Dermatitis is a skin inflammation that can be acute or chronic. Atopic dermatitis is a chronic form that usually develops in infants and is associated with family histories of atopic diseases. It is exacerbated by irritants, infections, and allergens. Treatment includes eliminating triggers, antihistamines, topical corticosteroids, and antibiotics for infections. Nursing focuses on skin care education and managing side effects of treatment.

1. DERMATITIS
Class by – Albert Blesson

2. DERMATITIS
• Dermatitis is characterized by inflammation of the skin and may be acute or chronic.
• It occurs in several forms, including contact, seborrheic, nummular, exfoliative, and stasis dermatitis.
• Atopic dermatitis (discussed here),
------------------------------ also commonly referred to as atopic or infantile eczema or Besnier prurigo, is a chronic
inflammatory response typically associated with other atopic diseases, such as bronchial asthma, allergic rhinitis, and chronic
urticaria.
• It usually develops in infants and toddlers between ages 6 months and 2 years, commonly in those with strong family
histories of atopic disease. These children typically acquire other atopic disorders as they grow older. In most cases, this
form of dermatitis subsides spontaneously by age 3 and remains in remission until prepuberty (ages 10 to 12), when it
flares up again.
• The disorder affects about 9 out of every 1,000 people.
• Atopic dermatitis is exacerbated by certain irritants, infections (commonly Staphylococcus aureus), and allergens.
• Common allergens include pollen, wool, silk, fur, ointment, detergent, perfume, and certain foods, particularly wheat,
milk, and eggs. Flare-ups may also occur in response to temperature extremes, humidity, sweating, and stress

8. Signs and Symptoms
• Intense itching
• Erythematous patches in excessively dry areas at flexion points, such as the antecubital fossa, popliteal
area, and neck; in children, may appear on the forehead, cheeks, and extensor surfaces of the arms and legs
• Edema, scaling, and vesiculation because of scratching
• Vesicles that may be pus-filled
• With chronic disease, multiple areas of dry, scaly skin with white dermatographism, blanching, and
lichenification

9. Treatment
• Eliminating allergens and avoiding irritants, extreme temperature changes, and other precipitating factors
• Systemic antihistamines, such as hydroxyzine hydrochloride and diphenhydramine, to relieve pruritus
• Topical application of a corticosteroid cream to alleviate inflammation
• Systemic corticosteroid therapy only during extreme exacerbations
• Weak tar preparations and UVB light therapy to increase the thickness of the stratum corneum
• Antibiotics to fight a bacterial infection; antifungals or antivirals to fight a fungal or viral infection

10. Nursing Considerations
• Help the patient schedule daily skin care. Keep his fingernails short to limit excoriation and secondary infections caused
by scratching.
• Be alert for possible adverse effects associated with corticosteroid use: sensitivity reactions, GI disturbances,
musculoskeletal weakness, neurologic disturbances, and Cushingoid symptoms.
• To help clear lichenified skin, apply occlusive dressings, such as a plastic film, intermittently. This treatment requires a
physician’s order and experience in dermatologic treatment.
• Encourage the patient to verbalize feelings about his appearance, including embarrassment and fear of rejection. Offer
him emotional support and reassurance and arrange for counseling, if necessary.

12. Health education :
• Provide written instructions for skin care and treatment with corticosteroids. Teach the patient and his family to recognize
signs of corticosteroid overdose and to notify the physician immediately if they occur.
• If the patient experiences an excessively dry mouth caused by antihistamine use, advise him to drink water or suck ice chips.
• Warn that drowsiness is possible with the use of antihistamines to relieve daytime itching. If nocturnal itching interferes with
sleep, suggest methods for inducing natural sleep, such as drinking a glass of warm milk, to prevent overuse of sedatives.
• Advise the patient to wear loose cotton clothing to decrease itching.
• Stress the importance of meticulous handwashing and good personal hygiene.
• Caution the patient to avoid bathing in hot water because heat causes vasodilation, which induces pruritus.

13. • Instruct the patient to use plain, tepid water (96°F [35.6°C]) with a nonfatty, nonperfumed soap but to avoid using any soap
when lesions are acutely inflamed. Advise him to shampoo frequently and to apply corticosteroid solution to the scalp
afterward. Suggest using a lubricating lotion after a bath.
• With severe dermatitis, show the patient how to apply occlusive dressings. For example, severe contact dermatitis may
require a topical corticosteroid and occlusion with gloves to increase drug absorption and skin hydration.
• Teach the patient how to apply wet-to-dry dressings to soothe inflammation, itching, and burning; to remove crusting and
scales from dry lesions; and to help dry up oozing lesions.
• Help the patient to identify and avoid aggravating factors and allergens associated with atopic dermatitis.

14. ALOPECIA
Alopecia or hair loss may be idiopathic (alopecia areata), male pattern, physiologic, due to hair pulling
(trichotillomania) or due to scarring from other skin or systemic disorders.
Physiologic alopecia may associated with hormonal changes such as childbirth, nutritional factors, or toxin exposure.

15. Also, chemotherapuetic agents cause some degree of alopecia. This is dependent on the
drug dose, half-life of the drug and duration of therapy. Usually, alopecia begins 2 weeks after administration of
chemotherapy. Hair regrowth takes about 3 to 5 months after the treatment

16. Clinical Manifestations:
Patterned, patchy or diffuse hair loss
Inflammation and scarring with some types
• Medical Management:
• Determine the underlying cause and treat it based on its
etiology.
• Minoxidil may cause fine hair regrowth in male pattern
baldness and alopecia areata. Finasteride, which is an oral
agent, can be used by males only with good results..
• Various methods of hair replacement can be done. This
includes surgical grafting of hair follicles, hair weaving or
use of hair pieces.

17. Nursing Management:
• Explain that alopecia areata and physiologic hair loss are usually only temporary and self-limiting.
• For alopecia due to chemotherapy, assure the client that the hair will eventually grow back a few months after the
treatment.
• Encourage the client to verbalize his/her fears and body-image concerns regarding alopecia, especially if the client is a
teenager or a young adult.
• For females, encourage them to change their hairstyle or to wear head pieces or beautiful head scarfs until their hair grows
back.
• Counsel male patients on the slow and limited effects of minoxidil and stress that when treatment is stopped, the effects are
reversed.
• Encourage to eat a well-balanced diet, especially rich in protein and iron to promote hair growth.
• Promote hair growth by encouraging them to be gentle with their remaining hair and to always keep their scalp and hair
clean.

18. Thank you
REFERENCE
LippincottVISUAL
NURSING
A Guide to Diseases,
Skills, and Treatments
Third Edition