Dermatitis

Dermatitis

- General term used for various types of skin inflammation (mostly involve superficial skin layer).

(A)   Atopic dermatitis (also known as eczema) 

-       Common in those who experience hay fever, asthma or chronic urticaria

-       Tends to run in family (genetic factor) and most common in childhood

-        Might be genetics (filaggrin protein maalfunction) + environmental factors ( e.g. allergen)  

·     Signs and symptoms : 

-       Pruritus (itchiness) , redness, inflamed, raised bumpy area(s), dry, scaling and crusted skin ;For moderate to severe conditions: bleeding, blistered or weepy patches

-       Usually happens at skin flexures at arms or legs. Often symmetrical

-       If the condition is chronic, thickening (lichenification) and hyperpigmentation of the skin 

   
·      What are some of the common medicines used to treat the condition and how to use them ? 

(a)   Emollients (ointment, creams, emulsion, lotion)

eg aqueous cream, emulsifying ointment

Apply liberally a few times daily (THREE to FOUR times daily)  to moisturise the skin and use as soap substitute

(b)  Topical corticosteroid – hydrocortisone 0.5%, 1% or clobetasone butyrate 0.05%

Apply to red/angry area ONCE or TWICE daily

(c)   Antihistamine tablet or solution (itching skin) eg cetirizine, loratadine

Take one tablet ONCE daily for itchiness.

(d)  Pinetarsol (Anti-itch solution) 

Add 15–30 mL to a warm to tepid bath (5 mL in baby’s bath or hand basin) and bathe for 5–10 minutes ONCE daily as necessary (could use more often if the itch is severe)

·      Advice 

1.      Use emollient liberally, frequently and continuously and in large quantities (up to 500g per week)

2.      Use topical steroids apprpriately (apply to red/angry area of skin)  when needed for flare up.

3.      Avoid the triggers of eczema/dermatitis  ( eg soap , detergent, some fabric ,  heat and sweating

 

 (B) Other types of dermatitis

Type of dermatitis	Signs and symptoms	Treatments/Advice
Seborrhoeic dermatitis (adult) - is common among us, and it is relatively harmless to our health.  - however, it is persistent and chronic, relapse from time to time	salmon pink scaly rash Tend to be chronic and persistent Red, mild, itchy scaly rash	Topical antifungal eg ketoconazole shampoo(a) Combinations of scalp products containing coal tar, salicylic acid , sulfur eg Coco-Scalp(b) Occasionally use of topical corticosteroid is it is inflamed
Cradle cap infantile seborrhoeic dermatitis)	Confined to the scalp of recently born babies (usually appears withon 6-weeks of life). May involve eyelid and eyebrow Scaly, crusty, greasy, yellow patches over the scalp Child is well and happy (not usually itchy)	- Use baby oil or paw paw ointment to soften the scales (NOT olive oil) - salicylic acid 6% eg Egozite Cradle Cap(b)  1. Gently massage your baby's scalp with your fingers 2. Use a soft brush to loosen the scales. 3. DO NOT peel the hard crust
Irritant contact dermatitis	Occurs when exposed to irritant substances such as soap and chemicals which remove natural oils form skin Red, itchy, dry skin Scaling, cracking and roughness upon repeated contact	Barrier cream Eg. Zinc and castor oil, dimethicone (Silic 15) Topical corticosteroid eg 0.5%; 1% hydrocortisone 1. Avoid irritant if possible  2. Wear protective gloves or use barrier cream 3.Use moisturisers eg cream, lotion
Allergic contact dermatitis	When in contact with allergen such as hair dye, nickels in jewellery, latex gloves etc Redness, swelling, water blisters confined to the area contacted by the allergen Blister may break, forming crusts and scales	Topical corticosteroid eg 0.5%; 1% hydrocortisone or clobetasone butyrate 0.05% ** 1.Identify allergen(s) and avoid them 2.Substitute products made of materials that do not cause rection 3.Use topical corticosteroid appropriately

 ** DO NOT confuse clobetasone butyrate 0.05% (mild topical corticosteroid) with clobetasonl propionate 0.05% ( VERY STRONG [potent] topical corticosteroid) 

·      How to use these products:

(a)   Ketoconazole shampoo

Apply to wet scalp TWICE weekly for up to 4-weeks leave preparation on for 3–5 minutes before rinsing.

May repeat treatment after a 4-weeks break

(b)   Coco-Scalp (coal tar, salicylic acid, sulfur)

Part hair and apply a thin ribbon to the affected area, rub in and leave for 1 hour before rinsing

For mild condition, use ONCE weekly. For severe scaly condition, use ONCE daily for 3-7days)

(c)   Egozite Cradle Cap (salicylic acid 6%)

Ensure scalp is dry. Apply carefully to crusts only, avoiding non-crusted areas. Wipe away any lotion from non-crusted areas with dry cotton wool. Do not comb or remove crusts forcibly.

Apply twice daily for 3 – 5 days without washing hair, then wash hair with gentle Hairscience Nourishing Shampoo.

·      Red flags / referral points 

-       Signs of secondary bacteria infection

-       Not responding to OTC treatment

-       Uncertainty over diagnosis

References

1.     Pharmacy Today Healthcare Guidebook

2.     American Osteopathic College of Dermatology http://www.aocd.org/

3.     Bpac website – contact dermatitis:” a working diagnosis; managing eczema; topical corticosteroid treatment for skin conditions;

4.     Dermnet.nz

5.     NZF

6.     http://www.babycenter.com/0_cradle-cap-infantile-seborrheic-dermatitis_80.bc

All images or photos obtained from Google Image Search.