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ECZEMA & DERMATITIS

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Marikannan Maharajan

on 23 November 2015

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Transcript of ECZEMA & DERMATITIS

ECZEMA & DERMATITIS
-KANNAN

WHAT DO YOU KNOW
ABOUT
ECZEMA/DERMATITIS
or SKIN?
What is Dermatitis?
NOMAL SKIN Vs DERMATITIS
EVERY GOOD CONVERSATION STARTS WITH
GOOD LISTENING

WHAT YOU ARE EXPECTING?
Dermatitis = inflammation of the skin.

One of the most common skin complaints.

Most treatments can give patients much needed symptomatic relief. 
When the term "eczema" is used alone, it usually refers to atopic dermatitis (atopic eczema)


DERMATITIS
Introduction
Dermatitis = inflammation of the skin.
Common condition
Usually isn't life-threatening or contagious.
Patient feel uncomfortable and
Self -conscious.
"Eczema" - refers to atopic dermatitis
1.ATOPIC DERMATITIS- ECZEMA
A chronic, relapsing, inflammatory skin condition characterised by an itchy red rash that favours the skin creases.
Mostly affects infants (3-6 month)
Strong genetic etiology
A chronic remitting pruritic (Severe itching)


Treatment
2.CONTACT DERMATITIS
Contact dermatitis
Two distinct groups

1. Allergic
contact dermatitis


2. Irritant
contact dermatitis


DIRECT IRRITANT CONTACT DERMATITIS
Eg: Detergents and de-greasing agents
Nonspecific response to direct chemical contact

Chemicals - strong irritant, - affect skin

Epidermal cell releases inflammatory mediators

Corrosive agents affects epidermal cells to death

Manifested by chemical burns and cutaneous ulcers.

Clinical features
Reddish-brown Skin
Formation of Vesicles.
Appearance of lesion (within 6-12 hrs) painful and itchy.
Exist as dry, hacked, or fissured areas of skin -susceptible to secondary infection.
TREATMENT
Avoidance of responsible irritant.
Suitable wet dressings and lotions include
Aluminium Acetate Lotion 5%
Calamine Lotion BP
Strong tropical steroid (short duration)
0.1% Betamethasone Valerate with 3% clioquinol
Fluocinolone Acetonide
Beclomethasone Dipropionate 0.025%
ALLERGIC CONTACT DERMATITIS
Hypersensitivity reaction in predisposed people after sensitisation with an allergen.

Allergen triggers an immune reaction in skin. 

Lead to specific cell-mediated sensitization.
Water (hard, chalky, and heavily chlorinated water),
Detergents and soaps, solvents and abrasives,
Oils, Acids and alkalis, including cement,
Nickel in cutlery, Fragrances or flavorings,
Strong detergents or soaps, Skin cleansers,
Makeup and other cosmetics,
Deodorant
Common sites of involvement

Ear lobes
Nape of neck
The wrist
The feet

Symptoms
Treatment
Valid patch testing to identify the allergens

Counselling on avoidance of responsible allergens.

Palms, soles, and scalp need treatment with a potent corticosteroid because the skin here is thick.

This reduces the penetration and effectiveness of topical treatment.

Betnovate ointment is ideal to treat in such conditions
minor dermatitis affecting your areolar area & produce itching.
Your Shoes may Make You Sick
-Contact dermatitis-
I've had issues with dandruff and dry skin since last 4 months.
In the past 2 months though, the condition has become very apparent on my face. It always looks like I'm blushing. As far as my face goes, I'm always embarrassed. People at work point it out to me like I don't know that my face is as red as a tomato all of the time. I try my best to cover it with make up, but the foundation often burns my skin and by the end of the day, it looks like plaster because my skin has raised up and has started flaking. I hate this. I wish I could afford the prescriptions or at least know why this happens and what I can do to prevent it.
3.SEBORRHOEIC DERMATITIS
Affects the area - rich in
sebaceous
glands
Unknown etiology
The scalp, face, and upper trunk
The presternal area,
The axillae,
Submammary folds,
Groin, and
External ear


Clinical features
Severe and persistent dandruff
Round or oval patches
Red, scaly, greasy skin rashes
Red to yellow, glazed-looking lesions (trunk)
Yellow-brown crusts on the top of each patch
Treatment
Salicylic acid 1-2% (aqueous cream)
Ichthyol 1-2% in zinc paste
Ketoconazole shampoos
Adverse reactions to
topical preparations are common.

4.Dyshidrotic eczema
AKA
acute vesiculobullous
hand eczema
Mostly unknown etiology
Stress, allergies, more exposure to water or moist
Exposure to chromium, cobalt, nickel
Clinical features
Pruritic vesicular eruption
on the fingers, palms, and soles
Vesicular eruption = pompholyx, (bubble).

TREATMENT
Avoid - (which can make itching worse).
Frequent bathing,
Hand washing, and
Irritating substances,
Steroid (carticosteroids) pills
Coal tar preparations
Phototherapy (ultraviolet light therapy)

ANTI ITCHING MEDICINES..
TREATMENT (cont.,)
Diphenhydramine (Benadryl) & loratiadine (such as Claritin)
Petroleum jelly (Vaseline),
Mineral oil
Eucerin and Lubriderm
Tacrolimus or pimecrolimus cream & ointment

Ointments or creams  b.i.d .,after every hand washing.

5.Neurodermatitis
Result of repeated rubbing or scratching-(chronic)

Skin to thicken and darken (lichenification)

The stimulus to scratch - unrecognized

(Mosquito bite, stress, or simply a nervous habit)

Starts with a patch of itchy skin,

But scratching it makes the area even itchier

TREATMENT
Stop Scratching 
Most important but will need a lot of will-power!
Apply moisturizers or a cold flannel whenever the need to scratch.
Cut nails short and use the pulp of fingers.

Steroid creams: 
Mild/ potend topical steroid
May not be suitable for the face, genitals/body folds
Strong steroid creams can cause skin thinning.

TREATMENT (cont.,)
Antihistamines- help relieve itching.
Anti-anxiety drugs-prevent the itchiness (anxiety and stress can trigger neurodermatitis symptoms)
Antibiotics (topical/oral) 
Helps to reduce a bacterial infection.
6.Nummular eczema
Unknown etiology
Allergy-related disorder
Itchy, coin-shaped spots or patches on the skin
Personal or family history of Allergies,
Asthma & Atopic dermatitis are at risk
Men get more often than women
TREATMENT
Protect skin from getting scraped
Hydrate skin.
20-minute lukewarm bath /
Shower once a day.
Apply moisturizer (Within 3 min after bath)
Adding bath oil to the water also may help

TREATMENT (cont.,)
Use medicine as directed by dermatologist. 
Corticosteroid ointments and
Tar creams.
To reduce inflammation (redness and swelling) and itch.
Antibiotic (If a bacterial skin infection)
Oral antihistamine-help to sleep.
7.Stasis dermatitis
Due to disturbed venous blood return
Mainly at lower leg region
Affects middle-aged and elderly patients

Clinical features
Venous insufficiency - chronic

Problem in sending blood back

Blood pools in the veins of the lower leg.

Leakage of fluid and blood cells -> skin and other tissues.

May lead to itching -->skin changes.

TREATMENT
Use elastic or compression stockings
to reduce swelling
Avoid standing or sitting for long periods
Keep your leg raised when you sit
Try varicose vein stripping or
Nonsurgical procedures
Wet dressings (use only when instructed)
Topical steroid - creams or ointments
Oral antibiotics

SAY TRUE OR FALSE
1.Eczema is a general medical term for many types of skin inflammation.
2.Eczema has no specific known cause.
3.Eczema is contagious
4.Eczema can be triggered by soap, sweat and clothing.
5.With eczema, the first symptom is usually itching
6.Pruritus is the medical term for itching
7.In children and adults, atopic dermatitis usually occurs on the scalp first.
8.Dermatitis is best controlled by good skin care
9.Eczema is diagnosed by blood test, CT scan and endoscopy
10.Dermatitis can mimic other skin diseases and infections.
11.People who have been diagnosed with eczema should avoid smallpox vaccine
12.Atopic dermatitis is believed to be at least partially inherited.
List of known skin irritants
in people with eczema:
Wool
Synthetic fibers
Chlorine
Mineral oil
Dust
Sand
Cigarette smoke
THANK YOU.!
THE END..
CLINICAL VARIETIES OF DERMATITIS
1

2

3

4

5

6

7
Story of a Girl..!
TIPS
UNDERSTAND ALL 8 TYPES OF DERMATITIS & THEIR CLINICAL SIGNIFICANCE
PREPARE A TABLE - CLINICAL SIGNIFICANCE & TREATMENT OPTIONS
UNDERSTAND THE REASON FOR DRUG SELECTION

is

Solvents

Rubbing alcohol

Bleach

Personal care products,
such as soaps, deodorants and cosmetics

Airborne substances,
such as sawdust or wool dust
After completing this lecture you will be able to:
Recognize the Diagnosis and
provide treatment option to the patients with atopic eczema or dermatitis.

Understand how to use the drug effectively

How to prevent atopic eczema or dermatitis


Learning Outcome
Symptoms
Itching, (severe at night)

Red to brownish-gray patches

Small, raised bumps,
(may leak fluid & crust over when scratched)

Thickened, cracked, dry, scaly skin

Raw, sensitive, swollen skin from scratching

Creams that control itching and inflammation. 
Topical corticosteroid cream or ointment.
Betamethasone, flurandrenolide, Fluticasone, hydrocortisone, triamcinolone
Overuse may cause skin irritation or discoloration, thinning of the skin, infections, and stretch marks.

Creams that help repair the skin. 
Calcineurin inhibitors - tacrolimus and pimecrolimus
Affect immune system, approved for children older than 2 & adults.

Drugs to fight infection. 
Antibiotics for a bacterial skin infection or an open sore or cracked skin caused by scratching.
It is recommended that
flucloxacillin, dicloxacillin and penicillin
be taken on an empty stomach but
amoxicillin with clavulanic acid
can be taken with meals.
Oral anti-itch drugs. 
Oral antihistamines-
Diphenhydramine, Promethazine/trimeprazine
Can make sleepy and may be especially helpful at bedtime.

Oral or injected drugs that control inflammation ( For severe cases) . 
Oral corticosteroid
Prednisolone 30-40 mg

Alitretinoin - newly licensed treatment for severe hand dermatitis.
Can't be used long term because of potential serious side effects.

Treatment
THOSE WHO ARE WORKING IN
Agriculture and fishing,
Cleaning,
Engineering and construction,
Food preparation and catering,
Hairdressing
Medical, dentistry, and veterinary work,
Printing and painting.

WHO IS AT RISK?
Common irritants
In infants, it typically occurs within the first six months of life

Resolves spontaneously by 8 months of age.

Infants most commonly present with cradle cap,

Characterised by greasy, yellow, scaly patches over the scalp.

In some patients a thick, scaly layer may cover the whole scalp.

Over time the scales may become flaky and rub off easily.

Clinical Features
The condition
Seborrhoeic dermatitis

is usually not itchy and in most situations the
baby does not seem to be troubled by it.
This is an important feature when differentiating
seborrhoeic dermatitis
from
atopic dermatitis
.

Seborrhoeic dermatitis Vs Atopic dermatitis
ANTI ITCHING MEDICINES
You are a Pharmacist in a dermatological clinic.
A 6 years old girl presents with a one week history of a dry, scaly rash on his scalp and cheeks.
She does not seem to be affected by this rash.
There is no family history of atopy.
What is the most likely diagnosis?

A. Atopic dermatitis

B. Neurodermatitis

C. Seborrhoeic dermatitis


Alan is a 12 year old boy
complaining with an intensely itchy rash.
and it is severe at night. on his skin there are brownish-gray patches also.
Which one of the following topical steroids
is suitable for him?
why?

A. 1% Betamethasone valerate ointment
B. 3% Salicylic acid ointment
C. 1% hydrocortisone ointment

An itchy rash & Altered appearance of skin

Collections of fluid, papules and vesicles

Crusting , scaling, cracking, swelling, and thickening of the skin.

The presence of vesicles.
Full transcript