SYSTEMATIC REVIEW ON THE EPIDEMOLOGY OF DERMATATITIS
Dermatitis, also known as eczema, is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches. The term eczema is also commonly used to describe atopic dermatitis also known as atopic eczema. In some languages, dermatitis and eczema are synonyms, while in other languages dermatitis implies an acute condition and eczema a chronic one. The cause of dermatitis is unclear. One possibility is a dysfunctional interplay between the immune system and skin.
The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin swelling, itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries. Scratching open a healing lesion may result in scarring and may enlarge the rash.
Treatment is typically with moisturizers and steroid creams. If these are not effective, creams based on calcineurin inhibitors may be used. The disease was estimated as of 2010 to affect 230 million people globally (3.5% of the population). While dermatitis is not life-threatening, a number of other illnesses have been linked to the condition, including osteoporosis, depression, and heart disease.
THE EPIDEMOLOGY OF DERMATATITIS
You call it a rash. Your doctor calls it dermatitis. Either way, your skin gets red and tender after you’ve touched something.
It could be caused by an allergy, or because the protective layer of your skin got damaged. Dermatitis is a general term that describes an inflammation of the skin. Dermatitis can have many causes and occurs in many forms. It usually involves an itchy rash on swollen, reddened skin. Skin affected by dermatitis may blister, ooze, develop a crust or flake off. Examples of dermatitis include atopic dermatitis (eczema), dandruff, and rashes caused by contact with any of a number of substances, such as poison ivy, soaps and jewelry with nickel in it.
Dermatitis is a common condition that’s not contagious and usually isn’t life-threatening. Even so, it can make you feel uncomfortable and self-conscious. A combination of self-care steps and medications can help you treat dermatitis.
Globally eczema affected approximately 230 million people as of 2010 (3.5% of the population). The lifetime clinician-recorded prevalence of eczema has been seen to peak in infancy, with female predominance of eczema presentations occurring during the reproductive period of 15–49 years. In the UK about 20% of children have the condition, while in the United States about 10% are affected.
Although little data on the rates of eczema over time exists prior to the Second World War (1939–45), the rate of eczema has been found to have increased substantially in the latter half of the 20th Century, with eczema in school-aged children being found to increase between the late 1940s and 2000. In the developed world there has been rise in the rate of eczema over time. The incidence and lifetime prevalence of eczema in England has been seen to increase in recent times.
Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males, and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%
A moderate case of dermatitis of the hands
Each type of dermatitis may look a little different and may tend to occur on different parts of your body. The most common types of dermatitis include:
• Atopic dermatitis (eczema). Usually beginning in infancy, this red, itchy rash most commonly occurs where the skin flexes — inside the elbows, behind the knees and the front of the neck. When scratched, the rash can leak fluid and crust over. People with atopic dermatitis may experience improvement and then flare-ups.
• Contact dermatitis. This rash occurs on areas of the body that have come into contact with substances that either irritate the skin or cause an allergic reaction, such as poison ivy. The red rash may burn, sting or itch. Blisters may develop.
• Seborrheic dermatitis. This condition causes scaly patches, red skin and stubborn dandruff. It usually affects oily areas of the body, such as the face, upper chest and back. It can be a long-term condition with periods of remission and flare-ups. In infants, this disorder is known as cradle cap.
When to see a doctor
See your doctor if:
• You’re so uncomfortable that you are losing sleep or are distracted from your daily routines
• Your skin becomes painful
• You suspect your skin is infected
• You’ve tried self-care steps without success
Contact dermatitis on the wrist
Seborrheic dermatitis on the face
A number of health conditions, allergies, genetic factors and irritants can cause different types of dermatitis:
• Atopic dermatitis (eczema). This form of dermatitis is likely related to a mix of factors, including dry skin, a gene variation, an immune system dysfunction, bacteria on the skin and environmental conditions.
• Contact dermatitis. This condition results from direct contact with one of many irritants or allergens — such as poison ivy, jewelry containing nickel, cleaning products, perfumes, cosmetics, and even preservatives in many creams and lotions.
• Seborrheic dermatitis. This condition may be caused by a yeast (fungus) that is in the oil secretion on the skin. People with seborrheic dermatitis may notice their condition tends to come and go depending on the season.
A number of factors can increase your risk of developing certain types of dermatitis. Examples include:
• Age. Dermatitis can occur at any age, but atopic dermatitis (eczema) usually begins in infancy.
• Allergies and asthma. People who have a personal or family history of eczema, allergies, hay fever or asthma are more likely to develop atopic dermatitis.
• Occupation. Jobs that put you in contact with certain metals, solvents or cleaning supplies increase your risk of contact dermatitis. Being a health care worker is linked to hand eczema.
• Health conditions. You may be at increased risk of seborrheic dermatitis if you have one of a number of conditions, such as congestive heart failure, Parkinson’s disease and HIV infection
Treatments and drugs
The treatment for dermatitis varies, depending on the cause and each person’s experience of the condition. In addition to the lifestyle and home remedies recommendations below, the cornerstone of most dermatitis treatment plans includes one or more of the following:
• Applying corticosteroid creams
• Applying certain creams or lotions that affect your immune system (calcineurin inhibitors)
• Exposing the affected area to controlled amounts of natural or artificial light (phototherapy)
Diagnosis of eczema is based mostly on the history and physical examination. However, in uncertain cases, skin biopsy may be useful. Those with eczema may be especially prone to misdiagnosis of food allergies. Patch tests are used in the diagnosis of allergic contact dermatitis.
There is no good evidence that a mother’s diet during pregnancy, the formula used, or breastfeeding changes the risk. There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.
People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.
An eczema diagnosis often implies atopic dermatitis (which is very common in children and teenagers) but, without proper context, may refer to any kind of dermatitis. In some languages, dermatitis and eczema are synonyms, while in other languages dermatitis implies an acute condition and eczema a chronic one. The two conditions are often classified together.
There is currently no scientific evidence for the claim that sulfur treatment relieves eczema. It is unclear whether Chinese herbs help or harm. Dietary supplements are commonly used by people with eczema. Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective. Both are associated with gastrointestinal upset. Probiotics do not appear to be effective. There is insufficient evidence to support the use of zinc, selenium, vitamin D, vitamin E, pyridoxine (vitamin B6), sea buckthorn oil, hempseed oil, sunflower oil, or fish oil as dietary supplements.
Other remedies lacking evidential support include chiropractic spinal manipulation and acupuncture. There is little evidence supporting the use of psychological treatments. While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.
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