DERMATITIS &

ECZEMA
GROUP 9
 Idah Namwenje 23-0991
Annah Nuli 23-1207
GROUP Abdimagid Mohamed 22-0340
MEMBERS Dickson Mutegi 21- 2356
Joel Kipchumba 21- 2434
 OBJECTIVES
By the end of the presentation, we should be able to
• Define dermatitis
• Classify the types of dermatitis
• Explain the pathophysiology of dermatitis
• Clinical manifestations of eczema and dermatitis.
• List the predisposing factors that predispose someone to dermatitis and eczema
• Explain how to diagnose dermatitis condition.
• Explain various medical, surgical and nursing management methods .
• Provide patient education to a patient suffering from dermatitits
 DERMATITIS
 This is the superficial inflammation of the skin
 It is classified in special features such as cause, pattern, age and type of treatment required.
 Some of the classes are:
Contact dermatitis- which is an itchy rash caused by direct contact to a substance or an
allergic reaction to it.
Atopic dermatitis/ eczema - type 1 hypersensitivity, usually genetic that causes dry,
itchy and inflamed skin
Urticartia - which has an allergic phenomena with presence of edema in upper dermis resulting
from local increase of permeability of capillaries usually from histamine
Drug reaction dermatitis – this is where a drug acts as an antigen and causes a
hypersensitivity reaction.
 Others are:
Lichens simplex chronicus - this results from repeated scratching.
Seborrheic dermatitis - which occurs in increased areas of sebbacan gland activity on
the face, ears, chest, scalp and back
PATHOPHYSIOLO • Characteristic dermatitis lesions appear
sooner in irritant contact dermatitis than in

GY allergic type.
• Manifestations of delayed hypersensitivity,
absorbed agent acting as antigen and
sensitization after several exposures,
appearance of lesions 2-7 days after contact
with allergies.
• Barrier dysfunction.
• Deficiency of structural protein (Fila grin)
can promote inflammation and T cells
infiltration occur.
• Filagrin gene (homozygous suppressive
Alleles) will lead to filagrin metabolism
which cause keratinocyte cytoskeleton.
• Metabolism will also lead to production of
lactic acid, amino acids, urea, sugar,
carboxylic acid, and inorganic salt. This
substance will cause natural moisturizing
factor hence hemostasis 5.5 ph.
• Decrease in the above content will lead to
xerosis in skin . Thus ichthyosis vulgaris
 CLINICAL
MANIFESTATIONS
 ECZEMA
Eczema can appear differently on each
person, and the symptoms can vary based on
the type of eczema and the individual’s skin • Swelling and rash- A rash may appear on the
tone. There are symptoms that appear affected area, which can be bumpy or scaly.
commonly to all individuals affected, they • Oozing and crusting- In severe cases, the
include
rash may ooze and crust, leading to raw and
• Itchiness - which is caused by changes to painful skin.
the skin barrier
some other manifestations may differ as in.
People with eczema have alterations to the INFANTS
skin barrier in the topmost layer of the
epidermis, the stratum corneum. • The rash usually appears on the face, scalp,
arms, legs, chest, and back. It can be oozing and
Because of these structural changes, the cells
are unable to retain water, and they shrink. crusting, leading to an uncomfortable condition.
As natural moisturizing factors decrease, the CHILDREN AND TEENS
skin becomes dry, and gaps open up and • The rash usually appears on the bends of the
enabling entrance of irritants thus itchiness
elbows, behind the knees, neck, wrists, or ankles.
• Redness- The affected area may appear The skin may become scaly and dry
red, pink, purple, brown, or gray,
depending on the individual’s skin tone ADULTS
• The rash usually appears on the face, the backs
• Dryness and cracking- The skin may
become dry, scaly, and cracked, which can of the knees, wrists, hands, or feet. The skin may
lead to pain and discomfort. This is as a become very dry, thick, or scaly
result of changes to skin barrier
 DERMATITIS
Their manifestations are nearly similar as both affect the skin. They vary depending on the type of
dermatitis and they include:
• Atopic dermatitis- Also known as eczema, atopic dermatitis is a chronic condition that often starts in
childhood. It is characterized by patches of dry, scaly skin that can be extremely itchy. Atopic
dermatitis tends to affect the insides of the elbows, behind the knees, and around the neck and
eyelids.
• Contact dermatitis- This type of dermatitis occurs when the skin comes into contact with an
allergen or irritant. Common allergens include poison ivy, nickel, and certain chemicals found in
personal care products. Symptoms include redness, itching, and blisters at the site of contact.
• Seborrheic dermatitis- affects areas of the body with a high concentration of oil glands, such as the
scalp, face, and chest. It is characterized by flaky, greasy skin and can be triggered by stress,
hormonal changes, or certain medications.
• Periorificial dermatitis- This affects the skin around the mouth and eyes. It is more common in
women and is often associated with the use of heavy creams or makeup products. Symptoms include
redness, papules and scaling.
• Dyshidrotic dermatitis- primarily affects the hands and feet. It is characterized by small blisters on
the soles of the feet or palms of the hands that can be painful and itchy.It may be triggered by stress
or exposure to certain metals like chromium or cobalt
PREDISPOSING
FACTORS
 • Genetic predisposition - Some individuals are
genetically predisposed to developing dermatitis, such as
atopic dermatitis. They have a higher risk of developing
the condition due to their inherited genes.
• Allergies - Allergies to substances like pollen, dust
mites, pet dander, and certain foods can trigger allergic
dermatitis.
• Irritants - Contact with irritants such as soaps,
detergents, chemicals, and certain fabrics can cause
irritant dermatitis.

DERMATITI • Environmental factors - Exposure to extreme

temperatures, humidity, and sunlight can contribute to

S dermatitis.
• Stress - Stress can worsen existing dermatitis or trigger
new episodes.
• Infections - Certain infections, such as fungal infections
can lead to dermatitis since the skin is compromised
• Medications - Some medications, such as antibiotics
and chemotherapy drugs, can cause drug-induced
dermatitis.
• Underlying medical conditions- Conditions like
diabetes, thyroid disease, and kidney disease can
increase the risk of developing dermatitis.
ECZEMA
• Infection- Bacterial or viral infections can trigger eczema flare-ups or
exacerbate existing symptoms by causing further inflammation and
impairing skin barrier. Staphylococcus aureus and Streptococcus
pyogenes
• Heat and Sweat - Increased body temperature and sweat can
exacerbate eczema symptoms in some individuals. This is why eczema
is often worse in hot, humid environments or after strenuous exercise.
• Stress
 PHYSICAL EXAMINATION AND MEDICAL HISTORY
•A dermatologist carefully examines the skin during a
physical exam.
•The pattern, location, and appearance of a rash
provide important information about causes of the
rash.

DIAGNOS •The doctor questions about when symptoms appeared,

what parts of the body they affect, and whether a rash

IS
is persistent or comes and goes.
•The doctor may ask on noticeable patterns about when
the rash appears, such as if there is a seasonal variation
or if the rash appears when using certain perfumes or
after exposure to certain metals or fabrics.
•Also family history is important in diagnosis of
eczema. Doctors may also ask about the personal
hygiene products used in the household. Many
cosmetics, moisturizers, and soaps contain irritating
ingredients that may cause eczema .
 PATCH TESTING
Done to identify substances to which the patient has
developed an allergy. The suspected allergens are
applied to normal skin under occlusive patches. After
about 48 hours , the patches are removed and
underlying skin is inspected. If dermatitis develops, the
presence of redness, fine blisters, papules and severe
itching may show a moderate positive reaction. During
testing the patient is advised to leave the patch in
place and not to bathe or scratch under the patch site.

SKIN BIOPSY
Is performed to obtain tissue for microscopic examination.
The procedure, is usually only necessary if doctors have not
been able to diagnose the condition during a physical exam
or patch test.
The doctor typically injects a local anaesthetic to numb the
skin and uses a scalpel, a sharp blade, or punch instrument
to remove a small section of the rash. The biopsied area is
covered by a bandage and heals within a week. The sample
is examined under a microscope to determine whether
eczema or dermatitis is present or if a different skin
condition accounts for the rash.
MEDICAL MANAGEMENT

TOPICAL TREATMENT FOR INFLAMMATION

• At present, the drugs that can sedate the inflammation of AD sufficiently and whose effectiveness and
safeness are proved scientifically are topical corticosteroids and tacrolimus ointment (topical calcineurin
inhibitor).Another topical calcineurin inhibitor widely used elsewhere in the world, pimecrolimus cream.
• The anti-inflammatory effect of topical non-steroid anti-inflammatory drugs (NSAIDs) is extremely weak,
and they sometimes cause contact dermatitis; therefore, they are not well suited for topical treatment
of AD.
• Tacrolimus ointment. Tacrolimus suppresses the functions of T lymphocytes by a mechanism which is
distinct from that of corticosteroids. Tacrolimus ointment can be expected to show a high level of
effectiveness against AD that is difficult to treat with topical corticosteroids. However, the effectiveness
of this medicine depends on absorbance of the drugs and is affected by the region of application and
the condition of the barrier function. It cannot be used for infants under 2 years of age because its
safety has not been proven. In addition, it cannot be used on pregnant or breast-feeding women.
• Topical corticosteroids: The effectiveness of topical corticosteroids and the occurrence rate of topical
side effects parallel each other; therefore it is important to select drugs at ranks appropriate for the
“severity of eruption” without selecting unnecessarily strong topical corticosteroids. Bases of topical
corticosteroids: Bases such as ointment, cream, lotion, and tapes must be selected according to the
condition and site of skin lesion.
MEDICAL MANAGEMENT continued..

TOPICAL TREATMENT FOR SKIN PHYSIOLOGICAL DYSFUNCTION/SKIN CARE

• For the purpose of improving dry skin with decreased barrier functions and preventing recurrence of
inflammation, it is necessary to care for such skin by applying topical emollients/protective agents such as
Lanolin. It was reported that applying moisturizers twice daily significantly reduced the inflammation
relapse of AD.
Systemic treatment
• Atopic dermatitis is characterized by pruritus as a subjective symptom. Drugs with antihistaminic effects
are used for the purpose of suppressing pruritus and preventing exacerbation due to scratching. Example
is Cetirizine hydrochloride.
• Patients with AD are likely to develop complications such as skin bacterial infections caused
by Staphylococcus or hemolytic Streptococcus and Kaposi’s varicelliform eruption caused by herpes simplex
virus. If patients are suspected of having these infections during treatment, appropriate antibiotics or
antiviral drugs should be administrated p.o. immediately.
Other treatments
• Ultraviolet (UV) therapy is one of the alternative (or additional) therapies for AD. There are various
protocols such as UV therapy in combination with topical or short-term oral corticosteroids.
SURGICAL MANAGEMENT
• Skin Biopsy: While not a treatment per se, a skin biopsy may be performed to confirm the
diagnosis and rule out other conditions mimicking dermatitis or eczema.
• Skin Grafting: In cases where dermatitis or eczema has caused significant damage to the
skin, or when there are non-healing ulcers, skin grafting may be performed to replace the
damaged skin with healthy skin from another part of the body.
• Laser Therapy: Various types of laser treatments, such as excimer lasers or photodynamic
therapy (PDT), may be used to manage chronic and severe eczema by targeting affected
areas of the skin.
• These treatments aim to reduce inflammation and promote healing.
• Surgical Debridement: For severe cases of dermatitis or eczema complicated by infected or
necrotic tissue, surgical debridement may be necessary to remove damaged or dead tissue
and promote healing.
• Surgical Correction of Complications: In some cases, chronic dermatitis or eczema can
lead to complications such as secondary infections, chronic wounds, or skin thickening
(lichenification).
• Surgical procedures may be required to address these complications, such as drainage of
abscesses or excision of thickened skin.
 NURSING
MANAGEMEN
T
PATIENT • Focus on care and stress prevention of
hypersensitivity and control signs and symptoms

TEACHIN • Persons with Atopic dermatitis will be given education

as follows:

G
• Avoid soap over lesions because soap is an
irritant.
• Soak affected areas for 15 to 20 minutes in
water for dehydration, pat the skin dry and
immediately apply the recommended lotion/
cream to seal moisture.
• Wet wraps can be used inplace of soaking as it
cools the skin and decreases pruritus.
• Apply corticosteroids in a thin layer. Do not apply
fluconated corticosteroids on the face.
• Avoid wool/ furror rough fibers against the skin.
• Avoid overheating it increases sweating which
irritates the skin.
• Avoid excessive cold, it dries the skin.
• Avoid anything that aggrevates the eczema.
• Rinse all the garments and the bed linen twice to
avoid residue of cleaning agents.
NURSING PROCESS.
 • Nursing History .To obtain history
ask questions.
• Physical assessment .You assess
the colour, temperatures, moisture,
dryness, skin texture and possible
signs of inflammation.
ASSESME • Psychosocial assessment. Can
NT be related to isolation, economic
hardship, depression, frustrations
and rejections. Here the best
treatment is nursing support by
explaining the problem and it's
treatment.
NURSING DIAGNOSES
Alteration in comfort (itching)related to skin lesions.

Potential alteration in skin integrity related to change in barrier functions of

the skin.

Disturbance in self- image related to embarrassment and frustrations over

appearance .

Knowledge deficit on the cause and treatments methods related to eczema as

evidenced by patients asking many questions during treatment.

Ineffective individual coping related to emotional drain of dealing with an

unsightly and often uncomfortable skin care.
PLANNING AND IMPLEMENTATION

Goals includes;
• Relief of comfort.
• Maintenance of skin integrity.
• Acquiring knowledge of skin care.
• Development of self-acceptance.
• Achieving restful sleep.
EVALUATION
• Achieving relief of discomfort. Patient reports relief of
itching.
• Demonstrating increased self acceptance. The patient
voices fewer self-depreciating remarks and pays attention to
appearance.
• Acquiring understanding on skin care .The patient
verbalises rationale of prescribed treatment and
demonstrates ability to perform treatment.
• Patient maintains skin integrity. Patient applies
emollients to skin as prescribed and also protects the skin
from contacts with irritants.
• Achieving restful sleep. The patient states that he or she
 • Brunner and Suddarth's Textbook of
Med.-Surg. Nursing 12th ed. (2 vols) - S.
REFERENC Smeltzer, et al., (Lippincott, 2010) BBS

ES • BT Basavanthappa - Essentials of Medical

Surgical Nursing (2)
THE END