Dermatology- Core conditions
Inflammatory disorders of the skin
Eczema/ Dermatitis
Derives from the Greek word for ‘boiling’ which reflects how the skin can
become so inflamed that fluids weeps out of the vesicles which appear.
Clinical Features
PRINCIPAL SYMPTOM=ITCHING
o Prolonged scratching and itching of the skin tends to polish
fingernails and patients often have nails that are covered in
varnish.
Clinical signs depend on the location but usually are comprised of
erythema, oedema, papules, vesicles and exudation (common in
acute presentation)
Chronic eczema- oedema is not a prominent feature but epidermis
thickens and skin markings are exaggerated (LICHENIFICATION)
Fissures over hands and feet are common
In acute dermatitis particular (allergic contact dermatitis) secondary
spread of the eczema to distant sites from the originally affected
area.
IT IS VERY HARD TO ACCURATELY CLASSIFY ECZEMA DUE TO OUR
INCOMPLETE UNDERSTANDING OF IT. Broadly speaking it is separated
into
Exogeneous
Endogeneous
Exogenous Endogenous
Primary irritant contact Atopic eczema
dermatitis Seborrhoeic dermatitis
Allergic contact dermatitis Discoid eczema
Varicose eczema
Endogeneous eczema of
palms and soles
Asteatotic eczema (eczema
craquelé)
Endogenous eczema
Primary Irritant contact dermatitis
Physically damage skin (acids/ alkalis/ detergents and petroleum
products)
Anyone who has atopic dermatitis is more susceptible to effects of
primary irritants
, Common in housewives who’s hands are immersed doing washing up
and being chronically exposed to fairy liquid
Occupational- HAIRDRESSERS/ MACHINE TOOL OPERATORS. Both
hands are always immersed in irritant fluids.
TREATMENT- appears simple i.e. remove the patient from contact with
the irritant or protect the hands against it. In practice often hard to
avoid contact without switching jobs.
o Skin can be helped to an extent with exposure to emollients but
it cannot be restored to normal state while exposure to irritant
continues.
Allergic contact dermatitis
Due to delayed hypersensitivity reaction to external allergen
Numerous chemicals which can cause issues
Some chemicals are such potent allergens that following one exposure
sensitization will occur
Diagnosis
nickel
(commones Patch testing (delayed
t cause in hypersensitivity 48 hours) wait
females)
until the episode of acute asthma
has settled before patch testing-
medication
causes positive reactions may
(neomycin)
of rubber
Treatment
Potent topical steroids should be
contact used to settle the eczema before
dermatit patch testing. Once an allergen
has been identified the patient
is should avoid exposure to it If
hair dye components of allergy are
(chemical
PPD)
chromate medication related must inform
the GP about what patient is
Endogenous Eczema
Atopic eczema
Atopy implies a genetic predisposition to developing eczema/
asthma and hay fever
Mutations in the FLG gene (FILLAGRIN) predispose to atopic eczema
Greater proportion in western world suggests that environment also
plays a role/ other factors (IMMUNOLOGICAL AND EMOTIONAL)
Immunological changes- Increased serum total IgE and specific IgE
antibody to ingested or inhaled antigens as well as a preference to
activation of TH2 (of the CD4+ subset) which produce interleukins
(IL4,5 AND 13) WHICH ARE INVOLVED IN THE SYNTHESIS OF IgE
from B lymphocytes.
Not present at birth. Appears often first year of life.
, o Early childhood often generalized
o Later charachteristic FLEXURAL INVOLVEMENT IS SEEN IN
WRISTS, ANTECUBITAL FOSSAE AND POPLITEAL FOSSAE
AS WELL AS DORSAE OF THE FEET.
o Skin is dry and immensely itchy
o Lichenification occurs
ATOPIC ECZEMA OFTEN RESOLVES IN CHILDHOOD BUT MAY
PERSIST INTO ADULTHOOD.
Common complication- Secondary bacterial infections which produces
folliculitis or impetigo
Viral warts and molluscum contagiosum occur more frequently on
atopic individuals
Treatment
Emollients are essential in management. Can be used as a comination
at bath time and emollient cream after
Topical steroids- mild (children) potent (adults)
o A topical steroid/ antibacterial combination may be useful if
eczema becomes frequently secondarily infected.
o Recent years topical preparations of calcineurin inhibitors
(tacrolimus and pimecrolimus) developed for treatment of atopic
eczema. At present they are principally used in patients whose
eczema has not responded to conventional therapy, USEFUL
FOR FACIAL ECZEMA
THE WET WRAP TECHNIQUE useful in management of severe
eczema and medicated bandages such as zinc paste and itchammol or
zinc oxide and coal tar, applied over a topical steroid are beneficial for
eczema of the limbs.
Phototherapy can be useful though often as soon as stop treatment
they relapse
CICLOSPORIN great benefit to severe atopic eczema
Value of dietary changes sometimes recommended for children.
Seborrhoeic dermatitis
Constitutional disorder- exact pathogenesis unknown
o Malassezia yeasts role?
Affects the SCALP, FACE, PRESTERNAL AREA, UPPER BACK AND
FLEXURES
o Scalp involvement- itchy diffuse scaling on an erythematous
background
o Face- scaly erythema on nasolabial folds and on forehead,
eyebrows
o Flexural- moist, glazed erythema
o Lesions on chest are often marginated
PARTICULARLY SEVERE FORM OF ECZEMA IN AIDS PATIENTS
Treatment
No cure- treatment for many years
Inflammatory disorders of the skin
Eczema/ Dermatitis
Derives from the Greek word for ‘boiling’ which reflects how the skin can
become so inflamed that fluids weeps out of the vesicles which appear.
Clinical Features
PRINCIPAL SYMPTOM=ITCHING
o Prolonged scratching and itching of the skin tends to polish
fingernails and patients often have nails that are covered in
varnish.
Clinical signs depend on the location but usually are comprised of
erythema, oedema, papules, vesicles and exudation (common in
acute presentation)
Chronic eczema- oedema is not a prominent feature but epidermis
thickens and skin markings are exaggerated (LICHENIFICATION)
Fissures over hands and feet are common
In acute dermatitis particular (allergic contact dermatitis) secondary
spread of the eczema to distant sites from the originally affected
area.
IT IS VERY HARD TO ACCURATELY CLASSIFY ECZEMA DUE TO OUR
INCOMPLETE UNDERSTANDING OF IT. Broadly speaking it is separated
into
Exogeneous
Endogeneous
Exogenous Endogenous
Primary irritant contact Atopic eczema
dermatitis Seborrhoeic dermatitis
Allergic contact dermatitis Discoid eczema
Varicose eczema
Endogeneous eczema of
palms and soles
Asteatotic eczema (eczema
craquelé)
Endogenous eczema
Primary Irritant contact dermatitis
Physically damage skin (acids/ alkalis/ detergents and petroleum
products)
Anyone who has atopic dermatitis is more susceptible to effects of
primary irritants
, Common in housewives who’s hands are immersed doing washing up
and being chronically exposed to fairy liquid
Occupational- HAIRDRESSERS/ MACHINE TOOL OPERATORS. Both
hands are always immersed in irritant fluids.
TREATMENT- appears simple i.e. remove the patient from contact with
the irritant or protect the hands against it. In practice often hard to
avoid contact without switching jobs.
o Skin can be helped to an extent with exposure to emollients but
it cannot be restored to normal state while exposure to irritant
continues.
Allergic contact dermatitis
Due to delayed hypersensitivity reaction to external allergen
Numerous chemicals which can cause issues
Some chemicals are such potent allergens that following one exposure
sensitization will occur
Diagnosis
nickel
(commones Patch testing (delayed
t cause in hypersensitivity 48 hours) wait
females)
until the episode of acute asthma
has settled before patch testing-
medication
causes positive reactions may
(neomycin)
of rubber
Treatment
Potent topical steroids should be
contact used to settle the eczema before
dermatit patch testing. Once an allergen
has been identified the patient
is should avoid exposure to it If
hair dye components of allergy are
(chemical
PPD)
chromate medication related must inform
the GP about what patient is
Endogenous Eczema
Atopic eczema
Atopy implies a genetic predisposition to developing eczema/
asthma and hay fever
Mutations in the FLG gene (FILLAGRIN) predispose to atopic eczema
Greater proportion in western world suggests that environment also
plays a role/ other factors (IMMUNOLOGICAL AND EMOTIONAL)
Immunological changes- Increased serum total IgE and specific IgE
antibody to ingested or inhaled antigens as well as a preference to
activation of TH2 (of the CD4+ subset) which produce interleukins
(IL4,5 AND 13) WHICH ARE INVOLVED IN THE SYNTHESIS OF IgE
from B lymphocytes.
Not present at birth. Appears often first year of life.
, o Early childhood often generalized
o Later charachteristic FLEXURAL INVOLVEMENT IS SEEN IN
WRISTS, ANTECUBITAL FOSSAE AND POPLITEAL FOSSAE
AS WELL AS DORSAE OF THE FEET.
o Skin is dry and immensely itchy
o Lichenification occurs
ATOPIC ECZEMA OFTEN RESOLVES IN CHILDHOOD BUT MAY
PERSIST INTO ADULTHOOD.
Common complication- Secondary bacterial infections which produces
folliculitis or impetigo
Viral warts and molluscum contagiosum occur more frequently on
atopic individuals
Treatment
Emollients are essential in management. Can be used as a comination
at bath time and emollient cream after
Topical steroids- mild (children) potent (adults)
o A topical steroid/ antibacterial combination may be useful if
eczema becomes frequently secondarily infected.
o Recent years topical preparations of calcineurin inhibitors
(tacrolimus and pimecrolimus) developed for treatment of atopic
eczema. At present they are principally used in patients whose
eczema has not responded to conventional therapy, USEFUL
FOR FACIAL ECZEMA
THE WET WRAP TECHNIQUE useful in management of severe
eczema and medicated bandages such as zinc paste and itchammol or
zinc oxide and coal tar, applied over a topical steroid are beneficial for
eczema of the limbs.
Phototherapy can be useful though often as soon as stop treatment
they relapse
CICLOSPORIN great benefit to severe atopic eczema
Value of dietary changes sometimes recommended for children.
Seborrhoeic dermatitis
Constitutional disorder- exact pathogenesis unknown
o Malassezia yeasts role?
Affects the SCALP, FACE, PRESTERNAL AREA, UPPER BACK AND
FLEXURES
o Scalp involvement- itchy diffuse scaling on an erythematous
background
o Face- scaly erythema on nasolabial folds and on forehead,
eyebrows
o Flexural- moist, glazed erythema
o Lesions on chest are often marginated
PARTICULARLY SEVERE FORM OF ECZEMA IN AIDS PATIENTS
Treatment
No cure- treatment for many years
