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  2. INTRODUCTION : Dermatitis is an inflammation of the skin and which are commonly swollen, reddened and irritatingly itchy. Although not an alarming condition, this type of skin diseases can makeyou very uncomfortable, unease and self-conscious. Dermatitis is an itchy inflammation of the skin. It is notcontagious ordangerous, but it can be uncomfortable. There are many types of dermatitis, including allergic dermatitis, eczema, and seborrheic dermatitis (which causes dandruff). A rash is an abnormal condition and reaction of the skin.
  3. DEFINITION : ACCORDING TO BRUNNER AND SUDDHART - Dermatitis is inflammation of the upper layers of theskin, causing itching, blisters, redness, swelling, and often oozing, scabbing, and scaling. ACCORDING TO LEWIS – Dermatitis isan inflammation of the skin and which arecommonly swollen, reddened and irritatingly itchy.
  4. A medical condition in which the skin becomes red, swollen, and sore, sometimes with small blisters, resulting from direct irritation of theskin byan external agentoran allergic reaction to it. According to Lippincott….
  5. INCIDENCE : Itaffects males and females and accounts for 10 to 20 percent of all visits to dermatologists (doctors who specialize in the careand treatmentof skin diseases). Although atopic dermatitis may occur at any age, it most often begins in infancy and childhood. Women tends to develop the disease at an earlierage (20 to 40 years of age ) compared to men ( 60 to 70 years of age ), and women areaffected more frequently.
  6. Stages of dermatitis - Acutedermatitis - Acute dermatitis is characterised by erythema, vesiculation and oozing, often with oedema.
  7. Subacute dermatitis Subacute dermatitis is similar to acute dermatitis, but with scaling and crusting
  8. CHRONIC DERMATITIS - Chronic dermatitis is characterised by thickened dry patches, often lichenified chronicrubbing (increased markings). Lichenification from skin is often predominantly follicular in pigmented skin.
  9. Generalized exfoliative Pompholix Herpitiform Seborrheic Stasis Perioral Atopic Nummular Localized stretch Classification Contact
  10. 1.CONTACT DERMATITIS Contact dermatitis is skin inflammation caused by direct contact with a particular substance. The rash is very itchy, is confined to a specific area, and often has clearlydefined boundaries.
  12. IRRITANT CONTACT DERMATITIS : - Irritant contact dermatitis, which accounts for 80% of all cases of contact dermatitis, occurs when a chemical substance causes direct damage to the skin; symptoms are more painful than itchy. Typical irritating substances are acids, alkalis (such as drain cleaners), solvents (such as acetone in nail polish remover), strong soaps, and plants (such as poinsettias and peppers).
  13. ALLERGIC CONTACT DERMATITIS Allergic contact dermatitis is a reaction by the body's immune substance contacting system to a the skin. Sometimes a person can be sensitized by only one exposure, sensitization occurs and other only after times many exposures to a substance. After a person is sensitized, the next exposure causes itching and dermatitis within 4 to 24 hours.
  14. ATOPIC DERMATITIS Atopic dermatitis is chronic, itchy inflammation of the upper layers of theskin that oftendevelops in peoplewho have hay fever or asthma and in people who have family members with theseconditions. Infants may develop red, oozing, crusted rashes on the face, scalp, diaper area, hands, arms, feet, or legs. Infants may developred, oozing, crusted rashes on the face, scalp, diaperarea, hands, arms, feet, or legs. Treatment The scalp can be treated with a shampoo containing pyrithione zinc, selenium sulfide , an Antifungal drug, salicylicacid and sulfur, or tar.
  15. NUMMULAR DERMATITIS Nummular dermatitis is a persistent, usually itchy, rash and inflammation characterized by coin- shaped spots, often with tiny blisters, scabs, and scales. Most people benefit from skin moisturizers. Other treatments include antibiotics taken by mouth, corticosteroid creams and injections, and phototherapy. Most people benefit from skin moisturizers. Other treatments Include antibiotics taken by mouth, corticosteroid creams and injections, and phototherapy.
  16. 2.SEBORRHOEIC DERMATITIS Seborrhoeic dermatitis (also known as "seborrheic eczema") is an inf lammatoryskin disorder affecting the scalp, face, and trunk. seborrheic dermatitis presents with scaly, flaky, itchy, red skin. The condition's symptoms appeargradually and usually the first signs of seborrheic dermatitis are the flakes of skin called dandruff. TREATMENT : Dermatologist recommend topical treatments such as shampoos, cleansers orcreams/lotions that contain antifungal , antiinf lammatory, sebosuppresive or keratolytic ingredients.
  17. STASIS DERMATITIS Stasis dermatitis is inflammation on the lower legs from pooling of blood and fluid. have varicose (dilated, twisted) veins and swelling (edema). It usually occurs on the ankles but may spread upward to the knees. have varicose (dilated, twisted) veins and swelling (edema). It usually occurs on the ankles but may spread upward to the knees. Treatment Long-termtreatment is aimed at keepingblood from poolingin the veins around the ankles. When sitting, the person should elevate the legs above the level of the heart. Antibiotics are used onlywhen the skin is alreadyinfected
  18. PERIORAL DERMATITIS Perioral dermatitis is a red, bumpy rash around the mouth and on the chin that resembles acne orrosacea Perioral dermatitis is distinguished from acne by the lack of blackheads and whiteheads Treatment is with tetracyclines or other antibiotics taken by mouth.
  19. 3. GENERALIZED EXFOLIATIVE DERMATITIS Generalized exfoliativedermatitis (erythroderma) is severe inflammation that causes the entire skin surface to become red, cracked, and covered with scales. Treatment - Peoplewith severe exfoliative dermatitis often need to be hospitalized and given antibiotics (for infection), intravenous fluids (to replace the fluids lost through theskin) , and nutritional supplements. Corticosteroids (such as prednisone) given by mouth or intravenously.
  20. POMPHOLYX Pompholyx/ dyshidrosis, is a chronic dermatitis characterized by itchy blisters on the palms and sides of the fingers and sometimes on the soles of the feet. The blisters are often scaly, red, and oozing.. Wetcompresses with potassium permanganate oraluminum acetate (Burow's solution) may help the blisters resolve. Strong topical corticosteroid
  21. Dermatitis herpitiform : Dermatitis herpitiform is a particular typeof dermatitis thatappears as a result of a gastrointestinal condition, known as celiacdisease .
  22. 4. LOCALIZED SCRATCH DERMATITIS Localized scratch dermatitis (lichen simplex chronicus, neurodermatitis) is chronic, itchy inflammation of the top layerof the skin. Localized scratch dermatitis can occur anywhere on the body, including the anus (pruritus ani ) and the vagina (pruritus vulvae ), but is most common on the head, arms, and legs. In theearly stages, the skin looks normal, but it itches. Laterdryness scaling, and dark patches developas a resultof the scratching and rubbing. Applying surgical tape saturated with a corticosteroid (applied in the morning and replaced in the evening) helps relieve itching and inflammation and
  24. PATHOPHYISIOLOGY : There is a vasoconstriction of superficial blood vessels and the skin blanches readily Cold and low humilidity are poorly tolerated because of drifting effects Heat and high humidity are poorly tolerated because vasodilatation increases the inflammatory reaction thus aggravating the dermatitis and causing increased the itching and discomfort Lesion become localized to the flexor surface of the neck , to the eyelids , behind the ears , in the anticubital and poplital areas and at the wrist The erythema is now dusty in colour and excoriations may become secondary secondiarily infected
  25. By the late twenties or early thirties the lesions usually disappear , but they may recur at a late date as chronic hand or foot eczema Person with atopic dermatitis is highly suseptable to viral infections, especially herpes, and to bacterial infections, such as those caused by staphyloccus or hemolytic streptococcus There is also an increased incidence of fungal infection such as tinae. By the late twenties or early thristies the lesions usually dissapper ,
  27. CLINICAL MANIFESTATION : Red rash. This is the usual reaction. The rash appears immediately in irritant contact dermatitis; in allergic contact dermatitis, the rash sometimes does not appear until 24–72 hours after exposure to theallergen. Blisters or wheals. Blisters, wheals (welts), and urticaria (hives) often form in a pattern where skin was directly exposed to the allergen or irritant. Itchy, burning skin. Irritant contact dermatitis tends to be more painful than itchy, while allergic contact dermatitis often itches.
  28. Symptomsof dermatitis The symptoms of dermatitis range from mild to severeand will look differentdepending on what part of the body is affected. Not all peoplewith dermatitis experienceall symptoms. In general, the symptoms of dermatitis may include: rashes blisters dry, cracked skin itchy skin painful skin, with stinging or burning redness swelling
  29. MANAGEMENT : MEDICAL MANAGEMENT •Bathing Reduce how often you bath or shower, using lukewarm water. Showers are better. Replace standard soap with a substitute such as a mild detergent soap-free cleanser : your chemist or dermatologist can advise you. • Clothing Wear soft smooth cool clothes; wool is best avoided. •Irritants Protect your skin from dust, water, solvents, detergents, injury. Avoid exposure to environmental or food allergens. Common foods that cause allergic reactions are dairy, soy, citrus, peanuts, wheat (sometimes all gluten containing grains), fish, eggs, corn, and tomatoes. •Emollients Apply an emollient liberally and often, particularly after bathing, and when itchy. Ask your doctor or dermatologist to recommend some to try; avoid perfumed products when possible.
  30. • Topical steroids Apply a topical steroid cream or ointment to the itchy patches fora 5 to 15 day course. •Pimecrolimus cream Pimecrolimus is a new anti- inflammatory cream shown to be very effective for atopic dermatitis, with fewersideeffects than topical steroids. •Antibiotics Your doctor will recommend antibiotics such as flucloxacillin or erythromycin if infection is complicating or causing the dermatitis. The infection is most often with Staphylococcus aureus or Streptococcus pyogenes . •Antihistamines Antihistamine tablets may help reduce the irritation, and are particularly useful at night. • Other treatments Systemic steroids , azathioprine , phototherapy , and other complicated treatments may also be used forseverecases.
  31. Medical care Corticosteroids - A corticosteroid medication similar to hydrocortisone may be prescribed to combat inflammation in a localized area.T his medication may be applied to your skin as a creamor ointment. I f the reaction covers a relatively large portion of the skin or is severe,a corticosteroid in pill or injection form may be prescribed. Antihistamines - Prescription antihistamines may be given if nonprescription strengths are inadequate .
  32. Cleansing Properly UseThe Right Products Protecting The Skin Environment Watch Your Diet Drink Water Prescriptiondrugs Reducing provoking factors NURSING MANAGEMENT :
  34. PREVENTION : Dermatitis relies on an irritantor an allergen to initiatethe reaction, itis importantfor thepatientto identify the responsible agent and avoid it. Inan industrialsetting theemployerhas a duty of care to the individual worker to provide the correct level of safety equipment to mitigate the exposure to harmful irritants. This can take the form of protective clothing, gloves or barrier cream depending on the working environment.
  37. Conclusions– Atopic dermatitis can be treated by following a few basic rules regarding skin hydration, use of a moisturizer, and topical steroid applications to reduce inflammation. The distinction between the various types of contact dermatitis is based on a number of factors. these findings have been acknowledged not to distinguish [9], and even positive patch testing does not rule out the existence of an irritant form of dermatitis as well as an immunological one. It is important to remember, therefore, that the distinction between the types of contact dermatitis is often blurred, with, for example, certain immunological mechanisms also being involved in a caseof irritantcontactdermatitis.