2. EPIDERMIS:
The epidermis is the most superficial layer of the skin and provides the first barrier of protection from the invasion of foreign
substances into the body. Epidermis, "epi" coming from the Greek meaning "over" or "upon", is the outermost layer of the skin. It
forms the waterproof, protective wrap over the body's surface and is made up of stratified squamous epithelium with an underlying
basal lamina. The main types of cells which make up the epidermis are Merkel cells, keratinocytes, with melanocytes and
Langerhans cells also present
DERMIS:
The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and
strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors (nerve
endings) that provide the sense of touch and heat. It contains the hair follicles, sweat glands, sebaceous glands, apocrine glands,
lymphatic vessels and blood vessels. The blood vessels in derma provide nourishment and waste removal from its own cells as
well as from the Stratum basal of the epidermis
HYPODERMIS: The hypodermis (subcutaneous layer or superficial fascia) lies between the dermis and underlying
tissues and organs. It consists of mostly adipose tissue and is the storage site of most body fat. Its purpose is to attach
the skin to underlying bone and muscle as well of supplying it with blood vessels and nerves. It consists of loose
connective tissue and elastin
3. DERMATITIS :
Dermatitis is inflammation of the upper layers of the skin, causing, itching, blisters, redness, swelling, and often
oozing, scabbing, and scaling. The term eczema is sometimes used for dermatitis. It is an inflammatory reaction of
skin to physical, chemical or biological agents Epidermis is damaged by repeated physical and chemical irritations. It
may be acute or chronic
CAUSES AND RISK FACTORS:
1) Heredity
2) Dryness of skin
3)Interaction b/w a combination of immune system , physical environment and genetic factors
4)Irritants and allergens like rubber, cosmetics allergies
5)Family history of allergic conditions like food allergy, asthma
6)Varicose veins
7)Constant scratching
8)Fungal infections
9)Nickle and gold in jeweller
10)emotional stress
4. CLINICAL MANIFESTATIONS
1. Red rash or bumps
2. Rash varies from a mild, short-lived redness to severe swelling and large blister,
3. Itching which may be severe
4. Dry, cracked, red patches, which may resemble a burn Blisters, draining fluid and crusting in
severe reactions
5. Skin rash limited to an exposed area -for example, directly under a watchband
6. Pain or tenderness
5. DIAGNOSTIC EVALUATIONS
The key to successful treatment of contact dermatitis is identifying what's causing symp-Homs.
Doctors rely on two chief strategies to determine the cause:
A thorough medical history and physical exam
A patch test (contact delayed hypersensitivity allergy test)
6. MANAGEMENT
Treatment is not effective until there is no further contact with the substance causing the
problem. Once the substance is removed, the redness usually disappears after a week.
1. Avoiding the irritant or allergen: The key to avoidance involves identifying what's causing
symptoms and then eliminating exposure to the culprit. It may take two to four weeks for
skin reaction to clear up.
2. Applying anti-itch creams or wet compresses: In mild to moderate cases, self-care measures,
such as using over-the-counter creams containing hydrocortisone or applying wet dressings can
help relieve redness and itching. In addition, small areas of dermatitis can be soothed by
applying pieces of gauze or thin cloth dipped in cool water or aluminum acetate (Burow solution)
several times a day for an hour. Larger areas may be treated with short, cool tub baths with or
without colloidal oatmeal.
3. Oral medications: In severe cases, doctor may prescribe oral corticosteroids to reduce
inflammation, or recommend antihistamines to relieve intense itching. If itching is severe,
hydroxyzine or diphenhydramine (both antihistamines) taken by mouth can be
7. HOME REMEDIES FOR
DERMATITIS
To help reduce itching and soothe inflamed skin, try these self-care strategies
1)Apply an anti-itch cream or calamine lotion to the affected area. A nonprescription cream
containing at least 1 percent hydrocortisone can temporarily relieve itch.
2) Take an over-the-counter antihistamine. A nonprescription oral antihistamine, such
diphenhydramine (Benadryl, others), may be helpful if itching is severe as
3). Apply cool, wet compresses. Moisten soft white washcloths and hold them against
affected areas to soothe skin.
8. 4). Avoid scratching whenever possible. Trim nails and wear white cotton gloves at night If can't
keep from scratching an itchy area, cover it with a dressing and bandages.
5). Wear protective clothing or gloves on the job. If work exposes potentially irritating agents,
it's important to shield skin.
6). Apply a barrier cream or gel. These products can provide a protective layer for skin.
7. Use moisturizer. This can help restore skin's outermost layer and keep skin supple. 8. Apply an
iron-on patch to cover metal fasteners next to skin. Covering clothing fasteners such as metal
fasteners on jeans that come in contact with skin can help avoid allergies and irritation from
metals
9. • NURSING DIAGNOSIS
• 1. Impaired skin integrity related to chronic inflammatory condition of
the skin, contact with irritants or allergens as evidenced by
inflammation, dry, flaky skin, erosions, excoriations, pain, blisters,
erythema, and fissures
• 2 Disturbed body image related to visible skin lesions as evidenced by
verbalizes feelings about change in body appearance verbalizes
negative feelings about skin condition
• . 3. Risk for infection related to impaired skin integrity, severe
inflammation and excoriation.
• 4. Deficient knowledge regarding condition, prognosis, treatment,
self-care, and discharge needs related to lack of exposure/recall;
information misinterpretation and unfamiliarity with information
resources
10. • NURSING INTERVENTIONS
• Maintains optimal skin integrity within limits of the disease. Assess skin,
noting color, moisture, texture, temperature; note erythema, edema,
tenderness. Assess the skin systematically. Look for areas of irritant and
allergic contact.
• Assess skin for lesions. Note presence of excoriations, erosions, fissures, or
thickening. Bathe or shower using lukewarm water and mild soap or non
soap cleansers
After bathing, allow skin to air dry or gently pat the skin dry. Avoid rubbing
or. Brisk drying. Apply topical lubricants immediately after bathing.
• Apply topical steroid creams or ointments reduce inflammation and
promote skin.
• Prepare the patient for phototherapy or photochemotherapy
