Dermatitis - a Distressing Disease

What Is Dermatitis?

Dermatitis means inflammation of the skin. It is also known as eczema, a group of skin conditions with different causes but clinically similar presentations. These are defined as skin inflammation patterns having characteristic morphologies during their acute, subacute, and chronic phases.

What Are The Causes of Dermatitis (Eczema)?

Eczema can be caused by dust mites, pet dander, pollen, and certain foods, but the exact cause is not known, but it is linked with the overactive response of the body's immune system.

The risk factors include:

• Weakened immune system.

• Health conditions such as hay fever and asthma.

• Dry skin or skin conditions such as psoriasis.

• Insect bites.

• Disorders of veins such as weakened veins.

• Environmental factors.

• Change in genes.

• Stress.

• Wet hands and feet.

• Allergies to chemicals, metals, or specific substances.

• Irritants from hairdressing, laundry, or dry cleaning.

What Are the Symptoms of Eczema?

Symptoms may include:

• Dry, cracked, and scaly skin.

• Redness.

• Itching, which may be severe.

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• Painful lesions.

• Change in color where skin rashes appear.

• Thickened skin with rashes.

• Fluid-filled blisters.

What Are the Phases of Eczema?

1. Acute phase.

2. Subacute phase.

3. Chronic phase.

1. Acute Phase:

There will be erythema or redness in the acute phase, edema or swelling, vesiculation or fluid-filled lesions, discharge, and crusting.

2. Subacute Phase:

The subacute phase exhibits hyperpigmentation, scaling, and crusting.

3. Chronic Phase:

In the chronic phase, there will be lichenification. It is a combination of thickening, hyperpigmentation, and prominent skin markings.

How Can Eczema Be Classified?

It can be divided into two groups. They are,

1. Exogenous eczemas.

2. Endogenous eczemas.

Exogenous Eczemas:

Exogenous eczemas could either be irritant or allergic in nature.

1. Irritant Contact Dermatitis:

Itis a type of eczema caused by many agents whose toxins or excretory products cause a variable degree of involvement depending upon their concentration and duration of contact with the skin of everyone exposed to them.

These agents can be any of the following:

1. Chemical: Detergents, soaps, acids, etc.

2. Physical: Sunlight, heat, etc.

3. Biological: Bacteria, viruses, mites, lice, etc.

2. Allergic Contact Dermatitis:

• Unlike irritant contact dermatitis, allergic contact dermatitis occurs in only some who become allergic to the causative external allergens. A great majority of those exposed continue to remain unaffected regardless of the duration of exposure.

• Allergic contact eczemas may occur due to footwear, cosmetics, hair dyes, pollens, etc.

3. Air-borne Contact Dermatitis(ABCD):

• Pollen and other airborne allergens mainly affect the face, eyes, 'V' of the neck, and other uncovered areas of the body.

How Is Dermatitis Diagnosed?

The diagnosis of allergic contact dermatitis can be established by doing a patch test, in which patches of suspected allergens in appropriate concentrations are put on the non-hairy skin of the back or arms, and readings were taken after 48-72 hours. The positive patch test reaction is indicated by redness or fluid-filled eruptions or ulceration at the test site.

Endogenous Eczemas:

Some common types of endogenous eczemas are as follows.

1. Atopic Dermatitis:

Atopic dermatitis is chronic eczema. It is one of the atopic conditions, together with asthma and hay fever, which has a heritable tendency.

2. Seborrheic Dermatitis:

There is an excessive sebum secretion in this type of eczema, presenting with scaly, itchy lesions over the scalp, nasolabial folds, sternal areas, and body folds.

3. Discoid Eczema:

Discoid eczema is a chronic recurrent discrete coin-shaped red area covered with exudates that crust over the limbs and trunk of the middle-aged due to unknown causative factors. Sometimes, it is very difficult to distinguish discoid eczema from psoriasis.

4. Pompholyx:

In this type of eczema, vesicular eruptions are generally seen on the palms or soles. The lesions may be non-inflammatory, chronic, and recurrent. The exact cause of pompholyx is not known.

General Principles of Therapy:

• In order to bring about rapid resolution and prevent relapses, it is helpful to explain to the patient the causes of the initiation and perpetuation of the disease and advise corrective measures.

• Discontinuation of contact with the offending agent leads to rapid resolution.

• In general, the management of eczema depends on its extent and chronic nature.

• Oral antihistamines like Cetirizine or Levocetirizine can diminish itching.

How Can Eczema Be Treated Locally?

Treatment for Acute Stage:

Normal saline or potassium permanganate (1:10,000 dilution) compresses or soaks are given to wash away serous discharges, crust, and debris, and it also helps to reduce oozing and inflammation. Calamine lotion should not be used. In case of discharge, avoid ointments or creams. Corticosteroids can be given in lotion form.

Treatment for Subacute Stage:

When there is no oozing or discharge or in cases of subacute or dry eczemas, corticosteroid cream can be applied twice a day locally. Local antibiotic cream with or without corticosteroid is helpful where bacteria is present.

Treatment for Chronic Stage:

When the skin becomes thick or lichenified, occlusive dressing with a corticosteroid ointment is required. Alternatively, a moderately potent corticosteroid ointment can be applied locally two to three times a day. The addition of 3% Salicylic acid to the corticosteroid ointment is beneficial.

How Can Eczema Be Treated Systemically?

It is required in widespread acute or subacute cases and selected chronic cases.

• Intralesional steroids 0.1 - 0.2 mL (10 mg/mL) per sq.cm should be given.

• Oral antihistamine should be given in a suitable dose, depending on the individual tolerance, the nature of the job, and the patient's age.

• Appropriate antibiotics are helpful in case of secondary infection.

• Systemic corticosteroids like oral Prednisolone with other supportive measures are tried in severe cases with extensive involvement only and not as a routine. The dose and duration depend on the merits of the cases.

Diet Recommended in Eczema:

Foods to Eat:

• Anti-inflammatory foods like omega-3 fatty acids (present in fatty fishes).

• Quercetin contains foods such as broccoli, blueberries, and cherries.

Foods to Avoid:

• Food allergens like soy and dairy products.

How To Prevent Eczema?

• Avoid substances that trigger or worsen the symptoms.

• Take the medication as prescribed.

• Apply ointments and creams as advised by the doctor.

• Apply moisturizer frequently.

• Avoid sudden changes in temperature or humidity.

• Use fragrance-free detergents, cleansers, and skincare products.

• Wear protective gloves and clothing while handling chemicals.

• Reduce stress.

What Are The Complications of Eczema?

Excessive scratching may lead to bacterial or fungal infections of the skin.

• Itching can affect the sleep cycle as well.