Pathophysiology of Eczema - PowerPoint Presentation Example

? RUNNING HEADING: Eczema School Eczema Eczema is a condition that is characterized by inflammation, redness, fluid accumulation and pruritius of the skin leading to bleeding, encrusting, thickening and scaling. There are several common types of eczema, but the most common is atopic eczema, that usually develops during infancy, worsens during childhood and gets better during adulthood. The exact cause of eczema and dermatitis is still not clearly known, but it may be a result of interplay of host, genetic and environmental factors. Besides, the disorder is known to run in families and may be caused by certain autoimmune dysfunction. However, there are a range of exacerbating factors that need to be taken into consideration such as stress, pressure, etc. With relation to the differential diagnosis, a range of conditions need to be differentiated including psoriasis, fungal infections, scabies, scarlet fever, pityriasis rosea, measles, tinea corporis and squamous cell carcinoma. Introduction/Definition Eczema or dermatitis is a disorder in which the skin is inflamed (especially epidermis) along with the development of vesiculation sometimes in acute phases. It has been derived from the Greek word meaning to ‘boil out’, and hence medical practitioners consider it to look like the skin is boiling out. The condition is usually acute in nature, but can be a chronic inflammatory disorder of the skin causing pruritius, redness, vesiculation, which finally become encrusted, hemorrhagic, thickened and scales off (Vorvick, 2009). Some of the common types include:- Allergic contact eczema – Following contact with a foreign substance such as a poison, lotion, etc, there is a local allergic reaction Atopic dermatitis – It is a chronic inflammatory skin disorder and often accompanied with other disorders such as asthma and hay fever. It is commonly seen on the arms and at the back of the knees, and flare up periodically Contact eczema – the reaction is localised when a allergen is contact causing itching, redness and swelling Seborrheic eczema- Commonly called as dandruff and is a mild skin inflammatory disorder arising due to unknown reasons and causing scaling, redness and itching of the scalp and face Neurodermatitis – This is characterised by scratching or picking of the skin resulting in development of rashes Stasis dermatitis – Develops from congestion of the veins of the legs resulting in irritation of the overlying skin Dyshidrotic eczema – Commonly occurs on the palms and soles and is seen as deep-seated skin lesions Perioral eczema – Bumpy rash and ulcers that develop around the mouth Nummular eczema – This is a coin-shaped lesion that develops in an irritated portion of the skin causing scaling, itching and encrusting (MedicineNet, 2011). Pathophysiology The exact cause of eczema and dermatitis is still not clearly known, but it may be a result of interplay of host, genetic and environmental factors. Further, stress and various emotional disorders can worsen or exacerbate the condition especially atopic dermatitis (Mayo Clinic, 2011). Most of the eczema occurs due to a hypersensitivity reaction of the skin, causing chronic skin inflammation (Lehrer, 2009). Some of the eczemas are autoimmune conditions and some of them are genetically transmitted, running in families. Atopic dermatitis is known to be transmitted through a genetic route and is often associated with asthma and hay fever. However, this association is often being questioned, as not all individuals with atopic dermatitis have asthma and hay ever, and not all individuals with asthma and hay fever have atopic dermatitis. However, both these conditions tend to run in families, and this may be due to common genetic trait being carried on (Mayo Clinic, 2011). Such disorder appears on trivial inflammation of the skin. Allergic eczemas are usually common and the individual may also have other allergic conditions such as asthma, hay fever, etc (DIS, 2011). There are several exacerbating factors for eczema including emotional distress, stress, anxiety, occupational hazards (such as exposure to nickel or cobalt), dryness of the air, etc (Mayo Clinic Staff, 2012). Etiology The prevalence is considered high with atopic dermatitis as 20 to 25 % of the children and 2 to 5% of the adults may develop this disorder. About 60% of the individuals would develop symptoms during the infancy stage, and 90% by the age of 5 years. Usually the condition gets better with time, but with some individuals may persist and recur (Emedicinehealth, 2011). Contact dermatitis usually arises with direct contact with certain allergens or substances. These include soaps, detergents, cleaning products, rubber, jewelry, nickel, cosmetics, fragrances, perfumes, weeds, poison ivy plant, topic antibiotic pastes, etc. Once an individual gets sensitized to an allergen, he/she tends to have the allergy to that particular substance for the rest of his/her life. Neurodermatitis is a lesion that develops on a specific spot and is characterized by intense itchiness and the individual keeps rubbing or scratching the area. It commonly occurs in the ankle, wrist, forearm and back of the neck. It may be exacerbated by chronic irritation, other eczema, or dry skin. Dandruff is common in people with oily skin, and there is also an interplaying hereditary factor. The exact cause is still not understood clearly, but several factors are noted as underlying factors including stress, and neurological disorder. The underlying factors associated with atopic dermatitis include dry and irritable skin, immune dysfunction, and genetic factors, along with stress, though stress is concerned as an exacerbating factor. Stasis dermatitis is characterized by the accumulation of fluid beneath the skin, mainly arising from blockage of the veins. This fluid puts extra pressure on the skin causing inflammation. There may be underlying causes such as obesity, varicose veins, pregnancy and deep vein thrombosis. Perioral dermatitis may be caused due to several factors including use of cosmetics and moisturizers, and topical use of corticosteroids (Mayo Clinic, 2011 & University of California, 2011) Symptoms and signs Eczema in the acute stages appears as fluid-filled blisters that may break, causing oozing and weeping, which ultimately dries out a forms a crust. With time, the lesions begin to harden and tend to become thick. Individuals with atopic dermatitis develop the lesions in an episodic pattern and the first episode usually begins before the age of 5 years (E-Medicine Health, 2012). However, atopic dermatitis can also develop in infants and children and is characterized by small and dry itchy bumps on the skin, scalp and forehead and begins to spread to other parts of the body. When the children develop at an older age, the lesions become less oozy and more scaly or thickened, and often itch badly (Kids Health, 2012). In adults, atopic dermatitis is characterized by red to brownish patches that itch, leak fluid and crust and sometimes leave a raw sensitive skin area. It can occur only almost any part of the body including face, neck, hands, feet, elbow, knees and ankles. Usually a round of atopic dermatitis, the lesions gets infected with Staphylococcus aureus (Mayo Clinic, 2011). Most of the signs and symptoms are discussed in the earlier part of the paper. Diagnosis The diagnosis is made based on the history, symptoms and signs, physical examination (of the lesions) and certain laboratory tests. The range of lab tests done include skin biopsy, allergic skin tests (patch and prick tests), blood tests (RAST and blood counts) and microbiological laboratory tests. Radioallergosorbent test is a test done to diagnose allergies by detecting the allergen-specific immunoglobulin E level that is present in the blood. Usually, the amount of IgE present would help determine how severe the allergic reaction would be (Darsow, 1993). A negative reaction may actually not indicate if the person is not allergic, but such results have to be utilized in caution by the physician. Absolute eosinophil count (AEC) is used to determine the eosinphils present in the blood, which are high during allergic states (Gersten, 2001). Prick tests is used to test whether the individual is allergic to a particular allergen, by placing a drop of the substance in low concentration on the skin and pricking with a needle (Lab Tests Online, 2011). Skin Patch test is usually required when there are chances that the inflammation would continue in spite of using treatment and avoiding the offending agent. It includes open patch test and closed patch test. TRUE Test is a readymade patch test that contains a very thin quantity of several standard allergens given in a pack (Habif, 2009). Differential Diagnosis With relation to the differential diagnosis, a range of conditions need to be differentiated including psoriasis, fungal infections, scabies, scarlet fever, pityriasis rosea, measles, tinea corporis and squamous cell carcinoma. Measles and rubella are viral skin infections and usually begin in the chest and trunk and spread later to the other parts of the body. Pityriasis rosea is characterized by the formation of a large pink patch on the back or chest known as ‘herald’s patch’. Psoriasis is characterized by raised patches of thickened skin with silvery scales, and attempts to remove the scales can result in bleeding spots. Squamous cell carcinoma appears as an ulcer, nodule, skin erosion or verrucous papule, and may rarely appear similar to eczema. Hence a biopsy is needed to rule out carcinoma. Scabies may be anticipated if the lesions occurs in individuals of the same family (CKS-NHS, 2011 & University of California, 2011) Bibliography Darsow, U. Et al (1994). “Atopy patch test with different vehicles and allergen concentrations: An approach to standardization.” Journal of Allergy and Clinical Dardissation, 95(3): 677-684. http://www.jacionline.org/article/S0091-6749(95)70172-9/abstract DIS (2011). Histopathology, Retrieved on April 13th 2011, from Web site: http://eczema.dermis.net/content/e01geninfo/e06histopathology/index_eng.html CKS-NHS (2011). Differential Diagnosis Eczema, Retrieved on February 21 2012, from Web site: http://www.cks.nhs.uk/eczema_atopic/management/scenario_diagnosis_and_assessment/differential_diagnosis#-323512 E-Guidelines UK (2011). Boggis Eczema, Retrieved on February 21 2012, from Web site: http://www.eguidelines.co.uk/eguidelinesmain/gip/media/images/Boggis_eczema_algo.jpg Emedicinehealth (2011). Eczema (Atopic Dermatitis), Retrieved on February 21 2012, from Web site: http://www.emedicinehealth.com/eczema/article_em.htm Gersten, T. (2001). Eosinophil Count, Retrieved on February 21 2012, from Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003649.htm Habif, C. (2009). Clinical Dermatology, Mosby, St. Louis. Mayo Clinic Staff (2011). Atopic Dermatitis (eczema), Retrieved on February 21 2012, from Web site: http://www.mayoclinic.com/health/eczema/DS00986 Medicine Net (2011). Atopic Dermatitis, Retrieved on February 21 2012, from Web site: http://www.medicinenet.com/atopic_dermatitis/article.htm Medline Plus (2011). Eczema, Retrieved on February 21 2012, from Web site: http://www.nlm.nih.gov/medlineplus/eczema.html Ong, P. Y. (2010). Atopic Dermatitis, Bope, R. (ed), Bope: Conn's Current Therapy 2011, 1st ed, Saunders, Philadelphia. University of California (2011). Atopic Dermatitis- Eczema, Retrieved on February 21 2012, from Web site: http://pedclerk.bsd.uchicago.edu/eczema.html Vorvick, L. J. (2009). Contact Dermatitis, Retrieved on February 21 2012, from Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000869.htm Vorvick, L. J. (2009). Eczema, Retrieved on February 21 2012, from Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000853.htm Read More