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DERMATITA ATOPICA
Asistent universitar Irina Batir
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Clasificarea dermatitei atopice
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Clasificarea dermatitei atopice in functie de varsta
D.A. infantila (debut 1-8luni)$leziuni papulo$veziculoase, de un rosu viu, cu marginidifuze, pruriginoase$localizare preponderent faciala (frunte, menton si obraji)
si pe scalp$respecta zona scutecelor- si regiunea periorala,$pot aparea focare diseminate pe trunchi si pe suprafetelede etensie ale membrelor, la nivelul genunchilor
$spre sfarsitul acestei perioade apare eroza cutanata$complicatii frecvente* suprainfectii$mai putin de !" din cazuri se remit pana la varsta de #luni
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Dermatita atopica infantila
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Clasificarea dermatitei atopice in functie de varsta
D.A. a copilului si a adolescentului (2-7 ani; 8-14 ani)$poate aparea de novo sau ca o continuare a dermatitei dinfaza neonatala
$afecteaza electiv zonele eurale ale articulatiilor mari (plicacotului, fosa poplitee si articulatia pumnului), ceafa siregiunea laterocervicala, dosulmanilor si picioarelor / eczema fexurala
$placi eritimatoase cu limite imprecise, cu ecoriatii produse
prin grataj$tegument uscat si accentuarea cadriluajului cu prodominantalicheni0carii in zonele eorii.$se poate asocia onicodistro0e.
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D.A. a copilului si a adolescentului
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Clasificarea dermatitei atopice in functie de varsta
D.A. a adultului$localizarea este simetrica pe fata ( frunte, pleoapesi perioral), gat, centura scapulara, torace
anterosuperior si zonele eoare ale articulatiilormari, dosul manilor$leziuni pruriginoase licheni0cate, inconjurate depapule, in0ltrate si adesea ecoriate$cadrilajul pielii accentuat$aspect de eczema numulara, eczemaperimamelonara si eczema uscata tip neodermita circumscrisa
$pruritul este intens$lichen sim le cronic neorodermita circumscrisa
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Semne suplimentare• $1egumente uscate, palide• $Cheratoza pilara• $2ar uscat si mat
• $2rezenta unui pliu suplimentar la nivelul pleopeiinferioare• $3uze uscate si 0surate• $Crize de hipersudoratie
• $Conjunctivita• $1emperatura scazuta la etremitati
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Forme particulare de D.A.
• 4.A a scalpului• 4.A. a pavilionului urechii• 4.A. a buzelor
• Eczema mamelonara• 2itiriazisul alb al fetei
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Afectarea in functie de varsta
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Etiopatoenie
Factori de mediu / colonizare cu sta0lococ,Pityrosporum, sensiblilate crescuta la subsatanteiritante, alergeni de contacat, alergeni alimentari,pneumoalergeni etc
Factori genetici / 56A 3% $ 4.A., 56A 3#' /2olinoza atopica, 56A 3', 37 si 3+! in astm bronsic
Factori imunologici / dezechilibrul limfocitilor 1h#81h', prezenta receptorilor pentru IgE pesuprafata celulelor 6angerhans,
Factorul pidermic / perturbari in sinteza
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EPIDERMUL ! prima linie de ap"rare dintre corp #i mediul e$tern
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Defecte ale %arierei cutanate
4e0cit al lipidelor din mantia hidrolipidica / 9erozacutanata4e0cit al cetosterolilor (lamele lipidice)4es0gurarea corneocitilor cu un defect al sintezeide pro0lagrina / 0lagrina si factorului natural dehidratare Corneocite
Corneodesmozomi
Stratul lipidic
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SCHIMBRILE !" S#RA#UL C$R"$S DUC LADIS%U"C&IA BARIEREI PIELII
!n pielea normal"$Corneodesmozomii sunt
intac:i la nivelul stratuluicornos$Corneodesmozomii sedistrug la suprafa:;, parte aprocesului normal dedescuamare
#a indi$i%ii predispu&igenetic la dermatit" atopic"
$4istrugerea prematur; acorneodesmozomilor duce la
o descuamare eagerat;$Agentii de mediu( sapun,
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Disfunctia %arierei pielei
<n pielea normal;, corneocitele =i straturilelipidice stratul cornos limiteaz; pierdereatransepidermal; de ap;4isfunc:ia barierei pielii duce la cre=tereapierderii transepidermale de ap;, pielea devinemai uscat;, compozi:ia straturilor lipidice semodi0c; corneocitele se sub:iaz; =i apar goluri
>n zidul de c;r;mizi
'ierdereatransepidermal" de
ap"
'ierdereatransepidermal" de
ap"
arier" alterat"ariera normala
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Etiopatoenie
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Criterii de dianostic &'anifin ( Ra)*a+
, ma)ore si , minore
a*ore#. 2rurit'. 1opogra0a si aspectul liziunilor $6icheni0carea pliurilor la copil sau cu dispozitie linira laadult $Afectarea fetei si a zonelor de etensie ale membrelor lanou$nascut si copii
&. Eruptie recidivanta si8sau cronica
+. Antecedente personale sau familiale de atopie*astm bronsic, rinita alergica, dermatita atopica.
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Criterii de dianostic &'anifin ( Ra)*a+
inore#. 9eroza cutanata, ihtioza, ?eratoza pilara, hiperliniaritate palmara'. 1egumente palide&. 2liu suplimentar la pleoapa inferioara (semnul 4ennie @organ)+. Cheilita 0surata. 2ar uscat si mat. 2itiriazis alb al fetei7. 4ermogra0sm alb. 2igmentare peri$orbitala%. eratoconus#!. Conjunctivita##. Crize de hipersudoratie#'. Interlinia paroasa a fruntii fos sitoata#&. 4ermatita manilor si a picioarilor#+. Crestera IgE seric, reactii cutanate de tip #
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Dianostic diferential
#. 4eramtita seboreica'. 4ermatita de contact&. 4ermatita iritativa
+. Bcabia. 2iodermite. 6ichen simple cronic7. Eczema numulara
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Complicatii
• Infectii bacteriene / infectii strepto / sta0lococice• Infectii virale /infectie vaccinala disiminata( eczema vaccinatum), primo$infectie herpeticasevera (eczema herpeticum)
• Infectii micotice (candidozice, triho0tice)• Eritrodermizarea•
Bensibilizarea la medicamente• Bubdezvoltarea staturo$ponderala• 1ulburari de dezvolatare psihica
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Tratamentul dermatitei atopice
• evitarea factorilor declan=atori ai leziunilor,• controlarea pruritului / antihistaminice anti5#
• suprimarea inama:iei / corticoizi• epunera la ultraviolete• refacerea barierei cutanate• >nl;turarea aniet;:ii• regim igieno$dietetic
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Tratament
• +erapia topic" >n dermatita atopica cuprinde *• Emoliente (9eraCalmAd)• dermatocorticoizi,
• inhibitori de calcineurin;• fototerapie• +ratamentul sistemic include*
• corticosteroizi
• metroteat• ciclosporina• antihistaminice