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1、,Contact DermatitisEczemaAtopic Dermatitis,Contact Dermatitis,Definition: Contact dermatitis is an inflammatory reaction of skin and mucous membrane caused by stimulative or allergic substances that coming in contact with them.,Pathogenesis: 1. Primary irritation 2. Allergic reaction,Pathogenesis of
2、 allergic contact dermatitis Delayed Type Hypersensitivity (DTH),1.sensitization phase (4 days) semi-antigen protein carrier virgin T cell mother THLA-DR antigen (EDJ) (local lymph node) memory T cell cell sensitized T cell circulation system,2.elicitation phase (12 days)semi-antigenprotein carrier
3、sensitized T cellHLA-DR antigenlymphokine releasing inflammatory reaction,Etiology: chemicals: most common cosmetics topical medicaments daily used articles agricultural & industrial chemicals animals plants,Clinical manifestation: 1.latent stage 2.skin lesion edematous patches of erythema or papule
4、s papulovesicles vesicles bullae erosion ,exudation,crusting The lesion has a clear border. 3.lesion position 4.subjective sensation 5.course,Diagnosis: contact history clinical features patch test,Treatment,Eliminate possible allergenSystemic treatment calcium & vit c glucocorticosteroids anti-hist
5、amineTopical treatment acute stage: calamine lotion, 3% boric acid, NS subacute stage: cs paste & cream chronic stage: cs cream & ointment,Eczema,Definition: Eczema is a repeated inflammatory reaction of skin to multiple stimuli, both endogenous and exogenous.,Etiology and Pathogenesis: exogenous fa
6、ctors: foods - fish, crab, shrimp inhalants dust mite, pollen, fungus, cat, dog contactants detergent, napkin, leather physical factors sunlight, dryness, humidity chemical irritants paint, dye endogenous factors: chronic infection metabolism and endocrine disorders circulation impediment mental str
7、ess allergic quality,Clinical manifestation of eczema1.skin lesion: acute eczema: edematous patches of erythema, papules,vesicles,papulovesicles erosion, exudation, crusting subacute eczema: dark red patches, papules, papulovesicles crusting, scaling chronic eczema: scattered papules lichenification
8、, fissure, pigmentation disorder The lesion has a blurred border.,Clinical manifestation of eczema: 2.course acute subacute chronic 3.lesion position symmetry, local or diffuse 4.subjective sensation,Acute eczema,Acute eczema,subacute eczema,chronic eczema,Pigmentation disorder in chronic stage of e
9、czema,chronic eczema,Clinical features of eczema,exudation tendencypolymorphic lesionssymmetric distribution severe pruritusrepeated onset,Diagnosis and differentiation acute eczema - contact dermatitis chronic eczema - neurodermatitis,Treatment,I. Eliminate every possible pathogenic factorII. Avoid
10、 all kinds of external irritationIII.Systemic treatment 1.anti-histamines 2.VitC and calcium 3.glucocorticosteroids 4.antibiotics 5.traditional Chinese medicineIV. Topical therapy,Topical drugs for allergic dermatitis,0.5-1% phenolManthol & camphorTar agentsGlucocorticosteroidsImmune inhibitor,acute
11、 subacute chronic erythema erythema erythema,papules lichenification erosion vesicles papulovesicles infiltration solution oil paste ointment solution plaster tincture emulsion,Atopic Dermatitis,Definition: Atopic dermatitis (AD) is a kind of chronically repeated, pruritic, inflammatory skin disease
12、. The patients usually have allergic inheritance ,high serum IgE level, and accompanied by allergic rhinitis or asthma.,Epidemiology of AD,Industrialized countries prevalence of AD: children 10-20%, adulds 1-3% England (1970) 12.2% Japan(1996) 24%China prevalence of AD: 19891990 Shanghai 0.46%，712y
13、0.68%，1318y 0.12% 1998 8 provinces 620y (78586 people) 0.69%，male 0.84%，female 0.51% 2002 10 cities 17y (49241 people) 3.07% male 3.86% ，female 2.20% 2013 12 cities 1-7y field epidemiology research: 12.94%,Clinical features: 1.family history 2.immune disorder: high serum Ig E level high eosinophil l
14、evel in peripheral blood abnormality of LC high level of Th2 cell in skin mitosis of IgE receptor with high affinity decrease of CD8 cell IgA defect,Clinical features:,3.clinical delimitation infant stage:02y child stage:412y adult stage:after 12y4.other manifestations concerned dry skin, pale face,
15、 dark orbit, suborbital wrinkles, deep palmprint, low immunity to bacteria and fungi,Infant stage,Infant stage,Infant stage,Child stage,Child stage,Adult stage,Diagnostic criteria of AD (Williams criteria),Pruritus and 3 or more of followings: 1. History of flexural involvement (fossa cubitalis & po
16、pliteal, pre-ankle, neck, cheek)2. Personal or family history of atopy (allergic asthma, rhinitis, or ad)3. Xerosis4. Existing flexural eczematous rash5. Attack before 2-year-old,Key points:1.The pathogenesis and clinical manifestations of contact dermatitis2.The differential diagnosis of eczema3.The clinical features and principle of topical therapy in different stages of eczema,
