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DIFFERENTIAL
DIAGNOSIS OF ECZEMA
Dr Diana Purvis
Paediatric Dermatologist
Eczema can be mimicked by:
• Inflammatory dermatoses
• Infections
• Infestations
• Metabolic disorders
• Genetic disorders
• Immunological disorders
• Malignancies
Quiz slide A
Quiz slide B
Quiz slide C
Quiz slide D
Quiz slide E
Inflammatory dermatoses
• Seborrhoeic dermatitis
• Psoriasis
• Lip lickers dermatitis
• Perioral dermatitis
• Pityriasis lichenoides
• Pityriasis alba
• Keratosis pilaris
• Contact dermatitis
Seborrhoeic dermatitis
Seborrhoeic dermatitis
• Infantile seborrhoeic dermatitis overlaps with eczema
• Adult seborrhoeic dermatitis overlaps with psoriasis
• Management: often not very responsive to treatment
• Prognosis: most improve but increased risk of eczema
Psoriasis
Psoriasis - treatment
• Emollients
• Topicals
• Calcipotriol
• Steroids
• Tars
• Phototherapy
• Systemic therapy
• Methotrexate, acitreti, cyclosporin, biologics
Pustular psoriasis
• Rare inflammatory form
• Can be life-threatening
• Often precipitated by
withdrawal from steroids
Lip lickers dermatitis
Perioral dermatitis
Pityriasis alba
Keratosis pilaris
Pityriasis lichenoides
Contact or phytophotodermatitis
Infections and infestations
• Bacterial
• Viral
• Fungal
• Other
• Infestations
Staphylococcal scalded skin syndrome
Scarlet fever
Pityriasis rosea
Tinea corporis
Scabies
Metabolic, genetic, immunologic,
malignant
• Metabolic
• Nutritional deficiencies, acrodermatitis enteropathica, PKU…
• Genetic
• Ichthyoses, Netherton’s, Ectodermal dyplasias…
• Immunologic
• Omenn’s syndrome, primary immunodeficiencies, Wiskott- Aldrich…
• Malignant
• Langerhan’s cell histiocytosis….
Zinc deficiency
Ichthyosis
Netherton’s syndrome
Hypohidrotic ectodermal dysplasia
Omenn’s syndrome
Langerhan’s cell histiocytosis
Erythroderma in the neonate
• >90% body surface affected by erythema
• Causes • Infections - SSSS, candida
• Drugs - vancomycin, ceftriaxone, TEN
• Dermatoses - atopic dermatitis, seborrhoeic dermatitis, psoriasis, pityriasis rubra pilaris - usu after first 6w of life
• Immunodeficiencies - Omenn’s syndrome, SCID
• Ichthyoses - Netherton’s syndrome, bullous / non-bullous ichthyosiform erythroderma
• Require immunological work up, skin biopsy, specific investigations eg hair, genetics
Quiz slide A
Quiz slide B
Quiz slide C
Quiz slide D
Quiz slide E
Quiz answers
• A – Zinc deficiency
• B – Tinea corporis
• C – Perioral dermatitis
• D – Pityriasis lichenoides
• E – Scabies