eczemaanddermatitis-8y-tostudents-20xx-3濕疹-wenkub
2023-02-28 08:25:48 本頁面
【正文】 ing dermatitis – Personal or family history of atopic disease UK working Party?s Diagnostic Criteria for AD ? Minor criteria: three of these ? Xerosis ? Ichthyosis ? IgE reactivity ? Elevated serum IgE ? Early age of onset ? Tendency for cutaneous infections ? Tendency to nonspecific hand/food dermatitis ? Nipple eczema ? Cheilitis ? Recurrent conjunctivitis ? DennieMan infraorbital fold ? Keratoconus ? Anterior subcapsular cataracts ? Orbital darkening ? Facial pallor/facial erythema ? Pityriasis alba ? Itch when sweating ? Intolerance to wool and lipid solvents ? Perifollicular accentuation ? Food hypersensitivity ? Course influenced by environmental and/or emotional factors ? White dermographism or delayed blanch to cholinergic agents Differential Diagnosis ? Dermatoses – Seborrheic dermatitis – Allergic contact dermatitis – Nummular dermatitis – Scabies – Psoriasis ? Immunodeficiency syndrome in infants Management of AD: General ? Infancy and Childhood – Avoid external irritation, scratching, soap, hot shower, food allergens – Antihistamine with sedative effect ? Adults – Avoid cold and heat, overbathing, hot shower, soap, wearing wool, emotional stress – Use moisturizers to get skin hydrated – Tackle the itch: ice cubes Management of AD: specific therapies 1 ? Topical – Hydration: 10%urea cream, Cod liver ointment – Stages of lesion ? Oozing: 3% boric acid solution, potassium permanganate solution ? Subacute: Zinc Oxide oil, Calamine lotion – Corticosteroid cream – Calcineurin inhibitors cream ? Systemic – Antihistamines, ? Immune modulator – Cyclosporine, IVIg Management of AD: specific therapies 2 ? Phototherapy – PUVA, UVB, UVA ? Immune suppressive ? Langerhans cells ? ? IL10??NK? and T cells? ? Apoptosis of T cells? ? HeNe Laser ? Freezing Eczema ? Greek word, ekzein, meaning “boil out” or “effervesce” ? A morphologic category ? Loosely defined as a group of diseases with epidermal changes of scale, parakeratosis and spongiosis ? Tendency to persist and relapse ? Pathogenesis less well understood than AD and contact dermatitis ? The most mon locations for eczema are: – Face, neck, front of the elbows, behind the knees, arms and legs (extremities) ? Skin lesion – Thickened, scaly, pinktored elevated areas (papules) and sheets of skin (plaques) are seen in these areas. – Areas with infection in the affected areas (superimposed infection) can develop thick crusts. ? Severity – Mild – few, scattered areas that are easily treated with selfcare measures – Moderate – more extensive areas that are more difficult to control with selfcare measures and may require prescription therapy – Severe – widespread (diffuse) affected areas that are difficult to treat even with prescription therapy Clinical Types ? Regional Eczema – Ear – Eyelid – Breast – Hand – Diaper ? Classical ? Dyshidrotic ? Seborrheic ? Asteatotic ? Stasis ? Special types – Circumileostomy – Autosensitization/dissemiated – Infectious eczematoid Dyshidrotic Eczema ? Secondary infection may plicate the course – pustules, crusts, cellulitis, lymphangitis, and painful lymphadenopathy. ? Wetdressing – For vesicular stage: Burow39。s solution changed every 2 to 3 h. – Topical glucocorticoid ointments/gels (classes I to III) – The newer immunomodulating topicals ? pimecrolimus and tacrolimus ? Systemic Therapy – Glucocorticoids ? are indicated if severe – Immunosuppression with oral cyclosporine ? In airborne ACD where plete avoidance of allergen may be impossible, Clinical application of ACD ? Alopecia area (AA) ? Tropical immune treatment of severe type of AA – DPCP Atopic Dermatitis (AD) ? “Atopy” –“Out of place”, “strange”, “unusual”, “no/without place” – Hereditary tendency to develop allergies to food and inhalant substances – Eczema, asthm
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