or their products that clear when the organisms are eradicated may
cause microbial eczema. This should be distinguished from infected
eczema, in which eczema is complicated by secondary bacterial or
viral invasion of the broken skin. The skin becomes sensitized to
bacterial products or chemicals present in the exudates. Infectious
eczematoid dermatitis is considered as an example of
mechanism by which microorganisms can cause eczema is not
understood. Bacterial antigens can promote a cytotoxic reaction in
distinction between infective and infected eczema is difficult.
eczema shows erythema with exudation and crusting. The exudation may
be profuse with crusting, or slight, with the accumulation of layers
of somewhat greasy moist scale, below the surface is raw and red.
is characteristically sharply defined. There may be small pustules
and fissures in the advancing edge .
eczema usually presents as an area of advancing erythema, sometimes
with micro vesicles. It is seen predominantly around discharging
wounds or ulcers, or moist skin lesions of other types.
dermatitis is relatively common in patients with venous leg ulcers,
but care must be taken to distinguish it from contact dermatitis due
to topical preparations .
or streptococci can be cultured and the lesions respond to
antiseptic and antibiotic therapy .
condition seems to occur particularly in patients with poor
standards of hygiene. Hyperhidrosis and heavy footwear may be an
important predisposing factor . Infective dermatitis may also
complicate chronic threadworm infestation, pediculosis, scabies and
excoriations of the skin due to repeated scratching .
eczema in children
,this must be distinguished from juvenile plantar dermatosis.
Tinea pedis may also become eczematous due to the overgrowth of Gram-negative
Fig. 209. Infective dermatitis
Fig. 210. Infective dermatitis
and treatment of the predisposing factors .
antibacterial agents are effective in mild forms of infective
eczema due to bacteria.
antibiotics . The important line of treatment is the treatment
of infection by an appropriate antibiotic.
exudative lesions, Potassium permanganate soaks are helpful for
the first 2 or 3 days, in combination with topical and systemic
antibiotic. Antihistamines oral preparations may be required to
relieve itching which is an important factor in causing
excoriations and traumatization of skin, predisposing for
seeding of bacteria into the skin.
dermatitis is a chronic eczematous lesion that is caused by
different known and unknown factors. The condition may be preceded
by atopic dermatitis. The lesion may appear as a separate entity as
annular, coin-like or discoid lesions on the extensor surface of
the extremities, trunk and the buttocks .
This type of
eczema appears mainly in older age groups .
: the papular and
urticarial lesions may become chronic in neglected untreated cases
or by the repeated severe itching and excoriation.
manifestation of atopic dermatitis
:Discoid eczema may appear at the end stage of chronic atopic eczema
agents : irritants
whether external such as topical sensitizing creams, detergents,
metal or internal allergens may cause nummular dermatitis.
the skin: dryness of
skin due to different factors such as excessive bathing , using
harsh and medicated strong alkaline soaps. In older age groups the
skin usually tends to be drier.
disorders may be
considered an important predisposing factor.
reaction due to different drugs such as sulfonamides and methyldopa,
where the fixed drug lesion may appear on the previous eczematized
are annular or coin-shaped papulo vesicular patches or plaques on an
erythematous base. Oozing surface of the lesion may occur with
excessive excoriation due to itching or rubbing followed by
secondary bacterial infection.
One of the
characteristic features of nummular dermatitis is that the patches
that seem to be dormant may become active again, particularly if
treatment is discontinued.
dermatitis in childhood is liable to become discoid eczema later on.
Cases of chronic discoid eczema have usually an atopic history.
In the chronic
stage , the lesions are dry and excoriated coin shaped. These are
single or multiple lesions and may be accompanied by severe
itching which usually increases with different irritating factors such as emotional
stress. Secondary lesions may follow later on involving the limbs
or the trunk.
Fig.211a. Discoid eczema
of this type of eczema is very chronic and has the characteristic of
relapse and remission, where after healing of the lesions, new
recurrent eruption occurs at the same older site .
Fig. 211. Discoid eczema
Fig. 212. Chronic eczema
of the irritating factor if possible .
steroid alone or combined with an antibiotic or salicylic acid (Locosalene,
diprosalic, salidecoderm) in an ointment base especially in dry
preparation such as Citrizine is given for few days preferably at
bedtime, where itching is more severe at night and to combat the
possibility of sedation especially with old sedating antihistamines.
orally or parentally are rarely indicated in nummular eczema.
eczema is a deep vesicular skin reaction involving the fingers, the
interdigital spaces and the feet. The vesicles have a characteristic
morphological appearance as that of sago grains. The condition is
rare in young age groups and more common in adults .
of the areas for a long time as by keeping the feet non-aerated
by the socks and shoes most of the day such as in athletes
such as Penicillin, Aspirin.
irritants due to nickel , dichromate , perfumes and strong
detergents can be considered among the precipitating factors .
or fungal infection is blamed as a triggering factor also.
Meanwhile, bacterial and fungal infections, usually secondarily
infect the dyshidrotic areas.
are vesicular and usually symmetrical accompanied with mild or
severe itching. Excoriation of the lesions is not uncommon.
Fig. 213. Dyshydrotic eczema
Fig. 214. Dyshydrotic eczema
(with secondary bacterial infection)
of dyshidrotic eczema involute spontaneously and do not rupture as
in other vesicular skin lesions.
cases resolve spontaneously .
and correction of the predisposing factors such as
eczematized cases need antihistamine and topical steroid cream
are preferred than ointments in these cases as cream is
less occlusive than ointments .
powder between the toes may help to keep the skin dry.
Fig. 215. Pustular dyshydrotic
(Dermatitis Plantaris Sicca)
dermatoses affects mainly children . Both feet may be involved
symmetrically and become macerated.
and occlusion of the feet by woolen or polyester socks.
foot for a long time without aeration is an important triggering
barefooted on woolen or polyester carpets. This may lead to
static electric charges that may also have a role in skin
dryness and initiation of such problem .
synthetic materials or chemicals used in the shoes or socks
may have an important role.
Fig. 216. Juvenile plantar
are involved which become macerated and fissured.
interdigital spaces and the weight bearing areas are spared .
Fig. 218. Juvenile plantar dermatoses
Fig. 217. Juvenile plantar dermatoses
- Avoid walking barefreted.
- Avoid occlusim of the
- Emollients such as
- Mild topical
corticosteraid alone or in combination with salicylic acid used
for a short time may give good results.
- Fluorouracil may be tried
in older children.
- Retonic acid.
- Vitamine A orally for a
dermatitis is an exogenous type of dermatitis, related to
peripheral vascular disturbances with venous incompetence and
more common in older age groups.
Fig. 219. Stasis dermatitis
manifestation is characteristically on the inner lower leg above the
internal maleolus. The lesion appears as a cyanotic , erythematous
and edematous due to local congestion. The condition may be
accompanied by mild itching, lichenifecation, ulceration and
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