DERMATITIS/ECZEMA

Skin allergies are prevalent and manifest in various forms across different ages and body areas. These allergies are often referred to as "dermatitis" or "eczema," terms that are used interchangeably. Typically, "eczema" is associated with atopic eczema, while "dermatitis" is used alongside descriptors like contact dermatitis.

The term "eczematous" is also used to depict skin changes characterized by scaling, crusting, or the oozing of serous fluid, accompanied by itching.

This discussion aims to outline common skin allergies, eczema, or dermatitis, enabling you to recognize their types, causes, clinical features, and treatment options.

Types of Eczema

Eczema can be classified into exogenous and endogenous types based on their triggers. Exogenous eczemas are triggered by external factors, while endogenous eczemas are primarily caused by internal factors. Managing exogenous eczemas involves removing the triggering cause if possible, while endogenous eczemas typically require ongoing pharmacological treatment.

Atopic Dermatitis

• Infants and toddlers (below 2 years): Itchy, red, oozing, and crusted skin lesions typically appear on the extensor surfaces of limbs (elbows, knees), trunk, face, and scalp.
• Older children and adolescents: Eczema lesions are commonly found in skin folds (elbow creases, knee folds, wrist joints), ankles, and neck.
• Adults: Atopic dermatitis may manifest as localized thickened and scaly skin lesions, although oozing lesions can also occur. Some patients may experience generalized eczema.
• Diagnosis of atopic dermatitis is supported by specific skin findings such as features of atopy (e.g., increased sneezing in the morning or with dust exposure, palmar hyperlinearity, ragged skin at nail folds, darkening around the eyes, nipple eczema, pityriasis alba, and overall dryness of the skin).

Nummular Eczema

Nummular eczema, also known as nummular dermatitis or discoid eczema, is a chronic skin condition that tends to recur and is more prevalent among middle-aged individuals. It typically appears on the extremities, although it can occasionally affect the trunk. The name "nummular" refers to the coin-shaped appearance of the skin lesions. The level of itching associated with nummular eczema can vary in severity.

Seborrheic Dermatitis

eborrheic dermatitis is an advanced and more severe form of dandruff. It manifests as red, greasy, scaly patches in areas with a high density of sebaceous glands, such as the scalp, eyebrows, nasolabial folds, between the eyebrows, behind the ears, the center of the chest, upper back, underarms, groin, and scrotum. For further information on dandruff and seborrheic dermatitis, please refer to...

Asteatotic Eczema

Asteatotic eczema primarily affects elderly individuals with dry skin, commonly appearing on the lower extremities, especially during winter months. This condition is aggravated by factors such as cold weather, warm water, indoor heating, and harsh detergents. Age-related changes in the skin barrier lead to water loss and dryness. In some cases, asteatotic eczema can be linked to systemic issues like malnutrition, hypothyroidism, malignancy, or as a side effect of medications such as retinoids, diuretics, and certain anti-cancer drugs.

Typically, asteatotic eczema presents as dry skin with superficial cracks and scaling, resembling a "dried river bed" pattern. The affected areas may exhibit redness and varying degrees of itching, depending on the severity of the condition. While the lower limbs, particularly the legs, are the most common sites, the upper limbs can also be affected.

Dyshidrotic eczema

Dyshidrotic eczema, also known as pompholyx or acute palmoplantar eczema, is characterized by intensely itchy, fluid-filled skin lesions that appear on the palms of the hands and soles of the feet. It accounts for 5 to 20% of hand eczema cases and is more prevalent in young adults, affecting both males and females equally. Common risk factors include a history of atopic dermatitis, exposure to contact allergens or irritants, systemic exposure to allergens, id reactions (fungal infections), hyperhidrosis, smoking, and warm weather conditions. Stress may also contribute to its occurrence.

The condition typically begins with episodes of itching, followed by the sudden and symmetric development of itchy vesicles filled with fluid on the palms, the outer and upper parts of the fingers, or the soles of the feet. In 70-80% of cases, only the hands are affected. These vesicles are deeply seated and may merge to form larger skin lesions. They eventually resolve, leaving behind scaling. However, frequent recurrences can lead to chronic hand eczema characterized by thick, scaly, and cracked skin lesions.

Pityriasis Alba

Pityriasis alba is a common skin condition that primarily affects children and adolescents, although it can occur in individuals without atopic eczema. It is more noticeable in people with darker skin tones. This condition typically manifests as multiple round to oval-shaped, asymptomatic hypopigmented spots on the face, upper trunk, and upper limbs. Lesions may exhibit slight redness and scaling, which can precede the development of hypopigmentation. Diagnosis is usually based on clinical examination, although differentiation from other causes of facial hypopigmentation may be necessary. Pityriasis alba is a self-limiting condition, but it can persist for months to several years in some cases.

Eyelid Eczema

Eyelid eczema, also known as periocular or periorbital dermatitis, is characterized by red or skin-colored scaly lesions on the upper, lower, or both eyelids, often accompanied by itching, burning, and occasionally swelling. This condition can be attributed to various factors, including atopic eczema, seborrheic dermatitis, or contact with irritants or allergens. Common allergens include fragrances, mineral-based cosmetics or sunscreens found in gold jewelry, nail polish, and certain topical eye drops containing chemicals like phenylephrine, gentamicin, neomycin, and phenylephrine. Airborne contact dermatitis, resulting from exposure to irritant particles in the air, can also contribute to eyelid eczema.

Juvenile planter dermatitis

Juvenile plantar dermatosis (JPD) is a form of eczema that affects the soles of the feet and commonly occurs in children between 3 to 14 years old, especially those with other allergic symptoms. Factors such as synthetic shoe materials, fabrics, friction, and sweating are believed to contribute to the development and worsening of this condition.

JPD typically begins with dryness and itching on the soles of the feet. Over time, the skin may become red, shiny, and cracked, with possible development of deep fissures and scaling. However, areas between the toes and the upper part of the feet are usually unaffected.

Diagnosing JPD is mainly based on clinical examination. If there's suspicion of allergic contact dermatitis from materials like leather or rubber in shoes, a patch test may be conducted. In rare cases, a KOH mount may be needed to rule out fungal infection.

JPD tends to resolve on its own over a few years, but oral and topical treatments may be necessary based on the severity of the dermatitis. Treatment typically involves avoiding synthetic socks and shoes, and regular use of moisturizers to keep the skin hydrated.

Contact Dermatitis

Contact dermatitis refers to the development of dermatitis due to direct exposure of the skin to a substance. It can manifest as either allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD). Irritant contact dermatitis is more common, accounting for about 80% of cases. In ACD, an allergen triggers an immune response, whereas in ICD, the substance itself directly harms the skin.

Irritant contact dermatitis

Irritant contact dermatitis is the most prevalent type of contact dermatitis, resulting from the direct contact of substances that cause physical, mechanical, or chemical irritation to the skin. Common irritants include water and wet work, soaps and cleansers, bleach, solvents, acids and alkalis, plant parts, vegetables, paper, and dust or soil.

Acute irritant contact dermatitis may manifest as redness, dryness, swelling, itching, a burning sensation, and pain. Severe cases can lead to the formation of vesicles or bullae with oozing. Chronic irritant contact dermatitis is characterized by skin thickening and fissuring. It frequently affects the hands and is common among food handlers, healthcare workers, those in the mechanical industry, cleaners, and housekeepers.

Diagnosis

Dermatologists can diagnose most cases of eczema or dermatitis rash through clinical examination, considering factors such as the patient's age, affected sites, pattern of involvement, and the appearance of skin lesions. They can also identify common causes of contact dermatitis by taking a detailed history of the skin condition, the patient's occupation, and their daily lifestyle, along with a thorough clinical examination. In some cases, a skin biopsy may be performed to rule out other possibilities. For contact dermatitis specifically, a patch test can be conducted to pinpoint the allergen or irritant substance responsible. Blood tests for allergies are generally not as effective in identifying causative allergens for skin allergies.

Treatment

Here are some measures that can be taken to treat dry and sensitive skin associated with dermatitis:

• Use lukewarm water instead of hot water for bathing or washing your face.
• Avoid using harsh detergents or soaps that can strip the skin of its natural oils.
• Choose fragrance-free cosmetics and skincare products to reduce irritation.
• Apply a sufficient amount of moisturizer immediately after bathing to lock in moisture.
• Individuals with hand eczema should opt for mild hand wash products and avoid harsh chemicals.
• After completing tasks like cooking, handling cement, or other occupational activities, wash your hands with clean water and apply moisturizer to prevent dryness.
• Wear clothing made of cotton or other soft, breathable materials to minimize skin irritation.