皮肤病学教学课件：eczema

ECZEMA

Definition1Etiologyandpathogenesis2Clinicalmanifestations3Diagnosisanddifferentialdiagnosis4Treatment5DefinitionEczema=Ekzein,“boilout”“pruriticpapulovesicularprocess,whichinitsacutephaseisassociatedwitherythemaandedemaandwhichinitschronicphase,whileretainingitspapulovesicularfeature,isdominatedbythickening,lichenificationandscaling.”EtiologyandpathogenesisInternalfactorsExternalfactorsHereditarytendencyeczemaEtiologyandpathogenesisInternalfactorsExternalfactorsHereditarytendencychronicinfectionblockofbloodcirculationchangeofendocrineandmetabolismEtiologyandpathogenesisInternalfactorsExternalfactorsHereditarytendencyeczemaIgEClinicalManifestationsWhatarethesymptomsofacute,subacuteandchroniceczema?AcuteSubacuteChronicAcuteSubacuteChronicallergenAcuteeczemaIntenselyitchingPrimaryandmultiformlesionsTheboundaryisnotclearPlacesymmetrically,mostlyonexposedareasInfectionAcuteeczemaIntenselyitchingPrimaryandmultiformlesionsTheboundaryisnotclearPlacesymmetrically,mostlyonexposedareasInfectionPrimaryandmultiformErythema,papulovesicle,exudation,erosionAcuteeczemaIntenselyitchingPrimaryandmultiformlesionsTheboundaryisnotclearPlacesymmetrically,mostlyonexposedareasInfectionPlacesymmetrically,appearanywhereonthebody,mostlyontheface,neck,elbows,wrists,breast,scrotum,backsofthekneesandankle.Subacuteeczemarelievefromtheabovesymptomscolorsoferuptionbecomedarkscalestouchallergicthingsagain,acuteconditionwillappearrepeatedlybecomechroniceczemaChroniceczemaalwayscomingfromacuteorsubacuteeczemathelesionsbecomethicken,roughandconcomitancewithpigmentationordepigmentationThisconditioncankeepforafewmonthsoryears

Diagnosis

primaryandmultiformlesionseasytoexudationwhenirritatedbymanyfactorseruptionsymmetricallydistributioneasytorecur

usuallyseverepruritusLichenificationinchroniccaseDifferentialdiagnosisAcuteEczemaContactDermatitisDifferentialdiagnosisEtiology-notclearLesionmultiform,boundarynotclearEruptionplacesymmetricallyEasytorecurandchronicContactdermatitisEtiology-clearLesionsimple

boundaryclearEruptionplaceononlycontactareasSelf-limited,eliminatingcontactfactorscanbecuredEczemaTreatmentGeneraltherapyTopictherapySystemictherapyGeneraltherapyEverydoubtfulfactormustbeavoidedallergens,irritants,infectionsPsychologictreatmentregulatingemotionalandstressMoisturizingprotectingimpairedskinanddryskinwithlubricants,especiallyeachafterwashingoratnightsuchaswith10%ureacreamsoonTopicaltherapyCorticosteroidtherapyisthedominantmethod:milderorpotencysteroids,mustbestrongenoughtocontrolthepruritusandremovetheinflammationGeneralsay:infantsorfaceshouldbemildersteroids,whilethickplaquesandlichenifiederuptionshouldbeverypotentsteroidsCorticosteroidhasmanyadversereactionssuchasskinatrophy,persistenterythemasoonTreatingacuteeczemaFortheacuteweepinglesions,wetcompressesofmildersolutionshouldbechosen,suchas3%boricacidsolutionIfnoexudationormildexudation,wecanchooseoilofzincoxide,topicalsteroidsormoisturizers

Ifinfectionpresent,potassiumpermanganate(1:5000)solutionischosen,appliedfor20to30minutesseveraltimesdaily.TreatingsubacuteorchroniceczemaInsubacuteeczema,topicallow-potentormedium-potentsteroidsmaybehelpfulsuchashydrocortisoneointment,ElosoncreamForlichenifiedlesionsshouldbechosenverypotentsteroidssuchasSicorten,sometimeswithocclusionforalimitedtimeForsomeobstinatelylocalizedlesions,localinjectionwithDiprospancanbeappliedfor1timeeverymonthUltravioletlightmaybeusedNewtopicalimmunemodulatorsPimecrolimusandtacrolimushavebeenshoweddramaticbeneficialinsevereeczemaTheyarenotadversereactionofsteroidssuchasskinatrophy,persistenterythemasoonSystemictherapyⅠAntihistaminicsmaybeusedtoaidinreliefoftheseverepruritussuchasdoxepinindosesofabout25to75mgasasingleeveningdosesisfrequentlyrecommendedinadultsNewantihistaminicsalsomaybeusedsuchasLoratadine,Mizolastine

soonInacuteperiod,eczemacanalsobetreatedwithcalcium,vitaminCSystemictherapyⅡSystemicantibioticssuchassemisyntheticpenicillins,cephalosporins,quinolones,erythromycinorminocyclinecanbehelpfulinsevereexudativecases(acuteoozinglesions)Somespecialeczemassuchasnummulareczema,stasisdermatitisalsoshouldbeusedwithtopicalorsystemicantibiotics,evenwhenclinicalevidenceofinfectionislackingLesscommonly,virusinfectionsuchasherpessimplexmaybeconsideredSystemictherapyⅢSystemicsteroidsforashortcoursemaybeneededinsomeseverepatientsbutcomplicatedbymanysideeffectsandunfortunatelyrelapseoftenoccursSystemicsteroidsarerecommendedinonlythemostseverecasesortocontrolexacerbation,thecauseofwhichcanbeeliminatedsuchasaflareresultingfromacontactallergen,orinfectedlocaleczemasoonOralprednisoneinadecreasingdose,beginningat40to60mgdailyisgivenandperhapsDiprospanadministeredintramuscularlyisalsoeffective,usuallyatadoseof1ml,1timeeverymonthSystemictherapyⅣInverysevereorunrespo