【正文】 giosis ? 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, asthma, rhinitis and hay fever Atopic Diseases Barson and Rogers. BMJ 2022。 exacerbation after reexpos. Causative agents occurs only above threshold level Relatively independent of amount applied Incidence May occur in everyone Occurs only in the sensitized Management of ICD ? Prevention – Avoid irritant or caustic chemical(s) by wearing protective clothing (., goggles). – If contact does occur, wash with water or weak neutralizing solution. – Barrier creams. – In occupational ICD that persists, change of job may be necessary. ? Treatment ? Acute – Identify and remove the etiologic agent. – Wet dressings with gauze soaked in Burow39。 a housewife, is atopic and has ignored instructions to wear gloves during work in the kitchen and to use lubricating creams. ICD ? Clinical features – Any one can have – With clear border – Resolved after removing of causative agent – Usually acute and can have bulla Allergen Contact Dermatitis Eczematous dermatitis due to reexposure to a substance to which the individual is sensitized. ? Epidemiology – Frequent: Accounts for 7% of occupationally related illnesses in the United States. – Occupation: One of the most important causes of disability in industry. ? Pathogenesis – A classic, delayed, cellmediated hypersensitivity reaction ? DTH, CMI – Contact allergens are diverse and range from metal salts to antibiotics, dyes to plant products. Neomycin Usually contained in creams, ointments Procaine, benzocaine Local anesthetics Sulfonamides Terpentine Solvents, shoe polish, printer?s ink Balsam of Peru Topical Thiuram Rubber Formalin Disinfectant, curing agents, plastics Mercury Disinfectant, impregnation Chromates Cement, antioxidants, industrial oils, matches Nickel sulfate Metals, metals in clothing, jewelry Cobalt sulfate Cement, galvanization, industrial oils pPhenylene diamine Black or dark dyes of textiles, printer?s ink Parahydroxybenzoic acid ester Conserving agent in foodstuffs CONTACT ALLERGENS Allergic con