Eczemaanddermatitis-8y-tostudents-2010-3湿疹.ppt

EczemaandDermatitis湿疹与皮炎中山一院皮肤性病学教研室章星琪XingqiZhang M D Ph D ContactDermatitisAtopicDermatitisEczemaClinicalfeatures Management Eczema dermatitis ThetermsareinterchangeableDenotingapolymorphicinflammatoryreactionpatterninvolvingtheepidermisanddermis Therearemanyetiologiesandawiderangeofclinicalfindings PolymorphicinflammatoryreactionAcute pruritus erythema andvesiculation chronic pruritus xerosis lichenification hyperkeratosis fissuring PathogenesisnotcompletelyunderstoodMostofthemcausedbyhypersensitivityInsultsmaynotbefound ClassificationofEczema dermatitis ContactDermatitis接触性AtopicDermatitis特应性EczemaClassical经典性SitespecificSeboehrricDermatitis eczema脂溢性AsteatoticEczema乏脂性StaticEczema郁积性Autosensitizedeczema自身敏感性NummularEczema钱币型 ContactDermatitis Acuteorchronicinflammatoryreactionstosubstancesthatcomeincontactwiththeskin Irritantcontactdermatitis ICD iscausedbyachemicalirritantAllergiccontactdermatitis ACD byanantigen allergen thatelicitsatypeIV cell mediatedordelayed hypersensitivityreaction IrritantContactDermatitis ICDiscausedbyexposureoftheskintochemicalorotherphysicalagentsthatarecapableofirritatingtheskin acutelyorchronically ThehandsarethemostcommonlyaffectedareaMostlyoccupationalaccidents EpidemiologyICDisthemostcommonformofoccupationalskindisease accountingforupto80 ofalloccupationalskindisorders OccupationalExposureIndividualsengagedinthefollowingoccupations activitiesareatriskforICD housekeeping hairdressing medical dental andveterinaryservices cleaning floralarranging agriculture horticulture forestry foodpreparationandcatering printing painting metalwork mechanicalengineering carmaintenance construction fishing MostCommonIrritant ToxicAgents Detergent Soaps waterlesshandcleanersAcidsandalkalis hydrofluoricacid cement chromicacid phosphorus ethyleneoxide phenol metalsalts Industrialsolvents coaltarsolvents petroleum chlorinatedhydrocarbons alcoholsolvents ethyleneglycolether turpentine ethylether acetone carbondioxide DMSO dioxane styrene Plants Euphorbiaceae spurges crotons poinsettias machneeltree Racunculaceae buttercup Cruciferae blackmustard Urticaceae nettles Solanaceae pepper capsaicin Opuntia pricklypear Others fiberglass wool roughsyntheticclothing fire retardantfabrics NCR paper IrritantContactDermatitis Chronicirritantcontactdermatitisinahousewife Thereiserythema hyperkeratosis scaling andfissuresparticularlyonthefingertipsinapatientwithanatopicbackground subacute chronicErythema edema scaling fissuring crustingofthepalmaraspectofthehandandwrist ahousewife isatopicandhasignoredinstructionstowearglovesduringworkinthekitchenandtouselubricatingcreams ICD ClinicalfeaturesAnyonecanhaveWithclearborderResolvedafterremovingofcausativeagentUsuallyacuteandcanhavebulla AllergenContactDermatitis Eczematousdermatitisduetore exposuretoasubstancetowhichtheindividualissensitized EpidemiologyFrequent Accountsfor7 ofoccupationallyrelatedillnessesintheUnitedStates Occupation Oneofthemostimportantcausesofdisabilityinindustry PathogenesisAclassic delayed cell mediatedhypersensitivityreactionDTH CMIContactallergensarediverseandrangefrommetalsaltstoantibiotics dyestoplantproducts NeomycinUsuallycontainedincreams ointmentsProcaine benzocaineLocalanestheticsSulfonamidesTerpentineSolvents shoepolish printer sinkBalsamofPeruTopicalThiuramRubberFormalinDisinfectant curingagents plasticsMercuryDisinfectant impregnationChromatesCement antioxidants industrialoils matchesNickelsulfateMetals metalsinclothing jewelryCobaltsulfateCement galvanization industrialoilsp PhenylenediamineBlackordarkdyesoftextiles printer sinkParahydroxybenzoicacidesterConservingagentinfoodstuffs CONTACTALLERGENS Allergiccontactdermatitis CommonallergensNickel toxicodendrons poisonivy fragrance thimerosal formaldehyde bacitracin andrubbercompounds ClinicalmanifestationsApruritic eczematousreactionWelldemarcatedandlocalizedtothesiteofcontactwiththeallergenTestingforsensitivityPatchtestChinesescreenset SubacuteACDinthebreastregion ThedistributionofthepapulareruptionsuggestedacausativeroleofthebraandindeedthepatientprovedtohaveatypeIVhypersensitivitytolatex Allergicphytodermatitisofleg poisonivyLinearvesicularlesionswitherythemaandedemaonthecalfatsitesofdirectcontactoftheskin5daysafterexposurewiththepoisonivyleaf MildsubacuteACDontheearandthesideoftheneck unilateral hypersensitivetotheplasticcoverofhiscellularphone ManagementofICD PreventionAvoidirritantorcausticchemical s bywearingprotectiveclothing i e goggles Ifcontactdoesoccur washwithwaterorweakneutralizingsolution Barriercreams InoccupationalICDthatpersists changeofjobmaybenecessary TreatmentAcuteIdentifyandremovetheetiologicagent WetdressingswithgauzesoakedinBurow ssolution changedevery2to3h SubacuteandChronicIdentifyandremoveetiologic pathogenicagent Employapotenttopicalglucocorticoidpreparation betamethasonedipropionateorclobetasolpropionate andprovideadequatelubrication chronicICDTopical pimecrolimusandtacrolimusPUVA TopicalTherapies PrinciplesChooserighttherapeuticreagentsChooserightsolventsAcuteWitherosionandsecretion solutionWithouterosionandsecretion powder lotion TopicalTherapies PrinciplesChooserighttherapeuticreagentsChooserightsolventsSubacuteWithsomedegreeofsecretion paste oilWithoutsecretion emulsion pasteChronicEmulsion ointment plaster film ManagementofACD TopicalTherapyWetdressingswithclothssoakedinBurow ssolutionchangedevery2to3h Topicalglucocorticoidointments gels classesItoIII ThenewerimmunomodulatingtopicalspimecrolimusandtacrolimusSystemicTherapyGlucocorticoidsareindicatedifsevereImmunosuppressionwithoralcyclosporineInairborneACDwherecompleteavoidanceofallergenmaybeimpossible ClinicalapplicationofACD Alopeciaarea AA TropicalimmunetreatmentofseveretypeofAADPCP AtopicDermatitis AD Atopy Outofplace strange unusual no withoutplace HereditarytendencytodevelopallergiestofoodandinhalantsubstancesEczema asthma rhinitisandhayfever AtopicDiseases BarnetsonandRogers BMJ2002 324 1376 9 0 5 10 15 发病率 年龄 岁 KeyFeatures Chronic relapsingdermatitisassociatedwithintensepruritusThreestages infantile childhoodandadulthoodOftenassociatedwithxerosisapersonalorfamilyhistoryofatopyasthmaandallergicrhinitisAgeneticbasisthatisinfluencedbyenvironmentalfactorsImmuno aberrationSerumIgEelevationandeosinophiliaTh2predominanceinacutelesionsevolvesintoapredominanceofIFN producingTcellsinchroniclesions Epidemiology 70 95 ofcasesarisebeforetheageof5yearsPrevalence10 20 ofschoolchildren F M 1 3 1Ontherise 2 10foldoverlast30yrsSignificanthigherchancewithfamiliaratopichistoryInteractionofenvironmentalandgeneticfactorsDegreeofurbanizationHygienetheory infectionandatopy Pathogenesis GeneticsSkinbarrierDysregulationofimmuneresponsesBarrier disruptedskin Impairedbarrierfunction TargetfortreatmentCeramide waterholding ceramidase Sphingomyelindeacylase FilaggrinClinicalfeatures theitchthatrashes Severedryness irritated itchy secondaryinfection ImmunologicalReactions Th2dominanceinacutephaseCytokineIL 4andIL 5IL 10IgE eosinophilTh1dominanceinchronicphaseIFN producingTcellsLangerhanscell InfantileAD 60 ofADpresentinthefirstyearoflife 2m 2yrSitesmostaffectedCheeks thenspreadtoneck forehead wrists andextensorextremitiesEruption acuteandmoistinfeatureErythematouspatches vesicles exudate crust pustules 奶癣 fungalinfectionduetomilk CausesFoodallergyegg milk chicken fishpeanut wheat soyMaternalingestofallergenInheritedskinbarrierdysfunction AdolescentandAdultAD EruptionAdolescentsSimilartochildhoodADOlderadultsLocalizedplagues erythematous scalyorpapular lichenified andscalySiteslesscharacteristicDryskin itchyEmotionalstress depression anxiety andexercisecanbethetriggerImprovementoccurs andADresolvesbeforemiddlelife Diagnosis CriteriaforDiagnosisWilliams Pruitusplus3 5itemsAADUKworkingParty sDiagnosticCriteriaforAD Majorcriteria threeofthesePruritusTypicalmorphologyanddistributionlichenificationinadultsFacialandextensorinvolvementininfancyChronicorchronicallyrelapsingdermatitisPersonalorfamilyhistoryofatopicdisease UKworkingParty sDiagnosticCriteriaforAD Minorcriteria threeoftheseXerosisIchthyosisIgEreactivityElevatedserumIgEEarlyageofonsetTendencyforcutaneousinfectionsTendencytononspecifichand fooddermatitisNippleeczemaCheilitisRecurrentconjunctivitisDennie MorganinfraorbitalfoldKeratoconusAnteriorsubcapsularcataracts OrbitaldarkeningFacialpallor facialerythemaPityriasisalbaItchwhensweatingIntolerancetowoolandlipidsolventsPerifollicularaccentuationFoodhypersensitivityCourseinfluencedbyenvironmentaland oremotionalfactorsWhitedermographismordelayedblanchtocholinergicagents DifferentialDiagnosis DermatosesSeborrheicdermatitisAllergiccontactdermatitisNummulardermatitisScabiesPsoriasisImmunodeficiencysyndromeininfants ManagementofAD General InfancyandChildhoodAvoidexternalirritation scratching soap hotshower foodallergensAntihistaminewithsedativeeffectAdultsAvoidcoldandheat over bathing hotshower soap wearingwool emotionalstressUsemoisturizerstogetskinhydratedTackletheitch icecubes ManagementofAD specifictherapies1 TopicalHydration 10 ureacream CodliverointmentStagesoflesionOozing 3 boricacidsolution potassiumpermanganatesolutionSubacute ZincOxideoil CalaminelotionCorticosteroidcreamCalcineurininhibitorscreamSystemicAntihistamines antibiotics S aureusImmunemodulatorCyclosporine IVIg ManagementofAD specifictherapies2 PhototherapyPUVA UVB UVAImmunesuppressiveLangerhanscells IL 10 NK andTcells ApoptosisofTcells He NeLaser632 8nmFreezing Eczema Greekword ekzein meaning boilout or effervesce AmorphologiccategoryLooselydefinedasagroupofdiseaseswithepidermalchangesofscale parakeratosisandspongiosisTendencytopersistandrelapse PathogenesislesswellunderstoodthanADandcontactdermatitis Themostcommonlocationsforeczemaare Face neck frontoftheelbows behindtheknees armsandlegs extremities SkinlesionThickened scaly pink to redelevatedareas papules andsheetsofskin plaques areseenintheseareas Areaswithinfectionintheaffectedareas superimposedinfection candevelopthickcrusts SeverityMild few scatteredareasthatareeasilytreatedwithself caremeasuresModerate moreextensiveareasthataremoredifficulttocontrolwithself caremeasuresandmayrequireprescriptiontherapySevere widespread diffuse affectedareasthataredifficulttotreatevenwithprescriptiontherapy ClinicalTypes RegionalEczemaEarEyelidBreastHandDiaper ClassicalDyshidroticSeborrheicAsteatoticStasisSpecialtypesCircumileostomyAutosensitization dissemiatedInfectiouseczematoid DyshidroticEczema Secondaryinfectionmaycomplicatethecoursepustules crusts cellulitis lymphangitis andpainfullymphadenopathy WetdressingForvesicularstage Burow swetdressings Largebullaedrainedwithapuncturebutnotunroofed Indyshidroticeczematousdermatitis vesiclesandblistersbreakandleavewell definedsuperficialerosionsthatarepainful Seborrheicdermatitis脂溢性皮炎 ClinicalfeaturesSymmetric onforehead eyebrowseyelids nasolabialfoldsYellowish rederythemawithfinescalingorflakygreasyscalesActivesebaceousglandApredilectionforareasrichinsebaceousglandssuchasscalpandface SeborrheicDermatitis ScalpPityriasissimplexcapillitii dandruff whiteorgreasyscalingTreatmentTopicalazolesasshampoosorcreamsTopicalcorticosteroidsandemollientsIsotretinoine AsteatoticEczema乏脂性湿疹 Xeroticeczema winteritch dessicationdermatitisRelatedtoaging xerosis lowrelativehumidityandfrequentbathingDriestskinareasAnteriorshins entensorarms flankDry rough scalyandinflamedskinwithsuperficialcrackingTreatment Limitationoftheuseofsoap useofmoisturizers Disseminated autosensitizationdermatitis SecondarylesionsofeczemadistantfromtheprimarysiteofexposureorinvolvementusuallyoccursafewdaystoweekslaterSymmetricpoorlydemarcatedpatchesofeczema mayleadtoeczematouserythrodermaOftenassociatedwithallergiccontactdermatitisstasisdermatitisnummulardermatitisPathogenesisisstillunclearwhatexactlyisdisseminatedviathebloodstreamInfectiouseczematoiddermatitis RegionalEczema EarEyelidBreastHandDiaper Eareczema EarsorotitisexternaHelix postauricularfold externalcanalMostcausedbyseborrheicoratopicdermatitisInfectionwithG cocciantibiotictopicalremediesNickelallergy earlobTreatmentRemovalofcausativeagentsConsultwithENTforlocaltreatment Eyeliddermatitis CausativeagentsCosmetics eyeshadow eyecreamSubstancesonhands nailpolishContactlensesVolatilegases HandandFootEczema手足湿疹 Environment contact occupation homemakers AD PatchtestPalmarandplantarimpairedbarrierplusallergicreactionClinicalmanifestationsVesiculobullous acuteeruptionDryness erythematoushardeningwithfissure scalyDiscontinuesoapandwaterexposure moisturizing Legs hands orextensorofthearmsDiscrete coinshaped erythematous edematous vesicularandcrustedpatches canbeoozingandthenthickenedandscaly Nummular Discoideczema钱币状湿疹 Long termprocessfollowedbyspreadingofnewlesionsSubacutedermatitisTopicalsteroidandantibiotic 幼年性掌趾角化病Juvenileplantardermatosis Age3topuberty atopyForefootandplantarRedpatchwithfissuringanddesquamatio