Dermatitis , also known as eczema , is a group of diseases that cause skin inflammation. These diseases are characterized by itching, red skin and rash. In the case of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The involved skin areas may vary from small to whole body.
Dermatitis is a group of skin conditions that include atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis and stasis dermatitis. The exact cause of dermatitis is often unclear. Cases may involve a combination of irritation, allergies, 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 in the hands of people who often make them wet. Allergic contact dermatitis occurs after exposure to allergens, causing a hypersensitivity reaction to the skin.
The treatment of atopic dermatitis is usually with moisturizers and steroid creams. Steroid creams should generally have moderate to high strength and are used for less than two weeks at a time because side effects can occur. Antibiotics may be needed if there are signs of skin infection. Contact dermatitis is usually treated by avoiding allergens or irritants. Antihistamines can help with sleep and reduce night scratches.
Dermatitis is thought to affect 245 million people globally by 2015. Atopic dermatitis is the most common type and generally begins in childhood. In the United States, it affects about 10-30% of people. Contact dermatitis is twice as common in women than men. Allergic contact dermatitis affects about 7% of people at some point in time. Irritant contact dermatitis is common, especially among people who do certain work; price is definitely not clear.
Video Dermatitis
Signs and symptoms
The symptoms of dermatitis vary with all different forms of the condition. Ranging from skin rashes to rashes that are wavy or include blisters. Although each type of dermatitis has different symptoms, there are certain signs that are common to all of them, including skin redness, swelling, itching and skin lesions with occasional discharge of fluid and scarring. Also, areas of the skin where symptoms appear tend to differ with each type of dermatitis, either in the neck, wrist, forearm, thigh or ankle. Although the location may vary, the main symptom of this condition is itchy skin. Less commonly, it may appear in the genital area, such as the vulva or scrotum. Symptoms of this type of dermatitis may be very intense and can come and go. Irritant contact dermatitis is usually more painful than itching.
Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin. Exposed skin areas typically include arm wraps, knee, wrist, face and hands. Perioral dermatitis refers to a red rash around the mouth.
Symptoms of dermatitis herpetiformis include itching, stinging and burning sensation. Papules and vesicles are usually present. Small red bumps experienced in this type of dermatitis are usually about 1 cm, red and can be found grouped symmetrically or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp. Less frequently, a rash may appear in the mouth or near the hairline.
Symptoms of seborrheic dermatitis, on the other hand, tend to appear gradually, from dry or oily scaling of the scalp (dandruff) to the scaling of the face area, sometimes with itching, but without hair loss. In newborns, this condition causes a thick and yellow scalp rash, often accompanied by a diaper rash. In severe cases, symptoms may appear along the hairline, behind the ears, in the eyebrows, in the bridge of the nose, around the nose, in the chest, and in the upper back.
Maps Dermatitis
Cause
The cause of dermatitis is unknown but is considered a combination of genetic and environmental factors.
Environment
The hygiene hypothesis states that the cause of asthma, eczema, and other allergic diseases is a very clean environment. This is supported by epidemiological studies for asthma. The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and the loss of this exposure increases the risk of asthma and allergies.
Although it has been suspected that eczema can sometimes be an allergic reaction to feces from house dust mites, with up to 5% of people exhibiting antibodies to mites, the overall role played is awaiting further justification.
Genetic
A number of genes have been linked to eczema, one of which is filaggrin. Genome studies found three new genetic variants associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.
Eczema occurs about three times more frequently in individuals with celiac disease and about twice as often in their relatives with celiac disease, potentially indicating a genetic relationship between conditions.
Pathophysiology
All eczema is characterized by spongiosis that allows inflammatory mediators to accumulate. Different dendritic cell subtypes, such as Langerhans cells, dendritic epidermal inflammatory cells, and plasmacytoid dendritic cells have a role to play.
Diagnosis
The diagnosis of eczema is based on history and physical examination. In an uncertain case, a skin biopsy may be useful. Those with eczema may be particularly susceptible to food allergy misdiagnosis.
The patch test is used in the diagnosis of allergic contact dermatitis.
Classification
The term "eczema" refers to a range of clinical characteristics. The underlying disease classification has been haphazard with many different classification systems, and many synonyms are used to describe the same conditions.
A type of dermatitis may be explained by the location (eg, hand eczema), by a specific appearance (eczema craquele or discoid) or by a possible cause (eczema varicose). Further adding to the confusion, many sources use the term eczema interchangeably for the most common type: atopic dermatitis.
The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001, which simplifies the nomenclature of allergic-related diseases, including atopic and eczemas contact allergies. Non-allergic Eczema is not affected by this proposal.
Terminology
There are several types of dermatitis including atopic dermatitis, contact dermatitis, stasis dermatitis and seborrhoeic eczema. Many use the term dermatitis and eczema synonymously.
Others use the term eczema to specifically mean atopic dermatitis. Atopic dermatitis is also known as atopic eczema. In some languages, dermatitis and eczema mean the same thing, while in other languages ​​dermatitis implies acute and eczema conditions that are chronic.
General type
Type diagnosis may be indicated by codes determined by the International Statistical Classification of Diseases and Associated Health Problems (ICD).
Atopic
Atopic dermatitis is an allergic disease that is believed to have a hereditary component and often runs in families whose members have asthma. Itchy rash is mainly seen on the head and scalp, neck, inside the elbow, behind the knee, and buttocks. This is very common in developed countries, and increasing. Irritant contact dermatitis is sometimes misdiagnosed as atopic dermatitis.
Contact
Contact dermatitis consists of two types: allergies (due to delayed reactions to allergens, such as poison ivy, nickel, or Balsam Peru), and irritants (resulting from direct reactions to detergents such as sodium lauryl sulphate, for example).
Some substances act as allergens and irritants (wet cement, for example). Other substances cause problems after exposure to sunlight, bringing phototoxic dermatitis. About three-quarters of the cases of contact eczema are the type of irritation, which is the most common occupational skin disease. Contact eczema can be cured, provided the offending substance can be avoided and traces removed from one's environment. (ICD-10 L23; L24; L56.1; L56.0)
Seborrhoeic
Seborrhoeic dermatitis or seborrheic dermatitis ("cradle cap" in infants) is a condition that is sometimes classified as a form of eczema that is closely related to dandruff. This results in exfoliation of the scalp, eyebrows, and face that is dry or oily, and sometimes stems. In the newborn it causes a thick, yellow, crusty scalp rash called the cradle cap, which seems to be associated with a lack of biotin and is often curable. (ICD-10 L21; L21.0)
Less common types
Dyshidrosis
Dishidrosis (dyshidrotic eczema, pompholyx, vesicular palmoplantar dermatitis) occurs only in the palms, soles of the feet, and the sides of the fingers and toes. Small opaque bumps called vesicles, thickening, and cracks are accompanied by itching, which worsens at night. Types of common hand eczema, getting worse in warm weather. (ICD-10 L30.1)
Discoid
Discoid eczema (nummular eczema, eczema eczema, microbial eczema) is characterized by rounded spots of rash that come out or dry, with clear boundaries, often on the lower legs. Usually worse in winter. The cause is unknown, and the condition tends to come and go. (ICD-10 L30.0)
Vena
Vein eczema (gravitational eczema, stasis dermatitis, varicose eczema) occurs in people with circulatory disorders, varicose veins, and edema, and is very common in the ankle area of ​​people over 50. There are redness, scaling, darkening of the skin, and itching. This disorder predisposes foot ulcers. (ICD-10 I83.1)
Herpetiformis
Dermatitis herpetiformis (Duhring disease) causes a very itchy rash and is usually symmetrical on the arms, thighs, knees, and back. The disease is directly related to celiac disease, can often be incorporated into forgiveness with the right diet, and tends to worsen at night. (ICD-10 L13.0)
Neurodermatitis
Neurodermatitis (lichen simplex chronicus, localized scratchy dermatitis) is an itchy area of ​​thickened eczema spots, pigments resulting from rubbing and scratching habits. There is usually only one place. Often curable through behavior modification and anti-inflammatory drugs. Prurigo nodularis is a related disorder that shows many lumps. (ICD-10 L28.0; L28.1)
Autoeczematization
Autoeczematization (reaction id, autosensitization) is an eczematous reaction to a parasitic, fungal, bacterial, or viral infection. It can be completely cured with the permission of the original infection that caused it. The appearance varies depending on the cause. It always happens some distance from the original infection. (ICD-10 L30.2)
Viral
There are eczemas that are coated by viral infections (eczema herpeticum or vaccinatum), and eczemas due to underlying diseases (eg, lymphoma). Eczemas derived from the consumption of drugs, food, and chemicals, have not been clearly systematized. Other rare eczematous disorders exist other than those listed here.
Prevention
There is no good evidence that maternal diet during pregnancy, the formula used, or breastfeeding alters the risk. There is tentative evidence that probiotics in infants can reduce levels but not enough to recommend their use.
People with eczema should not get smallpox vaccinations because of the risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.
Management
There is no known cure for some types of dermatitis, with medications aimed at controlling symptoms by reducing inflammation and relieving itching. Contact dermatitis is treated by avoiding what causes it.
Lifestyle
Taking a bath once or more a day is recommended, usually for five to ten minutes in warm water. Soaps should be avoided as they tend to peel the skin from natural oils and cause excessive dryness.
There has been no adequate evaluation to change the diet to reduce eczema. There is some evidence that infants with established egg allergies may have symptom reduction if eggs are eliminated from their diet. The benefits have not been proven for other elimination diets, although the research is small and poorly executed. Establishing that there is a food allergy before dietary changes can avoid unnecessary lifestyle changes.
People can wear clothing designed to manage itching, scratching and peeling.
Reductions of house dust mites and avoidance measures have been studied in low quality tests and have not shown evidence of increased eczema.
Moisturizer
Low quality evidence suggests that a moisturizing agent (emollient) can reduce the severity of eczema and cause less flare. In children, oil-based formulations appear to be better and water-based formulations are not recommended. It is not clear whether moisturizers containing ceramides are more or less effective than others. Products containing dyes, perfumes, or peanuts should not be used. Occlusive dressings at night may be useful.
Some moisturizers or barrier creams can reduce irritation of occupational hand irritant dermatitis, skin diseases that can affect people in jobs that are regularly in contact with water, detergents, chemicals or other irritants. Some emollients can reduce the number of flares in people with dermatitis.
Drugs
There is little evidence for antihistamines; they are thus generally not recommended. Antihistamine tranquilizers, such as diphenhydramine, can be tried in those who can not sleep due to eczema.
colloid oatmeal
Oatmeal contains avenanthramide (anthranilic acid amide), which can have anti-inflammatory effect.
Corticosteroids
If symptoms are well controlled with moisturizers, steroids are only necessary when flares occur. Corticosteroids are effective in controlling and suppressing symptoms in many cases. Once everyday use is generally enough. For mild-moderate eczema, weak steroids may be used (eg, hydrocortisone), whereas in more severe cases, higher-potency steroids (eg, clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While this usually brings a quick fix, they have bigger side effects.
Use of long-term topical steroids can cause skin, stria, telangiectasia, atrophy. Its use on the delicate skin (face or groin) is therefore usually with caution. They are, however, generally well-tolerated. Red burning skin, where the skin turns red after stopping the use of steroids, has been reported among adults who use topical steroids at least daily for more than a year.
Immunosuppressants
Topical immunosuppressants such as pimecrolimus and tacrolimus may be better in the short run and look the same as steroids after one year of use. Its use is fair to those who do not respond or are intolerant of steroids. Treatment is usually recommended for short or fixed periods rather than indefinitely. Tacrolimus 0.1% generally proves to be more effective than pimecrolimus, and equally effective with potential topical steroids. There is no association with an increased risk of cancer from topical use of 1% pimecrolimus cream.
When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressant is 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
Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good. A number of different types of light can be used including UVA and UVB; In some forms of treatment, light-sensitive chemicals such as psoralen are also used. Overexposure to ultraviolet rays carries its own risks, especially skin cancer.
Alternative medicine
Limited evidence suggests that acupuncture can reduce itching in those affected by atopic dermatitis. There is currently no scientific evidence to claim that sulfur treatment reduces eczema. It is unclear whether Chinese herbs are helpful or harmful. Food supplements are commonly used by people with eczema. Both evening primrose oil and oral borage ore oils have proven to be effective. Both are associated with gastrointestinal disorders. Probiotics do not seem to be effective. 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 a dietary supplement.
Spinal manipulation of chiropractic is lacking evidence to support its use for dermatitis. There is little evidence to support the use of psychological treatments. While a dilute bleach bath has been used for infected dermatitis there is little evidence for this practice.
Prognosis
Most cases are well managed with topical treatments and ultraviolet light. About 2% of cases are not. In more than 60% of young children, this condition is eased by adolescents.
Epidemiology
Global dermatitis affects about 230 million people in 2010 (3.5% of the population). Dermatitis is most often seen in infants, with female dominance of eczema presentations occurring during the reproductive period of 15-49 years. In the UK about 20% of children have these conditions, while in the United States about 10% are affected.
Although little data on the eczema rate over time existed before the 1940s, the rate of eczema has been found to increase substantially in the second half of the 20th century, with eczema in school-aged children being found increasing between the late 1940s and 2000s. developed countries have increased the rate of eczema over time. The incidence and prevalence of lifetime eczema in the UK has seen increases in recent times.
Dermatitis affects about 10% of US workers in 2010, representing over 15 million workers with dermatitis. The prevalence rate is higher among women than men, and among those with some college education or a bachelor's degree compared with those with a high school diploma or less. Workers in the health care industry and social and life support, physical, and social science work have the highest rates of reported dermatitis. About 6% of dermatitis cases among US workers are attributed to work by health care professionals, suggesting that the prevalence rate of occupational-related dermatitis among workers is at least 0.6%.
History
The term "atopic dermatitis" was invented in 1933 by Wise and Sulzberger. Sulfur as a topical treatment for eczema is fashion in the Victorian and Edwardian era.
The word dermatitis comes from the Greek ????? skin "skin" and - ???? -itis "inflammation" and eczema comes from the Greek: ?????? ekzema "eruption".
Society and culture
The terms "hypoallergenic" and "doctor tested" are not regulated, and no studies have shown that products labeled "hypoallergenic" are less problematic than others.
Research
A number of monoclonal antibodies are being studied as a treatment including dupilumab.
References
External links
- Dermatitis in Curlie (based on DMOZ)
Source of the article : Wikipedia
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