ECZEMA

Eczema is an itchy papulovesicular process which in its

acute phase is associated with erythema and edema
and its chronic phase, while retaining some of its
papulovesicular features, is dominated with thickening
and lichenification.
ECZEMATOUS SKIN CONDITIONS:

Lichen Simplex Chronicus

Nummular Eczema
Atopic dermatitis
Seborrheic dermatitis
Contact Dermatitis

ATOPIC DERMATITIS
Atopic dermatitis, categorized as acute, sub-acute and
chronic, is a pruritic inflammation of the skin, associated
with personal or family history of asthma, allergic
rhinitis or family history of atopic dermatitis and
bronchial asthma.
The skin is dry with fine scaling and intensely itchy.
Itching may be severe, leading to irritability and
sleeplessness.

 The sites of predilection differ for each age-group:

In patient until the age of two years:
exposed skin areas such as the face and extensor surfaces of the arms
and legs are the most involved
Diaper area usually remains unaffected.

In Children:
The sites of predilection are the flexors and extensors of the upper and
lower extremities.
They are often not toxic or febrile but are irritable because of severe itch.
The intake of cows milk or other foods such as eggs, yellow citrus fruits,
chocolates and nuts maybe a factor in the development of rash.

 In older children and adults:

The distribution of eruption often involve the flexural folds,
especially the antecubitals, poplitials, wrist and sides of the
neck, with redness, oozing and excoriations.

 MAJOR FEATURES

Itchiness*
Typical morphology and distribution*
Flexural lichenification and linearly in adults
Facial and extensor involvement during infancy and childhood
Chronic or chronically relapsing dermatitis*
Personal and family history of atopy

*= must be present to make a diagnosis of atopic dermatitis

 Other common findings

Dryness of the skin

Itchyosis/palmar hyperlinearity/keratosis pilaris
Immediate- type 1 skin test response
Hand/foot dermatitis
Hyperlinearity of palms and soles
Cheilitis
Nipple eczema
Facial pallor
Perifolliculary accentuation (Keratosis pilaris)
Darkening beneath the eyes (allergic shiners)
Accentuated grooves or lines below the margin of the eyelids (dennie-morgan folds)
Pityriasis alba

 MANAGEMENT
Treatment is the same for other eczematous conditions
includes moisturization to reduce dryness of skin, topical
steroids (if needed), and oral antihistamines.
Excessive sweating, use of rough clothing and the frequent
washing with cloth must be avoided.
Use of moisturizing soaps or oatmeal/starch baths, application
of moisturizing lotion every after wash

 The role of dietary factors in atopic dermatitis remains

controversial.
For chronic conditions, topical corticosteroids may help.
Antihistamines can be given orally but systemic
corticosteroids must be avoided.
Should also manage psychologically because of their
appearance.