Classification of eczema disease group

Classification of eczema
disease group
Dr. Krisztian Gaspar
Not including…
• Papulosqamous disorders (psoriasis, parapsoriasis,
pityriasis forms, parakeratoses)
• Erythroderma
• Lichen planus, and lichenoid dermatoses
• Atopic dermatitis
Ekzemas
• Heterogeneous group
• Non-infectious inflammatory dermatoses
• The pathological changes in the epidermis and the upper
dermis produce distinct clinical pictures
• Extremely common, 15-25% of patients with skin diseases
Ethiology of ekzemas
Exogenous agents and
genetic susceptibility
Exogenous agents
Dermo-epidermalis
barrier
Irritant
contact dermatitis
Dermo-epidermalis barrier
and immunological mechanisms
Asteatotic eczema
Allergic contact
dermatitis
Chronic cummulative
irritant eczema
Mikrobial eczema
Hyperkeratotic
hand and foot eczema
Nummular eczema
Pityriasis simplex
Seborrheic eczema
Dermatitis glutealis
infantum
Atopic dermatitis
Intertrigo
Intertriginous eczema
Special forms
Id-reaction
Disseminated
ekzema
Acute form
Chronic form
Clinical picture: erythema,
Clinical picture: exsudativehyperpigmentation,
inflammatory skin changes,
epidermal thickening,
erythema, oedema, papules,
papules, scaling,
oozing vesicules, erosion, crust lichenification
Histology:
Histology:
Epidermis: epidermal
Epidermis: spongiosis
thickening, acanthosis,
(intercellular oedema),
hyperkeratosis
intraepidermal vesiculation
Dermis: chronic inflammatory
Dermis: Inflammatory cells,
cell infiltration
capillary dilatation, perivascular
edema
Irritant contact dermatitis
Definition: direct cytotoxic effect of a chemical, or physical
agent (single, or repeated application) on the skin,
causing inflammatory reaction without immunological
mechanisms
Multifactorial syndrome, determined by the irritating
substance, host, environment
Etiopathogenetic factors:
chemicals: acids, detergents, alkalis, oxidants
physical agents: UV- light, X-ray, heat
Polymorphous clinical picture (resemble that of ACD)
Asteatotic eczema
Dry, rough, scaly and inflammed skin with superficial cracking
(‘dried river bed’)
Associated with: xerosis, aging, low humidity, frequent bathing
Hyperkeratotic fissured hand and foot eczema
Differential diagnosis:
Psoriasis vulgaris
Mycotic infection
Chronic allergic contact eczema
Treatment:
Local: 5-10% salicylic acid or urea containing emollients to
get rid of the hyperkeratosis, local corticosteroid creams to
reduce inflammation, local PUVA therapy
Systemic: oral retinoid (Alitretinoin - Toctino)
Dermatitis glutealis infantum (napkin dermatitis)
Etiopathogenesis:
Irritation: urine, stool, occlusion, friction,
scraping
Mycotic (Candida, Epidermophyton) and
bacterial superinfection (Stapylococcus)
Allergic contact dermatitis (ruber, soap, plastic
material)
Clinical features:
Localized to the napkin area
Erythema, vesicules, oozing, erosions
Differential diagnosis:
Intertrigo
Seborrheic dermatitis
Psoriasis
Allergic contact dermatitis
Reason:
A type IV. hyperergic reaction due to an intrinsically non-toxic material in
the previously sensitized skin.
Features:
It develops in the area of the contact with the allergen.
Factors determining the severity of the reaction and the extension: the
degree of sensitization, the features of the allergen, the condition of
absorption of the skin.
The border lines are not always distinguished sharply from the areas that
are not affected, the most expressive symptoms can be observed in the
middle of the lesion.
The symptoms develop 24-48 hours after the exposition.
Asymmetric location, but tends to disperse symmetrically.
In case of frequent recurrence, the flare-ups are becoming longer.
The developed hypersensitivity is lifelong.
Acute allergic contact dermatitis
Patch test – gold standard
The most frequent reasons:
Parts of plants
On uncovered parts of the body: hands, arms, face – stripe-like,
vesiculobullous lesions on erythemic odematous basis
On fingertips: hyperkeratosis, pitting, rhagades (tulip bulbs)
Herbal pollens – a picture resembling to solare dermatitis
Metals
Nickel
Papulosus lesions surrounded by normal skin
Can be manifested in the form of dyshidrosis
Chrome
Dry erythema, pitting
Can be manifested in the form of dyshidrosis
Rubber, perfumes, cosmetics, local therapeutics
Nummular eczema
Reason:
Background of possible allergic contact eczema,
atopic diathesis, xerosis, subtoxic-cumulative
factors, or coccogen sensibilization.
Features:
Round (‘coin-shaped’), sharply edged, infiltrated
papules/plaques
Edema, erythema, papulovesicules on the border –
oozing, crust
Chronic form: dry, squamous surface - lichenification
On the stretching surface of limbs, in severe forms
on gluteus and back
Develops in waves, symmetrically, recurring
Treatment:
Locally: antimicrobial externas
Internally: corticosteroid (in severe cases)
Seborrheic eczema
Evoking factors:
Originated from genetic factors
diseased keratinisation – wide pores,
fine pitting with the colour of greyish
yellow
Increased sebum production + diseased
composition of sebum (dysseborrhoea)
– skin with greasy surface, the skin is
alkaline – water content of stratum
corneum is reduced – the skin is dry in
focuses – protection disfunction – the
saprofita flora of the skin surface
becomes patogenic.
Microbial sensibilization: Pityrosporum ovale
(yeast)
Features:
On areas rich in sebaceuos glands: scalp,
forehead, eyebrows, nasolabial and
retroauricular areas, praesternal and
interscapular region
Greyish yellow, greasy, scurfy or plate-like
pitting on an inflammed basis
Increase of the edges
Sensibilisation: contact, microbial
Differential diagnosis:
Mycosis
Atopic dermatitis
Treatment:
locally: drying, antiseptic cleaning
reducing inflammation
Soothing adstringent products
Ointments and liquids with Burowsolution
Products with sulfur or tar
Antimycotic shampoo
Ointments with steroid (in severe
cases)