Dermatitis is an inflammation of the skin.

The word dermatitis is used to describe a number of different skin rashes that are caused by infections, allergies, and irritating substances.

The rashes range from mild to severe and can cause the following skin conditions depending on their cause.

Itchiness, Swelling, Painful ulcer, Reddening Thickening, Discoloration, Scaling, Crusting, Blisters, Creasing, Marking.
There are several different types. Usually all of them have in common an allergic reaction to specific allergens

Types of Dermatitis

  • Contact dermatitis. Caused by an allergen or an irritating substance. 
  • Atopic dermatitis. It presents usually with intense pruritus and is often associated with elevated levels of immunoglobulin E (IgE). Individuals who live in urban areas with low humidity are more prone to develop this type of dermatitis.
  • Dermatitis herpetiformis. Appears as a result of a gastrointestinal condition, known as celiac disease.
  • Seborrheic dermatitis. More common in infants and in individuals between 30 and 70 years old. It appears to affect primarily men and it occurs in 85% of people suffering from AIDS.
  • Nummular dermatitis. Also known as discoid dermatitis, it is characterized by round or oval-shaped itchy lesions. (The name comes from the Latin word “nummus,” which means “coin.”)
  • Stasis dermatitis. An inflammation on the lower legs which is caused by buildups of blood and fluid and it is more likely to occur in people with varicose veins.
  • Perioral dermatitis. Inflammation of the skin around the mouth 
  • Infective dermatitis. Dermatitis secondary to a skin infection
contact dermatitis of the face

Contact Dermatitis

Contact dermatitis is an acute or chronic skin inflammation that occurs when the skin comes in contact with a substance that causes a type IV delayed hypersensitivity reaction(allergic contact dermatitis) or when there is an injury to the skin’s surface (irritant contact dermatitis), or when the allergen or irritant is activated by sunlight hence Phototoxic dermatitis occurs.

Types of Contact Dermatitis
  1. Allergic dermatitis. Allergic dermatitis results from direct contact with substances called allergens, such as nickel, chlorine, presenting with; Skin reddening, Blisters that ooze, Itching which can become intense., Swelling in eyes, face and genital areas in severe cases.
  2. Irritant contact dermatitis. This is the most common form of contact dermatitis, Irritant contact dermatitis develops when your skin comes into contact with an irritating substance. Irritant contact dermatitis is either acute or chronic, according to the strength of the irritant, such as acids, kerosene. Stiff, tight feeling skin. May present with mild swelling, Dry, cracking skin, Blisters, Painful ulcers.
  3. Phototoxic contact dermatitis.  It is further divided into two categories, phototoxic and photoallergic 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. It is usually associated only with areas of skin which are left uncovered by clothing especially during scans and x-rays.
Causes of Contact Dermatitis

Contact dermatitis is caused by exposure to a substance that irritates your skin or triggers an allergic reaction, such irritants include;

  • Soaps. Most 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 highly sensitive even when exposed to extremes of temperature and could cause contact dermatitis. 
  • Products that cause a reaction when you’re in the sun (photoallergic contact dermatitis), such as some sunscreens and cosmetics
  • Formaldehyde, which is in preservatives, cosmetics and other products
  • Personal care products, such as body washes, deodorants, hair dyes and cosmetics
  • Plants such as poison ivy and poison oak, cashew nuts, which contain a highly allergenic substance called urushiol
  • Airborne allergens, such as pollen and spray insecticides
  • Nickel, which is used in jewelry, and many other items
  • Medications, such as antibiotic creams, and there side effects such as diazepam, ceftriaxone.
  • Latex and long exposure to wet surfaces such as staying in a wet diaper for a long time.
Signs and Symptoms

Allergic dermatitis is usually affects the area where the trigger has touched the skin, while irritant dermatitis may be more widespread on the skin. Clinical features of both forms include the following:

  • Red rash. This is the commonest reaction. The rash appears immediately in irritant contact dermatitis and later in allergic.
  • Blisters or hives. Blisters and hives     may present in a pattern where skin was directly exposed to the allergen or irritant.
  • Burning skin. Irritant contact dermatitis tends to be more painful than itchy, causing swelling, burning or tenderness
  • Itching. Once the patient is exposed to an irritating substance, the patient presents with severe itching.
  • Crusting. The vesicles start to form a crust as it slowly becomes dry, cracked, and scaly skin.
  • Hyperpigmentation. Leathery patches that are darker than usual often because of scratching from irritation.
Diagnosis of Contact Dermatitis
  • Diagnosis is done by performing patch test. In this test, small samples of a chemical are placed on an area of skin to see if a rash develops.
  • Thorough history taking where the child mentions of use of certain products that are in contact with his or her skin.
  • Note; There are no tests for irritant contact dermatitis, only history of irritating substance that a child regularly come into contact with will prove that a child has irritant contact dermatitis.
Treatment of Contact dermatitis
  • The form of treatment will depend on the cause of dermatitis. Common treatments include;
  1. Cortisone-type creams. In severe cases, drugs containing cortisone may be given orally.
  2. Antihistamines. These are itching relievers.
  3. Dry skin care by use of lotions and creams.
  4. Oatmeal baths also to relieve itching.
  5. Barrier cream. These products can provide a protective layer for the skin.
  6. Avoiding the irritant. The key is to identify the substance that causes the rash so that it could be avoided.


      For allergic contact dermatitis,

  • Avoid contact with substances that cause the skin rash.
  • Wash any child’s area that comes into contact with allergic substances.
  • Learn to recognize and remove poison oak and poison Ivy plants from playing areas of children

   For irritant contact dermatitis,

  • You can also use petroleum jelly to protect the child’s skin. Reapply the petroleum jelly two to three times a day and after washing hands.
  • Avoid contact with substances that irritate the child’s skin.
  • Use mild soaps.
  • Use hand creams frequently.


 Contact dermatitis is a type of hypersensitivity: 

A. Type I.
B. Type II.
C. Type III.
D. Type IV.

4. Answer: D. Type IV.

  • D: Type IV hypersensitivity is a delayed hypersensitivity reaction that are inflammatory in nature initiated by mononuclear leukocytes.
  • A: Type I hypersensitivity is triggered by an innocuous foreign substance (like dust, pollen or animal dander) that would cause no problems in the majority of people.
  • B: Type II hypersensitivity is the process by which IgG or IgM binds to a cell to cause injury or death (Antibody Dependent Cytotoxicity).
  • C: Type III hypersensitivity is tissue damage created by immune complexes, which are aggregations of antigen and antibodies.

Atopic Dermatitis

Atopic dermatitis, often referred to as eczema, is a chronic (long-lasting) disease that causes inflammation, redness, and irritation of the skin.

  • Unknown, idiopathic
  • Atopic dermatitis is the result of either skin barrier dysfunction
  • or immune dysregulation due to genetic defects
Clinical Features

In infancy

  • Severe pruritus: Can cause sleep disturbances in children. Red, very itchy dry patches of skin.
  • Rash on the cheeks that often begins at 2 to 6 months of age.
  • Rash oozes when scratched. Symptoms can become worse if the child scratches the rash. 
  • Chronic or relapsing skin lesions

 In adolescence and early childhood

  • Rash on creases of hands, elbows, wrists, and knees and sometimes on the feet, ankles and neck.
  • Dry, scaly, brownish grey skin rash.
  • Thickened skin with markings.
  • Skin rash may bleed and crust after scratching. 
  • Itch when sweating
  • There are no reliable diagnostic laboratory findings associated with atopic dermatitis.
  • Although there is sometimes elevated total and/or allergen-specific serum IgE level.
Management of Atopic Dermatitis

Atopic dermatitis is a chronic condition which means that it can not be cured. Treatments however, are very effective in reducing the symptoms of itching and dry skin. It has also been found out that provision of prescribed lotions and oral medications can be helpful. These treatments include, corticosteroid creams and antihistamines.

  • You can also do the following to help the Child.
  • Avoid long, hot baths, which can dry the skin.
  • Use Luke warm water instead and give a spong bath to a child.
  • Apply lotion immediately after bathing while the skin is still moist. This will help trap moisture in the skin.
  • Keep the room temperature as regular as possible. Changes in room temperature and humidity can dry the skin.
  • Keep the Child dressed in a cotton. wool silk, and man made fabrics such as polyester can irritate the skin.
  • Use mild laundry soap and make sure that clothes are well rinsed.
  • Watch for skin infections. These should be dealt with immediately.
  • Avoid rubbing or scratching the rash.
  • Use moisturizers several times daily.

Nursing Diagnosis

  • Impaired skin integrity related to contact with irritants or allergens as evidenced by Inflammation
    Dry, flaky skin Erosions, excoriations, fissures, Pruritus, pain, blisters.
  • Disturbed body image related to visible skin lesions as evidenced by patient verbalizing feelings about the change in body appearance, negative feelings about the skin condition, fear of rejection or reactions from others.
  • Risk for infection related to excoriations and breaks in the skin.
  • Risk for impaired skin integrity related to frequent scratching and dry skin.

Nursing interventions

  1.  Assess skin, noting color, moisture, texture, and temperature; note erythema, edema, and tenderness. Specific types of dermatitis may have characteristic patterns of skin changes and lesions.
  2. Identify aggravating factors. Inquire about recent changes in the use of products such as soaps, laundry products, cosmetics, wool or synthetic fibers, cleaning solvents, and so forth.
    Patients may develop dermatitis in response to changes in their environment. Extremes of temperature, emotional stress, and fatigue may contribute to dermatitis.
  3. Skin care. Encourage the patient to bathe in warm water using a mild soap, then air dry the skin and gently pat to dry.
  4. Bathe or shower using lukewarm water and mild soap or non soap cleansers. Long bathing or showering in hot water causes drying of the skin and can aggravate itching through vasodilation.
  5. Topical application. Usual application of topical steroid creams and ointments is twice a day, spread thinly and sparingly.
  6. Acknowledge patient’s feelings. Allow patient to verbalize feelings regarding their skin condition.
  7. Proper hygiene. Encourage the patient to keep the skin clean, dry, and well lubricated to reduce skin trauma and risk for infection.
  8. Assist the patient in articulating responses to questions from others regarding lesions and contagiousness. Patients may need guidance in determining what to say to people who comment about the appearance of their skin. Dermatitis is not a contagious skin condition.
  9. Educate the patient about the skin condition, including triggers, treatment options, and measures to treat symptoms. Providing education regarding these topics can help patients with atopic dermatitis better understand the disease condition and manage the symptoms more effectively.
  10. Encourage the patient to engage in activities that can boost their self-esteem, such as hobbies or exercise. By engaging in enjoyable and fulfilling activities, patients can improve their self-esteem and mood, which can help them adjust with the emotional effects of the skin condition.
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