Dr. Angelo Smith discusses various types of dermatitis and eczema. He covers topics such as the characteristic presentations, locations, triggers, and treatment approaches for atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, and seborrheic dermatitis among others. The document provides clinical guidance on distinguishing features, management, and considerations for different forms of dermatitis and eczema.

1. Dr. Angelo Smith M.D
WHPL

2.  10-15% children suffer
from atopic dermatitis
 Asteototic dermatitis is
becoming more and
more common in the
elderly
 Hand dermatitis is a
major cause of absence
from work

3.  Type
 Color
 Shape
 Arrangement
 Duration
 Distribution

4.  Skin symptoms
 Constitutional symptoms
 Travel/Occupation
 Systems review
 Self care

5.  The shape of a lesion frequently gives
clues to the etiology of the skin lesion.
 Shapes include lesions that are: round,
polygonal, polycyclic, annular, iris,
serpiginous, umbilicated,and target.
 Margination is also important – are the
lesions well or ill defined
 Arrangement – are the lesions grouped
or disseminated

6.  A significant number of skin
diseases are limited to specific
regions of the body
 Are the lesions isolated, localized,
regional, or generalized
 Are the lesions symmetrical; limited
to exposed areas, sites of pressure,
or intertriginous areas

9. Historically
 Endogenous (occurring from within)
dermatitis was given the name
“eczema”
 Exogenous dermatitis (occurring from
without) was termed “dermatitis”

10. Endogenous
 Atopic or IgE
 Seborrheic
 Discoid or nummular
 Pompholyx
 Venous
 Asteatotic
 Juvenile plantar
 Erythoderma
Exogenous
 Allergic
 Toxic irritant
contact
 Photosensitive

11.  Any itching rash
 Any red itching rash
 Any red itching rash that has scales or is
dry
 The itch that rashes
 Any rash that cannot otherwise be
identified

12.  An acute, subacute but usually
chronic pruritic inflammation of the
epidermis and the dermis, often
occurring in association with a
personal family history of hay fever,
asthma, allergic rhinitis or atopic
dermatitis. 1
 1 Color Atlas and Synopsis of Clinical Dermatology

13.  Well demarcated plaques of erythema
and edema on which are superimposed
and closely spaced small vesicles filled
with clear fluid with punctate erosions
and crusting
 Distribution may be isolated and
localized or general

14.  Term dyshidrotic is a misnomer as sweat
glands are not involved
 Also known as pompholyx

16.  Plaques of mild erythema with small dry
scales and or superficial desquamation,
sometimes associated with small red, pointed
or round papules
 Distribution may be isolated and localized or
general

17.  Note erythema, swelling and desquamation

18. Commonly misdiagnosed as tinea

19.  Plaques of lichenification with
deepening of the skin lines with satellite,
small, firm flat or round top papules,
excoriations and pigmentations or mild
erythema
Distribution – isolated and localized or
generalized

20.  Note lichenification, scaling and fissuring

21. Commonly misdiagnosed as psoriasis

22. Swelling and
erythema
Punctate erythema,
desquamation Lichenification

23.  10-20% of population
 Primary symptom:
itch
 Location, location,
location
 Associated with
atopic background
Periorbital pallor

24. Characteristics:
 60% have onset in the first year of life
 Influenced by genetics and environmental
factors
 More common in males that females
 Ethnicity may be a factor –less common in
Asians; more common inWesterners and
higher socioeconomic families
 Theory is - manifestation of well nourished
immune system rarely challenged by infection
 Rare to have adult onset
 2/3 of patients have family history of
asthma, hay fever or allergic rhinitis

25.  May persist months to years
 All patients have dry skin
 Exacerbations caused by allergens,
stress, hormones, climate, skin
dehydration
 Physical characteristic may include all
phases
Distinctive Characteristics:
 Lesions are usually bilateral
 Located frequently in skin folds/creases
and flexor surfaces

26. Note:
•Bilateral
•Skin folds and
flexor surfaces

27. Triggers:
Irritants
 Dry skin; bathing without moisturizing
 Harsh/perfumed soaps, detergents
 Disinfectants
 Contact with wool, occupational chemicals/fumes
Allergens
 Dust mites
 Pet dander (cat more allergenic than dog)
 Pollens, seasonal and molds
 Foods- strawberries, carrots

28. Infections
Bacterial
Viral
1. Cold and other URI viruses
2. GI viruses
Fungal
Environmental
Extremes in temperature and/or humidity
Perspiration
Stress

29. Confused with:
 Scabies, seborrhea, psoriasis and,
contact dermatitis

32. Eruption may become generalized, in most cases it first manifests with
severe “cradle cap” or severe intertriginous rashes (groin, neck, axillae).
As the patient approaches age 2 years, the flexor creases become involved.
Lesions consist of scaly, red, and occasionally oozing plaques that tend to be
symmetric.
Occurs on the
 scalp
 face, particularly cheeks
 neck
 chest
 extensor extremities

33. These patients tend to be less acute and lesions less exudative than those seen in
infancy.
Inflamed lesions become lichenified (especially in Asian and African-American
patients)
secondary to chronic rubbing and scratching.
Lesions tend to occur symmetrically, with characteristic distribution in the
flexural folds.
Occurs on the:
Antecubital and popliteal fossae
Neck, wrists, and ankles
May occur on the eyelids, lips, scalp, and
postauricular areas

34. Post inflammatory hyper or hypo pigmented changes tend to be seen.
The appearance of atopic dermatitis may change to a more poorly defined,
itchy, erythematous rash, possibly with papules and/or plaques.
Lichenified plaques of atopic
dermatitis are typically less well
demarcated than are the plaques
seen in psoriasis. These plaques
tend to blend into surrounding
normal skin.

36.  Characteristics: Positive family history is common
 Seen in all age groups equally
 May occur on presternal area and mid upper back
 Stress may increase symptoms
 Pityrosporum ovale may be causative factor
 Distinctive Characteristics:
 Red greasy scaling rash consists of patches and plaques with
indistinct margins and an underlying red glazed look to the
skin
 Most commonly located in the hairy areas, nasolabial folds,
retroauriclar folds
 Excoriations from scratching are rare

37.  Redness and flakes
appear in the head.
 Eruptions on scalp
may appear.
 Treated with
shampoos containing
ketokonazole or
hydrocortisone

41. Characteristic:
 Delayed, cell mediated hypersensitivity
 Strong sensitizer results in reaction soon after
exposure
 Weak sensitizer my take months or years to develop
reaction
 Age does not influence capacity for sensitization but
more common in adults
 Black skin is less susceptible
 Important cause of disability in industry
 Non seasonal

42. Characteristics:
 usually clears quite rapidly on withdrawal of
offending agent
 may appear as erythematous papules, vesicles
or bullous
 more common where epidermis is thinner
Distinctive Characteristics:
 Initial lesions usually limited to contact area
 not bilateral
 lesions with sharp borders or angles are
pathognomonic

43.  Metals- nickel, platinum (10% of women)
 Detergents
 Plants and fibers
 Chemicals and dyes
 Polyethylene glycol and polysorbate 60
 Topical antibiotics and medications
 Animal keratin

46. Note:
distribution

47. Note:
Linear
distribution
with
satellite
lesions

48.  Poison Ivy/Oak/Sumac
linearity

49.  Potassium Dichromate
in Leather

50.  Latex
 Cleaning products
 Cosmetics
 Occupational
exposures
Check the feet and nails!!!

52.  Contact dermatitis with
Nickel.
 Reddish marking and
itching will occur.

53.  Prevention is key!

56.  Coin shaped patches and
plaques
 Secondary to xerosis cutis
 Primary symptom itch
Notice the surrounding xerosis

57.  Characteristics:
 usually -personal or family history of allergy,
especially asthma, hay fever, and childhood
eczema
 Distinctive Characteristics - Coin-shaped
papulovesicular patches that develop in to
scaling and crusting lesions; lesions may be as
large as 4-5cm in diameter with distinct
margins, initial eruptions on arms and legs;
intense itching; tends to be chronic

58.  Characteristics:
 Most severe during winter; may be aggravated
by systematic administration of iodine or
bromine; secondary bacterial infections are
common
 Treatment: skin hydration, topical
corticosteroids, intralesional injection, coal tar
ointments, UVB treatment, treat secondary
infection

59. Note:
•Coin shaped
lesions
• dorsal
surface arms
•bilateral

60.  Extreme case of
xerosis
 Riverbed type cracking

61. Characteristics:
 Seen mainly in elderly
 Worse in the winter
 Precipitated by excessive washing
Treatment:
 Avoid excessive washing and use of soap
 Emollients
 Increase humidity in the environment
 Topical steroids for a short periods of time

62.  Venous hypertension
 Full spectrum of timing
 Id reaction common
 Complicated by ulceration

63. Venous ulceration
Dispigmentation (chronic)
Lipodermatosclerosis

64. Superimposed allegic
contact
Do: 1) dry weeping lesions
2) cover for infection
Don’t: 1) apply neosporin
2) just hope steroids
will fix it

65.  Characterisitcs:
 Origin often small patch of dermatitis or insect bite starting
the itch –scratch- itch cycle
 Condition unrelated to allergies or family history
 More common in women
 Nonseasonal
 aggravated by stress
 worse at night
 may be secondary to atopic eczema, contact dermatitis,
lichen planus, psoriasis, or insect bite

66. Distinctive Characteristics:
 Lesions lichenified or excoriated
 usually limited to a single patch at hairline of
nape of neck or on wrists, ankles, ears, or anal
area
 Not bilateral
 Llichenification of dark skin develops a
“follicular pattern”

68. Prurigo simplex
No fungus on the scrotum!

69. Butterfly sign
Prurigo Nodularis
Consider screening

71.  ConservativeTherapy
1. Education - prevention
2. Use of astringents and
emollients/moisturizers
3. OTC products (hydrocortisone, Benadryl,
Calamine, etc.)
 Low to mid potency steroid creams
 High potency steroid creams
 CoalTar
 PUVA therapy (phototherapy)

72. Moisturize daily
Wear cotton, avoid wool and tight clothes
Take lukewarm showers, using mild soap or
nonsoap cleansers
Pat dry – do not rub
Apply moisturizer within 3 min. to “lock in”
moisture
Avoid extremes of heat / humidity and
perspiration
Learn triggers and how to avoid them
Keep fingernails short
Remove carpets and pets from the home

73. Irritants:
 Recommend non-irritant fabric,
such as cotton. Wool may induce
itching
 Overheating and sweating:
Excess dryness or humidity should be
avoided.
An air conditioner or humidifier in a
child’s bedroom may help to avoid
the dramatic changes in climate that
may trigger outbreaks.
Allergens:
 Environmental elimination of
airborne substances may bring lasting
relief.

75.  Cetaphil
 Aquanil
 Aveeno Daily Mositurizer
 Eucerin Gentle Hydrating Cleanser
 Lobana Body Shampoo
 Moisturel
 pHisoderm
Indications:
For use in those eczema patients who may be
sensitive to one or more of the various potential
sensitizers in soaps and shampoos.
To cleanse, reduce irritation (if sensitive to soaps),
and reduce dryness (thereby increase absorption of
other topicals).

76.  Aquaphor
 Balmex Daily
 AmLactin
 Cutemol
 DML Forte
 Eucerin Original
 Hydrisinol
 Lanolor
 Indication: To soften and soothe rough, dry skin
and increase absorbability of topical medications
 Directions: Apply as necessary or as prescribed;
generally after showering/bathing and pat drying;
apply liberally to affected areas
 Neutrogena Norwegian Formula
 Lac-Hydrin
 Aveeno
 Pen-Kera
 Curel
 Lubriderm AdvancedTherapy
 Minerin

77.  Astringents – reduce secretions (by causing
contraction of tissues) and are antibacterial
 Best used in eczema where vesicular or draining
lesions are present
 Acetic Acid 5% (white vinegar) – especially useful in
Pseudomonas infections
 Burow’s Solution (Domeboro and others)
 Potassium Permanganate

78.  Topical Steroids should be applied only
to inflamed skin (active disease).
 When Topical Steroids are applied
immediately after bathing their
penetration and potency are increased.
 Low-potency topical steroids are
recommended for use on the face and in
skin folds.

80.  Tegrin cream and lotion
 Medotar ointment
 PsoriGel gel
 Polytar andTegrin soaps
 Tegrin,T/Gel, and other shampoos
Indication: to relieve and control itching, and
flaking skin associated with psoriasis and
seborrhea as well as eczema
Directions: Depending on product 1-4 times
daily

81. Contraindications:
 Hypersensitivity
Precautions:
 Do not use on broken skin, genital or rectal area
except on the advise of your health care provider.
 Photosensitivity x 24hr after application
 May stain light colored hair
Warning:
 High concentrations of some chemicals in coal tar
may cause cancer. Concentrations of 0.5% to 5%
appear to be safe.

82. Indications: Psoriasis, eczema, pruritic rashes
of other causes
Consists of psoralen (photosensitizing agent)
followed by UVA phototherapy
Must avoid sunlight for 24h after psoralen
Sessions are 3d/wk, may be from 12-30
sessions, increasing in duration
Side effects are redness, burning, occasional
nausea