Dermatitis Textbook - Adult Nursing

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Dermatitis Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define dermatitis Enumerate types of dermatitis Differentiate between types of dermatitis...

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Dermatitis Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define dermatitis Enumerate types of dermatitis Differentiate between types of dermatitis Understand risk factors and causes and common complication of dermatitis Mention treatment of dermatitis 1 Dermatitis Atopic dermatitis Atopic dermatitis is a type I immediate hypersensitivity disorder characterized by inflammation and hyper reactivity of the skin. The term is used synonymously with atopic eczema. Other terms used to describe this kind of disorder include atopic eczema, atopic dermatitis, and atopic dermatitis/eczema syndrome. Atopic dermatitis is a chronic pruritis inflammatory skin disease. Increased serum IgE levels have been indicated in 80% of the patients with a family history of type 1 allergies, allergic rhinitis, and asthma. Seborrheic Dermatitis Seborrhea is excessive production of sebum (secretion of sebaceous glands), which typically occurs in areas where sebaceous glands are normally found in large numbers, such as the face, scalp, eyebrows, eyelids, sides of the nose and upper lip, malar regions (cheeks), ears, axillae, under the breasts, groin, and gluteal crease of the buttocks. Clinical Manifestations Two forms of seborrheic dermatitis can occur: an oily form and a dry form. Either form may start in childhood and continue throughout life. The oily form appears moist or greasy. There may be patches of sallow, greasy skin, with or without scaling, and slight erythema, predominantly on the forehead, nasolabial fold, beard area, scalp, and between adjacent skin surfaces in the regions of the axillae, groin, and breasts. Small pustules or papulopustules resembling acne may appear on 2 the trunk. The dry form, consisting of flaky desquamation of the scalp with a profuse amount of fine, powdery scales, is commonly called dandruff. Noninfectious inflammatory dermatoses Noninfectious inflammatory dermatoses include dermatologic disorders such as irritant contact dermatitis, psoriasis, and generalized exfoliative dermatitis (also called erythroderma). Irritant Contact Dermatitis Contact dermatitis (also called eczema) is an inflammatory reaction of the skin to physical, chemical, or biologic agents. The epidermis is damaged by repeated physical and chemical irritations. Contact dermatitis may be of the primary irritant type, in which a non-allergic reaction results from exposure to an irritating substance, or it may be an allergic reaction resulting from exposure of sensitized people to contact allergens. Common causes of irritant contact dermatitis are soaps, detergents, scouring compounds, and industrial chemicals. Risk factors include extremes of heat and cold, frequent contact with soap and water, and a preexisting skin disease. Persons at risk include those whose occupations require repeated handwashing (e.g., nurses) or repeated exposure to food or other irritants (e.g., food preparation workers, cleaners, hairdressers). Women tend to be affected more commonly than men. Clinical Manifestations The eruptions begin when the causative agent contacts the skin. The first reactions include pruritus, burning, and erythema, followed closely by edema, papules, vesicles, and oozing or weeping. In the subacute phase, these vesicular 3 changes are less marked, and they occur alternatively with crusting, drying, fissuring, and peeling. Psoriasis Psoriasis is a chronic inflammatory multisystem disorder of the skin that affects approximately 3.2% of Americans. Although the primary manifestation of this non communicable disease tends to involve the skin, psoriasis may involve the oral cavity, eyes (including the lids, conjunctivae, and corneas), and joints. Psoriasis is typically characterized by the appearance of silvery plaques that most commonly appear on the skin over the elbows, knees, scalp, lower back, and buttocks. Clinical Manifestations Psoriasis may range in severity from a cosmetic source of annoyance to a physically disabling and disfiguring disorder. Lesions appear as red, raised patches of skin covered with silvery scales. Complications Asymmetric rheumatoid factor—negative arthritis of multiple joints occurs in up to 42% of people with psoriasis, most typically after the skin lesions appear. Pharmacologic Therapy Three types of therapy are commonly indicated: topical, phototherapy, and systemic. Topical agents, possibly in tandem with phototherapy, are recommended for mild disease. Patients with moderate or severe disease should receive topical agents, phototherapy, and systemic treatment. 1. Methotrexate 2. Cyclosporine 4 3. Infliximab Generalized Exfoliative Dermatitis Generalized exfoliative dermatitis, also called erythroderma, is characterized by a scaling erythematous dermatitis that may involve more than 90% of the skin. Clinical Manifestations This condition starts as a patchy or generalized erythematous eruption accompanied by fever, malaise, and chills. The skin color changes from pink to dark red. Treatment: 1. Home care of dermatitis 2. Use of moistures, topical steroid creams 3. Take antihistamine to reduce sever itching 4. Maintain normal body temperature 5. Avoid triggers that cause allergies 6. After taking bath, it is important to apply lubrication and lotions Diagnostic evaluation: o Physical examination o Skin biopsy o Taking family history and personal health history General risk factors:  Asthma or seasonal allergy  Family history of allergic reaction  Skin allergy to certain stimuli 5  Allergies to dust  Contact with irritants and chemicals  Dry skin  Sudden temperature change (too cold or too high)  Contact with rough material such as wool Exfoliative dermatitis Atopic dermatitis Contact dermatitis 6