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Clinical Morphology
Acute stage
Chronic eczema may show all of the above changes but in general is:
A u t h o r
Prof.Dr.K.Senthilkumaran, MD (Hom)
Professor & HOD, Dept of Medicine
Email-drkksk@gmail.com
Mob-9443326206
Prof.Dr.K.Senthilkumaran
vegetables like chillies and citrus fruits, and certain medications like Atopic dermatitis is a chronic relapsing pruritic skin disorder of
benzoyl peroxide and retinoic acid. Two common varieties of irritant unknown aetiology, associated with personal and/or family history of
contact dermatitis are housewife’s eczema and diaper dermatitis. atopy and a typical distribution and morphology. It is characterised by
distressing symptoms due to a low threshold for itching, tendency of
Housewife’s eczema is caused by prolonged and repeated
the skin to lichenification and frequently, raised level of serum IgE.
contact with water, soaps, detergents and vegetables. It affects
dorsal aspects and sides of the fingers, fingertips and webs of the It is estimated that about 3% of all infants and 10% of school
hands. children suffer from atopic dermatitis. These figures are for Europe
but in India, the prevalence and severity are less, though on the
Diaper dermatitis occurs in infants due to prolonged occlusion
rise.
with non-absorbable plastic diapers. Ammonia produced by
decomposition of urea in the urine by certain microorganisms Immunological abnormalities are: (i) Raised IgE levels in 80%,
causes more irritation. Secondary infection with Candida albicans is (ii) Defects in cell-mediated immunity, (iii) Defects in neutrophil and
common. The dermatitis affects the convexities of the thighs, monocyte chemotaxis.
buttocks and genitalia while sparing the folds. Clinical features: The symptom of itch is so central in the
C) Infectious eczematoid dermatitis (Infective eczema) pathogenesis that atopic dermatitis is described as "the itch that
rashes and not the rash that itches". The disorder is characterised
This is due to an allergic reaction to organisms or their products.
by infantile, childhood and adult phases. The infantile phase starts
The eczema responds to treatment with antibiotics which eradicate
between 2-6 months of age, and pruritic papulovesicular, oozing
the organisms. It is distinct from infected eczema and occurs
lesions are distributed on the face, scalp and front of the knees and
commonly on the legs due to chronic folliculitis.
legs (see colour atlas). By the age of 18 months, the childhood
2) Endogenous Eczemas phase starts and is characterised by itchy lichenified lesions in the
A) Atopic dermatitis cubital and popliteal fossae, sides of the neck, wrists and ankles.
The distribution in the adult phase is similar and there is a marked
The word ‘atopy’, which literally means ‘out of place’, represents
tendency to lichenification and generalisation. The disorder may
an inherited tendency which predisposes to atopic dermatitis,
begin and remit in any of these phases.
bronchial asthma and allergic rhinitis.
B) Seborrheic Dermatitis