Dermatitis – Wikipedia

Dermatitis, also known as eczema, is a group of diseases that results in inflammation of the skin.[1] These diseases are characterized by itchiness, red skin, and a rash.[1] In cases of short duration there may be small blisters while in long term cases the skin may become thickened.[1] The area of skin involved can vary from small to the entire body.[1][2]

Dermatitis is a group of skin conditions that includes atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and stasis dermatitis.[1][2] The exact cause of dermatitis is often unclear.[2] Cases are believed to often involve a combination of irritation, allergy, and poor venous return. The type of dermatitis is generally determined by the person's history and the location of the rash. For example, irritant dermatitis often occurs on the hands of people who frequently get them wet. Allergic contact dermatitis; however, can occur following brief exposures to specific substances to which a person is sensitive.[1]

Treatment of atopic dermatitis is typically with moisturizers and steroid creams.[3] The steroid creams should generally be of mid to high strength and used for less than two weeks at a time as side effects can occur.[4]Antibiotics may be required if there are signs of skin infection.[2] Contact dermatitis is typically treated by avoiding the allergen or irritant.[5][6]Antihistamines may be used to help with sleep and to decrease nighttime scratching.[2]

Dermatitis was estimated to affect 334 million people globally in 2013.[7] Atopic dermatitis is the most common type and generally starts in childhood.[1][2] In the United States it affects about 10-30% of people.[2] Contact dermatitis is two times more common in females than males.[8] Allergic contact dermatitis affects about 7% of people at some point in time.[9] Irritant contact dermatitis is common, especially among people who do certain jobs, however exact rates are unclear.[10]

Dermatitis symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring. Also, the area of the skin on which the symptoms appear tends to be different with every type of dermatitis, whether on the neck, wrist, forearm, thigh or ankle. Although the location may vary, the primary symptom of this condition is itchy skin. More rarely, it may appear on the genital area, such as the vulva or scrotum.[11] Symptoms of this type of dermatitis may be very intense and may come and go. Irritant contact dermatitis is usually more painful than itchy.

Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin. Typical affected skin areas include the folds of the arms, the back of the knees, wrists, face and hands.

Dermatitis herpetiformis symptoms include itching, stinging and a burning sensation. Papules and vesicles are commonly present. The small red bumps experienced in this type of dermatitis are usually about 1cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp.[12] Less frequently, the rash may appear inside the mouth or near the hairline.

The symptoms of seborrheic dermatitis on the other hand, tend to appear gradually, from dry or greasy scaling of the scalp (dandruff) to hair loss. In severe cases, pimples may appear along the hairline, behind the ears, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.[13] In newborns, the condition causes a thick and yellowish scalp rash, often accompanied by a diaper rash.

Perioral dermatitis refers to a red bumpy rash around the mouth.[14]

A patch of dermatitis that has been scratched

The cause of dermatitis is unknown but is presumed to be a combination of genetic and environmental factors.[2]

The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma.[15] The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites,[16] with up to 5% of people showing antibodies to the mites,[17] the overall role this plays awaits further corroboration.[18]

A number of genes have been associated with eczema, one of which is filaggrin.[3] Genome-wide studies found three new genetic variants associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.[19]

Eczema occurs about three times more frequently in individuals with celiac disease and about two times more frequently in relatives of those with celiac disease, potentially indicating a genetic link between the two conditions.[20][21]

Diagnosis of eczema is based mostly on the history and physical examination.[3] However, in uncertain cases, skin biopsy may be useful.[22] Those with eczema may be especially prone to misdiagnosis of food allergies.[23]

Patch tests are used in the diagnosis of allergic contact dermatitis.[24][25]

The term "eczema" refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms being used to describe the same condition.

A type of dermatitis may be described by location (e.g. hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema interchangeably for the most common type of eczema (atopic dermatitis) .

The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001, which simplifies the nomenclature of allergy-related diseases, including atopic and allergic contact eczemas.[26] Non-allergic eczemas are not affected by this proposal.

There are several different types of dermatitis including atopic dermatitis, contact dermatitis, stasis dermatitis, and seborrheic eczema.[2] Many use the term dermatitis and eczema synonymously.[1]

Others use the term eczema to specifically mean atopic dermatitis.[27][28][29] Atopic dermatitis is also known as atopic eczema.[3] In some languages, dermatitis and eczema mean the same thing, while in other languages dermatitis implies an acute condition and eczema a chronic one.[30]

There is no good evidence that a mother's diet during pregnancy, the formula used, or breastfeeding changes the risk.[32] There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.[33]

People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.[34]

There is no known cure for some types of dermatitis, with treatment aiming to control symptoms by reducing inflammation and relieving itching. Contact dermatitis is treated by avoiding what is causing it.

Bathing once or more a day is recommended.[3] It is a misconception that bathing dries the skin in people with eczema.[35]Soaps should be avoided as they tend to strip the skin of natural oils and lead to excessive dryness.[36] It is not clear whether dust mite reduction helps with eczema.

There has not been adequate evaluation of changing the diet to reduce eczema.[37][38] There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets.[37] Benefits have not been shown for other elimination diets, though the studies are small and poorly executed.[37][38] Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.[37]

People can also wear clothing designed to manage the itching, scratching and peeling.[39]

Moisturizing agents (also known as emollients) are recommended at least once or twice a day.[3] Oilier formulations appear to be better and water-based formulations are not recommended.[3] It is unclear if moisturizers that contain ceramides are more or less effective than others.[40] Products that contain dyes, perfumes, or peanuts should not be used.[3]Occlusive dressings at night may be useful.[3]

There is little evidence for antihistamine and they are thus not generally recommended.[3] Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.[3]

If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.[3]Corticosteroids are effective in controlling and suppressing symptoms in most cases.[41] Once daily use is generally enough.[3] For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.

Long term use of topical steroids may result in skin atrophy, stria, telangiectasia.[3] Their use on delicate skin (face or groin) is therefore typically with caution.[3] They are, however, generally well tolerated.[42]Red burning skin, where the skin turns red upon stopping steroid use, has been reported among adults who use topical steroids at least daily for more than a year.[43]

Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use.[44] Their use is reasonable in those who do not respond to or are not tolerant of steroids.[45] Treatments are typically recommended for short or fixed periods of time rather than indefinitely.[3] Tacrolimus 0.1% has generally proved more effective than picrolimus, and equal in effect to mid-potency topical steroids.[32]

The United States Food and Drug Administration has issued a health advisory a possible risk of lymph node or skin cancer from these products,[46] however subsequent research has not supported these concerns.[45] A major debate, in the UK, has been about the cost of these medications and, given only finite NHS resources, when they are most appropriate to use.[47]

When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressants are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine, and methotrexate.

Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good.[48] A number of different types of light may be used including UVA and UVB;[49] in some forms of treatment, light sensitive chemicals such as psoralen are also used. Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer.[50]

There is currently no scientific evidence for the claim that sulfur treatment relieves eczema.[51] It is unclear whether Chinese herbs help or harm.[52] Dietary supplements are commonly used by people with eczema.[53] Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective.[54] Both are associated with gastrointestinal upset.[54]Probiotics do not appear to be effective.[55] There is insufficient evidence to support the use of zinc, selenium, vitamin D, vitamin E, pyridoxine (vitamin B6), sea buckthorn oil, hempseed oil, sunflower oil, or fish oil as dietary supplements.[53]

Other remedies lacking evidence to support them include chiropractic spinal manipulation and acupuncture.[56] There is little evidence supporting the use of psychological treatments.[57][needs update] While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.[58]

Most cases are well managed with topical treatments and ultraviolet light.[3] About 2% of cases however are not.[3] In more than 60% the condition goes away by adolescence.[3]

Globally dermatitis affected approximately 230million people as of 2010 (3.5% of the population).[59] Dermatitis is most commonly seen in infancy, with female predominance of eczema presentations occurring during the reproductive period of 1549 years.[60] In the UK about 20% of children have the condition, while in the United States about 10% are affected.[3]

Although little data on the rates of eczema over time exists prior to the 1940s, the rate of eczema has been found to have increased substantially in the latter half of the 20th Century, with eczema in school-aged children being found to increase between the late 1940s and 2000.[61] In the developed world there has been rise in the rate of eczema over time. The incidence and lifetime prevalence of eczema in England has been seen to increase in recent times.[3][62]

Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males, and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%.[63]

from Ancient Greek kzema,[64] from - ekz-ein, from ek "out" + - z-ein "to boil"

The term "atopic dermatitis" was coined in 1933 by Wise and Sulzberger.[65]Sulfur as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.[51]

The word dermatitis is from the Greek derma "skin" and - -itis "inflammation" and eczema is from Greek: ekzema "eruption".[66]

The terms "hypoallergenic" and "doctor tested" are not regulated,[67] and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others.

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Dermatitis - Wikipedia