【正文】 atches of eczema, may lead to eczematous erythroderma ? Often associated with – allergic contact dermatitis – stasis dermatitis – nummular dermatitis ? Pathogenesis is still unclear – what exactly is disseminated via the bloodstream ? Infectious eczematoid dermatitis Regional Eczema ? Ear ? Eyelid ? Breast ? Hand ? Diaper Ear eczema ? Ears or otitis externa – Helix, postauricular fold, external canal ? Most caused by – seborrheic or atopic dermatitis – Infection with G+ cocci – antibiotic topical remedies – Nickel allergyear lob ? Treatment – Removal of causative agents – Consult with ENT for local treatment Eyelid dermatitis ? Causative agents – Cosmetics: eye shadow, eye cream – Substances on hands: nail polish – Contact lenses – Volatile gases Hand and Foot Eczema 手足濕疹 ? Environmentcontact, occupation, home makers, AD. ? Patch test ? Palmar and plantar ? impaired barrier plus allergic reaction ? Clinical manifestations – Vesiculobullousacute eruption – Dryness, erythematous hardening with fissure, scaly ? Discontinue soap and water exposure, moisturizing ? Legs, hands, or extensor of the arms ? Discrete, coin shaped, erythematous, edematous, vesicular and crusted patches, can be oozing and then thickened and scaly Nummular/Discoid eczema 錢幣狀濕疹 ? Longterm process followed by spreading of new lesions ? Subacute dermatitis ? Topical steroid and antibiotic 幼年性掌趾角化病 Juvenile plantar dermatosis ? Age 3 to puberty, atopy ? Forefoot and plantar ? Red patch with fissuring and desquamation, scaling ? Related to athletic shoes ? Sweet gland occlusion ? Foot powder, absorbent socks, change of shoes Scrotum eczema ? Thickening and lichenification of scrotum Differential Diagnosis ? Contact dermatitis ? Drug eruption ? Lichen simplex chronicus ? Eczema secondary to other dermatosis – Scabies Contact Dermatitis and Acute eczema CD Acute eczema Cause Contact allergen/irritant Hard to define Site Exposed area or site of contact Symmetric Eruptions Edema with bulla, erosion, ulceration and even necrosis. Well demarcated Polymorphic, small vesicles, not well demarcated Symptom Itchy, burning or aching itchy Clinical course Short Recurrent Drug Eruption/Reactions ? History of medication ? Pathogenesis – Hypersensitivity, hapten induced CMI or humoral response ? Most mon medications – NSAIDs – Antibiotics – anticonvulsants ? Early withdrawal of all potentially responsible drugs is essential Chronic eczema and Lichen simplex chronicus 慢性濕疹 慢性單純苔蘚 病史 常由急性演變來 初以瘙癢為主 后呈苔蘚樣變 損害 暗紅、浸潤肥厚 苔蘚化明顯， 色素加深 正常皮色 分布 面、手足、四肢 頸項、四肢伸側 病程 多有滲出史 慢性，無滲出史 Management ? General – Removal of causative agents ? Systemic medication – Antihistamine, sedatives, calcium, sodium theosulfur, – Antibiotics – Steroids ? Topical treatment – Choose right topical agents according to stages – Steroids Topical treatment ? Principles ? Choose right therapeutic reagents ? Choose right solvents – Acute ? With erosion and oozing: solution ? Without: powder, lotion – Subacute ? With some degree of oozing: paste, oil ? Without oozing: emulsion, paste – Chronic ? Emulsion, ointment, plaster, film Topical Therapies ? Principles ? Choose right therapeutic reagents ? Choose right solvents – Acute ? With erosion and secretion: solution ? Without erosion and secretion: powder, lotion Topical Therapies ? Principles ? Choose right therapeutic reagents ? Choose right solvents – Subacute ? With some degree of secretion: paste, oil ? Without secretion: emulsion, paste – Chronic ? Emulsion, ointment, plaster, film Other therapies ? Phototherapy – PUVA, UVB, UVA ? Immune suppressive ? Langerhans cells ? ? IL10??NK? and T cells? ? Apoptosis of T cells?