DERMATITIS, also known as ECZEMA, is a group of diseases that results in inflammation of the skin . These diseases are characterized by itchiness , red skin , and a rash. In cases of short duration there may be small blisters while in long-term cases the skin may become thickened . The area of skin involved can vary from small to the entire body.
Treatment of atopic dermatitis is typically with moisturizers and steroid creams. 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. Antibiotics may be required if there are signs of skin infection . Contact dermatitis is typically treated by avoiding the allergen or irritant. Antihistamines may help with sleep and to decrease nighttime scratching.
* 1 Signs and symptoms
* 2 Cause
* 2.1 Environmental * 2.2 Genetic
* 3 Diagnosis
* 3.1 Classification * 3.2 Terminology * 3.3 Common types * 3.4 Less common types
* 4 Pathophysiology * 5 Prevention
* 6 Management
* 6.1 Lifestyle * 6.2 Moisturizers
* 6.3 Medications
* 6.4 Light therapy * 6.5 Alternative medicine
* 7 Prognosis * 8 Epidemiology * 9 History * 10 Society and culture * 11 Research * 12 References * 13 External links
SIGNS AND SYMPTOMS
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 1 cm 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 . 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. In newborns , the condition causes a thick and yellowish scalp rash, often accompanied by a diaper rash .
More severe dermatitis *
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.
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. 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 , with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration.
A number of genes have been associated with eczema, one of which is filaggrin . Genome-wide studies found three new genetic variants associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.
Diagnosis of eczema is based mostly on the history and physical examination. In uncertain cases, skin biopsy may be useful. Those with eczema may be especially prone to misdiagnosis of food allergies .
Patch tests are used in the diagnosis of allergic contact dermatitis.
The term "eczema" refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard with numerous different classification systems, and 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: 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. Non-allergic eczemas are not affected by this proposal.
There are several types of dermatitis including atopic dermatitis , contact dermatitis , stasis dermatitis , and seborrheic 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 an acute condition and eczema a chronic one.
* Atopic dermatitis is an allergic disease believed to have a hereditary component and often runs in families whose members have asthma . Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. It is very common in developed countries, and rising. Irritant contact dermatitis is sometimes misdiagnosed as atopic dermatitis. * Contact dermatitis is of two types: allergic (resulting from a delayed reaction to an allergen , such as poison ivy , nickel , or Balsam of Peru ), and irritant (resulting from direct reaction to a detergent, such as sodium lauryl sulfate , for example).
Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis . About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable, provided the offending substance can be avoided and its traces removed from one's environment. ( ICD-10 L23; L24; L56.1; L56.0)
* Xerotic eczema (asteatotic eczema, eczema craquele, eczema craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder. (ICD-10 L30.8A; L85.0) * Seborrhoeic dermatitis or seborrheic dermatitis ("cradle cap " in infants) is a condition sometimes classified as a form of eczema that is closely related to dandruff . It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. In newborns it causes a thick, yellow, crusty scalp rash called cradle cap, which seems related to lack of biotin and is often curable. ( ICD-10 L21; L21.0)
LESS COMMON TYPES
* Dyshidrosis (dyshidrotic eczema, pompholyx, vesicular palmoplantar dermatitis) only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles , thickening, and cracks are accompanied by itching, which gets worse at night. A common type of hand eczema, it worsens in warm weather. ( ICD-10 L30.1) * Discoid eczema (nummular eczema, exudative eczema, microbial eczema) is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go. (ICD-10 L30.0) * Venous eczema (gravitational eczema, stasis dermatitis, varicose eczema) occurs in people with impaired circulation, varicose veins , and edema , and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin, and itching. The disorder predisposes to leg ulcers . ( ICD-10 I83.1) * Dermatitis herpetiformis (Duhring's disease) causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease , can often be put into remission with appropriate diet, and tends to get worse at night. ( ICD-10 L13.0) * Neurodermatitis (lichen simplex chronicus , localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps. ( ICD-10 L28.0; L28.1) * Autoeczematization (id reaction, autosensitization) is an eczematous reaction to an infection with parasites , fungi , bacteria , or viruses . It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection. ( ICD-10 L30.2) * There are eczemas overlaid by viral infections (eczema herpeticum or vaccinatum ), and eczemas resulting from underlying disease (e.g., lymphoma ). Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.
All eczemas are characterized by spongiosis which allows inflammatory mediators to accumulate. Different dendritic cells subtypes, such as Langerhans cells, inflammatory dendritic epidermal cells and plasmacytoid dendritic cells have a role to play.
There is no good evidence that a mother's diet during pregnancy, the formula used, or breastfeeding changes the risk. There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.
People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum , a potentially severe and sometimes fatal complication.
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. It is a misconception that bathing dries the skin in people with eczema. Soaps should be avoided as they tend to strip the skin of natural oils and lead to excessive dryness. It is not clear whether dust mite reduction helps with eczema.
There has not been adequate evaluation of changing the diet to reduce eczema. There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets. Benefits have not been shown for other elimination diets, though the studies are small and poorly executed. Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.
People can wear clothing designed to manage the itching, scratching and peeling.
Moisturizing agents (also known as emollients ) are recommended at least once or twice a day. Oilier formulations appear to be better and water-based formulations are not recommended. It is unclear if moisturizers that contain ceramides are more or less effective than others. Products that contain dyes, perfumes, or peanuts should not be used. Occlusive dressings at night may be useful.
There is little evidence for antihistamine ; they are thus not generally recommended. Sedative antihistamines, such as diphenhydramine , may be tried in those who are unable to sleep due to eczema.
If symptoms are well controlled with moisturizers, steroids may only
be required when flares occur.
Long term use of topical steroids may result in skin atrophy , stria , telangiectasia . Their use on delicate skin (face or groin) is therefore typically with caution. They are, however, generally well tolerated. 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.
Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use. Their use is reasonable in those who do not respond to or are not tolerant of steroids. Treatments are typically recommended for short or fixed periods of time rather than indefinitely. Tacrolimus 0.1% has generally proved more effective than pimecrolimus, and equal in effect to mid-potency topical steroids. There is no link to 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 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. A number of different types of light may be used including UVA and UVB ; 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 .
Limited evidence suggests that acupuncture may reduce itching in those affected by atopic dermatitis . There is currently no scientific evidence for the claim that sulfur treatment relieves eczema. It is unclear whether Chinese herbs help or harm. Dietary supplements are commonly used by people with eczema. Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective. Both are associated with gastrointestinal upset. Probiotics do not appear 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 dietary supplements.
Most cases are well managed with topical treatments and ultraviolet light. About 2% of cases are not. In more than 60% of young children, the condition subsides by adolescence .
Globally dermatitis affected approximately 230 million people as of
2010 (3.5% of the population).
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. 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.
The term "atopic dermatitis" was coined in 1933 by Wise and
The word dermatitis is from the Greek δέρμα derma "skin" and -ῖτις -itis "inflammation" and eczema is from Greek : ἔκζεμα ekzema "eruption".
SOCIETY AND CULTURE
The examples and perspective in this section MAY NOT REPRESENT A WORLDWIDE VIEW OF THE SUBJECT. You may improve this article , discuss the issue on the talk page , or create a new article , as appropriate. (June 2017) (Learn how and when to remove this template message )
The terms "hypoallergenic" and "doctor tested" are not regulated, and no research has been done showing that products labeled "hypoallergenic" are less problematic than any others.
A number of monoclonal antibodies are being studied as treatments including dupilumab .
* ^ A B C D E F G H I J K L Nedorost, Susan T. (2012). Generalized
* ^ A B "Sulfur". University of Maryland Medical Center. 1 April
2002. Retrieved 2007-10-15.
* ^ Armstrong NC, Ernst E (August 1999). "The treatment of eczema
with Chinese herbs: a systematic review of randomized clinical trials"
. British Journal of Clinical Pharmacology. 48 (2): 262–4. PMC
2014284 . PMID 10417508 . doi :10.1046/j.1365-2125.1999.00004.x .
* ^ A B Bath-Hextall, FJ; Jenkinson, C; Humphreys, R; Williams, HC
(15 February 2012). Bath-Hextall, Fiona J, ed. "Dietary supplements
for established atopic eczema". Cochrane database of systematic
reviews (Online). 2: CD005205. PMID 22336810 . doi
* ^ A B Bamford, JT; Ray, S; Musekiwa, A; van Gool, C; Humphreys,
R; Ernst, E (30 April 2013). Bamford, Joel TM, ed. "Oral evening
primrose oil and borage oil for eczema". The Cochrane database of
systematic reviews. 4: CD004416. PMID 23633319 . doi
* ^ Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang ML
(2008). Boyle, Robert John, ed. "
Probiotics for treating eczema".
Cochrane Database of Systematic Reviews (4): CD006135. PMID 18843705 .
doi :10.1002/14651858.CD006135.pub2 . CS1 maint: Multiple names:
authors list (link )
* ^ Eldred DC, Tuchin PJ (November 1999). "Treatment of acute
atopic eczema by chiropractic care. A case study" . Australasian
* ^ Vos, T; et al. (15 Dec 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. PMID 23245607 . doi :10.1016/S0140-6736(12)61729-2 . * ^ Osman M, Hansell AL, Simpson CR, Hollowell J, Helms PJ (February 2007). "Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care". Primary Care Respiratory Journal. 16 (1): 28–35. PMID 17297524 . doi :10.3132/pcrj.2007.00006 . * ^ Taylor B, Wadsworth J, Wadsworth M, Peckham C (December 1984). "Changes in the reported prevalence of childhood eczema since the 1939–45 war". Lancet. 2 (8414): 1255–7. PMID 6150286 . doi :10.1016/S0140-6736(84)92805-8 . * ^ Simpson CR, Newton J, Hippisley-Cox J, Sheikh A (2009). "Trends in the epidemiology and prescribing of medication for eczema in England" . J Roy Soc Med. 102 (3): 108–117. PMC 2746851 . PMID 19297652 . doi :10.1258/jrsm.2009.080211 . * ^ Luckhaupt, SE; Dahlhamer, JM; Ward, BW; Sussell, AL; Sweeney, MH; Sestito, JP; Calvert, GM (June 2013). "Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey". Am J Ind Med. 56 (6): 625–634. PMID 22674651 . doi :10.1002/ajim.22080 . * ^ Henry George Liddell; Robert Scott. "Ekzema". A Greek-English Lexicon. Tufts University: Perseus. * ^ Textbook of Atopic Dermatitis. Taylor & Francis. 2008-05-01. p. 1. ISBN 9780203091449 . * ^ "Definition of ECZEMA". www.merriam-webster.com. Retrieved 2016-02-15. * ^ Murphy LA, White IR, Rastogi SC (May 2004). "Is hypoallergenic a credible term?". Clinical and Experimental Dermatology. 29 (3): 325–7. PMID 15115531 . doi :10.1111/j.1365-2230.2004.01521.x . * ^ Lauffer, F; Ring, J (2016). "Target-oriented therapy: Emerging drugs for atopic dermatitis.". Expert opinion on emerging drugs. 21 (1): 81–9. PMID 26808004 . doi :10.1517/14728214.2016.1146681 .
CLASSIFICATION V · T · D
* ICD -10 : L20-L30 * ICD -9-CM : 692 * OMIM : 603165 * MESH : D004485