Eczematous dermatitis: Description, Causes and Risk Factors:The group of inflammatory disorders in the eczematous family of skin diseases includes a wide range of entities including, atopic dermatitis, nummular dermatitis, contact dermatitis (both allergic and irritant contact dermatitis), dyshidrotic dermatitis (pompholyx), id reaction, and eczematous drug eruptions. Here is one of the secrets of dermatopathology: all of these entities are essentially histologically identical. They all can demonstrate the three patterns of spongiotic dermatitis depending on when the lesion is biopsied. With some of the entities, there can be clues to the diagnosis histologically, but clinical information is often crucial to the diagnosis. With that in mind, it is important to review some of the clinical aspects of these diseases.Both genetics and environment play a role in the cause of eczematous dermatitis. Many believe that eczematous dermatitis is a genetically inherited condition that is triggered by certain environmental factors such as:Excessive heat.
Dry air (use a humidifier).
Soaps, bubble bath.
Grass during grass pollen season (May and June).
People with fever blisters.
Since there is no real cure, recovery from eczematous dermatitis is all about alleviating the symptoms of dry skin, itchiness, and swollen painful lesions.Symptoms:Severe itching is usually the first symptom of eczematous dermatitis, followed by a red bumpy rash. Skin discoloration, painful sores or lesions, and dry crusty patches are also characteristic symptoms of eczematous dermatitis. If the rash is scratched too intensely the bumps will likely ooze or crack making the condition even more painful.Diagnosis:Eczematous dermatitis is frequently secondarily impetiginized resulting in neutrophilsin the stratum corneum. This is also a key feature of a dermatophyte infection. Whenneutrophils are present in the stratum corneum or upper epidermis, a PAS (periodic acid-Schiff stain) or GMS(Gomori methenamine silver stain) should be performed to exclude a possible fungal infection.Nummular dermatitis and psoriasis may have significant clinical overlap anddifferentiating these entities is often a diagnostic problem. Nummular dermatitishas more edema fluid in the stratum corneum, less uniform hyperplasia, a retainedor thickened granular layer and usually has eosinophils in the dermal infiltrate.These are not features of psoriasis. A minority of cutaneous drug eruptions is eczematous (spongiotic) in nature.They can be indistinguishable from other forms of eczematous dermatitis. Diagnosisrequires good correlation with medication history. Unfortunately, some drug eruptions commence months after initiation of a new medication. In that case it is ultimately up to the clinician to sort out the diagnosis; it is beyond the scope of histologyin that situation.Treatment:The importance of proper skin care, especially selecting an appropriate cleanser and moisturizer, is well established in managing eczematous dermatitis. Although various inflammatory pathways may be triggered during development and progression of specific eczematous dermatoses, such as atopic dermatitis, nummular eczema and asteatotic eczema, epidermal barrier dysfunction is an integral component involved in the pathophysiology of these disorders. Using appropriate gentle skin cleanser formulations and moisturizers during treatment with prescribed topical medications has been shown to enhance therapeutic response. Proper skin care and moisturizer use may also exert both prophylactic and corticosteroid-sparing effects in patients who have atopic dermatitis and corticosteroid-sparing benefit in patients with psoriasis.Corticosteroid creams such as hydrocortisone are used to treat the symptoms of eczematous dermatitis. Severe cases may require an injectable or oral corticosteroid. Oral antihistamines may also help relieve itching, and antibiotics may be prescribed if the rash becomes infected.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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