Dermatitis:A group of itchy inflammatory conditions characterised by epidermal changes
Definition
Acute eczema (or dermatitis) refers to a rapidly evolving red rash which may be blistered and swollen.
Chronic eczema (or dermatitis) refers to a longstanding irritable area. It is often darker than the surrounding skin, thickened (lichenified) and much scratched.
Subacute eczema is an in between state
Types
Atopic dermatitis: prevalent in children; inherited factors seem important, as there is nearly always a family history of dermatitis or asthma.
Irritant contact dermatitis is a non-immunological inflammatory reaction provoked by body fluids, handling water, detergents, solvents or harsh chemicals, and by friction.
Allergic contact dermatitis is due to skin contact with substances that most people don't react to, most commonly nickel, perfume, rubber, hair dye or preservatives. A dermatologist may identify the responsible agent by patch testing. Type IV hypersensitivity reaction.
Dry skin: especially on the lower legs, may cause asteatotic dermatitis, also called eczema craquele.
Discoid eczema may be set off initially by an injury to the skin: scattered coin-shaped irritable patches persist for a few months.
Seborrhoeic dermatitis and dandruff are due to irritation from toxic substances produced by Malassezia yeasts that live on the scalp, face and sometimes elsewhere
Treatment
Infective dermatitis seems to be provoked by impetigo (bacterial infection) or fungal infection.
Gravitational dermatitis arises on the lower legs of the elderly, due to swelling and poorly functioning leg veins.
Meyerson naevus – dermatitis affecting melanocytic naevi (moles)
Otitis externa – dermatitis affecting the external ear canal
Topical steroids-itchy patches 5-15 day course
Emollients- apply liberally
Pimecrolimus cream- anti-inflammatory cream for atopic dermatitis with fewer s/e than steroid creams
antibiotics- if infected
Irritants- protect from incontinence, dust, water, solvents , injury
Clothing-soft cool clothing
antihistamines- reduces itching particularly at night
Bathing- showers better, soap free substitute
other treatments
Long term control
soap substitute
steroid cream/ointment- flare up
Emollient
if no improvement in 2 weeks refer to GP/ANP
Assessment
PMHx, Fhx, SHx, signs and symptoms, onset
Examination of site
screen for secondary infection
Referral to dermatitis
Dermatitis (in particular hand and facial dermatitis) is severe, chronic, recurring or persistent.
Previously stable dermatitis has become difficult or impossible to control with standard treatments.
Allergy to prescribed or over-the-counter topical treatments is suspected.
Suspected contact dermatitis does not respond to treatment in primary care, has atypical features (other diagnoses should be considered) or the diagnosis is unclear.
Contact dermatitis is thought to be associated with occupation.