Dermatitis: A Comprehensive Guide for Nursing Students

Definition

Dermatitis is an umbrella term for inflammation of the skin, characterized by redness, itching,
swelling, and sometimes blistering or oozing. It encompasses a variety of skin conditions with
different causes and presentations, commonly grouped into categories such as atopic dermatitis,
contact dermatitis, and seborrheic dermatitis.

Types of Dermatitis

1. Atopic Dermatitis (Eczema):

o A chronic, inflammatory skin condition often linked to allergies or asthma.
o Common in children but may persist into adulthood.
2. Contact Dermatitis:
o Irritant Contact Dermatitis:
 Caused by exposure to irritants such as detergents, soaps, or chemicals.
o Allergic Contact Dermatitis:
 Caused by an immune response to allergens like poison ivy, nickel, or
latex.
3. Seborrheic Dermatitis:
o A chronic condition affecting areas rich in oil glands, such as the scalp, face, and
upper chest.
o Linked to Malassezia yeast and can appear as dandruff or scaly patches.
4. Nummular Dermatitis:
o Coin-shaped, itchy patches, often on the legs and arms.
o Common in older adults.
5. Stasis Dermatitis:
o Associated with poor circulation, commonly in the lower legs, leading to redness,
scaling, and swelling.
6. Perioral Dermatitis:
o A red, bumpy rash around the mouth, often linked to steroid cream use or
cosmetics.

Causes and Risk Factors

1. Atopic Dermatitis:
o Genetic predisposition.
o Environmental allergens (e.g., dust mites, pollen).
o Dry skin or irritants.
 2. Contact Dermatitis:
o Irritants: Harsh chemicals, soaps, or cleaning agents.
o Allergens: Nickel, fragrances, plants (e.g., poison ivy).
3. Seborrheic Dermatitis:
o Overgrowth of yeast on the skin.
o Hormonal changes or stress.
o Chronic conditions like Parkinson's disease or HIV.
4. Stasis Dermatitis:
o Venous insufficiency or varicose veins.
o Prolonged standing or sedentary lifestyle.
5. General Risk Factors:
o Family history of allergies or asthma.
o Frequent exposure to irritants.
o Poor skin hygiene or excessive dryness.

Pathophysiology

1. Atopic Dermatitis:
o Impaired skin barrier allows allergens to penetrate, triggering an inflammatory
response mediated by immune cells like T-helper cells.
2. Contact Dermatitis:
o Irritant Type: Direct damage to the skin from chemicals or friction.
o Allergic Type: Delayed hypersensitivity reaction, where exposure to an allergen
activates T-cells, causing inflammation.
3. Seborrheic Dermatitis:
o Overgrowth of Malassezia yeast triggers an inflammatory response in areas with
abundant sebaceous glands.
4. Stasis Dermatitis:
o Increased venous pressure leads to leakage of blood into the skin, causing
inflammation and skin changes.

Clinical Manifestations

1. General Symptoms:
o Redness (erythema).
o Itching (pruritus).
o Swelling (edema).
o Dry, cracked skin.
o Scaling or flaking.
2. Atopic Dermatitis:
o Intense itching.
 oDry, thickened patches (lichenification), often in flexural areas (e.g., elbows,
knees).
3. Contact Dermatitis:
o Well-demarcated redness and swelling at the site of exposure.
o Blistering or oozing in severe cases.
4. Seborrheic Dermatitis:
o Greasy, yellowish scales or patches.
o Affects the scalp, eyebrows, and nasolabial folds.
5. Stasis Dermatitis:
o Redness, swelling, and scaling, often near varicose veins.
o Dark pigmentation (hemosiderin deposits) over time.

Diagnosis

1. History and Physical Examination:

o Assess for triggers like allergens, irritants, or family history of eczema.
o Evaluate rash characteristics (e.g., location, appearance).
2. Patch Testing (for Contact Dermatitis):
o Identifies specific allergens causing an allergic reaction.
3. Skin Biopsy:
o May be performed to rule out other conditions like psoriasis or fungal infections.
4. Serum IgE Levels:
o Elevated in atopic dermatitis, indicating an allergic component.
5. Wood’s Lamp Examination:
o Helps identify fungal infections in seborrheic dermatitis.

Medical Management

1. Topical Therapies:
o Corticosteroids:
 Reduce inflammation and itching. Used for short-term management.
o Calcineurin Inhibitors:
 Tacrolimus or pimecrolimus for sensitive areas like the face.
o Moisturizers and Emollients:
 Restore the skin barrier and prevent dryness.
2. Antihistamines:
o Relieve itching, especially at night (e.g., diphenhydramine, loratadine).
3. Systemic Medications:
o Oral Corticosteroids:
 For severe cases or widespread dermatitis.
o Immunosuppressants:
 Cyclosporine or methotrexate for refractory atopic dermatitis.
 4. Antibiotics or Antifungals:
o Used for secondary infections or seborrheic dermatitis associated with yeast.
5. Phototherapy:
o Narrow-band UVB therapy for chronic atopic dermatitis or other refractory forms.
6. Lifestyle Modifications:
o Avoid known triggers (e.g., allergens, irritants).
o Use gentle, hypoallergenic skin care products.

Complications

1. Infections:
o Secondary bacterial infections (e.g., Staphylococcus aureus) due to scratching.
o Fungal or viral infections in compromised skin.
2. Chronicity and Scarring:
o Repeated inflammation leads to thickened skin (lichenification).
3. Psychological Impact:
o Itching and visible rash may cause anxiety, depression, or sleep disturbances.

Nursing Management

Nursing Diagnosis 1: Impaired Skin Integrity related to inflammation and

scratching

Goal: The patient will demonstrate intact skin with reduced redness and itching.

Nursing Interventions:

 Assess the affected areas daily for changes in redness, swelling, or infection.
o Rationale: Early detection prevents worsening.
 Encourage the use of moisturizers immediately after bathing.
o Rationale: Hydrates the skin and restores the barrier.
 Teach the patient to avoid scratching, using mittens or gloves if needed.
o Rationale: Prevents further skin damage and infection.

Nursing Diagnosis 2: Risk for Infection related to compromised skin barrier

Goal: The patient will remain free from signs of infection, such as fever or purulent discharge.
Nursing Interventions:

 Monitor for signs of infection, including redness, warmth, or oozing.

o Rationale: Early intervention reduces complications.
 Administer prescribed antibiotics or antifungals if infection is present.
o Rationale: Treats secondary infections effectively.
 Educate on proper hygiene practices, such as gentle cleansing and avoiding harsh
soaps.
o Rationale: Maintains skin cleanliness without irritation.

Nursing Diagnosis 3: Disturbed Body Image related to visible lesions and

scarring

Goal: The patient will verbalize improved self-esteem and coping strategies.

Nursing Interventions:

 Provide emotional support and encourage the patient to express feelings about their
condition.
o Rationale: Addresses psychological effects of dermatitis.
 Educate on treatment options to improve skin appearance.
o Rationale: Increases confidence in managing the condition.
 Refer to a support group or counselor, if needed.
o Rationale: Promotes coping and mental well-being.

Patient Education

1. Skin Care:
o Use fragrance-free, hypoallergenic products.
o Moisturize frequently to prevent dryness.
2. Trigger Avoidance:
o Identify and avoid allergens or irritants like harsh soaps, certain fabrics, or
specific foods.
3. Managing Symptoms:
o Use cold compresses to relieve itching.
o Avoid hot showers or baths, which can dry out the skin.
4. Signs of Infection:
o Teach patients to recognize symptoms of infection and seek prompt treatment.
5. Follow-Up Care:
o Stress the importance of regular follow-ups to monitor progress and adjust
treatment.
Dermatitis is a manageable condition with appropriate interventions and lifestyle adjustments.
Nurses play a critical role in educating patients, managing symptoms, and preventing
complications, ultimately improving the patient’s quality of life.

Dermatoses: Infectious and Non-Infectious Types for Nursing Students

Definition

Dermatoses refer to a broad range of skin conditions and disorders that affect the skin’s
appearance, texture, or function. They can be classified as infectious (caused by bacteria,
viruses, fungi, or parasites) or non-infectious (caused by genetic, environmental, or systemic
factors).

Infectious Dermatoses

Infectious dermatoses are caused by microorganisms such as bacteria, viruses, fungi, or parasites.

Types of Infectious Dermatoses

1. Bacterial Infections:
o Impetigo:
 Superficial bacterial infection caused by Staphylococcus aureus or
Streptococcus pyogenes.
 Appears as honey-colored crusts on the face or extremities.
o Cellulitis:
 Deep skin infection causing redness, swelling, and warmth.
o Folliculitis:
 Infection of hair follicles caused by bacteria, often Staphylococcus
aureus.
o Erysipelas:
 An acute bacterial infection affecting the dermis, usually caused by
Streptococcus species.
 o Leprosy:
 Chronic infection caused by Mycobacterium leprae, leading to
hypopigmented skin patches and nerve damage.
2. Viral Infections:
o Herpes Simplex Virus (HSV):
 Causes cold sores (HSV-1) or genital herpes (HSV-2).
o Varicella-Zoster Virus:
 Causes chickenpox and shingles (reactivation of the virus).
o Warts (Human Papillomavirus - HPV):
 Benign skin growths caused by HPV.
o Molluscum Contagiosum:
 Caused by a poxvirus, appearing as small, dome-shaped papules.
3. Fungal Infections:
o Tinea Infections (Ringworm):
 Includes tinea corporis (body), tinea capitis (scalp), and tinea pedis
(athlete’s foot).
o Candidiasis:
 Caused by Candida albicans, affecting moist areas like the groin,
armpits, or oral cavity (thrush).
o Pityriasis Versicolor:
 Caused by Malassezia yeast, leading to hypopigmented or
hyperpigmented patches.
4. Parasitic Infections:
o Scabies:
 Caused by Sarcoptes scabiei, leading to intense itching and burrow
tracks.
o Pediculosis (Lice Infestation):
 Caused by lice (head, body, or pubic).
o Cutaneous Larva Migrans:
 Caused by hookworm larvae, presenting as serpiginous tracks on the skin.
5. Viral Exanthems:
o Associated with systemic viral infections, such as measles, rubella, and roseola.

Symptoms of Infectious Dermatoses

 Redness (erythema).
 Itching or burning.
 Swelling.
 Blisters, pustules, or scaly patches.
 Fever and systemic symptoms in severe cases.

Treatment of Infectious Dermatoses

 1. Bacterial Infections:
o Topical or oral antibiotics (e.g., mupirocin for impetigo, amoxicillin-clavulanate
for cellulitis).
2. Viral Infections:
o Antiviral medications (e.g., acyclovir for herpes, valacyclovir for shingles).
3. Fungal Infections:
o Topical or systemic antifungals (e.g., clotrimazole, terbinafine).
4. Parasitic Infections:
o Topical scabicides (e.g., permethrin for scabies) or oral antiparasitic drugs (e.g.,
ivermectin).

Non-Infectious Dermatoses

Non-infectious dermatoses are caused by genetic predisposition, autoimmune conditions,

environmental factors, or systemic diseases. They are not contagious.

Types of Non-Infectious Dermatoses

1. Autoimmune Dermatoses:
o Psoriasis:
 Chronic inflammatory condition with silvery scales on erythematous
plaques, often on the scalp, elbows, or knees.
o Vitiligo:
 Depigmentation caused by destruction of melanocytes.
o Pemphigus Vulgaris:
 Autoimmune blistering disorder involving mucosal and skin surfaces.
o Bullous Pemphigoid:
 Chronic blistering disease, typically in older adults.
2. Inflammatory Dermatoses:
o Atopic Dermatitis (Eczema):
 Chronic, itchy inflammation often associated with allergies or asthma.
o Contact Dermatitis:
 Inflammatory response to irritants (irritant contact dermatitis) or allergens
(allergic contact dermatitis).
o Seborrheic Dermatitis:
 Affects oily areas of the skin, presenting as flaky, yellowish scales.
o Lichen Planus:
 Purplish, flat-topped bumps often associated with an itchy rash.
3. Genetic Dermatoses:
o Ichthyosis:
 Causes dry, scaly skin due to abnormal keratinization.
o Epidermolysis Bullosa:
 A genetic condition causing fragile skin prone to blistering.
4. Pigmentation Disorders:
o Melasma:
 Hyperpigmentation on the face, often due to sun exposure or hormonal
changes.
o Albinism:
 Lack of melanin due to genetic mutation.
5. Neoplastic Dermatoses:
o Basal Cell Carcinoma:
 A slow-growing skin cancer, often appearing as a pearly nodule.
o Squamous Cell Carcinoma:
 Scaly, crusty lesions that may ulcerate.
o Melanoma:
 Aggressive cancer arising from melanocytes, often identified using the
ABCDE criteria.
6. Environmental Dermatoses:
o Photosensitivity:
 Exaggerated skin reaction to sunlight, often drug-induced.
o Frostbite:
 Skin damage caused by freezing temperatures.

Symptoms of Non-Infectious Dermatoses

 Redness and swelling.

 Itching or burning.
 Scaly, flaky, or thickened skin.
 Pigmentation changes (e.g., vitiligo, melasma).
 Blisters or plaques.

Treatment of Non-Infectious Dermatoses

1. Topical Therapies:
o Corticosteroids: To reduce inflammation and itching.
o Calcineurin Inhibitors: For eczema or psoriasis (e.g., tacrolimus).
o Moisturizers: For dry, scaly skin.
2. Systemic Medications:
o Immunosuppressants: For autoimmune conditions (e.g., methotrexate for
psoriasis).
o Biologics: For severe psoriasis (e.g., adalimumab, etanercept).
3. Phototherapy:
o Narrow-band UVB therapy for chronic conditions like psoriasis or vitiligo.
4. Lifestyle and Prevention:
 o Avoid triggers (e.g., allergens, irritants, or sun exposure).
o Use sun protection for photosensitivity or pigmentation disorders.

Comparison: Infectious vs. Non-Infectious Dermatoses

Feature Infectious Dermatoses Non-Infectious Dermatoses

Autoimmune, genetic, environmental, or
Cause Bacteria, viruses, fungi, parasites
systemic
Contagious Yes, often contagious No, not contagious
Redness, scaling, thickened plaques,
Symptoms Redness, itching, blisters, pustules
depigmentation
Antibiotics, antivirals, antifungals, Corticosteroids, immunosuppressants,
Treatment
antiparasitics phototherapy

Nursing Management

Nursing Diagnosis 1: Impaired Skin Integrity related to inflammation or

infection

Goal: The patient will demonstrate intact skin with reduced redness and itching.

Nursing Interventions:

 Monitor affected areas daily for signs of worsening or infection.

o Rationale: Early detection prevents complications.
 Apply prescribed topical medications as directed.
o Rationale: Reduces inflammation or treats infection.
 Educate on proper skin care (e.g., gentle cleansing and moisturizing).
o Rationale: Promotes healing and prevents further irritation.

Nursing Diagnosis 2: Risk for Infection related to compromised skin barrier

Goal: The patient will remain free from secondary infection.

Nursing Interventions:

 Maintain aseptic technique during wound care.

o Rationale: Prevents introduction of pathogens.
  Teach patients to avoid scratching and keep nails trimmed.
o Rationale: Reduces the risk of bacterial superinfection.
 Monitor for signs of systemic infection, such as fever or swelling.
o Rationale: Ensures timely intervention.

Nursing Diagnosis 3: Disturbed Body Image related to visible skin lesions

Goal: The patient will verbalize improved self-esteem and acceptance of appearance.

Nursing Interventions:

 Provide emotional support and encourage open discussion about feelings.

o Rationale: Reduces psychological distress.
 Educate on treatment options and expected outcomes.
o Rationale: Promotes confidence in managing the condition.
 Refer to a support group or counselor, if needed.
o Rationale: Enhances coping strategies.

Patient Education

1. Preventive Measures:
o Maintain good hygiene.
o Avoid known triggers (e.g., allergens, irritants).
2. Treatment Adherence:
o Follow prescribed medication regimens for optimal results.
3. Signs of Complications:
o Teach patients to recognize symptoms of secondary infections or worsening
conditions.
4. Lifestyle Adjustments:
o Use sunscreen and protective clothing for photosensitivity.
o Stay hydrated and moisturize regularly.

Understanding infectious and non-infectious dermatoses helps nursing students provide holistic
care, promote patient education, and prevent complications effectively.