Eczema and Atopic Dermatitis Overview
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Questions and Answers

What is the primary meaning of the term 'dermatitis'?

It refers to inflamed skin.

Distinguish between exogenous and endogenous eczema.

Exogenous eczema is caused by external factors like irritants, while endogenous eczema originates from internal factors, such as genetic predisposition.

Describe the acute stage of eczema.

The acute stage of eczema is characterized by erythema, edema, oozing, and papulovesicular eruption.

Identify the components involved in the pathogenesis of atopic dermatitis.

<p>Genetic factors, impaired epidermal barrier, environmental influences, and immune dysregulation.</p> Signup and view all the answers

What management step focuses on skin care and education for eczema patients?

<p>Complete emollient therapy and education.</p> Signup and view all the answers

What are common aggravating factors for atopic dermatitis?

<p>Environmental allergens, stress, and skin irritation.</p> Signup and view all the answers

Where does seborrheic dermatitis commonly appear on the body?

<p>It mainly affects hairy areas, such as the scalp, face, and intertriginous regions.</p> Signup and view all the answers

What type of treatment is recommended for mild to moderate seborrheic dermatitis?

<p>Topical steroids and medicated shampoos.</p> Signup and view all the answers

What morphological changes differentiate chronic eczema from acute eczema?

<p>Chronic eczema presents with dryness and thickening (lichenification), while acute eczema shows erythema, edema, oozing, and papulovesicular eruption.</p> Signup and view all the answers

Explain the role of genetic factors in the pathogenesis of atopic dermatitis.

<p>Genetic factors contribute to atopic dermatitis by causing an impaired epidermal barrier, which is associated with a decrease in Filaggrin protein.</p> Signup and view all the answers

How do environmental factors exacerbate eczema symptoms?

<p>Environmental factors can trigger or worsen eczema by interacting with the impaired skin barrier and immune dysregulation present in individuals with atopic dermatitis.</p> Signup and view all the answers

What is the significance of the Atopic Triad in relation to eczema?

<p>The Atopic Triad, which includes eczema, asthma, and allergic rhinitis, emphasizes the interconnectedness of allergic conditions and the need for a comprehensive approach in managing patients.</p> Signup and view all the answers

Describe the typical skin appearance involved in seborrheic dermatitis.

<p>Seborrheic dermatitis typically presents with greasy, yellowish scales in hairy areas and intertriginous lesions, particularly in the armpits and on the face.</p> Signup and view all the answers

What strategies are involved in the management of flare-ups in eczema patients?

<p>Management of flare-ups includes the use of topical corticosteroids or calcineurin inhibitors, combined with complete emollient therapy and allergen avoidance.</p> Signup and view all the answers

What features characterize infantile atopic dermatitis?

<p>Infantile atopic dermatitis typically occurs in children aged 2 months to 2 years and is characterized by intense itch, redness, and inflammation, often on the face and scalp.</p> Signup and view all the answers

Identify how the immune system is involved in the pathogenesis of eczema.

<p>The immune system in eczema is characterized by a TH1-TH2 imbalance, which contributes to inflammation and allergic responses in the skin.</p> Signup and view all the answers

What role do emollients play in the management of eczema?

<p>Emollients restore skin barrier function and hydration, which is essential for managing eczema.</p> Signup and view all the answers

What are the preferred sedating antihistamines for children with eczema and why?

<p>First generation H1 blockers are preferred because they decrease itching and improve sleep quality.</p> Signup and view all the answers

Describe the 'itch-scratch cycle' in relation to eczema.

<p>The itch-scratch cycle involves itching that leads to scratching, which further irritates the skin and worsens the itch.</p> Signup and view all the answers

Identify one key characteristic of atopic dermatitis compared to other forms of eczema.

<p>Atopic dermatitis often presents with a genetic predisposition and is associated with other atopic conditions.</p> Signup and view all the answers

What topical treatment is specifically used to manage nummular eczema alongside emollients?

<p>Topical steroids.</p> Signup and view all the answers

What is the significance of using the weakest topical corticosteroids in eczema treatment?

<p>Using the weakest effective corticosteroid minimizes potential side effects while controlling eczema.</p> Signup and view all the answers

What role do antihistamines play in the treatment of eczema?

<p>Antihistamines help to manage itching associated with eczema.</p> Signup and view all the answers

What is a common exacerbating factor in eczema and how should it be managed?

<p>Environmental factors, such as allergens, should be identified and avoided to manage eczema effectively.</p> Signup and view all the answers

In the context of eczema, describe the pathogenesis of allergic contact dermatitis.

<p>Allergic contact dermatitis involves an acquired delayed hypersensitivity reaction to allergens.</p> Signup and view all the answers

How does exogenous eczema differ from endogenous eczema in terms of triggers?

<p>Exogenous eczema is triggered by external irritants or allergens, while endogenous eczema is related to internal factors.</p> Signup and view all the answers

Explain the relationship between chronic scratching and neurodermatitis.

<p>Chronic scratching leads to skin thickening (lichenification) and a persistent habit of itching, resembling obsessive compulsive behavior.</p> Signup and view all the answers

List two treatment options for managing flare-ups in eczema patients.

<p>Topical corticosteroids and topical calcineurin inhibitors are commonly used to manage flare-ups.</p> Signup and view all the answers

What characterizes the typical progression of a papule in nummular eczema?

<p>Papules can evolve into round, coin-shaped plaques that coalesce and may become scaly.</p> Signup and view all the answers

What is a common secondary infection associated with diaper dermatitis, and what is its treatment?

<p>Candida albicans is a common secondary infection, treated with antifungals and zinc-rich ointments.</p> Signup and view all the answers

What is the significance of phototherapy in eczema treatment?

<p>Phototherapy is significant as it helps to reduce inflammation and relieve symptoms in chronic cases.</p> Signup and view all the answers

In managing the itch-scratch cycle associated with eczematous conditions, what is a key strategy?

<p>A key strategy is to maintain skin hydration and apply emollients regularly.</p> Signup and view all the answers

What treatment options are typically recommended for managing acute eczema symptoms?

<p>Topical corticosteroids and emollients are commonly recommended for managing acute eczema symptoms.</p> Signup and view all the answers

In what ways does atopic dermatitis prevalence differ among different age groups?

<p>Atopic dermatitis is more prevalent in infants and young children, often decreasing in older age groups but persisting in some individuals into adulthood.</p> Signup and view all the answers

What strategies can be employed to interrupt the itch-scratch cycle associated with eczema?

<p>Strategies include the use of moisturizers, corticosteroids, and antihistamines to alleviate itching, along with education to discourage scratching.</p> Signup and view all the answers

Describe the pathogenesis of eczema concerning environmental and immune factors.

<p>Eczema pathogenesis involves a dysfunctional skin barrier allowing allergens and irritants to penetrate, combined with an exaggerated immune response.</p> Signup and view all the answers

How are the stages of eczema classified, and what features distinguish acute from chronic stages?

<p>Eczema stages are classified as acute, subacute, and chronic, with acute stages showing erythema and vesicles, while chronic stages exhibit dryness and lichenification.</p> Signup and view all the answers

What role do eosinophils play in the chronic stage of eczema?

<p>Eosinophils are often present in the chronic stages of eczema, indicating ongoing inflammation and an immune response.</p> Signup and view all the answers

What morphological characteristics distinguish allergic contact dermatitis from other types of eczema?

<p>Allergic contact dermatitis typically presents with well-defined lesions and symptoms that arise after exposure to specific allergens, differing from other types of eczema.</p> Signup and view all the answers

Discuss how the concept of barrier dysfunction relates to the management of eczema.

<p>Barrier dysfunction emphasizes the importance of maintaining skin hydration and integrity through consistent use of emollients to manage eczema effectively.</p> Signup and view all the answers

Study Notes

Eczema (Dermatitis)

  • Eczema is the same as dermatitis, meaning inflamed skin.
  • It is classified as exogenous or endogenous.
    • Exogenous includes irritant contact dermatitis & allergic contact dermatitis.
    • Endogenous includes atopic dermatitis & seborrheic dermatitis.
  • Eczema typically progresses through stages:
    • Acute: Erythema (redness), edema (swelling), oozing, and papulovesicular eruption (small bumps).
    • Sub-acute: Less erythema & edema, scaling, and crusting.
    • Chronic: Dryness, thickening, and lichenification (thickened skin).

Atopic Dermatitis

  • Multifactorial condition influenced by:
    • Genetics
    • Impaired epidermal barrier (decreased filaggrin protein).
    • Environmental factors.
    • Immune dysregulation (TH1-TH2 imbalance).
  • Characterized by the "Atopic Triad," which includes atopic dermatitis, asthma, and allergic rhinitis.
  • Aggravating factors include contact allergens (nickel, fragrances, soaps), food allergies (eggs, milk, nuts), environmental triggers (dust mites, pet dander), and climate (cold, dry air).
  • Presents in distinct stages:
    • Infantile: 2 months to 2 years old.
    • Childhood: 2 years to 10 years old.
    • Adult: Adolescence to adulthood.

Management of Atopic Dermatitis

  • Step 1:
    • Complete emollient therapy (moisturizers) to restore the skin barrier.
    • Educate patients about the condition and its management.
  • Step 2:
    • Identify and avoid allergens and triggers.
  • Step 3:
    • Treat flares with topical corticosteroids or calcineurin inhibitors (medications that reduce inflammation).

Seborrheic Dermatitis

  • Primarily affects hairy areas, often presenting with characteristic greasy yellowish scales.
  • Common locations include:
    • Interscapular areas (between shoulder blades).
    • Intertriginous lesions (folds of skin, like armpits and umbilicus).
    • Face, particularly the inner thirds of the eyebrows and nasolabial folds (lines around the nose).
  • Etiology (causes):
    • Pityrosporum ovale (Malassezia furfur) yeast.
    • Increased sebaceous gland activity.
    • More common in patients with Parkinson's disease and HIV.

Treatment of Seborrheic Dermatitis

  • Mild to Moderate Cases:
    • Topical steroids (creams/ointments).
    • Anti-dandruff shampoos:
      • Tar.
      • 2% selenium sulfide.
      • Ketoconazole.
      • Ciclopirox olamine.
      • Pyrithione zinc.
  • Topical Antifungals (creams):
    • Cotrimazole.
    • Micanazole.
  • Severe Cases:
    • Systemic antifungals (oral medications):
      • Itraconazole.
      • Fluconazole.

Eczema: Definition and Classification

  • Eczema is a general term for skin inflammation.
  • Also known as dermatitis
  • Etymology of "eczema": Greek origin meaning "over", "out", and "boiling" to describe the appearance of inflamed skin.

Eczema Classification:

  • Exogenous: External agents causing inflammation
    • Irritant contact dermatitis: Caused by direct irritation from substances like soaps, detergents, and chemicals.
    • Allergic contact dermatitis: Caused by an allergic reaction to substances like poison ivy, nickel, and fragrances.
  • Endogenous: Internal factors causing inflammation
    • Atopic dermatitis: A common, chronic inflammatory skin condition driven by genetic factors and environmental triggers.
    • Seborrheic dermatitis: Characterized by oily, scaly patches, often in areas with many sebaceous glands.

Morphology and Stages of Eczema

  • Morphology: The visual characteristics of eczema lesions.
  • Stages: Reflect the progression and severity of eczema
    • Acute: Redness, swelling, oozing, and small blisters
    • Sub-acute: Less redness and oozing, with scaling and crusting.
    • Chronic: Dryness, thickening, and roughening of the skin called "lichenification".

Atopic Dermatitis:

  • Multifactorial: Multiple factors contribute to development.
  • Genetic Factors: Strong genetic predisposition.
  • Impaired Epidermal Barrier: Defective skin barrier caused by lower levels of filaggrin protein.
  • Environmental Factors: Triggers like allergens, irritants, and changes in temperature and humidity.
  • Immune Dysregulation: Imbalance in the immune system, particularly with the T helper 1 (TH1) and T helper 2 (TH2) cells.

Atopic Triad:

  • A set of three conditions often seen together in individuals with atopic dermatitis:
    • Atopic dermatitis (eczema)
    • Allergic rhinitis (hay fever)
    • Asthma

Atopic Dermatitis: Aggravating Factors

  • Triggers: Irritants, allergens, infections, stress, and some types of food.

Atopic Dermatitis: Stages

  • Infantile: 2 months to 2 years
  • Childhood: 2 years to 10 years
  • Adult: Adolescence to adulthood

Atopic Dermatitis: Management

  • Step 1: Complete Emollient Therapy and Education: Daily use of emollients to hydrate the skin and prevent dryness.
  • Step 2: Identification and Avoidance of Allergen Triggers: Identifying and eliminating triggers specific to the individual.
  • Step 3: Treatment of Flare-Ups: Topical corticosteroids and calcineurin inhibitors are used to manage inflammation during flares.

Seborrheic Dermatitis

  • Characteristics: Affects hairy areas of the body, often showing yellowish, oily scales.
  • Common Sites: Interscapular areas, armpits, umbilicus, inner parts of eyebrows, and nasolabial folds.

Seborrheic Dermatitis: Etiology

  • Pityrosporum Ovale (Malassezia Furfur): A type of yeast that may play a role.
  • Sebaceous Gland Activity: Increased activity of sebaceous glands may contribute.
  • Associations: More common in Parkinson's disease and HIV-infected individuals.

Seborrheic Dermatitis: Treatment

  • Mild to Moderate Cases: Topical corticosteroids.
  • Shampoo: Tar, selenium sulfide, ketoconazole, ciclopirox olamine, and pyrithione zinc shampoos.
  • Topical Antifungals: Cotrimazole and miconazole creams.
  • Severe Cases: Systemic antifungal medications (itraconazole and fluconazole).

Eczema Herpeticum

  • Typical vesicular lesions on the hand, around the eye, and on the face
  • Management includes complete emollient therapy, identification and avoidance of allergen triggers, and education
  • Treatment of flares includes topical corticosteroids, calcineurin inhibitors, and sedating antihistamines for children

General Eczema Management

  • The first step is to break the "itch-scratch cycle" - to avoid triggers, control exacerbating factors in the environment, restore skin barrier function, and hydrate the skin with emollients

Eczema Treatment Options

  • Topical corticosteroids
  • Topical immunosuppressants
  • Topical calcineurin inhibitors (TCI) have anti-inflammatory effects without the side effect profile of topical corticosteroids
  • Treatment principles for topical corticosteroids: Use the weakest strength that controls the eczema, review use regularly, consider calcineurin inhibitors in children with long-term treatment

Types of Eczema

  • Atopic dermatitis
  • Seborrheic dermatitis
  • Nummular eczema
  • Dyshidrosis
  • Lichen simplex chronicus (Neurodermatitis)
  • Asteatotic dermatitis
  • Stasis Eczema (Gravitational)
  • Pityriasis alba
  • Juvenile plantar dermatitis

Lichen Simplex Chronicus

  • Chronic repetitive rubbing, scratching, and picking of the skin
  • Skin thickens (lichenification)
  • Itching becomes a habit
  • Round or coin-shaped, erythematous, scaly plaques, often with minute fissures, round erosions, or crusts located within
  • Plaques may begin as papules or vesicles that then coalesce
  • The dorsum of the hand, forearm, feet, and legs are sites of predilection

Nummular Eczema

  • Well-defined and scaly

Nummular Eczema Treatments

  • Emollients
  • Topical steroids
  • Topical calcineurin inhibitors
  • Phototherapy
  • Antihistamines
  • Antibiotics if it is an infectious reaction

Diaper Dermatitis

  • Erythematous, papulovesicular dermatitis
  • Irritation caused by bacteria, change in the environment (moisture, higher or lower PH, feces)
  • Candida albicans occurs as a secondary infection
  • Treatment is by zinc-rich ointments, low-potent topical steroid, antifungals, change of diaper, or no diaper

Exogenous Eczema

  • Contact dermatitis: irritant, allergic, phototoxic, allergic contact dermatitis

Contact Dermatitis

  • The generic term applied to acute and chronic inflammatory reactions to substances that come in contact with the skin

Irritant Contact Dermatitis

  • An inflammatory reaction in the skin resulting from exposure to a substance that causes an eruption in most people who come in contact with it

Allergic Contact Dermatitis

  • An acquired delayed sensitivity to various substances that produce inflammatory reactions in only those who have been previously sensitized to the allergen
  • It is a type 4 hypersensitivity reaction

### Irritant Contact Dermatitis Pathogenesis

  • Irritants cause cell damage if applied for sufficient time and in adequate concentration

Eczema and Dermatitis

  • Eczema and dermatitis are the same thing
  • Dermat(o): refers to skin
  • -itis: inflamed
  • Therefore, it is inflamed skin
  • It is classified as a non-papulosquamous skin disorder, accounts for 25% of dermatological cases

Eczema Stages

  • Acute: erythema, edema, oozing, and papulovesicular eruptions
  • Sub-acute: less erythema, edema, and oozing with scaling and crusting
  • Chronic: dryness and thickening (lichenification)

Eczema Histology

  • Acute Stage: Spongiosis, intraepidermal vesicles, blisters
  • Chronic Stage: Less spongiosis, increased thickening of the epidermis (acanthosis, hyperkeratosis, and parakeratosis)
  • Eosinophils may be seen

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This quiz covers essential information about eczema and atopic dermatitis, including their classification, stages, and influencing factors. Explore the differences between exogenous and endogenous eczema, as well as the characteristics of atopic dermatitis and its aggravating factors.

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