COMMON ADULT RASHES
Dermatitis The term dermatitis is most commonly used to describe a constellation of skin eruptions. The term is often used interchangeably with eczema . Eczematous also indicates some scaling, crusting, or serous oozing as opposed to mere
erythema. The term dermatitis is typically used with qualifiers (e.g., c ontact dermatitis ) to describe several different skin disorders (Howe, 2022a). Different types of dermatitis and their characteristics are presented in Table 5.
Table 5. Dermatitis and Characteristics Type Characteristics Seborrheic
Common skin disorder characterized by erythematous, scaly patches on the scalp, face, and upper trunk. Dandruff of the scalp is a mild form of seborrheic dermatitis characterized by scaling with minimal inflammation. Severe seborrheic dermatitis is common in HIV infection. A delayed hypersensitivity reaction following topical exposure to an allergen. Patients typically present with a pruritic eruption at the site of exposure. Common allergens include the plant oleoresin urushiol found in poison ivy, metals (e.g., nickel in the jewelry), preservatives, fragrances, topical antibiotics, and paraphenylenediamine (commonly used in hair dyes). The most common form of contact dermatitis. It results from exposure to substances that cause physical, mechanical, or chemical skin irritation. The hands are commonly affected, particularly among food handlers, healthcare workers, mechanical industry workers, cleaners, and housekeepers. Patients may present with erythema, dryness, and/or fissuring of the skin. Stasis eczema is a common inflammatory dermatosis of the lower extremities occurring in patients with chronic venous insufficiency. It typically presents with erythematous, scaling, eczematous patches, and hyperpigmentation on chronically edematous legs. An intensely pruritic, chronic, and recurrent vesicular dermatitis typically involves the fingers, palms of the hands, soles of the feet, and lateral aspects. Also called pompholyx. It typically presents with multiple small, deep-seated vesicles on the palmar or plantar skin, especially along the lateral aspects of the fingers and toes. Large bullae may also form. Erythema, scaling, and fissures can occur in older lesions.
Allergic contact
Irritant contact
Stasis
Dyshidrotic
Atopic dermatitis Atopic dermatitis is a chronic, pruritic, inflammatory skin disease that occurs most frequently in children but also affects adults. Atopic dermatitis is often associated with an elevated serum level of immunoglobulin E (IgE) and a personal or family history of atopy, which describes a group of disorders that includes eczema, asthma, and allergic rhinitis. Although sensitization to environmental or food allergens is clearly associated with the atopic dermatitis phenotype, it does not seem to be a causative factor. However, it may contribute to a subgroup of patients with severe disease (Howe, 2022a). Dry skin and severe pruritus are the cardinal signs of atopic dermatitis. However, the clinical presentation is highly variable, depending upon the patient’s age, ethnicity, and disease activity. Acute eczema is characterized by intensely pruritic, erythematous papules and vesicles with exudation and crusting, whereas subacute or chronic lesions present as dry, scaly, or excoriated erythematous papules. Skin thickening from chronic scratching (lichenification) and fissuring may develop over time. In many patients, lesions in different stages may be present at
In children and adults with deeply pigmented skin, erythema may appear dark brown or violaceous instead of pink or red, as typically seen in patients with lighter complexions. The typical erythematous and scaly eczema lesions may appear with a grayish, violaceous, or dark brown hue. Dry skin may have a whitish or ashy color and a reduction in skin shininess. Lichenified areas typically appear hyperpigmented. Postinflammatory hyper- and hypopigmentation are also common. Treatment goals are to reduce symptoms (pruritus and dermatitis), prevent exacerbations, and minimize therapeutic risks. Standard treatment modalities for the management of these patients are centered around the use of topical anti- inflammatory preparations and moisturization of the skin. However, patients with severe disease may require phototherapy or systemic treatment. A practical guide to visual assessment of eczema severity that also includes the evaluation of disease impact on quality of life and psychosocial well-being has been proposed by the United Kingdom National Institute for Health and Care Excellence (2021). ● Mild : Areas of dry skin, infrequent itching (with or without small areas of redness); little impact on everyday activities, sleep, and psychosocial well-being ● Moderate : Areas of dry skin, frequent itching, redness (with or without excoriation and localized skin thickening); moderate impact on everyday activities and psychosocial well-being, frequently disturbed sleep ● Severe : Widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation); severe limitation of everyday activities and psychosocial functioning, nightly loss of sleep The optimal management of atopic dermatitis requires a multipronged approach that involves the elimination of exacerbating factors, restoration of the skin barrier function and hydration of the skin, patient education, and pharmacologic
the same time (Howe, 2022a). Figure 7. Atopic Dermatitis
From Jambula. (2006). Eczema on arms https://commons.wikimedia. org/wiki/File:Eczema-arms.jpg. In public domain.
Page 44
Book Code: AUS3024
EliteLearning.com/Nursing
Powered by FlippingBook