Dermatitis
Atopic dermatitis | |
---|---|
Other names | Eczema |
Frequency | 245 million in 2015[6] (3.34% of world population) |
Dermatitis is inflammation of the
The exact cause of the condition is often unclear.[2] Cases may involve a combination of allergy and poor venous return.[1] The type of dermatitis is generally determined by the person's history and the location of the rash.[1] For example, irritant dermatitis often occurs on the hands of those who frequently get them wet.[1] Allergic contact dermatitis occurs upon exposure to an allergen, causing a hypersensitivity reaction in the skin.[1]
Prevention of atopic dermatitis is typically with essential fatty acids,[4] and may be treated with moisturizers and steroid creams.[5] 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.[7] Antibiotics may be required if there are signs of skin infection.[2] Contact dermatitis is typically treated by avoiding the allergen or irritant.[8][9] Antihistamines may help with sleep and decrease nighttime scratching.[2]
Dermatitis was estimated to affect 245 million people globally in 2015,[6] or 3.34% of the world population. Atopic dermatitis is the most common type and generally starts in childhood.[1][2] In the United States, it affects about 10–30% of people.[2] Contact dermatitis is twice as common in females as in males.[10] Allergic contact dermatitis affects about 7% of people at some point in their lives.[11] Irritant contact dermatitis is common, especially among people with certain occupations; exact rates are unclear.[12]
Terminology
Many authors use the terms dermatitis and eczema synonymously,
Others use the term eczema to specifically mean atopic dermatitis.[13][14][15] Atopic dermatitis is also known as atopic eczema.[5] In some languages, dermatitis and eczema mean the same thing, while in other languages dermatitis implies an acute condition and eczema a chronic one.[16]
Signs and symptoms
There are several types of dermatitis including atopic dermatitis, contact dermatitis, stasis dermatitis and seborrhoeic dermatitis.[2] Dermatitis symptoms vary with all different forms of the condition. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring. Also, the area of the skin on which the symptoms appear tends to be different with every type of dermatitis, whether on the neck, wrist, forearm, thigh or ankle.
Although the location may vary, the primary symptom of this condition is itchy skin. More rarely, it may appear on the
Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin, on light skin. However, this redness does not appear on darker skin and dermatitis can appear darker brown or purple in color.[19] Typical affected skin areas include the folds of the arms, the back of the knees, wrists, face and hands. Perioral dermatitis refers to a red bumpy rash around the mouth.[20]
The symptoms of
-
Dermatitis
-
More severe dermatitis
-
A patch of dermatitis that has been scratched
-
Complex dermatitis
Complications
People with eczema should not receive the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.[24] Other major health risks for people with dermatitis are viral and bacterial infections because atopic dermatitis patients have deficiencies in their proteins and lipids that have barrier functions along with defects in dendritic cells and as a result are unable to keep foreign invaders out leading to recurring infections.[25] If left untreated, these infections may be life-threatening, so skin barrier improvement (such as daily moisturizing to minimize transepidermal water loss) and anti-inflammatory therapy are recommended as preventative measures.[25]
Cause
The cause of dermatitis is unknown but is presumed to be a combination of genetic and environmental factors.[2]
Environmental
The
Malnutrition
Genetic
A number of genes have been associated with eczema, one of which is
Eczema occurs about three times more frequently in individuals with
Prevention
There have been various studies on the prevention of dermatitis through diet, none of which have proven any positive effect.
Exclusive breastfeeding of infants during at least the first few months may decrease the risk.[35] There is no good evidence that a mother's diet during pregnancy or breastfeeding affects the risk,[35] nor is there evidence that delayed introduction of certain foods is useful.[35] There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.[36] There is moderate certainty evidence that the use of skin care interventions such as emollients within the first year of life of an infant's life is not effective in preventing eczema.[37] In fact, it may increase the risk of skin infection and of unwanted effects such as allergic reaction to certain moisturizers and a stinging sensation.[37]
Healthy diet
There has not been adequate evaluation of changing the diet to reduce eczema.[38][39] There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets.[38] Benefits have not been shown for other elimination diets, though the studies are small and poorly executed.[38][39] Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.[38]
Fatty acids
Oils with fatty acids that have been studied to prevent dermatitis include:[40][41]
- Corn oil: Linoleic acid (LA)
- Fish oil: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
- alpha-Linolenic acid(ALA)
In the 1950s Arild Hansen showed that in humans: infants fed skimmed milk developed the essential fatty acid deficiency. It was characterized by an increased food intake, poor growth, and a scaly dermatitis, and was cured by the administration of corn oil.
Management
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.
Lifestyle
Bathing once or more a day is recommended, usually for five to ten minutes in warm water.[5][43] Soaps should be avoided, as they tend to strip the skin of natural oils and lead to excessive dryness.[44] The American Academy of Dermatology suggests using a controlled amount of bleach diluted in a bath to help with atopic dermatitis.[45]
People can wear clothing designed to manage the itching, scratching and peeling.[46]
House dust mite reduction and avoidance measures have been studied in low quality trials and have not shown evidence of improving eczema.[47]
Moisturizers
Low-quality evidence indicates that moisturizing agents (
Some moisturizers or barrier creams may reduce irritation in occupational irritant hand dermatitis,[50] a skin disease that can affect people in jobs that regularly come into contact with water, detergents, chemicals or other irritants.[50] Some emollients may reduce the number of flares in people with dermatitis.[48]
Medications
Corticosteroids
If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.
Long term use of topical steroids may result in
Antihistamines
There is little evidence supporting the use of antihistamine medications for the relief of dermatitis.[5][54] Sedative antihistamines, such as diphenhydramine, may be useful in those who are unable to sleep due to eczema.[5] Second generation antihistamines have minimal evidence of benefit.[55] Of the second generation antihistamines studied, fexofenadine is the only one to show evidence of improvement in itching with minimal side effects.[55]
Immunosuppressants
Topical
When eczema is severe and does not respond to other forms of treatment, systemic
Dupilumab is a new medication that improves eczema lesions, especially moderate to severe eczema.[62] Dupilumab, a monoclonal antibody, suppresses inflammation by targeting the interleukin-4 receptor.
Antifungals
Others
In September 2021, ruxolitinib cream (Opzelura) was approved by the U.S. Food and Drug Administration (FDA) for the topical treatment of mild to moderate atopic dermatitis.[63] It is a topical Janus kinase inhibitor.[63]
Light therapy
Narrowband UVB
Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer.[68]
Alternative medicine
Topical
Chiropractic spinal manipulation lacks evidence to support its use for dermatitis.[69] There is little evidence supporting the use of psychological treatments.[70] While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.[71]
Supplements
- Sulfur: There is currently no scientific evidence for the claim that sulfur treatment relieves eczema.[72]
- Chinese herbology: it is unclear whether Chinese herbs help or harm.[73] Dietary supplements are commonly used by people with eczema.[74]
- Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective.[75] Both are associated with gastrointestinal upset.[75]
- Probiotics are likely to make little to no difference in symptoms.[76]
Pathophysiology
Eczema can be characterized by
Diagnosis
Diagnosis of eczema is based mostly on the
Patch tests are used in the diagnosis of allergic contact dermatitis.[81][82]
Classification
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.[83]
A type of dermatitis may be described by location (e.g.,
The
Histopathologic classification
By histopathology, superficial dermatitis (in the epidermis, papillary dermis, and superficial vascular plexus) can basically be classified into either of the following groups:[85]
- Vesiculobullous lesions
- Pustular dermatosis
- Non vesicullobullous, non-pustular
- With epidermal changes
- Without epidermal changes. These characteristically have a superficial perivascular inflammatory infiltrate and can be classified by type of cell infiltrate:[85]
- Lymphocytic (most common)
- Lymphoeosinophilic
- Lymphoplasmacytic
- Mast cell
- Lymphohistiocytic
- Neutrophilic
Common types
Diagnosis of types may be indicated by codes defined according to
Atopic
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 the 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. Stress can cause atopic dermatitis to worsen.[86]
Contact
Some substances act both as allergen and irritants (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on
Seborrhoeic
Seborrhoeic dermatitis or seborrheic dermatitis 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)
There is a connection between seborrheic dermatitis and Malassezia fungus, and antifungals such as anti-dandruff shampoo can be helpful in treating it.[42]
Less common types
Dyshidrosis
Discoid
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. The cause is unknown, and the condition tends to come and go. (ICD-10 L30.0)
Venous
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)
Herpetiformis
Neurodermatitis
Autoeczematization
. 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)Viral
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.
Prognosis
Most cases are well managed with topical treatments and ultraviolet light.[5] About 2% of cases are not.[5] In more than 60% of young children, the condition subsides by adolescence.[5]
Epidemiology
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.
Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%.[92]
History
from Ancient Greek ἔκζεμα ékzema,[93]
from ἐκζέ-ειν ekzé-ein,
from ἐκ ek 'out' + ζέ-ειν zé-ein 'to boil'
(
The term atopic dermatitis was coined in 1933 by Wise and Sulzberger.[94] Sulfur as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.[72]
The word dermatitis is from the Greek δέρμα derma 'skin' and -ῖτις -itis 'inflammation' and eczema is from Greek: ἔκζεμα ekzema 'eruption'.[95]
Society and culture
Some cosmetics are marketed as hypoallergenic to imply that their use is less likely to lead to an allergic reaction than other products.[96] However, the term hypoallergenic is not regulated,[97] and no research has been done showing that products labeled hypoallergenic are less problematic than any others. In 1977, courts overruled the U.S. Food and Drug Administration's regulation of the use of the term hypoallergenic.[96] In 2019, the European Union released a document about claims made concerning cosmetics,[98] but this was issued as guidance, not a regulation.[99]
Research
Monoclonal antibodies are under preliminary research to determine their potential as treatments for atopic dermatitis, with only dupilumab showing evidence of efficacy, as of 2018.[100][101]
References
- ^ ISBN 978-1-4471-2897-7. Archivedfrom the original on 15 August 2016. Retrieved 29 July 2016.
- ^ a b c d e f g h i j k "Handout on Health: Atopic Dermatitis (A type of eczema)". NIAMS. May 2013. Archived from the original on 30 May 2015. Retrieved 29 July 2016.
- ISBN 978-0-323-07699-9.
- ^ ISBN 978-0-323-55188-5.
- ^ S2CID 36038433.
- ^ PMID 27733282.
- ISBN 978-0-323-26607-9. Archivedfrom the original on 17 August 2016. Retrieved 5 July 2016.
- PMID 27185422.
- S2CID 40077567.
- ISBN 978-0-323-08593-9. Archivedfrom the original on 15 August 2016.
- ISBN 978-1-118-44117-6. Archivedfrom the original on 15 August 2016. Retrieved 29 July 2016.
- ISBN 978-3-662-03104-9. Archivedfrom the original on 16 August 2016.
- ^ "Eczema". ACP medicine. Archived from the original on 10 January 2014. Retrieved 9 January 2014.
- S2CID 207536375.
- ^ ICD 10: Diseases of the skin and subcutaneous tissue (L00-L99) – Dermatitis and eczema (L20-L30) Archived 9 January 2014 at the Wayback Machine
- ISBN 978-3-540-23133-2. Retrieved 4 May 2010.
- ^ "Neurodermatitis (lichen simplex)". DermNet New Zealand Trust. 2017. Archived from the original on 2 February 2017. Retrieved 29 January 2017.
- ^ "Neurodermatitis". Mayo Clinic. 2015. Archived from the original on 16 June 2010. Retrieved 6 November 2010.
- ^ Hewett L (2 September 2022). "Eczema in skin of color: What you need to know". National Eczema Association. Retrieved 16 November 2023.
- ^ "Periorificial dermatitis". DermNet New Zealand Trust. 2017. Archived from the original on 2 February 2017. Retrieved 29 January 2017.
- ^ "Dermatitis herpetiformis". DermNet New Zealand Trust. 2017. Archived from the original on 2 February 2017. Retrieved 29 January 2017.
- ^ "Seborrheic dermatitis". DermNet New Zealand Trust. 2017. Archived from the original on 2 February 2017. Retrieved 29 January 2017.
- ^ "Seborrheic Dermatitis". Merck Manual, Consumer Version.
- ^ "CDC Smallpox | Smallpox (Vaccinia) Vaccine Contraindications (Info for Clinicians)". Emergency.cdc.gov. 7 February 2007. Archived from the original on 25 January 2010. Retrieved 7 February 2010.
- ^ PMID 32771354.
- PMID 15878454.
- ^ a b "Atopic Dermatitis (Eczema)". The Lecturio Medical Concept Library. Retrieved 2 July 2021.
- S2CID 205259960. Retrieved 8 March 2022.
- S2CID 23111491.
- PMID 17633128.
- ^ Atopic Dermatitis at eMedicine
- PMID 22197932.
- PMID 22693492.
- PMID 15208605.
- ^ PMID 30886111.
- PMID 20130079.
- ^ PMID 36373988.
- ^ from the original on 21 October 2013.
- ^ a b Institute for Quality and Efficiency in Health Care. "Eczema: Can eliminating particular foods help?". Informed Health Online. Institute for Quality and Efficiency in Health Care. Archived from the original on 21 October 2013. Retrieved 24 June 2013.
- S2CID 25066444.
- S2CID 18445488.
- ^ S2CID 13686180.
- ^ "Coping with atopic dermatitis". 2017. Retrieved 11 September 2017.
- PMID 16365257.
- ^ "Atopic dermatitis: Bleach bath therapy". www.aad.org. Archived from the original on 29 July 2020. Retrieved 4 May 2020.
- )
- PMID 25598014.
- ^ PMID 28166390.
- S2CID 9471706.
- ^ PMID 29708265. Archived from the original(PDF) on 6 March 2020. Retrieved 26 June 2019.
- ]
- S2CID 46445371.
- ^ Oakley A. "Topical corticosteroid withdrawal". DermNet NZ. DermNet New Zealand Trust. Archived from the original on 16 March 2016.
- PMID 23450580.
- ^ PMID 30666626.
- S2CID 42321918.
- PMID 23549982.
- ^ "Atopic eczema - Treatment". NHS Choices, London, UK. 12 February 2016. Archived from the original on 16 January 2017. Retrieved 27 January 2017.
- ^ a b "Medication Guide. Elidel® (pimecrolimus) Cream, 1%" (PDF). US Food and Drug Administration. March 2014. Archived (PDF) from the original on 11 February 2017. Retrieved 27 January 2017.
- S2CID 24638685.
- S2CID 253470127.
- PMID 32927498.
- ^ a b "Incyte Announces U.S. FDA Approval of Opzelura (ruxolitinib) Cream, a Topical JAK Inhibitor, for the Treatment of Atopic Dermatitis (AD)". Incyte. 21 September 2021. Retrieved 21 September 2021 – via Business Wire.
- PMID 15793518.
- S2CID 41245703.
- S2CID 29045951.
- S2CID 25684608.
- ^ Stöppler MC (31 May 2007). "Psoriasis PUVA Treatment Can Increase Melanoma Risk". MedicineNet. Archived from the original on 29 September 2007. Retrieved 17 October 2007.
- PMID 17987197.
- PMID 24399641.
- S2CID 19644659.
- ^ a b "Sulfur". University of Maryland Medical Center. 1 April 2002. Archived from the original on 5 August 2012. Retrieved 15 October 2007.
- PMID 10417508.
- PMID 22336810.
- ^ PMID 23633319.
- PMID 30480774.
- S2CID 9812727.
- ^ Darsow U, Eyerich K, Ring J (October 2007). "Eczema Pathophysiology – World Allergy Organization". www.worldallergy.org. Archived from the original on 2 February 2017. Retrieved 28 January 2017.
{{cite journal}}
: Cite journal requires|journal=
(help) - ^ "Eczema". University of Maryland Medical Center. Archived from the original on 27 July 2016.
- PMID 18206721.
- ISBN 978-3-642-03827-3. Archivedfrom the original on 5 July 2014. Retrieved 21 April 2014.
- ISBN 978-1-55009-378-0. Retrieved 21 April 2014.
- S2CID 30780460. Retrieved 2 July 2021.
- PMID 11551246.
- ^ PMID 16311340.
- ^ Atopic Dermatitis National Eczema Association.
- ^ "Balsam of Peru contact allergy". Dermnetnz.org. 28 December 2013. Archived from the original on 5 March 2014. Retrieved 5 March 2014.
- PMID 23245607.
- PMID 17297524.
- S2CID 2842761.
- PMID 19297652.
- PMID 22674651.
- ^ Liddell HG, Scott R. "Ekzema". A Greek-English Lexicon. Tufts University: Perseus.
- ISBN 978-0-203-09144-9. Archivedfrom the original on 28 May 2016.
- ^ "Definition of ECZEMA". www.merriam-webster.com. Archived from the original on 22 February 2016. Retrieved 15 February 2016.
- ^ a b Center for Food Safety and Applied Nutrition (1 September 2020). ""Hypoallergenic" Cosmetics". FDA.
- S2CID 41482522.
- ^ "Technical document on cosmetic claims". ec.europa.eu. European Commission. Retrieved 7 December 2020.
- ^ Kulliney K (6 September 2019). "EU 'free from' cosmetics claims technical document is guidance, not regulation: Expert". cosmeticsdesign-europe.com. Retrieved 7 December 2020.
- S2CID 4220890.
- S2CID 207484890.
External links
- Eczema Resource Center. American Academy of Dermatology.