The document provides an overview of various types of eczema and dermatitis, including atopic dermatitis, contact dermatitis, and others, detailing their symptoms, diagnosis, and treatment options. It emphasizes the importance of identifying triggers, managing inflammation, and maintaining skin integrity through appropriate care. The document also highlights nursing assessments, interventions, and patient education necessary for effective management of these skin conditions.

1. ECZEMA/
DERMATITIS

2. ECZEMA -
 Characterized by redness, itching, and sometimes oozing vesicular lesions,
which may become scaly, crusted, or hardened.

3. Eczema
Atopic
Dermatitis
Contact
Dermatitis
Dyshidrosis
Nummular
(Discoid)
Seborrheic Stasis

4. DIFFERENTIATION AND DIAGNOSIS
 Every type – additional symptoms
 Area of skin affected – Different
 Diagnosis - History and Physical examination
 Patch test – test any allergies
 Skin biopsy

5. ATOPIC DERMATITIS OR ECZEMA
 Chronic inflammatory condition common in young children last into adulthood
 Results from allergy
 As well as exposed skin surfaces like on the face the hands and the feet
 Aggravating factors- Allergens like cigarette, mold, dust mites, changes in
weather, emotional stress
 Signs and symptoms - dry itchy rash on flexor surfaces like creases of wrist,
insides of elbow, back of knees
 Red itchy skin, blister that peel, lichenified skin

6.  Clinical diagnosis
 Based on itchy skin
 >3 criteria
 1) History of dermatitis –Skin creases
 2) Visible dermatitis – Flexural surfaces, personal or family history of Asthma, hay
fever
 3) Presence of dry skin since past year
 4) Symptoms - Age <2yrs
 Age <4 yrs with dermatitis on cheeks, dorsal aspect of extremities

7. TREATMENT
 To decrease inflammation and prevent exacerbations
 Identify the triggers and avoid them – Prevent overheating, manage stress and use
of soft fabrics
 Dry skin treatment - Frequent Moisturization after lukewarm bath
 Oral H1 Antihistamines to reduce itching
 For Inflammation - Topical Corticosteroids
 If uncontrolled by corticosteroids then Topical Calcineurin inhibitors Ex Tacrolimus,
Pimecrolimus
 If uncontrolled then Phototherapy or systemic immunosuppressants (contra in
infants and young children)

9. SEBORRHEIC DERMATITIS
 Chronic relapsing mild type of dermatitis, less common on chest back
and axilla
 Causes :- idiopathic, believed to involve genetic and environmental
factors
 Severity

10. TREATMENT
 Mild with only dandruff – Antifungal agents – shampoo or creams
until remission is achieved
 Moderate to severe with Scale, Inflammation, pruritis – Antifungal
agent with topical corticosteroid

11. DYSHIDROSIS (ACUTE PALMOPLANTAR ECZEMA)
 Condition with intensively pruritic, chronic with recurrent intraepidermal vesicles on PALMS,
SOLES, SIDES OF FINGERS
 Vesicles form coalesce and superinfected remain for several weeks and desiccate and resolve
with desquamation
 Erythema, Scale and fissures can occur in older lesions

12. TREATMENT
 Causes are unknown, but potential triggers are allergens and frequent hand
washing
 Treatment :- Avoid Potential triggers
 Reduce irritation – Lukewarm water, soap free cleansers, emollients,
antihistamines
 Mild to moderate – topical corticosteroids
 Severe – Systemic corticosteroids

13. NUMMULAR DERMATITIS (DISCOID ECZEMA)
 Chronic, Relapsing dermatitis with PRURITIC, ROUND, ECZEMATOUS PLAQUES
(dry and scaly coin shaped 1-10cm diameter on extremities
 Causes – Not understood but the implicated factors are – DRY SKIN,
STAPHYLOCOCCUS AURES, METAL CONTACT, ENVIRONMENTAL ALLERGENS

14. TREATMENT
 Frist line – Topical corticosteroids
 Extensive or unresponsive – PHOTOTHERAPY with NARROWED UV B
PHOTOTHERAPY
 SYSTEMIC IMUNOSUPPRESSANTS – Corticosteroids, Methotrexate,
cyclosporine

15. STASIS DERMATITIS
 Common inflammatory dermatosis occurring in Legs in individuals with chronic
venous insufficiency (blood pooling)
 Presents with

16. TYPES AND TREATMENT
 Acute – Inflamed, weeping Plaques, Vesiculation, Crusting, Pruritis leading to
Lichenification
 Chronic – Hyperpigmentation due to :- Dermal Hemosiderin, Scaling,
Lipodermatosclerosis
 Treatment – venous insufficiency – Manual compression increases blood flow,
compression bandages and stocking, elevating legs above heart
 Surgical – Vein transplant, vein repair or removal
 Skin dryness and pruritis – Gentle skin cleansing and emollients
 Skin inflammation – Topical corticosteroids, in failure use systemically

17. CONTACT DERMATITIS
• Contact dermatitis, a type IV delayed hypersensitivity reaction, is an acute or chronic skin
inflammation that results from direct skin contact with chemicals or allergens.
• Often sharply demarcated inflammation and irritation of the skin caused by contact to substances by
which the skin is sensitive.
• Allergic dermatitis. Allergic dermatitis results from direct contact with substances called allergens.
• Irritant contact dermatitis. Irritant contact dermatitis develops when your skin comes into contact
with an irritating substance.
• Phototoxic contact dermatitis. Phototoxic contact dermatitis is a sunburn-like skin disorder
resulting from direct tissue damage following the ultraviolet light-induced activation of a phototoxic
agent.
• Photoallergic contact dermatitis. Photoallergic contact dermatitis is a delayed-type
hypersensitivity cutaneous reaction in response to a photo antigen applies to the skin in subjects
previously sensitized to the same substance.

18. PATHOPHYSIOLOGY
• Binding. The hapten (small hydrophobic molecules)-protein
complex enters the stratum corneum and binds to epidermal antigen-
presenting Langerhans cells.
• Deception. These cells process the antigen and travel to
regional lymph nodes where they present the antigen to naive CD4 T cells.
• Proliferation. These T cells then proliferate into memory and effector T cells,
which elicit contact dermatitis within 48 to 96 hours of re exposure to the
allergen.

19. STATISTICS AND INCIDENCES
 Contact dermatitis incidences are widespread around the world.
• 80% of cases are caused by excessive exposure to or additive effects of
irritants.
• The most common type of dermatitis is irritant contact dermatitis, which
accounts for about 80% of all cases of contact dermatitis.
• In occupational irritant contact dermatitis, the incidence of confirmed cases is 5
per 100,000 workers.

20. CAUSES
 If there is a history of suffering from allergic conditions, then the skin must be
sensitive and is more likely to develop contact dermatitis.
• Water. You may be surprised, but water can aggravate contact dermatitis,
through frequent hand washing and prolonged contact with water.
• Soaps. All kinds of soaps, detergents, shampoos and other cleaning agents
have harmful substances that could possibly irritate the skin.
• Solvents. Solvents such as turpentine, kerosene, fuel, and thinners are strong
substances that are harmful to the sensitive skin.
• Extremes of temperature. There are people who are really sensitive even when
exposed to extremes of temperature and could cause contact dermatitis.

21. CLINICAL MANIFESTATIONS
 Usually, there are no systemic symptoms unless the eruption is widespread.
• Itching. Once the patient is exposed to an irritating substance, severe itching would
occur.
• Erythema. The skin turns red as a result of the irritation.
• Skin lesions. Vesicles are a common manifestation of contact dermatitis.
• Weeping. Weeping refers to the oozing of the contents of the vesicles, which can be
pus or a watery substance.
• Crusting. The vesicles start to form a crust as it slowly becomes dry.
• Drying. The skin finally becomes dry and peels off.

22. COMPLICATIONS
 Contact dermatitis could lead to the following complications:
• Chronic itchy, scaly skin. A skin condition
called neurodermatitis starts with a patch of itchy skin, which, when
scratched habitually, may result in a thick leathery, and discolored
skin.
• Infection. If a rash is scratched habitually, it may turn into an open
wound wherein bacteria could enter and cause infection.

23. ASSESSMENT AND DIAGNOSTIC FINDINGS
 The location of the skin eruption and the history of exposure aid in
determining the condition.
• Patch test. Patch test on the skin with suspected offending agents
may clarify the diagnosis.
• Thin-layer Rapid Use Epicutaneous (TRUE) test. The patch test
most commonly used is the TRUE test.

24. MEDICAL MANAGEMENT
 The most important step in the medical management of dermatitis is to
recognize the causative factor so that it could be avoided.
• Avoiding the irritant. The key is to identify the substance that causes
the rash so that it could be avoided.
• Phototherapy. There are patients that need light therapy to calm their
immune system, and the method is called phototherapy.
• Medicated baths. Medicated baths are prescribed for larger areas of
dermatitis.

25. PHARMACOLOGIC THERAPY
 Drug therapy for contact dermatitis usually consists of lotion, creams, and oral
medications.
• Hydrocortisone, a corticosteroid, may be prescribed to combat inflammation in a
localized area.
• Antihistamines. Prescription antihistamines may be given if non-prescription
strength is inadequate.
• Barrier cream. These products can provide a protective layer for the skin.
• Antibiotics. Topical or oral antibiotics may be used to treat secondary infection.

26. NURSING MANAGEMENT
NURSING ASSESSMENT
 Skin assessment should be the focus in a patient with contact
dermatitis.
• Skin characteristics. Assess skin, noting color, moisture, texture,
and temperature.
• Lesions. Note erythema, edema, tenderness, presence of erosions,
excoriations, fissures, and thickening.
• Appearance. Assess the patient’s perception of and behavior
related to changed appearance.

27. NURSING DIAGNOSIS
 Based on the assessment data, the major nursing diagnoses are:
• Impaired skin integrity related to contact with irritants or allergens.
• Disturbed body image related to visible skin lesions.
• Risk for infection related to excoriations and breaks in the skin.
• Risk for impaired skin integrity related to frequent scratching and
dry skin.

28. NURSING CARE PLANNING & GOALS
 The major goals for the patient are:
• Patient maintains optimal skin integrity within limits of the disease, as
evidenced by intact skin.
• Patient verbalizes feeling about lesions and continues daily activities
and interactions.
• Patient remains free of secondary infection.
• Patient reports increased comfort level and skin remains intact.

29. NURSING INTERVENTIONS
 Nursing interventions appropriate for the patient include:
• Skin care. Encourage the patient to bathe in warm water using a mild soap, then
air dry the skin and gently pat to dry.
• Topical application. Usual application of topical steroid creams and ointments is
twice a day, spread thinly and sparingly.
• Phototherapy preparation. Prepare the patient for phototherapy, because this
method uses ultraviolet A or B light waves to promote healing of the skin.
• Acknowledge patient’s feelings. Allow patient to verbalize feelings regarding
their skin condition.
• Proper hygiene. Encourage the patient to keep the skin clean, dry, and well
lubricated to reduce skin trauma and risk for infection.

30. EVALUATION
 Expected patient outcomes include:
• Patient maintained optimal skin integrity within limits of the disease,
as evidenced by intact skin.
• Patient verbalized feeling about lesions and continues daily activities
and interactions.
• Patient remained free of secondary infection.
• Patient reported increased comfort level and skin remains intact.

31. DISCHARGE AND HOME CARE GUIDELINES
 To help reduce itching and soothe inflamed skin, the following should be
followed:
• Avoid the irritant. Avoid allowing the reaction-causing substance
to touch the skin
• Anti-itch creams. Apply anti-itch creams or calamine lotion to the affected
area.
• Cold application. Moisten soft cloths and hold them against the rash to
soothe the skin for 15 to 30 minutes.
• Avoid fragrance-containing substances. Choose soaps, powders, and
other personal products that are fragrance-free, as it could irritate the
affected area.

32. DOCUMENTATION GUIDELINES
• Characteristics of lesions or condition.
• Causative and contributing factors.
• Impact of condition on personal image and lifestyle.
• Observations, presence of maladaptive behaviors, emotional changes, level of independence.
• Support system available.
• Recent or current antibiotic therapy.
• Signs and symptoms of infectious process.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcomes.
• Modifications to plan of care.