DERMATITIS

DEFINITION
• ACCORDING TO BRUNNER AND SUDDHART
Dermatitis is inflammation of the upper layers of the skin,
causing itching, blisters, redness, swelling, and often oozing, scabbing,
and scaling.
INCIDENCE
• It affects males and females and accounts for 10 to 20 percent of all
visits to dermatologists (doctors who specialize in the care and
treatment of skin diseases). Although atopic dermatitis may occur at
any age, it most often begins in infancy and childhood. Women tends
to developthediseaseatanearlierage(20 to40 years of age ) compared to
men ( 60 to 70 years of age ), and womenareaffected more frequently
STAGES OF DERMATITIS
ACUTE DERMATITIS
Acute dermatitis is characterised by erythema, vesiculation and
oozing, often with oedema
CHRONIC DERMATITIS
Chronic dermatitis is characterised by thickened dry patches, often
lichenified from chronic rubbing (increased Skin markings).
Lichenification is often pre dominantly follicular in pigmented skin.
CLASSIFICATION
• Contact
• Atopic
• Nummular
• Seborrheic
• Stasis
• Perioral
• Generlized exfoliative
• Pompholix
• Herpitiform
• Localized stretch
CONTACT DERMATITIS
Contact dermatitis is skin inflammation caused by direct contact with a
particular substance. The rash is very itchy, is confined to a specific
area, and often has clearly defined boundaries
 TYPES OF CONTACT DERMATITIS

• Irritant dermatitis
• Allergic dermatitis
IRRITANT DERMATITIS
• Irritant contact dermatitis, which accounts for 80% of all cases of
contact dermatitis, occurs when a chemical substance causes direct
damage to the skin; symptoms are more painful than itchy. Typical
irritating substances are acids, alkalis (such as drain cleaners), solvents
(such as acetone in nail polish remover), strong soaps.
ALLERGIC DERMATITIS
• Allergic contact dermatitis is a reaction bythe body's system to a
immune substance contacting the skin. Sometimes a person can be
sensitized by Only one exposure, and other times sensitization occurs
only after many exposures to a substance. After a person is sensitized,
the next exposure causes itching and dermatitis within 4 to 24 hours
ATOPIC DERMATITIS
• Atopic dermatitis is chronic, itchy inflammation of the upper layers of
the skin that often develops in people who have hay fever or asthma
and in people who have family members with these conditions. Infants
may develop red, oozing, crusted rashes on the face, scalp, diaper area,
hands, arms, feet, or legs. Infants may develop red, oozing, crusted
rashes on the face, scalp, diaper area, hands, arms, feet, or legs.
Treatment The scalp can be treated with a shampoo containing
pyrithione zinc, selenium sulfide, an Antifungal drug, salicylic acid
and sulfur, ortar.
NUMMULAR DERMATITIS
• Nummular dermatitis is a persistent, usually itchy, rash and
inflammation characterized by coin- shaped spots, often with tiny
blisters, scabs, and scales. Most people benefit from skin moisturizers.
Other treatments include antibiotics taken by mouth, corticosteroid
creams and injections, and phototherapy. Most people benefit from
skin moisturizers. Other treatments Include antibiotics taken by
mouth, corticosteroid creams and injections, and phototherapy.
SEBORRHOEIC DERMATITIS
• Seborrhoeic dermatitis (also known as "seborrheiceczema") isan
inflammatory skin disorder affecting the scalp, face, and trunk.
seborrheic dermatitis presents with scaly, flaky, itchy, red skin. The
condition's symptoms appear gradually and usually the first signs of
seborrheic dermatitis are the flakes of skin called dandruff.
TREATMENT : Dermatologist recommend topical treatments such as
shampoos, cleansers or creams/lotions that contain antifungal , anti
inflammatory, sebosuppresive or keratolytic ingredients
STASIS DERMATITIS
• Stasis dermatitis is inflammation on the lower legs from pooling of
blood and fluid. have varicose (dilated, twisted) veins and swelling
(edema). It usually occurs on the ankles but may spread upward to the
knees.
• Treatment : Long-term treatment is aimed at keeping blood from
pooling in the veins around the ankles. When sitting, the person should
elevate the legs above the level of the heart. Antibiotics are used only
when the skin is already infected.
PERIORAL DERMATITIS
• Perioral dermatitis is a red,bumpy rash around the mouth and on the
chin that resembles acne or rosacea Perioral dermatitis is distinguished
from acne by the lack of blackheads and whiteheads Treatment is with
tetracyclines or other antibiotics taken by mouth.
GENERALIZED EXFOLIATIVE
DERMATITIS
• Generalized exfoliative dermatitis (erythroderma) is severe
inflammation that causes the entire skin surface to become
red,cracked,and covered with scales.
• Treatment
People with severe exfoliative dermatitis often need to be
hospitalized and given antibiotics (for infection), intravenous fluids (to
replace the fluids lost through the skin), and nutritional supplements.
Corticosteroids (such as prednisone) given by mouth or intravenously.
POMPHOLYX
• Pompholyx/ dyshidrosis, is a chronic dermatitis characterized by itchy
blisters on the palms and sides of the fingers and sometimes on the
soles of the feet. The blisters are often scaly, red, and oozing.. Wet
compresses with potassium permanganate or aluminum acetate
(Burow's solution) may help the blisters resolve. Strong topical
corticosteroid
DERMATITIS HERPITIFORM
• Dermatitis herpitiform is a particular type of dermatitis that appears as
a result of a gastrointestinal condition, known as celiac disease.
LOCALIZED SCRATCH DERMATITIS
• Localized scratch dermatitis (lichen simplex chronicus, neuro
dermatitis) is chronic, itchy inflammation of the top layer of the skin.
Localized scratch dermatitis can occur anywhere on the body,
including the anus (pruritus ani ) and the vagina (pruritus vulvae), but
is most common on the head , arms, and legs. In the early stages, the
skin looks normal, but it itches. Later dryness scaling, and dark
patches develop as a result of the scratching and rubbing. Applying
surgical tape saturated with a corticosteroid (applied in the morning
and replaced in the evening) helps relieve itching and inflammation
and protects the skin from scratching
CAUSES OF DERMATITIS
• GENETIC
• NUTRITIONAL
• STRESS
• ALLERGENS
• SEASONAL CHANGES
• HORMONAL SWINGS
• DISEASE
• INFECTION
PATHOPHYSIOLOGY
various exogenous and endogeneous agent(dyes perfumes)
↓
initiate inflammatory response of the skin
↓
skin eruption present that are specific to causative agent
↓
erythema, vesicles, scales and pruritis occur
↓
Cause stretching In response to irritation and edema serous discharge and crusti
↓
Long term irritation also causes thickened lethargy and darker skin
RISK FACTORS
• GENETIC
• ENVIRONMENT
• MEDICAL CONDITION
• AGE
 CLINICAL MANIFESTATION
• Red rash. This is the usual reaction. The rash appears immediately in
irritant contact dermatitis; in allergic contact dermatitis, the rash
sometimes does not appear until 24–72 hours after exposure to the
allergen.
• Blisters or wheals. Blisters, wheals (welts), and urticaria (hives) often
form in a pattern where skin was directly exposed to the allergen or
irritant. Itchy, burning skin. Irritant contact dermatitis tends to be more
painful than itchy,while allergic contact dermatitis often itches.
CLINICAL MANIFESTTION
• ALLERGIC CONTECT DEREMATITIS
Erythema swelling and pruritic vesicles in area of allergen
• CONTECT DERMATITIS
[Link] Phase
Patient have erythema itching burning exposed to agent.
2. Sabacute phase
Crusting, drying, fissuring, burning, exposed to agent
[Link] phase
After repeted reaction patient Scratch the skin
DIAGNOSTIC EVALUATION
• HISTORY COLLECTION
• PHYSICAL EXAMINATION
• ALLERGIC TEST
MANAGEMENT
• MEDICAL MANAGEMENT
Bathing Reduce how often you bath or shower, using lukewarm water. Showers are
better. Replace standard soap with a substitute such as a mild detergent soap-free
cleanser : your chemist or dermatologist can advise you.
• Clothing Wear soft smooth cool clothes; wool is best avoided.
•Irritants Protect your skin from dust, water, solvents, detergents, injury. Avoid
exposure to environmental or food allergens. Common foods that cause allergic
reactions are dairy, soy, citrus, peanuts, wheat (sometimes all gluten containing
grains), fish, eggs, corn, and tomatoes.
•Emollients Apply an emollient liberally and often, particularly after bathing, and
when itchy. Ask your doctor or dermatologist to recommend some to try; avoid
perfumed products when possible
• Topical steroids Apply a topical steroid cream or ointment to the itchy patches fora
5 to 15 day course.
•Pimecrolimus cream Pimecrolimus is a new anti- inflammatory cream shown to be
very effective for atopic dermatitis, with fewer side effects than topical steroids.
•Antibiotics Your doctor will recommend antibiotics such as flucloxacillin or
erythromycin if infection is complicating or causing the dermatitis.
Corticosteroids-
A corticosteroid medication similar to hydrocortisone may be prescribed to combat
inflammation in a localized area. This medication may be applied to your skin as a
cream or ointment. If the reaction covers a relatively large portion of the skin or is
severe, a corticosteroid in pill or injection form may be prescribed.
NURSING MANAGEMENT
• Cleansing properly
• Use the right products
• Protecting the skin
• Drink plenty of water
• Nutritional diet