tective epidermis exposes the inner layers of skin
and tissues to infection.
Treatment aims to restore skin integrity and
function as well as to remedy any underlying dis-
order. Symptomatic treatment typically includes
oral antihistamines to control itching, topical cor-
ticosteroids to reduce inflammation, and warm
baths. Prolonged or chronic exfoliative dermatitis
may require IMMUNOSUPPRESSIVE THERAPY such as
psoralen plus ultraviolet-A (PUVA) therapy or
methotrexate. The success of treatment depends
on identifying and treating the underlying cause.
Idiopathic exfoliative dermatitis tends to recur,
with periods of exacerbation alternating with peri-
ods of remission.
Nummular dermatitisCircular lesions about the
size of coins that crust and weep are the distinctive
hallmark of nummular dermatitis. Researchers do
not know what causes the lesions to take such a
precise form. Sometimes mistaken for tinea cor-
poris (ringworm) at the onset of an outbreak, the
lesions begin as red, raised circles that quickly
progress. Usually the lesions remain confined to
small areas, and typically recur in the same loca-
tions. Outbreaks can cause significant itching. As
with other forms of dermatitis, antihistamines and
topical corticosteroids help control symptoms.
Severe or persistent symptoms may require a
course of oral or intramuscular corticosteroids.
Seborrheic dermatitisA common cause of DAN-
DRUFF, seborrheic dermatitis affects the sebaceous
structures primarily of the head and face, notably
on the scalp, behind the ears, around the eyebrows,
and in the beard area on men’s faces. Seborrheic
dermatitis may also develop on other parts of the
body that have numerous sebaceous structures,
such as the chest and axilla (underarms), and typi-
cally occurs in a symmetrical pattern. Inflammation
stimulates the sebaceous glands to increase sebum
production, which in turn accelerates the turnover
rate of dermal and epidermal cells that plug the
sebaceous ducts and HAIRfollicles. Key symptoms of
seborrheic dermatitis include oily patches of skin
that crust, scale, and flake.
Most seborrheic dermatitis is idiopathic (occurs
without identifiable cause) and is more common
in people between the ages of 20 and 40. Sebor-
rheic dermatitis that occurs later in life may be a
sign of PARKINSON’S DISEASE, though researchers do
not fully understand this correlation. Treatments
for dandruff are often effective for seborrheic der-
matitis, and emphasize reducing sebum produc-
tion and accumulation.
Stasis dermatitisRestricted or damaged periph-
eral blood circulation allows fluid to collect
between the layers of the skin, causing inflamma-
tion and itching characteristic of dermatitis. The
skin typically becomes discolored, turning reddish
brown, and scaly as the condition persists. People
who have DIABETES, VARICOSE VEINS, PERIPHERAL VAS-
CULAR DISEASE(PVD), orINTERMITTENT CLAUDICATION
have increased risk for stasis dermatitis, as do peo-
ple who have restricted mobility or are bedridden.
The impaired circulation limits the skin’s ability to
resist or fight infection, and can allow the skin to
break down into ulcerations that require aggres-
sive medical intervention. Wearing support hose,
elevating the legs when sitting or lying down, and
walking are measures that help reduce fluid accu-
mulations (edema).Symptoms and Diagnostic Path
Though each type of dermatitis has unique symp-
toms, all types share certain symptoms in com-
mon. These include lesions that:- are erythematous and edematous (reddened
and swollen) - crust, weep, scale, and SCAR
- itch intensely
- recur
The dermatologist often can make the diagnosis
based on the appearance, characteristics, and loca-
tion of the lesions as well as the individual’s age
and family health history. When the diagnosis is
questionable, the dermatologist may biopsy sev-
eral lesions for further examination under the
microscope. Tests for immune response also may
be helpful for confirming a diagnosis.Treatment Options and Outlook
Antihistamine and corticosteroid medications are
the mainstay of pharmacological therapy for
nearly all forms of dermatitis. Secondary bacterial
infections require treatment with antibiotic med-
ications. Most dermatitis is, or becomes, chronic.
Treatment approaches strive to minimize the fre-dermatitis 151