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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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