Dermatitis

Dermatitis refers to skin inflammation that causes itchy, red, swollen skin that may or may not is accompanied by blisters, oozing, and skin thickening. Dermatitis is a broad term subdivided into some types, each of which has a specific cause, symptoms, and treatment. The most common styles include Atopic dermatitis, contact dermatitis, seborrheic dermatitis, infant dermatitis, etc. 

Dermatitis is standard worldwide, with children and young females most commonly affected for atopic type, while males are more widely affected for seborrheic type. 

There is no cure for dermatitis; however, medications are used in acute episodes, and lifestyle changes are adopted to prevent further attacks. It is treated mainly by steroids, emollients, creams, fungi, or topical antibiotics.

The most common types of dermatitis are;

• Atopic Dermatitis is a chronic allergic disease that runs in families and is associated with an increased number of allergic antibodies (IgE). These patients may also present with asthma and hay fever later in their lives. 
• Seborrheic Dermatitis: this type of dermatitis is characterized by red, itchy, greasy, inflamed, and scaly skin. Oil-producing regions of the body are most commonly affected, like the scalp, face, and chest.
• Contact Dermatitis: In this common type of dermatitis, the inflammation of the skin occurs after contact with the causative agent, which can be an allergen (allergic contact dermatitis) or chemicals (irritant contact dermatitis) resulting in red swollen skin rash accompanied by blisters.

The cause of atopic dermatitis is unknown, but two theories have been proposed, one of which involves the disturbance of immune reaction, and the other suggests the abnormality of epithelial barriers. The onset of the disease usually occurs in early childhood.

The exact cause of Seborrheic dermatitis is unknown; however, genetic and environmental factors may play a role. The Malassezia yeast is also thought to be the culprit. The condition is common in infants or older adults and is prevalent in males more than females. Infants may develop yellow scales on the scalp called cradle cap and diaper rash. 

Contact dermatitis can occur at any part that comes in contact with the causing agent, especially hands. The most common causing agents are nickel, chromium, poison ivy, poison oak, latex, and even sunlight (photo contact dermatitis).

The signs and symptoms specific to atopic dermatitis are:

• Redness and itchiness
• Skin thickening
• Superinfection with staphylococcus aureus bacteria
• Dry skin
• Specific regions include elbows and behind knees, head, and scalp, neck and buttocks. 
• Early age of onset 
• Presence of other allergic diseases like asthma, hay fever, etc.

The typical signs and symptoms of Seborrheic dermatitis include;

• Redness
• Itchiness
• Greasy skin
• Scales that may be yellow or white
• Skin folds, scalp, skin behind ears 

Signs and symptoms of contact dermatitis are;

• Localized rash that may be burning
• large and itchy rashes
• Blisters and oozing vesicles
• Urticaria (hives)

Atopic dermatitis is prevalent worldwide. It affects infants and children more, and the male to female ratio is 1:1.4. The illness decreases with increasing age.

Seborrheic dermatitis is prevalent throughout the world in all races. Males are affected more at the ages of puberty and then at 40. 

Allergic contact dermatitis is prevalent worldwide with no age or race preference. It is more commonly found in females due to the increased use of nickel.

Irritant dermatitis is more commonly found in occupations involving repeated handwashing and certain chemicals. Such professions include healthcare, cooking and serving food, and hairdressers.  

The following risk factors may make you susceptible to dermatitis;

• Age groups affected: atopic dermatitis affects infants and children more.
• Male genders are affected more by seborrheic dermatitis.
• Family history of allergies and asthma.
• Working at occupations that involve exposure to certain chemicals.
• Certain health conditions increase the risk of seborrheic dermatitis.

Diagnosis is made based on history and examination. 

A biopsy of the skin tissue can be taken to rule out other serious causes. 

A patch test is done to find out the allergen in contact dermatitis.

All types of dermatitis can be confused for each other, and other conditions may mimic the presentation of dermatitis.

• Mycosis fungoides
• Plaque Psoriasis
• Scabies
• Tinea Corporis
• Lichen simplex
• Dermatitis herpetiformis

Atopic Dermatitis:  The treatment of this specific type includes;

• Moisturizers: Moisturizers are used to prevent the dryness of the skin.
• Topical Steroids: Ointments of hydrocortisone, betamethasone.
• Immunomodulators: Tacrolimus, pimecrolimus creams
• Antibiotics: For superimposed reactions
• Ultraviolet light Therapy: A combination of both UV-B and PUVA may be given.

Seborrheic Dermatitis: The treatment of this type includes:

• Antifungal creams or shampoos, including ketoconazole, ciclopirox. 
• Topical corticosteroids 
• Antiandrogens, such as cyproterone acetate, spironolactone, and nilutamide, are highly effective 
• Antihistamines are used to reduce itching if present.
• Coal tar can be effective
• Isotretinoin may be used to reduce sebaceous gland activity in refractory disease

Contact Dermatitis: Treatment of contact dermatitis includes: 

• Avoidance of the allergen is the fundamental law.
• Applying cold compresses on blisters
• Oral antihistamines (diphenhydramine) and Calamine lotion for itch relief
• Corticosteroids ( hydrocortisone) as a cream or ointment. For larger areas, an oral steroid is used.
• Using barrier creams containing zinc can help.

Dermatitis is a chronic condition. It relapses after treatment. This causes a significant financial burden. The episode of atopic dermatitis decreases as age increases. It is easier to cope with the problem by avoiding triggers and adopting lifestyle changes.