Curs Eczeme - Dermatite

8/7/2019 Curs Eczeme - Dermatite

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ECZEME/DERMATITE


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Eczeme (dermatite)

Sindrom clinic caracterizatprin eritem, veziculaie,

exudaie i prurit


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eritem

papule

vezicule

pustule

exudaie

cruste

scuame

ECZEM

regresie

PR

URIT

vindecareprogresieEczem

cronic


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Eczeme

forme clinico-evolutive Eczem acut

Veziculo-buloas

Buloas Zemuind

Eczem subacut

Eczem cronic Uscat Lichenificat


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Eczemacut

Eczemsubacut

Eczemcronic


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ECZEM DE CONTACT CRONIC


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Clasificarea eczemelor (dermatitelor) Eczeme exogene

Eczema ( dermatita) de contact alergic / alergic pe cale sistemic iritativ ( ortoergic - fr mecanism alergic)

Eczeme endogene Eczema ( dermatita) atopic

Eczeme mixte (exo-endogene) Eczema ( dermatita) numular Dishidroza, eczema ( dermatita) dishidrozic Eczema microbian ( numular) Eczema( dermatita) de staz

Eczema ( dermatita) seboreic Eczema fisurar ( craquel) Eczema prin diseminare secundar


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I. Dermatite de contact fr

substrat alergic ( iritative) Reacii de iritaie Dermatite de iritaie

Acute Cronice

Reacii i dermatite fototoxice locale fitofotodermatite

Dermatite caustice


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Dermatite de contact cu substrat alergic

Forme clinico-evolutive: acute subacute cronice

Teritorii limitate, sugernd contactul cu alergenul Diseminare:

hematogen transpiraie friciune

Forme clinice particulare: dermatite fotoalergice

dermatite de contact aeropurtate dermatite de contact pe cale sistemic


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Dermatita de contact alergic-localizri

Cosmetice, deodorant,ampon, lac de unghii

Gablonuri, nichel, crom

Ageni chimici,detergent, ciment

Plante


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Dermatita de contact alergic


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D.C.A TANANTI


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Test epicutan ( patch-test)


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Eczema (dermatita) atopic Afeciune cutanat inflamatorie, cronic, pruriginoas,

survenind la indivizi cu antecedente personale saufamiliale de atopie

Prevalen variabil ( 0,5-20%), n continu cretere,predominant la copii

Corelaie pozitiv a prevalenei cu nivelul socio-economicridicat i gradul de poluare "Ipoteza Igienei" ( expunere insuficient la antigene bacteriene n copilrie n

mediile favorizate determin dezechilibru Th1/Th2, i manifestri de atopie)


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Stigmate de atopie

Pliuri Dennie-MorganHalou periorbital

Dermografism alb Hiperliniaritate palmar

Eczema atopic


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Eczema atopic


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ECZEM ERITRODERMIC

ECZEMA HERPETICUM

Criteriile de diagnostic Hanifin Rajka


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Criteriile de diagnostic Hanifin-RajkaCRITERII MINORE ( 3 DIN 23)

Xeroz cutanat Ichtioz/hiperlinairitate palmar/keratosis pilaris Reacii cutanate de hipersensibilitate imediat ( tipI) IgE seric crescut Debut n copilrie Tendin la infecii cutanate, aprare imun mediat

celular sczut Tendin la dermatite nespecifice palmo-platare Eczem

perimamelonar

Cheilit Conjunctivit recurent Pliuri Dennie-Morgan Keratoconus Cataract subcapsular anterioar Hiperpigmentare periocular

Paloare facial/ eritem Pitiriazis alba Riduri anterocervicale Prurit asociat transpiraiei Intoleran la lni detergeni Accentuare perifiolicular Intolerane alimentare

Evoluie influenat de factori d emediu i emoionali Dermografism alb

CRITERII MAJORECRITERII MAJORE(3 DIN 4)(3 DIN 4)

PruritPrurit Leziuni cutanate cuLeziuni cutanate cumorfologiemorfologie i localizarei localizaretipictipic DermatitDermatit croniccronic sausaurecidivantrecidivant Antecedente personaleAntecedente personale

sau familiale de atopiesau familiale de atopie


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Criteriile Hanifin-Rajka

Prea complicate

Utilizeaza date de laborator

Nu au fost niciodata validate inpopulatie

Stabilite prin consens de experti


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Criteriile britanice de

diagnostic a dermatitei atopiceAfectiune cutanata pruriginoasa+

minimum 3 dintre urmatoarele: istoric de eruptie in zone flexurale

istoric personal de astm sau febra de fan

istoric de xeroza cutanata debut sub varsta de 2 ani

dermatita flexurala vizibila


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Criterii de diagnostic al DA


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gconsensul Academiei Americane de Dermatologie

2001

CRITERII ESENIALE : prezente obligatoriu, cnd suntndeplinite complet, sunt sufiiente pentru diagnostic

Prurit Leziuni eczematoase: morfologie tipic, specific vrstei Afectare facial, cervicali a suprafeelor de extensie la sugari i copii Leziuni flexurare prezente sau n antecedente la aduli/orice vrst Evolu

ie cronic

, recidivant

CRITERII IMPORTANTE: prezente n majoritatea cazurilor,susin diagnosticul

Debut precoce Atopie (IgE) crescut Xeroz cutanat

CRITERII ASOCIATE, sugestive pentru diagnostic Keratosis pilaris/ hiperlinearitate palmar Rspuns vasomotor atipic Accentuare perifolicular, lichenificare/ prurigo Modificri perioculare/periorbitale Leziuni periorale/periauriculare

Eczem numular


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Eczem numular

Eczem dishidrotic


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Eczem dishidrotic

DISHIDROZ


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ECZEM SEBOREIC

ECZEMA

SEBOREIC


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Eczema de staz


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Necesarul de dermatocorticoid

- the fingertip unit - A finger tip unit (FTU) isdefined as the amount ofointment, cream or othersemi-solid dosage form

expressed from a tube with a5mm diameter nozzle,applied from the distal skin-crease to the tip of the indexfinger of an adult.

One FTU is enough to treat

an area of skin twice the sizeof the flat of an adult's handwith the fingers together, i.e.a handprint.

Finlay et al. Lancet, 1989


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2 FTU = 1g topic

One handprint is 0.8% (i.e.approximately 1%) of thetotal body surface area, andone FTU covers

approximately twohandprints.

As two FTUs areapproximately equivalent to1g of topical application, the

Rule of Hand states that 4hand areas = 2 FTU = 1g.

Ef t d ifi l


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Efecte adverse specifice alecorticoizilor topici

Efecte locale Atrofie cutanat, striuri,

telangiectazii Purpur steroid

Ulceraii , pseudoescare Acnee steroid Hipertricoz Dermatit perioral Hiperpigmentare

Hipopigmentare Alergii de contact Favorizarea infeciilor

Efecte sistemice Inhibiia axei hipotalamo-

hipofizo-cortico-suprarenalian

Sindrom Cushing Hirsutism Vergeturi, purpur Acnee steroid Hipertensiune

Hiperglicemie Galucom ntrzierea creterii la copii

Traditional stepwise


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ad t o a step semanagement paradigm

Step 1: Dry skin only

Step 2: Mild to moderate AD

Step 3: Moderate to severe AD

Step 4: Recalcitrant, severe AD

Basic treatment: skin hydration, emollients,avoidance of irritants, identification and

addressing of specific trigger factors

Lowmid potency TCS or TCI*(TCI if moderate AD not adequatelyresponsive or intolerant to TCS)

Midhigh potency TCS or TCI*(TCI if not adequately responsive

or intolerant to TCS)

Systemic therapy (e.g.ciclosporin A) or UV therapy

1.Akdis C, et al.Allergy2006; 61:969987.

2.Wollenberg A, et al.J Dtsch Dermatol Ges 2009; 7:117121.

* Over the age of 2 years. AD = atopic dermatitis; TCS = topical

corticosteroid; TCI = topical calcineurin inhibitor

Many acute flares can be treated successfully using thestepwise treatment paradigm2

However, repeatedly recurrent flares constitute a frustratingand frequent problem for both patient and physician2


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