Eczema
Pathophysiology and Types of Eczema:
There is a recognized association with genetic
predisposition in patients with atopic eczema.
In these patient,an abnormality of T helper lymphocyte
exists (especially TH 2 cells) that have important role in the disease.
These abnormal TH2 cels interact with Langerhan”s cells
causing increased levels of interleukins/IgE and reduction in interferon (INF
Gamma) resulting in release of pro-inflammatory cells.
Pathology:
There is oedema in epidermis that cuases separation of
keratinocuyes and vesicle formation.
Epidermis becomes thickened and blood vessels become
dilated.
There would be inflammatory cell infiltrate in dermis ( of
eosinophils).
Types of Eczema:
As discussed before Eczema canbe broadly divided into two
types:
Endogenous and Exogenous Eczema
Endogenous Eczema/
Constitutional Eczema :
Atopic Eczema
This usually presents in infancy or early childhood.
It affects face and flexural regions.
There is a strong family history and it is associated with
Asthma.
Venous Eczema:
This appears on the lower limbs of patients with venous
insufficiency
These patients have backflow of blood from deep to
superficial veins leading to venous hypertension.
Patients have peripheral oedema and ulceration may occur as
well.
There would be brown haemosiderin pigmentation of skin.
Compression is used for treatment.
Asteatotic Eczema:
This occurs on lower legs of elderly people who have dry
skin.
Discoid Eczema:
This occurs on lower limbs and is characterized by annular
lesions .
Vesicles may also develop.
It is more common in men that women.
Pompholyx Eczema:
It affects fingers palms and soles.
There are itchy vesicular lesions that develop on these
areas.