLOGY

ACUTE ECZEMA

--- Content provided by⁠ FirstRanker.com ---

? The epidermis shows distinct vesicle

formation due to " spongiosis"

? Vesicle contains serum, and a moderate

--- Content provided by​ FirstRanker.com ---

number of inflammatory cells.

SUBACUTE ECZEMA

--- Content provided by FirstRanker.com ---

? Irregular acanthosis
? Patchy spongiosis with the formation

of incipient microvesicles.

--- Content provided by‌ FirstRanker.com ---

? Few lymphocytes are migrating up

from the dermis into the epidermis

--- Content provided by⁠ FirstRanker.com ---

CHRONIC ECZEMA

? Compact hyperkeratosis,
? Patchy parakeratosis
? Irregular acanthosis.

--- Content provided by FirstRanker.com ---

? Mild spongiosis is seen

throughout

? Lymphocytic infiltrate in the

--- Content provided by‌ FirstRanker.com ---

upper dermis

CLASSIFICATION

--- Content provided by‍ FirstRanker.com ---

(acc. to etiology)

ENDOGENEOUS

EXOGENEOUS

--- Content provided by⁠ FirstRanker.com ---

1. Atopic dermatitis

1. Irritant dermatitis

--- Content provided by‌ FirstRanker.com ---

2. Seborrhoeic dermatitis

2. Allergic dermatitis

3. Nummular eczema

--- Content provided by​ FirstRanker.com ---

3. Photodermatitis

4. Stasis dermatitis

--- Content provided by⁠ FirstRanker.com ---

4. Infective dermatitis

5. Asteatotic dermatitis

5. Post traumatic dermatitis

--- Content provided by⁠ FirstRanker.com ---

6. Pityriasis Alba
7. Dyshidrotic eczema
8. Lichen Simplex Chronicus
ATOPIC DERMATITIS

--- Content provided by⁠ FirstRanker.com ---

? Itchy, chronic, relapsing inflammatory skin condition, often

starts in early childhood (< 2 years)

--- Content provided by‌ FirstRanker.com ---

? Characterized by erythema, itchy papules and / or

papulovesicles, may become excoriated and lichenified,

? Typically has a flexural distribution

--- Content provided by‌ FirstRanker.com ---

HANIFIN AND RAJKA'S Diagnostic

Criteria Of Atopic Dermatitis

--- Content provided by​ FirstRanker.com ---

UK refinement

?Itchy skin condition (parental report of scratching /rubbing in a child)
?Plus three or more of the following:
? Onset below age of 2 years

--- Content provided by FirstRanker.com ---

? History of skin crease involvement (including cheeks in children under 10

years)

? History of a generally dry skin

--- Content provided by‌ FirstRanker.com ---

? Personal history of other atopic disease (or history of any atopic disease in

a firstdegree relative)

? Visible flexural dermatitis (or dermatitis of cheeks/forehead and outer

--- Content provided by⁠ FirstRanker.com ---

limbs in children under 4 years


AETIOLOGY & PATHOGENESIS

--- Content provided by‍ FirstRanker.com ---

?Genetic susceptibility

?Immunological changes

--- Content provided by FirstRanker.com ---

1. Familial - ATOPY

1. Abnormalities in lymphocytes

2. Precise mode of inheritance

--- Content provided by FirstRanker.com ---

Acute ? Th2 cytokines

unknown

--- Content provided by FirstRanker.com ---

Chronic ? Th1 cytokines

?Defective Skin Barrier

?Abnormalities of IgE

--- Content provided by‍ FirstRanker.com ---

1. Increased TEWL

1. Elevated levels

--- Content provided by FirstRanker.com ---

2. Easy entry of allergen,

antigens from environment

INFANTILE PHASE

--- Content provided by​ FirstRanker.com ---

(2 MONTHS- 2 YEARS)

? Frequently start on the face
? Erythema and edematous papules, intensely

--- Content provided by‍ FirstRanker.com ---

itchy, ? exudative and crusted

? As the child begins to crawl, the extensor

--- Content provided by‌ FirstRanker.com ---

aspect of the knees & elbows are most

involved.

? Secondary infection, lymphadenopathy

--- Content provided by FirstRanker.com ---

common


CHILDHOOD PHASE

--- Content provided by FirstRanker.com ---

(2-12 YEARS)

? Sites- elbow, knee flexures,
? sides of the neck,

--- Content provided by‍ FirstRanker.com ---

? wrists and ankles.
? Erythema, crusting, excoriation, hyper and

hypopigmentation, and lichenification

--- Content provided by FirstRanker.com ---

? sides of the neck may show a striking reticulate

pigmentation: 'atopic dirty neck'

? Itching intense.

--- Content provided by​ FirstRanker.com ---

ADULT PHASE

(12 YEARS AND MORE)

--- Content provided by‍ FirstRanker.com ---

? similar to that in later childhood, with predominant lichenification, especially the

flexures and hands.

--- Content provided by​ FirstRanker.com ---

COMPLICATIONS AND COMORBIDITIES

?Psychosocial aspect: Itching, scratching and sleep disturbance cause

impairment in quality of life

--- Content provided by​ FirstRanker.com ---

?Growth delay
?Secondary bacterial infection , viral infection
?Ocular changes: Dennie- Morgan fold
Keratoconjunctivitis

--- Content provided by⁠ FirstRanker.com ---

Keratoconus
?Urticaria
?Food allergy
?Alopecia areata
?Lip licking cheilitis

--- Content provided by FirstRanker.com ---

KAPOSI VARICELLIFORM ERUPTION

ECZEMA HERPETICUM

--- Content provided by‌ FirstRanker.com ---

? HSV infection superadded
? Characteristic viral papulovesicles over

existing patches of eczema

--- Content provided by⁠ FirstRanker.com ---

? Rapid evolution to a state of extensive

purulent exudate

? To be suspected in case of rapid

--- Content provided by‌ FirstRanker.com ---

deterioration of the eczema.

--- Content provided by FirstRanker.com ---

TREATMENT

General measures
1. Counselling : disease, chronicity, course

--- Content provided by⁠ FirstRanker.com ---

2. Avoid scratching
3. Hot water bath
4. Avoid triggers : wool, synthetic clothes, strong soaps,

housedust mite etc

--- Content provided by‌ FirstRanker.com ---

5. Liberal use of emmolients: MAINSTAY of THERAPY


TREATMENT

--- Content provided by‌ FirstRanker.com ---

SEBORRHEIC DERMATITIS

? Chronic dermatitis
? Red, sharply marginated lesions covered with greasy scales
? Scalp, face, central chest, anogenital areas, flexures and submammary

--- Content provided by‍ FirstRanker.com ---

areas

? Symmetrical distribution.
? Males commonly

--- Content provided by‌ FirstRanker.com ---

? 30 years men and 40-50 yrs women

ROLE OF MALASSEZIA

? The commensal lipophilic yeasts of the genus Malassezia

--- Content provided by FirstRanker.com ---

are generally considered pathogenic through indirect and

possibly immunological mechanisms

--- Content provided by​ FirstRanker.com ---

? exist as skin commensals in a state of symbiosis


CLINICAL FEATURES

--- Content provided by‌ FirstRanker.com ---

? Dandruff/ pityriasis capitis : isolated to the scalp with little

or no overt inflammation, mildest forms of SD

? Seborrheic dermatitis: starts as dull or yellowish red pruritic

--- Content provided by FirstRanker.com ---

lesions covered with greasy scales.

? Erythroderma

--- Content provided by‌ FirstRanker.com ---

Facial SD
? nasolabial area, ear creases, eyelids and

glabellar area, medial eyebrows

--- Content provided by​ FirstRanker.com ---

? eyelid margin involvement(anterior

blepharitis): flaky debris on the

eyelashes, typically near the base.

--- Content provided by‌ FirstRanker.com ---

SCALP INVOLVEMENT

? Mild flaking without underlying

--- Content provided by‍ FirstRanker.com ---

erythema to a more inflammatory

? Eruption with thicker, yellow, greasy

--- Content provided by FirstRanker.com ---

scales and crusts;

? Similar changes can occur in the

beard

--- Content provided by‌ FirstRanker.com ---

Truncal involvement
? presternal area :petaloid (petalshaped)

lesion

--- Content provided by FirstRanker.com ---

? `pityriasiform': generalized

erythematosquamous eruption

--- Content provided by​ FirstRanker.com ---

? Flexural lesion


INFANTILE SEBORRHEIC DERMATITIS

--- Content provided by‌ FirstRanker.com ---

? Appears by 3 months and disappears spontaneously by 8

months of age

? presents primarily with cradle cap

--- Content provided by‍ FirstRanker.com ---

? and/or napkin dermatitis.

TREATMENT

--- Content provided by‍ FirstRanker.com ---

DISCOID / NUMMULAR ECZEMA

? Coin shaped plaque of closely set, thin-walled

vesicles on an erythematous base.

--- Content provided by‌ FirstRanker.com ---

? Itching severe.
? Middle aged men
? Sites- lower legs, dorsa of hands, extensor

--- Content provided by‌ FirstRanker.com ---

surfaces of the arms.

? Secondary lesions appear as mirror images
? Dormant patches may become active again

--- Content provided by‍ FirstRanker.com ---

TREATMENT DISCOID ECZEMA

First line
? Emollient, topical corticosteroid, topical or oral antibiotic
Second line

--- Content provided by‍ FirstRanker.com ---

? Topical calcineurin inhibitor
Third line
? Phototherapy (narrowband UVB/PUVA)
? oral immunosuppressants: methotrexate or oral steroids

--- Content provided by⁠ FirstRanker.com ---

ASTEATOTIC ECZEMA

ECZEMA CRAQUELE

--- Content provided by​ FirstRanker.com ---

? Elderly ; legs, arms and hands
? Winter: reduction in humidity
? The asteatotic skin is dry and slightly scaly
? Backs of the hands : crisscross lines.
? Finger pulps: dry, cracked, producing distorted

--- Content provided by‌ FirstRanker.com ---

prints. retain prolonged depression after pressure

`parchment pulps'.

--- Content provided by FirstRanker.com ---

? Legs marked superficial markings:

`crazypaving' pattern (eczema craquele)

TREATMENT ASTEATOTIC ECZEMA

--- Content provided by⁠ FirstRanker.com ---

First line
? Humidify environment
Second line
? Emollients, with or without urea, bath oil and soap

--- Content provided by‌ FirstRanker.com ---

substitute

Third line
? Mild topical corticosteroids

--- Content provided by‍ FirstRanker.com ---

? tacrolimus


PITYRIASIS ALBA

--- Content provided by‍ FirstRanker.com ---

? Age : 3 and 16 years
? Confined to the face: cheeks, around

mouth and chin

--- Content provided by​ FirstRanker.com ---

? Start as slightly erythematous with fine

scaling

? Later: rounded, oval or irregular

--- Content provided by FirstRanker.com ---

hypopigmented patch, not well

marginated

--- Content provided by‌ FirstRanker.com ---

? D/D - Nevus depigmentosus, early

vitiligo, PMLE

TREATMENT PITYRIASIS ALBA

--- Content provided by​ FirstRanker.com ---

? Response to treatment is often disappointing
First line
? Emollient
Second line

--- Content provided by‍ FirstRanker.com ---

? Mild topical corticosteroids
Third line
? Topical tacrolimus or pimecrolimus
GRAVITATIONAL/VENOUS/STASIS

--- Content provided by‌ FirstRanker.com ---

/VARICOSE ECZEMA

? Secondary to dysfunctional venous drainage of the lower legs.
? middle-aged elderly females.
? Predisposition: previous DVT , presence of venous stasis:

--- Content provided by‍ FirstRanker.com ---

prolonged standing, obesity, immobility,and previous cellulitis

? around the ankle and lower legs

--- Content provided by​ FirstRanker.com ---

? High ambulatory venous pressure within the calf muscle pump
? Transmitted to the capillary circulation
? Distends the local capillary bed
? Widens the endothelial pores
? Fibrinogen molecules escape into the interstitial fluid, form a fibrin sheath around

--- Content provided by​ FirstRanker.com ---

the capillaries - pericapillary barrier

? Prevents diffusion of oxygen and other nutrients essential for the normal vitality

--- Content provided by‍ FirstRanker.com ---

of the skin

? Also, increased sequestration of white cells in the venules,
? Consequent release of proteolytic enzymes and free radicals which produce

--- Content provided by‍ FirstRanker.com ---

tissue damage


? first sign - pitting edema - medial aspects of shin; proximal

--- Content provided by FirstRanker.com ---

to the ankle

? Edema more pronounced in evening; resolves overnight.
? Skin in area- dry and itchy.
? Over years, the skin, subcutaneous adipose tissue and deep

--- Content provided by FirstRanker.com ---

fascia indurated and mutually adherent

("lipodermatosclerosis")

--- Content provided by⁠ FirstRanker.com ---

? Erythema and scaling most pronounced around the inner

malleoli

? Episodes of vesiculation , oozing and erosive occur

--- Content provided by‍ FirstRanker.com ---

? Repeated episodes of acute eczema gives way to venous

ulcers

TREATMENT VENOUS ECZEMA

--- Content provided by​ FirstRanker.com ---

First line
? Any underlying venous hypertension and/or pedal oedema controlled.
? Obese patients to lose weight.
? Skin care, including leg elevation

--- Content provided by‍ FirstRanker.com ---

? Emollients, topical corticosteroids, tacrolimus
? Antibiotics for sec. Bacterial inf


TREATMENT VENOUS ECZEMA

--- Content provided by‌ FirstRanker.com ---

Second line
? Compression hosiery (Ankle brachial pressure index, ABPI >.08, in

absence of calcified vessels)

--- Content provided by‌ FirstRanker.com ---

Third line
? Referral to vascular surgeon: surgical intervention

DYSHIDROTIC ECZEMA

--- Content provided by FirstRanker.com ---

? Acute and recurrent
? Firm, pruritic "sago grain-like"vesicles
? Site- palms, soles, lateral and medial

--- Content provided by‌ FirstRanker.com ---

aspects of the fingers and toes

? No disturbance of sweat gland function-

`dyshidrotic' misnomer

--- Content provided by⁠ FirstRanker.com ---

? Treatment - Topical and systemic

corticosteroids

--- Content provided by FirstRanker.com ---

? Topical calcineurin inhibitors , PUVA

may be helpful.
FEW MCQS

--- Content provided by‍ FirstRanker.com ---

? This secondary lesion develops when serum, blood or purulent exudate dries on the skin surface.

a)

Crusts

--- Content provided by FirstRanker.com ---

b) Excoriation
c)

Ulcer

--- Content provided by​ FirstRanker.com ---

d) Scale

? The best maintenance therapy in atopic dermatitis is
a)

--- Content provided by​ FirstRanker.com ---

Emol ients.

b) Topical tacrolimus
c)

--- Content provided by‌ FirstRanker.com ---

Topical glucocorticoids

d) Oral and topical antibiotics
? Infantile atopic dermatitis present as red skin topped by tiny vesicles over face

--- Content provided by‌ FirstRanker.com ---

a)

At birth

--- Content provided by​ FirstRanker.com ---

b) After 1 week of age
c)

After 3 months of age

--- Content provided by​ FirstRanker.com ---

d) After 1 year of age

? A 15 year old child presented with sudden onset of many deep-seated pruritic, clear "sago grain-

like"vesicles in both hands associated with severe itching. The probable diagnosis is

--- Content provided by‌ FirstRanker.com ---

a)

Scabies

--- Content provided by FirstRanker.com ---

b) Pompholyx
c)

Herpes zoster

--- Content provided by‌ FirstRanker.com ---

d) Irritant dermatitis

? A 29 year old female presents with dandruff and a rash on her face. On examination there is evidence

of areas of erythema with fine greasy scaling over her nasal bridge, around her nasolabial fold and

--- Content provided by​ FirstRanker.com ---

eyebrows and ears and on scalp. What is the most likely diagnosis?

a)

Psoriasis

--- Content provided by‍ FirstRanker.com ---

b) Contact dermatitis
c)

Seborrheic dermatitis

--- Content provided by​ FirstRanker.com ---

d) Pityriasis versicolor

? A patient presents with papules which are greasy and brown over her chest. She also complains of

--- Content provided by⁠ FirstRanker.com ---

greasy scales on scalp. She is otherwise wel . What is the most likely diagnosis?

a)

Seborrheic dermatitis

--- Content provided by‌ FirstRanker.com ---

b) Atopic dermatitis
c)

Pityriasis rosea

--- Content provided by‍ FirstRanker.com ---

d) Guttate psoriasis
THANK YOU