Eczema constitutional and contact

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I- ECZEMA CONSTITUTIONAL = atopic dermatitis :

1- Definition :

  • Atopic dermatitis is the set of cutaneous manifestations that occur in a subject genetically predisposed to the development of other atopic diseases : asthma, rhinitis, conjunctivitis. ( = 1 atopic manifestations of hypersensitivity)
  • This is the most common skin disease in children
  • Its prevalence is increasing 5% (1960) at 15 – 20% currently
  • It begins in 60 at 70 % cases before 6 month (30 at 40 before 3 month), mean age = 8 month

2- pathophysiology :

  • genetic and immunological factors

– Atopy is a personal and / or familial tendency to produce Ac (IgE) when exposed to protein allergens (mites, fur, saliva of animals, pollens, food…)
allergen , Irritant,Surinfection,Stress Two types of Atopic Dermatitis:
– extrinsic atopic dermatitis or allergic: Hyper blood IgE and specific IgE high
– atopic dermatitis intrinsic or nonallergic: no hyperlgE and a lower risk of asthma

  • Anormalies constitutive or induced epidermal barrier (fillagrine deficit, increased insensible water loss, anomalies of surface skin lipids )

3- clinical appearance :

  • Eczema is a superficial skin inflammation accompanied by pruritus, and characterized by a polymorphous rash :

Erythema, vesicles, crusts, squames and formed a limites des placards émiettées.

The manual scraping is often preceded by similar movements from the 2th month : friction, agitation, fluttering

Location :

0 —> 2 years

  • facial convex areas: scalp, front, play, menton (sparing nose and perioral area).
  • Ear lobe, crack under and behind the ear.
  • thumb sucking.
  • Faced extension or flexion of the members.

After 2 years

  • Face least reached (retro-auricular grooves, lips , perioral)
  • folds of flexion (popliteal, folds of the elbows).
  • folds interfessiers
  • Hands, the neck, the backs of the feet, ankles.
  • Built lichenifie very pruritic.

4- diagnostic criteria :

A- d & rsquo; after Hanifin JM, Rajko G. Diagnostic features of atopie dermatitis. Acta Derm Venereol (Stoc) 1980 ; (suppl. 92) : 44-7).

Three major criteria and three minor criteria are at least required for diagnosis.

a- major criteria :

  • pruritus
  • Typical morphology and distribution
  • lichenification of flexures or linear appearance at the & rsquo; adult,
  • involvement of the face and d & rsquo faces; extension in children and infants
  • dermatosis chronic or recurrent ;
  • personal or family history of & rsquo; atopy (asthma, allergic rhinitis, atopic dermatitis).

b- minor criteria :

  • xerosis ;
  • ichthyosis / palmar hyper-linearity / keratosis pilaris ;
  • skin reactions d & rsquo; immediate hypersensitivity (type 1) ;
  • elevated IgE serum eosinophilia
  • beginning at an early age ;
  • tendency to skin infections (in particular Staphylococcus aureus or Herpes simplex) related to an alteration of the & rsquo; cell-mediated immunity ;
  • Eczema of the nipples ;
  • chéilites ;
  • recurrent conjunctivitis ;
  • fold under-lower eyelid (signe de Dennie-Morgan) ;
  • kératocônes ;
  • anterior subcapsular cataract ;
  • pigmentation infraorbital ;
  • facial pallor / facial erythema ;
  • pityriasis alba, dartres, eczematides
  • folds at the front of the neck ;
  • itching to perspiration ;
  • intolerance to wool and lipid solvents ;
  • perifollicular worsening ;
  • Food intolerance ;
  • evolution influenced by the & rsquo; environment and / or emotional factors ;
  • white dermographisme.

B- atopic dermatitis criteria of & rsquo; UK Working Party :

  • mandatory requirement

Itchy skin disease or parents reporting that & rsquo; child scratches or rubs.

  • associated with at least 3 following criteria
  • personal history of flexural dermatitis (antecubital pits, popliteal, anterior surfaces of the ankles, by the neck) and / or the cheeks in children under 10 years ;
  • personal history of & rsquo; asthma or allergic rhinitis (or atopic disease in a first degree relative with the & rsquo; children under 4 years) ;
  • xerosis history of broadcasts during the & rsquo; previous year ;
  • eczema reaching cheeks, forehead and convexity of members in the & rsquo; children under 4 years ;
  • early signs of skin before & rsquo; age 2 years (criterion used for a child over 4 years).

Intensity and scalable monitoring DA

5- Differential diagnosis :

In infants :

  • Infant Seborrheic Dermatitis, erythroderma Leiner Moussous:

earlier onset (first week of life)
Contours relatively well limited
Location to seborrheic areas (scalp, seat, more)
Absence of pruritus
healing to 6 month

  • Gale infant
  • Histiocytose langerhansienne

In adults :

  • Contact dermatitis
  • Hématodermie
  • toxiderma

6- Evolution :

  • in spurts
  • triggers / aggravating : pneumallergens, trophallergènes, psychic trauma, infectious, irritation…
  • The DA may disappear completely or persist into adulthood
  • The resurgence in adolescence can
  • Development of asthma to 3 years

7- Complications :

  • bacterial infection: impetiginisation
  • Surinfection viral

– Syndrome de Kaposi- Juliusberg = herpetic infection high fever, TIME
– Molluscum contagiosum

  • Contact dermatitis to topical

8- allergy testing :

  • Skin prick tests
  • The serum total IgE assay
  • Les atopy patch-tests: cow milk, flour, corn,egg under evaluation
  • Plan food eviction for diagnosis
  • TPO( Oral provocation test

These tests are reserved for severe AD and DA presenting evocative signs of food allergy, respiratory or contact

9- Prevention :

  • dietetic
  • breastfeeding
  • diversification slow

Insert after one year foods containing peanut oil, egg, fish and exotic fruits

  • Aéroallergénique : TO AVOID +++
  • mites: curtains plush toys, carpet

polyurethane mattress -►Housse

  • molds
  • Hair and saliva of pets

10- Treatment :

  • Fight against inflammation :
  • Dermocorticoïdes +++: Class II for the trunk and members (Diprosone®) or III for the face and the seat ( Tridésonit®)
  • During outbreaks better hit hard and not long!
  • Cons-indications of corticosteroids (constant side effects, ttt not effective short)
  • Tacrolimus par voie local : Protopic® gel: 1appl x2 / pdt six weeks and then maintenance ttt two appl week to avoid relapse
  • Fight against infection
  • Maximum 33 ° C warm bath with antiseptic foaming solution : septivon®
  • active systemic antibiotics on Staphylococcus
  • Fight against dryness (+++)
  • Pain surgras, sinned : liquid soap cleansing gel.
  • emollient cream
  • Spa treatment: Roche Posay, Avène, St Gervais
  • TREATMENT OF EXCEPTION
  • Phototherapy type UVBTL01 from 7-8 years
  • Cyclosporin in adults

lifestyle advice

  • Avoid clothing made of wool or synthetic direct contact with the skin (to wear cotton underwear)
  • Cut nails (+/- wearing mittens, intense pruritus)
  • Avoid fabric softeners and replace, if possible, laundry by Marseilles soap in flake
  • Moisten the apartment
  • Avoid subjects with herpes
  • Vaccinations : BCG to control outbreaks outside
  • Therapeutic education: New approach in atopic dermatitis. Its main objective is to improve the therapeutic alliance between the caregiver, the neat and his entourage to enable optimal care. Therapeutic education increases the effectiveness of treatment of pruritus and sleep. It seems beneficial to the understanding of the disease and its treatment

II- ECZEMA DE CONTACT :

1- pathophysiology :

  • cell mediated delayed hypersensitivity reaction
  • 2 phases :
  • Sensitization : asymptomatic, a few days to several years.

release

Subject already sensitized > 24 at 48 hours before

2- clinical appearance :

  • Phase erythematous
  • vesicular stage
  • Phase Seeping
  • Phase desquamative

pruritus,
Cupboard with crumbled contours

topographic form :

  • Face, genitals : edema
  • Hand and foot : embedded vesicles

symptomatic form :

  • Nummular eczema
  • dysidrose

photo-allergic form :

• Face, Upper and lower members

3- differential diagnosis :

• Dermatitis d & rsquo; irritation

Ecréma contact Dermatitis of irritarion
Skin lesions edges crumbled sharp edges
topography Beyond the contact aone limited to the contact area
symptomatology pruritus burn
epidemiology Achieved some sensitized subjects Achieved the majority of subjects
histology Spongiose exocytose epidermal necrosis
Test épieutanés positive negative
  • Other skin itchy vesicular:

– fungal (dermatophyties, candidoses)
– Herpes, zone
– Gale

  • other eczema:

– Atopic dermatitis
– varicose eczema
– eczema dysidrosique

  • Face edema :

– erysipelas
– Zone
– Angioedema
– Insect bite
– Lupus, dermatomyosite

4- Etiology :

  • Examination +++
  • initial Topography
  • triggering circumstance
  • Chronology
  • Local treatments used
  • Physical examination
  • topography
  • ear skin tests : patch tests

Les patch tests :

  • A distance from the thrust eczema, a corticosteroid, an anti-ttt histaminique
  • reading 48 h 72 h
  • European Standard battery (23 substances)
  • made products
  • specialized batteries (hairdressing, painting…)
  • Photopatchs tests
  • Relevance test

causes identified :

  • occupational allergens, the most common occupational diseases compensable
  • Start at hands, improve during the holidays
  • Building Trades
  • Occupation hairstyle
  • Occupation Health
  • topical medication
  • Cosmetic
  • clothing products
  • Picture allergens
  • Metals : nickel /

5- Evolution, complications :

  • If allergen avoidance : healing
  • If persistence, think of allergies to corticosteroids
  • If not :
  • Surinfection
  • erythroderma
  • socio-professional repercussions

6- Treatment :

  • Ouster of allergen sometimes difficult as ubiquitous
  • List of eviction to be given to patients
  • Think cross allergies
  • Corticoid class II, no indication of systemic corticosteroids
  • and surinfection : antibiotic 7 days without delaying treatment with corticosteroids
  • professional eczema : work stopping, skin tests, declaration occupational disease in collaboration with the company doctor
  • Prevention : gloves, protective clothing
  • No desensitization possibility

Courses of Dr. Bariout – Faculty of Constantine