Seborrhoeic eczema Cause Infection of Pityrosporium ovale
/malassezia furfur Genetic predisposition Presentation: Mostly in
adults Sebum may be permissive for the development of the rash but
otherwise the name is a poor one. Mainly affects hairy areas of the
body Often shows characteristic greasy yellowish scales.
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Sites : Red scaly/ exudative eruption of the scalp(dandruff in
milder form), ears, face,eye lashes and eyebrows.(in severe form
resembles psoriasis) Seborrhoeic eczema is a feature of AIDS and
can be very severe in this condition. Dry and scaly lesions of
presternal and interscapular region and Intertrigenous lesions of
armpits, umbilicus and groins or under spectacles and hearing aids
Morphology Follicular variant(red follicular papule covered with
greasy yellow scales) Eczematous(erythematous scaly,over hairline
of scalp,associated with blepharitis and otitis externa)
Petaloid(nonexudative annular scaly ) Seborrheic
folliculitis(extensive erythematous follicular papules) Flexural
(well defined erythema with greasy scales)
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Complications:bacterial infn candid inf. Invest. Rule out HIV
Treatment Suppressive treatment rather than curative Topical
imidazoles Topical corticosteroids Others:topical agents like
2%sulfur,2%salicylic acid in aqueous cream and selenium
sulfide(1-2%),lithium prepn systemic therapy: used in HIV induced
extensive lesion,antibiotics and antifungul
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Active seborrhoeic eczema of face Infantile seborrhoeic
eczema
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Discoid eczema Cause: unknown Maybe associated with chronic
stress,atopy,rxn to bacterial antigen Presentation: Limbs of middle
aged men Common presentation-multiple, coin shaped, vesicular or
crusted, highly itchy plaques Less than 5cm Persists for many
months Tendency to recur at the same site Can occur in children
with atopic eczema Treatment Antihistamincs for symptomatic relief
Topical steroid and antibiotic combination. Extensive lesion : PUVA
sol.(topical psoralen + solar energy uvA
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Contact Dermatitis Irritant eczema Cause: Detergents, alkalis,
acids, solvents and abrasive dusts Predisposing factor: Elderly-
vulnerable groups are those with fair and dry skin, atopics
Pathogenesis:due to direct action of chemicals on skin and no
involvement of immunologic pathways Presentation Acute exudative
lesion if strong exposure,dry dermatitis lesion if chronic repeted
weak irritent exposure(housewife dermatitis /cumulative insult
dermatitis)
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Children- napkin rashes Prolonged contact of skin with fecal
enzymes and ammonia produced by urea-splitting bacteria Overgrowth
of yeast Must be differentiated from allergic CD by patch test.
Complication: Candida superinfection Treatment -Clean the area
-Avoit irritant exposure -Napkin area should be cleaned thoroughly
and protective ointments like Zn and castor oil ointment are useful
-Topical imidazoles to arrest the growth of yeast -Acute cases
-moderately potent corticosteroid hasten recovery -Chronic topical
steroids,emollients
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Contact eczema caused by allergy to nickel in a jean stud and
ear ring
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Acute vesicular contact eczema of hand
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Vesicular and crusted contact eczema of face (Cosmetic
allergy)
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Dry fissured finger tips-caused by handling garlic
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Allergic contact dermatitis Etiopathogenesis Exposure to
allergens/ antigens in single or repeted contact Type IV/ delayed
hypersensitivity Specific to one chemical or closely related
chemicals All sites are allergic even though lesions manifest only
over area of contact Allergy is permanent
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Langerhans cells process antigen Antigen Realease of cytokines
Interaction with sensitized lymphocytes Multiplication of
lymphocytes Tissue injury Etiopathogenisis
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Common allergens AllergensCommon sourceComments Metals
NickelNickel plated objects like jewellery, jean stud Steel is
safer DichromateCement, Paints, green tattoos, some leathers
Construction workers Rubber chemicalsShoes, gloves, tyres,
clothesAdditives used are allergens rather than rubber itself
Resins ColophonyNaturally occurring, found in pine saw dust Used as
an adhesive in sticking plasters and bandages Most common cause of
plaster allergy Epoxy resinsAdhesives, electrical and plastic
industries
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Common allergens AllergensCommon sourceComments Cosmetics
Paraphenylenediamine (PPD) Dark dyes for hair and clothing Patch
test done before dyeing hair Balsam of PeruPerfumes,
suppositoriesMay indicate allergy to perfumes Wool alcoholsLanolin,
cosmetics, creamsCommon cause of reactions to topical medicines and
creams Medicaments NeomycinTopical antibioticCross reacts with
framycetin and gentamycin, so swapping antibiotics may not always
help Preservatives and biocides ParabensPreservatives in both
cosmetics and medical creams Common cause of allergy to different
creams
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Presentation Can manifest as acute or chronic Original site of
eruption gives a clue to likely allergen Easily recognizable
pattern Usually related to occupation Areas involved: Eyelids,
external auditory meatus, hands / feet Investigations: find out
allergen from hx and pattern of distribution patch test Treatment
Avoid allergens completely Topical corticosteroids and if
extensive, oral steroids
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Asteatotic eczema Cause: Elderly patients Dry skin Other:
Overwashing, low humidity of winter and central heating,underlying
malignancy, hypothyroidism. Presentation Extremly itchy Occurs in
shins,low back Crazy paving appearance- dry skin with fine
reticulate red superficial fissures. Treatment Topical steroid in
greasy base Regular emollient,substituting aqueous cream for
soap
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Gravitational eczema Cause: Detergents, alkalis, acids,
solvents and abrasive dusts Often accompanied by venous
hypertension or late sequel of previous DVT Presentation Chronic
patchy eczematous condition, accompanied by varicose veins pedal
oedema and hemosiderin deposition-brownish pigmentation
Lipodermatosclerosis(ivory white sclerotic plaques with dilated
capillary loops) Minor trauma leads to ulcer
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Occurs over lower third of the leg and ulcer over medial
mallelus Severe-spreads to other leg and may become generalized.
Complications Ulceration,infection,alllergic contact dermatitis to
topical applications,deformity like inverted campagne
bottle,malignancy (rare) Treatment Elevation of affected limb/
pressure bandages Mild steroids relieve irritation Rx infection
Treatment of underlying cause
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Lichen simplex/ localized neurodermatitis Cause: Damage to the
skin due to repeated scratching and rubbing and licking lips,
usually as a habit or in response to stress,may be associated with
atopy Presentation Single and sometime multiple, fixed itchy
lichenified plaque Common areas-nape of neck in female, legs in
male, anogenital areas in both sexes. Treatment Topical
steroid,keratolytic agents antihistaminics Helps break scratch-itch
cycle
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Licking lips as a nervous habit caused characteristic pattern
of dry fissured irritant eczema
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Pompholyx Cause: Usually unknown but provoked by heat and
emotional upsets. In patients with allergy to nickel, small amount
of nickel can provoke pompholyx Presentation Recurrent bouts of
bland looking vesicles and large blisters appear on palms, fingers
and soles of adults Bouts last for few weeks and recur at irregular
intervals Secondary infection, lymphangitis are common problems
Treatment Wet wrap dressings with corticosteroids Antibiotics for
bacterial infection
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Topical Steroid Classification Group I is the strongest, or
superpotent. Group VII is the weakest and mildest. Topical Steroid
Group I Very potent - up to 600 times stronger than hydrocortisone.
Betamethasone diproprionate, Halbetasol proprionate Topical Steroid
Group II Fluocinonide, Halcinonide Topical Steroid Group III
Triamcinolone acetonide, Fluticasone proprionate, Betamethasone
diproprionate Topical Steroid Group IV Fluocinolone acetonide,
Hydrocortisone Valerate Hydrocortisone butyrate Topical Steroid
Group V Triamcinolone acetonide, Fluticasone propionate,
Hydrocortisone valerate Topical Steroid Group VI Prednicarbate,
Triamcinolone acetonide, Fluocinolone acetonide Topical Steroid
Group VII The weakest class of topical steroids. Has poor lipid
permeability, and can not penetrate mucous membranes well.
Hydrocortisone 2.5%, Hydrocortisone 1%
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Common side effects of long term steroid use Thinning of skin-
striae, fragility, purpura Vulnerable to infections Systemic
absorption- Suppression of hypothalamic-adrenal axis Cushingoid
features(centralized obesity, moon face, flushed cheek double chin,
buffalo hump, hypertension, demineralization of bones and short
stature)
