Definition

Dermatitis is a broad term that refers to the inflammation of the skin. Dermatitis is derived from the Greek words "derm," meaning "skin," and "itis," meaning "inflammation." Typical signs of dermatitis consist of dry skin, erythema, and pruritus or may result in the formation of blisters, fluid discharge, crust, and peeling of the skin. Rashes can vary in severity and can lead to various complications, depending on the root cause. Dermatitis typically does not give rise to significant complications within the body and is not a communicable disease.

There exist several types of dermatitis, which include:

Atopic dermatitis

An atopic dermatitis is a form of dermatitis that is associated with allergic factors that could be inherited. This dermatitis typically manifests during infancy, however it can also occur in adults. Currently, no medication can fully eradicate this disease. Individuals afflicted with atopic dermatitis typically experience intermittent and recurring symptoms. Common symptoms of this condition may manifest as skin rashes with itchiness and a rough and dry appearance.

Contact dermatitis

Contact dermatitis is a condition characterized by inflammation of the skin that occurs when your skin comes into contact with a particular substance and triggers a reaction on the skin. This reaction might manifest as lesions accompanied by burning or stinging sensations, itchiness or blisters. Contact dermatitis is categorized into two types, allergic contact dermatitis and irritant contact dermatitis. Irritant contact dermatitis occurs when an external irritant directly harms the skin, leading to inflammation. In the case of allergic contact dermatitis, the skin is not physically harmed by an external chemical, but rather the immune system responds excessively to it.

Dyshidrotic dermatitis 

This is a skin condition characterized by the formation of small blisters, mainly on the hands and feet. The condition can also affect individuals who sweat too much in these regions. The skin's protective barrier is impaired and leads to pruritus, and skin dryness, accompanied by small blisters.

Seborrheic dermatitis

This condition is also known as cradle cap in infants. It primarily manifests on the scalp, however it could also be found on the face, chest, and in the vicinity of the ears. This condition frequently results in the formation of scaly lesions, skin discoloration, and the presence of dandruff. These symptoms might be exacerbated by stress or sleep deprivation.

Other types of dermatitis

• Neurodermatitis. This condition is characterized by intensely itchy lesions and is frequently provoked by stress or substances that might cause skin irritation.
• Nummular dermatitis. This dermatitis typically manifests as an elliptical or circular rash. It frequently arises following a skin injury. Nummular is a term that describes something that resembles or is similar to a coin.
• Static dermatitis. This dermatitis includes skin alterations resulting from poor circulation. This can lead to changes in the skin pigmentation in the lower extremities, particularly the legs, and may also increase the thickness of the skin.
• Dermatitis neglecta. This dermatitis is caused by the accumulation of sebum (oil), perspiration, corneocytes (skin cells), and germs in a specific area of the skin, resulting in the formation of a thick, sticky crust of dirt.

Causes

Dermatitis is the result of a combination of multiple factors, including:

• Immune system. Occasionally, the immune system may display an excessive response. If you have atopic dermatitis, your immune system will respond to a material or substance that could be common and does not cause any harm in others but causes inflammation on your skin.
• Genetics. Studies indicate that those with a family history of dermatitis have a higher probability of experiencing the condition themselves. Furthermore, alterations in genes responsible for regulating proteins involved in the maintenance of skin health could be found in some dermatitis cases. Maintaining enough protein levels in the body is essential for the health of your skin.
• Environmental factors. External factors can induce alterations in the immune system, leading to changes in the skin barrier. This can lead to loss of skin moisture, which might potentially induce dermatitis. Possible environmental factors that could have an impact include being exposed to cigarette smoke and air pollution. The presence of fragrance in certain skincare products and soaps may also have an impact.
• Exposure to certain substances. Exposure to certain chemicals and irritants can induce particular dermatitis.
• Stress. Elevated levels of stress can also trigger flare-ups and exacerbate symptoms in certain dermatitis.

Risk factor

Several variables that can elevate your risk of developing dermatitis include:

• Age. Dermatitis can manifest at any stage of life, however, atopic dermatitis is more prevalent in children compared to adults and typically begins during infancy.
• History of allergies and asthma. Individuals with a familial or personal history of dermatitis, allergies, or asthma are at a higher risk of experiencing atopic dermatitis.
• Occupations. Occupations involving exposure to metals, solvents, or specific cleaning chemicals can elevate your risk of developing contact dermatitis.
• Specific medical conditions. Seborrheic dermatitis is more likely to occur in individuals with certain health conditions such as congestive heart failure, Parkinson's disease, and HIV/AIDS

Symptoms

The symptoms of dermatitis vary from mild to severe and can exhibit various features based on the affected body area. The symptoms of dermatitis will differ depending on the specific type of dermatitis that is responsible. Typically, dermatitis symptoms might include:

• Skin rashes
• Dry and cracked skin
• Vesicles
• Scaly skin or crusts
• Pruritus
• Skin discomfort characterized by soreness or burning sensation 
• Swelling of the skin
• Thickening or hardening of the skin
• Alterations in skin pigmentation. Dermatitis rashes on darker skin typically manifest as gray, purple, or hyperpigmented rashes compared to the natural skin color. On fairer skin, the lesions typically manifest as pink or red rashes
• When irritated, there could be fluid discharge or bleeding

Diagnosis

The first step in diagnosing dermatitis is to interview with the patient. When you visit a physician, they will ask you about the symptoms you are experiencing. This includes questions about the appearance and location of any skin lesions you may have, how long they have been present, and if you are experiencing any itching. The doctor will also ask about your medical history, including any instances of asthma, allergies, or dermatitis in you or your family. They will also question your history of dermatitis, history of exposure to specific substances before the onset of symptoms, and any medicines that you have. Subsequently, the physician will do a physical examination by directly observing the state of your lesions and skin. Typically, the doctor can diagnose dermatitis by evaluating the information obtained during the interview and physical examinations of the skin. The physician might, however, advise the following diagnostic tests in some cases:

• Blood tests are performed to rule out medical conditions other than dermatitis that could be causing the rash.
• A skin biopsy is performed to distinguish different types of dermatitis. During the procedure, the doctor will collect a small sample of the affected skin and analyze the sample using a microscope.
• Skin allergy test. If the doctor feels that allergy is contributing to the development of symptoms, they may conduct a skin patch test. During this test, various substances (presumed to be the cause of the rashes) in small amounts will be applied as plasters to the skin. After a few days, the plasters will be extracted, and the physician will assess the skin region to find out if you have an allergy to certain substances.

Management

The treatment of dermatitis is determined by the type of dermatitis, the degree of symptoms, and the underlying causes. Certain types of dermatitis are self-limited, such as contact dermatitis, which will improve after you stop contact with the irritant responsible for the rash. Nevertheless, if your dermatitis does not improve spontaneously, your physician may suggest:

• Medicines that will alleviate itchiness and reduce allergic responses, such as antihistamines, like diphenhydramine
• Phototherapy, which involves the controlled exposure of the affected skin area to specific lights
• Corticosteroid creams, such as hydrocortisone, can be used to alleviate itchiness and inflammation
• Lotion or cream for moisturizing dry skin

Complications

A rash caused by dermatitis may be itchy, resulting in an inclination to scratch the lesions. Scratching can lead the skin rashes to be wounded, which could potentially become infected. This skin infection has the potential to spread to nearby skin, although it often poses no significant risk. In individuals with brown and black skin, dermatitis can result in hyperpigmented or hypopigmented lesions. The process of your skin returning to its usual color may take a considerable amount of time, ranging from months to even years.

Prevention

To minimize the chances of developing dermatitis, you can consider these steps:

• Minimize contact with substances that irritate. Wear protective equipment when engaging in activities that would make you exposed to particular irritating substances
• Do not take a shower for too long, limit the duration of your showers to 5 to 10 minutes. Use warm water instead of hot water. Prolonged bathing can cause your skin to dry
• Use soap with gentle ingredients and select unscented soap, certain varieties of soap have the potential to excessively dry your skin
• Rub yourself dry gently with a soft towel after completing your shower
• Apply a moisturizer promptly after showering to your damp skin
• Minimize or reduce stress

When to see a doctor?

It is advisable to seek medical attention if you experience symptoms such as itchy, painful, or burning skin lesions. A physician can help identify the underlying cause of the symptoms and provide appropriate treatments.

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