DERMATITIS (Eczema)
Posted by recep on June 25th, 2009DERMATITIS
(Eczema)
Often used interchangeably or in combination, the terms eczema and dermatitis indicate superficial inflammation of the skin due to irritant exposure, allergic sensitization (delayed hypersensitivity), genetically determined factors, or idiopathic factors. Pruritus, erythema, and edema progress to vesiculation, oozing, crusting, and scaling. Eventually, the skin may become thickened or lichenified with prominent markings from repeated rubbing or scratching.
Dermatitis of unknown cause is common in the elderly. The patient complains of pruritus; the skin is often excoriated, and papules and lichenified areas may be seen. Frequently, the skin is dry with fine scaling.
Treatment: Patients should avoid any practice or product that might irritate the skin, such as excessive use of soaps and detergents. Clothing made of nonirritating fabrics such as cotton should be worn. An emollient should be used liberally, especially after bathing (see Xerosis, above).
A medium-potency corticosteroid ointment should be applied to affected areas tid to help relieve pruritus and control inflammation. If the skin remains dry, an emollient should be applied between applications of the ointment. Once symptoms are alleviated, topical corticosteroid use can be reduced or even discontinued, but use of an emollient should continue.
An antihistamine may reduce pruritus and help the patient sleep. However, in the elderly these agents must be used cautiously because they sometimes produce paradoxical agitation and are strongly anticholinergic. Phototherapy with ultraviolet light in the 290- to 320-nm range (UV-B) or photochemotherapy with PUVA (psoralens plus UV-A) is sometimes effective; however, it is often inconvenient for the patient because supervised treatments at the phototherapy facility are required two or three times a week for several weeks. Therefore, it is not usually considered a treatment option until all others have failed.
Seborrheic Dermatitis
A scaly, erythematous eruption affecting the central part of the face, eyebrows, eyelids, nasolabial folds, postauricular and beard areas, scalp, and body flexures. The central chest and interscapular areas can also be affected. Seborrheic dermatitis affecting the eyelids causes blepharitis and sometimes associated conjunctivitis. Despite its name, seborrheic dermatitis appears to have nothing to do with sebum.
Treatment: Seborrheic dermatitis of the scalp can be effectively treated with various shampoos. Active ingredients include sulfur, zinc pyri-thione, salicylic acid and sulfur, and tar. The scalp should be shampooed frequently, daily if necessary, and the product left in contact with the scalp for the recommended interval, usually 5 min. If shampooing is inconvenient or physically impossible, the patient can use topical corticosteroid lotions instead. Applied to the scalp bid, such lotions are helpful in severe cases. Hydrocortisone 1% lotion is often sufficient, but many fluorinated corticosteroid preparations are available as well.
Seborrheic dermatitis of the face and trunk is usually effectively treated with hydrocortisone 1% cream applied bid or tid. Preparations containing sulfur or salicylic acid are also helpful.
Seborrheic blepharitis can be treated with hydrocortisone 1% cream. If associated conjunctivitis requires intraocular administration of a corticosteroid ointment or suspension, an ophthalmologist may need to monitor intraocular pressure.
Irritant Contact Dermatitis
The most common form of contact dermatitis, this condition results from skin contact with strong chemicals or other irritants. Although the elderly have a less pronounced inflammatory response to most irritants than do younger patients, chronic irritant dermatitis occurs frequently in the elderly. The reason may be that their slower, muted cutaneous reactions make the contactant less obvious, so exposure continues.
Tags: DERMATITIS (Eczema)
