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Dermatitis -overview

Here a primary external factor is not responsible for the manifestation -it is mediated by inflammatory processes and pharmacological intervention is required

Atopic eczema / atopic dermatitis most common form of eczema, particularly in children ( occurs in all ages ) chronic disorder presents with generalised skin dryness , itch and rash-favours the skin creases pathology is not well known but it is thought to happen due to a complex interplay between defects in skin barrier function , environmental and infectious agents and immune dysregulation

Asteatotic eczema ( eczema craquele ) also known as xerosis ( dry skin ) starts with dry skin often during winter months leading to skin cracks ( criss-cross pattern which look like crazy paving or a dried-up river bed ) and fissures seen frequently in the elderly

Seborrhoeic dermatitis chronic dermatitis which affects scalp , face , chest , back , axilla and groin ( areas rich in sebaceous glands ) presents as flaky , greasy , erythematous patches inflammatory response to a common skin organism Malassezia 

Nummular ( discoid ) eczema sharply defined , oval or coin shaped , erythematous eczematous plaques often described also by other terms as Pompholyx , dyshidrotic eczema intensely pruritic lesion which can be multiple , symmetrically distributed often affecting the lower limbs followed by upper limbs.

Neurodermatitis – lichen simplex a localised area of eczema due to repeated rubbing or scratching skin is scaly and thick ( hypertrophic ) it can be due to a primary reason for e,g psychological or secondary to other cutaneous issues as eczema or psoriasis

Endogenous vesicular hand ( and foot ) eczema also known as pompholyx , dyshidrotic, vesicular eczema affects hands and feet- often co-exists with atopic eczema intensely itchy vesicles or bullae called pedopompholyx when it affects the feet

Stasis ( gravitational ) dermatitis / Venous eczema due to chronic venous insufficiency inflammatory process often present along with oedema as poorly demarcated erythematous plaques b/l in lower legs clinical manifestations can include erythema , scaling , weeping , crusting , hyperpigmentation , lipodermatosclerosis and ulcerations.

Here a well defined trigger can be identified and removing the cause if possible can achieve remission 

Irritant contact dermatitis more common of the two seen in about 80 % of all contact dermatitis no immune mechanism in play and happens when skin comes in contact with substances and / or environmental factors that injure the skin and damaging the skin barrier seen more often in people with atopic dermatitis- common skin irritants are water , soaps , hand sanitisers

Allergic contact dermatitis when a specific allergy develops and the immune system over-reacts to some substance when they come in contact with the skin delayed allergic reaction triggers can be substances as metals ( e.g.nickel and cobalt ) , latex rubber , adhesives , plants , scents , cleaning agents , solvents , topical medications

Dermatophytide ( Id or Ide reaction ) spontaneous development of widespread dermatitis distant from a local inflammatory focus -autoeczematization ( secondary rashes ) various forms have been described in literature with common ones being e.g distant dermatitis in patients with chronic eczematous leg ulcer , acute vesicular eczema or pompolyx on hand and feet in patients with tinea ( dermatophyte )

Eczematous polymorphic light eruption ( PMLE ) most common of the immunologically mediated photosensitivity dermatoses several variants have been described , a rash develops a few days after exposure to sunlight in spring or summer can affect women particularly age 20-40 in areas as N Europe , considered to be a delayed allergic reaction to Ultraviolet radiation

Infective dermatitis it is as a severe form of recurrent skin changes that present in childhood considered as a cutaenous manifestation of HTLV-1 infection an oozing dermatitis which affects the scalp , face , retroauricular areas , the neck , intertriginous area such as axilla and groin

Post-traumatic dermatitis happening at the sites of chemical , physical , mechanical or surgical trauma

Acute -erythema and moderate to intense degrees of inflammation erosions , oozing and vesicles

Subacute -erythema and scaling redness, swelling , crust , scale , infection

Chronic -from uncontrolled scratching and or continuing irritation lichenification , dark pigmentation and thick papules and plaques

REFERENCES

  1. Specht S, Persaud Y. Asteatotic Eczema. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549807/
  2. Givler DN, Basit H, Givler A. Pityriasis Alba. 2021 Oct 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28613715. ( Abstract )
  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Allergic contact dermatitis: Overview. [Updated 2020 May 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK447113/
  4. Kapur, Sandeep et al. “Atopic dermatitis.” Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology vol. 14,Suppl 2 52. 12 Sep. 2018, doi:10.1186/s13223-018-0281-6
  5. Charifa A, Badri T, Harris BW. Lichen Simplex Chronicus. 2021 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29763167. ( Abstract )
  6. Leung AKC, Lam JM, Leong KF, Leung AAM, Wong AHC, Hon KL. Nummular Eczema: An Updated Review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(2):146-155. doi: 10.2174/1872213X14666200810152246. PMID: 32778043. ( Abstract )
  7. Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015 Feb 1;91(3):185-90. PMID: 25822272. ( Abstract )
  8. Eczema and its management : A Guide for Healthcare Professionals National Eczema Society https://eczema.org/wp-content/uploads/Healthcare-Professionals-Guide-June-2018.pdf
  9. Dermatitis ( Eczema ) including Occupational Dermatitis Synopsis of Causation Dr Tony Woolfson et al September 2008 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/384493/dermatitis.pdf
  10. Rook’s Textbook of Dermatology Edited by Christopher Griffiths et al Wiley Blackwell
  11. Oakley AM, Ramsey ML. Polymorphic Light Eruption. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430886/
  12. Dermnetz https://dermnetnz.org/topics/dermatitis

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