ECZEME/DERMATITE

Eczeme (dermatite)
Sindrom clinic caracterizat prin eritem, veziculaie, exudaie i prurit

eritem papule

ECZEM

pustule exudaie cruste scuame

Eczem cronic

progresie

regresie

PRURIT

vezicule

vindecare

Eczeme forme clinico-evolutive

Eczem acut
Veziculo-buloas Buloas Zemuind

Eczem subacut Eczem cronic

Uscat Lichenificat

Eczem acut

Eczem subacut

Eczem cronic

ECZEM DE CONTACT CRONIC

Clasificarea eczemelor (dermatitelor)

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

Eczeme endogene

Eczeme mixte (exo-endogene)

Eczema ( dermatita) atopic

Eczema ( dermatita) numular Dishidroza, eczema ( dermatita) dishidrozic Eczema microbian ( numular) Eczema( dermatita) de staz Eczema ( dermatita) seboreic Eczema fisurar ( craquel) Eczema prin diseminare secundar

I. Dermatite de contact fr substrat alergic ( iritative)

Reacii de iritaie Dermatite de iritaie
Acute Cronice

Reacii i dermatite fototoxice locale

fitofotodermatite

Dermatite caustice

Dermatite de contact cu substrat alergic

Forme clinico-evolutive:
acute subacute cronice

Teritorii limitate, sugernd contactul cu alergenul Diseminare:

hematogen transpiraie friciune dermatite fotoalergice dermatite de contact aeropurtate dermatite de contact pe cale sistemic

Forme clinice particulare:

Dermatita de contact alergic-localizri

Cosmetice, deodorant, ampon, lac de unghii Gablonuri, nichel, crom Ageni chimici, detergent, ciment Plante

Dermatita de contact alergic

D.C.A TANANTI

Test epicutan ( patch-test)

Eczema (dermatita) atopic

Afeciune cutanat inflamatorie, cronic, pruriginoas, survenind la indivizi cu antecedente personale sau familiale de atopie Prevalen variabil ( 0,5-20%), n continu cretere, predominant la copii Corelaie pozitiv a prevalenei cu nivelul socio-economic ridicat i gradul de poluare
"Ipoteza Igienei" ( expunere insuficient la antigene bacteriene n copilrie n
mediile favorizate determin dezechilibru Th1/Th2, i manifestri de atopie)

Tip de personalitate: Astenic, stres emoional

Imunitate celular Dezechilibru Th1/Th2 Citokine proinflamatorii

Predispoziie imunologic ereditar

Piele uscat, deficit al secreiei de sebum i sudoare, prag redus de prurit

ECZEMA ATOPIC

Nivel ridicat de IgE

Blocaj al receptorilor beta-adrenergici

Alergii alimentare i de mediu

Stigmate de atopie

Pliuri Dennie-Morgan

Halou periorbital

Dermografism alb

Hiperliniaritate palmar

Eczema atopic

Neurodermit

ECZEM ERITRODERMIC

ECZEMA HERPETICUM

Criteriile de diagnostic Hanifin-Rajka

Prurit Leziuni cutanate cu morfologie i localizare tipic Dermatit cronic sau recidivant Antecedente personale sau familiale de atopie

CRITERII MAJORE (3 DIN 4)

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 MINORE ( 3 DIN 23)

Criteriile Hanifin-Rajka
Prea complicate Utilizeaza date de laborator Nu au fost niciodata validate in populatie Stabilite prin consens de experti

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 vizibila

consensul Academiei Americane de Dermatologie 2001

CRITERII ESENIALE : prezente obligatoriu, cnd sunt ndeplinite complet, 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 de diagnostic al DA

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

Eczem dishidrotic

DISHIDROZ

ECZEMA SEBOREIC

ECZEM SEBOREIC

Eczema de staz

Clasificarea dermatocorticoizilor

Necesarul de dermatocorticoid - the fingertip unit A finger tip unit (FTU) is defined as the amount of ointment, cream or other semi-solid dosage form expressed from a tube with a 5mm diameter nozzle, applied from the distal skincrease to the tip of the index finger of an adult. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together, i.e. a handprint.
Finlay et al. Lancet, 1989

2 FTU = 1g topic
One handprint is 0.8% (i.e. approximately 1%) of the total body surface area, and one FTU covers approximately two handprints. As two FTUs are approximately equivalent to 1g of topical application, the Rule of Hand states that 4 hand areas = 2 FTU = 1g.

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 hipotalamohipofizo-corticosuprarenalian Sindrom Cushing Hirsutism Vergeturi, purpur Acnee steroid Hipertensiune Hiperglicemie Galucom ntrzierea creterii la copii

Traditional stepwise management paradigm

Step 4: Recalcitrant, severe AD
Systemic therapy (e.g. ciclosporin A) or UV therapy Midhigh potency TCS or TCI* (TCI if not adequately responsive or intolerant to TCS) Lowmid potency TCS or TCI* (TCI if moderate AD not adequately responsive or intolerant to TCS) Basic treatment: skin hydration, emollients, avoidance of irritants, identification and addressing of specific trigger factors

Step 3: Moderate to severe AD

Step 2: Mild to moderate AD

Step 1: Dry skin only

Many acute flares can be treated successfully using the stepwise treatment paradigm2 However, repeatedly recurrent flares constitute a frustrating and frequent problem for both patient and physician2
* Over the age of 2 years. AD = atopic dermatitis; TCS = topical 1. Akdis C, et al. Allergy 2006; 61:969987. corticosteroid; TCI = topical calcineurin inhibitor 2. Wollenberg A, et al. J Dtsch Dermatol Ges 2009; 7:117121.