ECZEMA
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1.basis
on chronological : -
( a) acute -
redness , vesicles , oozing ,itching .
(b) subacute - intensity reduce , rash
and vesicles down and become reddish brown , scaly , some times oozing
(c)
chronic -
hypopigmented , skin become thick with rashes
, skin margins
become crack
2.etiologically:-
(a) Exogenesis eczema – cause of rash out side the body
§ Contact dermatits – to touch
§ Phyto dermatits – cause from plant
§ Photo dermatits - cause from sun light
§ Atopic
§ Pityriasis alba
§ Pompholyx
§ Seborrheric
Contact dermitits –
It is due to substances which come in
contact with skin
Ex- deo, detergent, jewellary, etc.
Mechanism of rash
–
(a)
Irritant
– develop due to toxic
substances which cause skin rash develop very short period Important cause –
1. detergent,
2.
Alkalis and
solvents used in industries
3. Diaper dermatitis it is develop due
to irritant component of urine and stool and Fascilated by moisture
4. Paedrous dermatits – it is cause by insects bite its shows blisters pattern most common in rainy seasons
(b)
Allergic –
1.
metal cause -
ring, neckle piece
2. Cement dermatitis most common in cement workers due
to cement contain potassium dichromyte
3. Hair dye – para phenyl diamine,
acute rash on scalp face and neck
4. Bindi dermatitis – cause by chemical in adhesive of bindi para tertiary betyl phenyl
Phytodermatitis- It cause by plant (parthenium
hysterophorus)
Allergen – plant leaves, stems, pollens
Infection flow in air and settle on
expoused area of body
Clinical features – sub-acute to
chronic Reddish brown,scaly, dry, itchy,rash Diagnosis- clinical history of
living area
3. Photodermatitis- It is cause by exposer of sun light
on exposed part of body
Clinical features – itchy, rash
Endogenesis
eczema –
1.
Atopic dermatitis – atopic means allergic
This is chronic relapsing inflammatory condition of skin.
Etio
pathogenesis –
a. Gentice
factor – skin
genes FLG gene on chromosomes 1, immune gene IL-4, IL-13 (IgE)
b.
Defective skin barrier – decrease skin lipid skin become dry.
c. environmental – dust, infection, seasonal factors, level of
humidity, other allergy.
d.
immune disbalance - increase IL-4, IL13 ,dominant immune to increase
tendency , IgE response lead to lots of histamine cause rash .
Clinical features – in different phases
a.Infantile (birth- 2 years) – acute rash :- red vesicular
oozing on face and scalp spread to periorbital & perioral , and due to
crawling exposure area like knee & elbow
b.Childhood ( 2years to puberty) – subacute rash:- reddish
brown , scaly , some time oozing
c. Adult – chronic:- increased skin
thickness , hyperpigmentation , most common shape discoid
,skin margins crack
Diagnosis:-
1.
pruritis
2. typical morphology and distribution
3.chronic and chronically relapsing
4.
Personal and family history (a) asthma (b)eczema (c) hey fever (d) recurrent
cold and urticaria (e) food allergy
2. pityriasis alba :- most common in children
Clinical
features:- multiple hypopigmented macule with fine scaling
3.
pompholyx :- most common- sites palm and sole
Clinical
features :-a. multiple tense deep vesicle contain flood
b.intense itcning
c.eruption like sabudana
4.
seborrheic
dermatitis :- Inflammatory
reaction of sebaceous gland caused by p.ovale . common site is face ,cliscalp
,up back ,and chest ,axillary , and groin .
Common
age group :- infaint – commonly on scalp called cradle cap
Teenage,
Edrly
Clinical features :-
(a) erythamous rash in seborrheic site
(b)
Yellowish greasy
scale
5. asteototic eczema :- it is due to decrease lipid in skin
cause intense dryness , commonly in elderly .
6.
nummular
eczema :- also called
discoid eczema Coin shaped ecazematous rash , common site lower limb
6.vericose eczema :- ptatient with long standing varicose
vein also called statis eczema , vascular damage to skin
due
to venous pulling blood.
TREATMENT :- basis on chronological
classification.
1. CLEMATIS :- red , burning , vesicular, scaly ,
scabby , intense itching , eruption on face , hand and
scalp around occiput ( varicose eczema , acute and
subacute condtion
and seborrheic eczema )
2. DULCAMARA :- pruritus agg. Cold wet weather ,
herpes zoozter , pemphigus , vesicular eruption sensitive
bleeding ulcer , red spot urticaria , humid eruption on
face hand genital , palmar surface of hand thick brown
yellow crust , bleeding when scratch (acute and sub acute
condtion )
3. BOVISTA :-itching on getting warm , moist eczema ,
formation of thick crust , pruritus ani worse from
bathing .
4. ARSENIC ALBUM :- itching , burning , swelling ,
eruption , dry rough scaly , worse cold and scratching ,
(acute)
5. RHUSTOX:- red swellen intense itching ,
vesicles , burning eczematous eruption with tendency to scale formation. (acute)
6. SULPHUR :- dry , scaly , unhealthy , itching ,
burning , pustules , excoriation specially on fold .( acute , sub acute and chronic)
7. GRAPHTIES :- rough , hard persistent dryness of portion
of skin effected eczema , eruption oozing out a sticky exudation , raw ness on
bends of limb , groin , neck behind ears , cracks in nipples between toes and
anus, ( acute and chronic )
8. PETROLEUM:- skin dry , very sensitive , rough
and cracked , leathery thick greenish crust , burning and itching, redness ,
raw , crack bleed easily ( chronic)
9. OLEANDER :- violent
itching eruption , bleeding , oozing ( acute)
10. MEZERUEM :- intolerable itching , vesicles ,
eruption ulcerate and form thick scab under purulent matter which purulent
matter exudes .
