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ECZEME/DERMATITE

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Terminologie Termenii de eczema/dermatita sunt

considerati sinonimi.

Termenul de dermatita este mai frecvent inliteratura anglo-americana, iar cel de eczemain cea francofona.

Etimologic, eczema deriva din limba greaca siinseamnaoparit .

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Eczema/dermatita= sindrom cutanat inflamator definit: Clinic: succesiune de modificari cutanate:

eritem, veziculatie, exsudatie, crustificare,descuamare si uneori lichenificare + prurit Histopatologic: spongioza, vezicule

spongiotice si infiltrat limfohistiocitarperivascular in dermul superior.

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Clinic

Sindrom clinic caracterizat prineritem, veziculaie, exudaie i

prurit

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eritem

papule

vezicule

pustule

exuda ! ie

cruste

scuame

ECZEM "

regresie

P R U R I T

vindecareprogresieEczem # cronic #

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Spongioza trasaturahistopatologica esentiala

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Vezicula spongiotica = veziculaclinic

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Eczeme

forme clinico-evolutive Eczem acut Eczem subacut

Eczem cronic

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Eczem # acut #

Eczem # subacut #

Eczem # cronic #

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ECZEM ! DE CONTACT CRONIC !

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Clasificarea eczemelor (dermatitelor) Dermatite exogene

Dermatita de contact Alergic (mecanism alergic) Iritativ (ortoergic ) - f r mecanism alergic

Eczeme (dermatite endogene Eczema (dermatita) atopic

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

Eczema prin diseminare secundar

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I. Dermatite de contact iritative (f r

substrat alergic) Nu necesita expunere anterioara Zone afectate: locul contactului, extensie mica in jur

Susceptibilitate: universala Debutul leziunilor: rapid (ore de la expunere) Legatura cu expunerea: apar de la prima expunere

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II. Dermatite de contact alergice

Expunere anterioara este obligatorie Zone afectate: locul contactului, posibil si la distanta

Susceptibilitate: numai persoane sensibilizate Debutul leziunilor: lent (48 ore) Legatura cu expunerea: nu apar la prima expunere

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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 #

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D.C.A TANANTI

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Dermatita de contact alergic #-localiz #ri

! Cosmetice, deodorant,$ampon, lac de unghii! Gablon ! uri, nichel, crom! Agen ! i chimici,detergent, ciment! Plante

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Test epicutan (patch-test)

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Clasificarea eczemelor (dermatitelor) Dermatite exogene

Dermatita de contact Alergic (mecanism alergic) Iritativ (ortoergic ) - f r mecanism alergic

Eczeme (dermatite) endogene Eczema (dermatita) atopic

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

Eczema prin diseminare secundar

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Eczema (dermatita) atopic Afec

iune cutanat

inflamatorie, cronic

, pruriginoas

, survenindla indivizi cu antecedente personale sau familiale de atopie

Prevalen variabil ( 0,5-20%), n continu cre tere, predominantla copii

Corela ie pozitiv a prevalenei cu nivelul socio-economic ridicat

i gradul de poluare "Ipoteza Igienei"( expunere insuficient la antigene bacteriene n copilrie n mediilefavorizate determin dezechilibru Th1/Th2,i manifestri de atopie)

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Imunitate celular # Dezechilibru Th1/Th2

Citokine proinflamatorii

Piele uscat #,deficit al secre ! iei

de sebum $i sudoare,prag redus de prurit

Blocaj al receptorilorbeta-adrenergici

Alergii alimentare$i de mediu

Nivel ridicat de IgE

Predispozi ! ie imunologic # ereditar #

Tip de personalitate: Astenic #, stres emo ! ional

ECZEMA ATOPIC "

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Stigmate de atopie

Pliuri Dennie-Morgan Halou periorbital

Dermografism alb Hiperliniaritate palmar #

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Eczema atopic #

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Lichen simplexcronic

(Neurodermit #)

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ECZEM " ERITRODERMIC "

ECZEMA HERPETICUM

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Criteriile de diagnostic Hanifin-Rajka CRITERII 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 ln i detergeni Accentuare perifiolicular Intolerane alimentare Evoluie influenat de factori d emediu i emoionali Dermografism alb

CRITERII MAJORE(3 DIN 4)

" Prurit" Leziuni cutanate cumorfologie $i localizaretipic# " Dermatit # cronic # saurecidivant # " Antecedente personalesau familiale de atopie

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Criteriile Hanifin-Rajka

Prea complicate Utilizeaza date de laborator

Nu au fost niciodata validate in populatie Stabilite prin consens de experti

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Criteriile britanice de diagnostic a

dermatitei atopice Afectiune 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 vizibilaSensibilitate: 74%; Specificitate: 99% (Romania)

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Criterii de diagnostic al DAconsensul Academiei Americane de Dermatologie 2001

CRITERII ESENIALE : prezente obligatoriu, cnd sunt ndeplinitecomplet, sunt sufiiente pentru diagnostic Prurit Leziuni eczematoase: morfologie tipic, specific vrstei Afectare facial, cervical i a suprafeelor de extensie la sugari i copii Leziuni flexurare prezente sau n antecedente la aduli/orice vrst Evoluie cronic, recidivant

CRITERII IMPORTANTE: prezente n majoritatea cazurilor, susindiagnosticul Debut precoce Atopie (IgE) crescut Xeroz cutanat CRITERII ASOCIATE, sugestive pentru diagnostic

Keratosis pilaris/ hiperlinearitate palmar R spuns vasomotor atipic Accentuare perifolicular, lichenificare/ prurigo Modificri perioculare/periorbitale Leziuni periorale/periauriculare

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Clasificarea eczemelor (dermatitelor) Dermatite exogene

Dermatita de contact Alergic (mecanism alergic) Iritativ (ortoergic ) - f r mecanism alergic

Eczeme (dermatite) endogene Eczema (dermatita) atopic

Eczeme mixte (exo-endogene) Eczema numular Dishidroza, eczema dishidrozic Eczema (dermatita) de staz Eczema (dermatita) seboreic Eczema fisurar (craquel) Eczema prin diseminare secundar

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Eczem # numular #

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Eczem # dishidrozic #

DISHIDROZ "

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ECZEM " SEBOREIC "

ECZEMASEBOREIC "

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Eczema de staz # (varicoasa)

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Clasificarea dermatocorticoizilor

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Necesarul de dermatocorticoid

- thefingertip unit (FTU) - A finger tip unit (FTU) is definedas the amount of ointment,cream or other semi-solid dosageform expressed from a tube witha 5mm diameter nozzle,appliedfrom the distal skin-crease to thetip of the index finger of anadult.

One FTU is enough to treat anarea of skin twice the size of theflat of an adult's hand with the

fingers together, i.e. ahandprint .

Finlay et al. Lancet, 1989

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2 FTU = 1g topic = 4palme= 4%

din suprafata corpului One handprint is 0.8% (i.e.approximately 1%) of the totalbody surface area, and one FTUcovers approximately two

handprints. As two FTUs are approximatelyequivalent to 1g of topicalapplication, theRule of Hand states that4 hand areas = 2FTU = 1g .

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Efecte adverse specifice ale corticoizilor

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

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Traditional stepwise managementparadigm

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 . Allergy 2006; 61:969987.2. Wollenberg A, et al. J Dtsch Dermatol Ges 2009; 7:117121.

* Over the age of 2 years. AD = atopic dermatitis; TCS = topicalcorticosteroid; TCI = topical calcineurin inhibitor

Many acute flares can be treated successfully using the stepwisetreatment paradigm 2 However, repeatedly recurrent flares constitute a frustrating and

frequent problem for both patient and physician 2

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