Causes, symptoms, types of dermatitis
Dermatitis skin disease
- Dermatitis symptoms
- Dermatitis causes
- How to distinguish from psoriasis?
Types of dermatitis:
- Dry dermatitis
- Itchy dermatitis
- Infectious dermatitis
- Fungal dermatitis
- Ear dermatitis
- Red dermatitis
- Food dermatitis
- Forms of dermatitis
- Dermatitis treatment
- Diet for dermatitis
Dermatitis is a skin disorder caused by external or internal (physical, chemical, biological) agents, often associated with hereditary predisposition and stress. Dermatitis is manifested by local and general reactions. Depending on the nature and severity of pathogenesis, the disease is accompanied by a decrease in skin functions, impaired homeostasis of the body.
Dermatitis is a term that unites a wide variety of skin diseases into a common nosological group. In textbooks on medical dermatology, skin diseases are designated as mainly local (dermatitis) or systemic (toxidermia, dermatoses). However, there is almost always a relationship between local and general diseases.
Factors of pathogenic effects in dermatitis:
- Stress. In the stage of depletion of adaptive reactions, stress can be the only factor against the background of unstable health (hereditary predisposition, weak immunity) or be combined with other factors of pathogenic influence;
- Contact. Burns (thermal, chemical, solar, allergic), frostbite - all this provokes contact dermatitis;
- Penetration. The pathogen enters the bloodstream through the digestive tract, the respiratory system or parenterally (subcutaneously, intramuscularly, intravenously) - then atopic dermatitis develops.
Dermatitis is closely associated with inflammatory and allergic reactions, occurs in acute and chronic forms, in some cases they are characterized by seasonal exacerbation and persistent course of the disease. In differential diagnosis, mandatory (large) and additional (small) symptoms are distinguished.
Mandatory symptoms characteristic of most dermatitis, regardless of the cause:
- Itching (prurigo). Its intensity depends on the strength of irritation of the skin nerve endings. The discrepancy between the strength of prurigo and skin manifestations (severe itching with minor rashes) is a sign of allergy in atopic dermatitis. In contact dermatitis, itching at the site of application of the pathogen is adequate to damage;
- Redness (erythema). Erythema - increased blood filling of the dermal capillaries. In the acute form, redness with fuzzy edges and swelling is observed. For the chronic course of dermatitis, erythema is not necessary. When pressed, the area of hyperemic skin turns pale for a while. Erythema should not be confused with hemorrhage (bleeding under the skin). Hemorrhage is considered as a separate manifestation in skin pathologies - hemorrhagic diathesis;
Rash (eczema). The morphology of the rash and its localization are typical for a particular dermatitis. The most common localization of rashes is the moving parts of the body (skin over the joints), face, scalp, sides of the body, groin;
- Exudation. In acute forms of dermatitis, exudative inflammation with abundant discharge is possible. In chronic forms - lichenification (thickening of skin areas with a rough pattern), cracks in the skin and excoriation (self-scratching);
- Peeling of the skin (desquamation). Pathological desquamation is caused by increased dryness (xerosis) of the skin with dehydration and insufficiency of the sebaceous glands. Desquamation and xerosis are noted in chronic dermatitis with allergic and inflammatory processes.
Additional symptoms are important in the differential diagnosis of specific dermatitis, they are detected during questioning, examination, laboratory studies and functional tests.
The main forms of inflammatory and allergic skin diseases, excluding occasional dermatitis, are the result of distant (genetic and acquired) and close (provoked) causes.
I. Long-term causes due to genetic and acquired individual predisposition to dermatitis:
- Genetic (hereditary) predisposition to dermatitis. The causes and mechanism of inheritance of damaged genes are not fully understood. Dermatitis of newborns in 30-50% of cases is caused by allergies of one or both parents. Adult dermatitis is implicitly correlated with the allergies of their parents, which can significantly complicate the search for causes and diagnosis;
Acquired predisposition to dermatitis. It was found that 50-70% of people who first became ill with atopic dermatitis acquired sensitivity to dermatitis without the participation of genetic transmission. The parents of these people were not allergic. Proved is a life-long predisposition to dermatitis against the background of defective immunity. It has been noticed that regular training of the immune system with weak antigens, for example, when communicating in small groups, stimulates the development of full-fledged immunity (not to be confused with infections);
- Physical illness, mental anxiety, unfavorable social and living conditions;
- Recovering from infectious, invasive, internal non-infectious diseases, especially in a chronic form.
II. Close causes (trigger factors for dermatitis). When an organism from a relatively stable state under the influence of pathogenic factors develops dermatitis, the trigger mechanism of pathogenesis can be:
Stress. In the everyday sense, stress is associated with poor health. This is a common misconception. Stress is a complex protective and adaptive reaction involving hormones, which consists of several stages. At the first stage, under the influence of the hormone adrenaline, energy is released, and at the last stage, also under the influence of hormones (corticosteroids and others), depletion of the defenses and suppression of the immune system occurs. Stress is a provocateur of an imbalance in a genetically determined and / or acquired predisposition to dermatitis and can be combined with other trigger factors;
- Contact or other way of entering the blood of pathogenic substances (factors) and their further effect on the skin. Pathogens (allergens) can be protein structures, chemical substances, physical factors (solar radiation, heat, frost).
It has been established that dermatitis does not always develop; some people have individual sensitivity or resistance. Based on this, the factors (causes) of dermatitis are divided into obligate and facultative.
Mandatory (obligatory) factors that trigger the pathogenesis mechanism of dermatitis in absolutely all persons exposed to adverse factors:
- Strong allergens (contact and other actions);
- Radiation (sun, quartz, radiation);
High temperature (over 60 0 С);
- Low temperature or prolonged exposure to the skin;
- Aggressive liquids (concentrated acids, alkalis).
Optional (selective) factors that trigger the pathogenesis of dermatitis and have a negative impact only on people with individual hypersensitivity:
- Food, medicines, plant pollen, insect scales, animal hair;
- Some contact allergens (detergents, cosmetics, insect bites);
Temperature from +4 0 С (this is the threshold temperature at which the pathogenesis of contact allergy to cold begins).
Determination of the causes of the disease is a very important stage in the diagnosis of dermatitis and the appointment of adequate, effective treatment.
How to tell psoriasis from dermatitis?
Psoriasis is a non-communicable autoimmune disease.
An external examination of a patient with psoriasis on the skin reveals:
- Plaques are red and pink with a white coating, usually located on the outside of the joints or on the head;
- Itching, dryness and flaking of the skin.
In some cases, psoriasis also reveals:
- Damage to nails and joints;
- Damage to the skin and mucous membranes of the eyes.
Differential diagnosis of psoriasis is carried out using a dermatoscope (optical device for examining the skin with multiple magnification). On the affected area, pathognomonic (leading) symptoms of psoriasis are found that are not found in other dermatitis, namely, peculiar papules and a symptom of `` blood dew ''.
Unique differences between psoriasis and dermatitis:
- Papules in psoriasis consist of dead cells of the epidermis (areas of the skin where the natural process of peeling and renewal is disturbed);
- The symptom of "blood dew" is the result of increased capillary permeability and extravasation (going beyond the capillaries) of the liquid part of the blood.
Types of dermatitis:
Types of dermatitis:
- Dry dermatitis
- Itchy dermatitis
- Infectious dermatitis
- Fungal dermatitis
- Ear dermatitis
- Bullous dermatitis
- Red dermatitis
- Food dermatitis
Dermatitis has a complex classification - almost all dermatitis has several synonyms. The name is based on:
- Localization of pathogenesis (contact, atopic);
- The nature of the reactions (allergic, inflammatory, infectious, fungal);
- The nature of the course of the disease (acute, chronic);
- Name of primary (bullous, vesicular, etc.) or secondary (scaly, etc.) rashes;
- The size of the rash (miliary, numular, etc.);
- Leading symptoms (dry, itchy, exudative, etc.);
- A clinical manifestation of dermatitis that resembles any formation that does not have an etiological basis for this disease (lichen).
An exhaustive list of types of dermatitis can be found in the International Classifier of Diseases (ICD). Below is a description of the general symptoms of dermatitis without differentiation.
It manifests itself in the cold period, usually in the elderly and those with dry skin, prone to allergies. The disease during an exacerbation significantly reduces the quality of life. In advanced cases, it is a provocateur of other forms of dermatitis, complicates the patient's history of diseases (venous insufficiency, swelling of the lower extremities, and others).
Dry dermatitis causes:
- Cold and dry weather, dry indoor air;
- Organic and functional diseases;
- Hereditary factor;
- Psychosomatic factor.
Dry dermatitis has a characteristic localization on the feet, rarely occurs in other areas of the skin. The disease is characterized by:
- Chronic (sluggish) course and pronounced seasonality;
- Xerosis - increased dryness of the skin (the result of insufficient functioning of the sebaceous and sweat glands), cracking of the skin in the affected areas;
- Prurigo (itching) caused by a deficiency of amino acids and trace elements in the skin and dehydration;
- Inflammation - visually manifested by redness and the formation of exudate in the cracks.
Pruritus (prurigo) is the body's response to mild persistent irritation of the nerve endings. Itching is accompanied by scratching and nervousness. Allocate widespread (throughout the body) and local (local) itching.
Common itching results from:
- Atopic allergic dermatitis;
- Diabetes mellitus, liver and kidney diseases;
- Functional and organic brain damage;
- Dysfunction of the sebaceous and sweat glands;
- Allergies to animal hair, insect scales and helminthic infestations.
Local itching is a consequence of:
- Insect bites;
- Atopic allergic dermatitis at the initial stages of pathogenesis;
- Contact forms of dermatitis.
Local itching of various etiologies is diagnosed:
- On moving parts of the body;
- On areas with delicate skin;
- In open areas of the body.
Local itching against the background of venereal, gynecological and andrological diseases, as well as candidiasis and helminthic invasions, is diagnosed in the area:
- Thighs, buttocks and crotch;
- Genital organs.
Local itching against the background of ectoparasitosis and dermatomycosis is diagnosed in the scalp or in the pubic area.
The main clinical forms of pruritic dermatitis:
- Children's pruritus (strofula) develops in the first year of life. The rash appears on the head, face, trunk, arms, legs, and buttocks as bright pink papules with edematous infiltration. As development progresses, mixed forms of rash are revealed - papulovesicles (vesicles at the top of papules). With a prolonged course, a secondary rash is observed in the form of crusts, consisting of dried serous-hemorrhagic exudate;
- Pruritus in adults. It develops as a continuation of the stropulus, but an independent etiology is also possible. In the adult group, the disease is more common in older women. Dermatitis is detected on the outer (extensor) surfaces of the joints, back, abdomen, buttocks. Uncommon damage to the face and the inner (flexion) surface of the joints. A diffuse primary rash is diagnosed in the form of papules that do not merge into plaques. Secondary rash - hemorrhagic or serous crusts.
Pathogenesis takes place in the outer and deep layers of the skin.
Causes of infectious dermatitis:
- Diseases (smallpox, measles, scarlet fever), dermatitis are manifested in the form of primary and secondary rashes;
- Skin wounds, postoperative (surgical) complications that are caused by staphylococcus, streptococcus and other pyogenic microorganisms.
On human skin, surgical complications are diagnosed in the form of:
- Superficial abscesses without clear boundaries (impetigo);
- Limited purulent cavities in the subcutaneous tissue and deeper (abscesses);
- Pustules around one hair follicle, sebaceous gland and surrounding tissues (boils or boils);
- Pustules around several hair follicles or sebaceous glands (carbuncles);
- Spilled, without clear boundaries, purulent inflammation of the subcutaneous tissue (phlegmon).
Fungal dermatitis (dermatomycosis)
For many fungal dermatitis, peculiar rashes are characteristic - mykids.
Mikids (found only with fungal infections) are allergic skin rashes, which, in the presence of concomitant inflammation, manifest themselves as:
- Primary rashes (papules, pustules and others);
- Secondary rashes (crusts)
- Rash at some distance from the fungal colony.
A history of a patient with fungal dermatitis reveals:
- Immune and endocrine system disorders;
- Reducing the natural resistance of the skin and the whole body;
- Increased skin moisture.
It happens in acute and chronic forms, accompanied by severe itching. The acute form is characterized by areas of erythema (redness), swelling, the presence of primary rashes in the form of urticaria, papules and vesicles. With a protracted (chronic) course, peeling, weeping crusts, erosion, a feeling of ear congestion are observed. Wet areas are easily infected when damaged.
Causes of ear dermatitis:
- Auricle scratching;
- Irritation of the skin around the ears;
- Fungal lesions of the ear canal;
- Chemical or mechanical damage to the skin.
If left untreated, the disease can spread to the tissues of the middle and inner ear. For ear dermatitis, relapses and persistent pathogenesis are characteristic.
Bulla (bladder) is a type of primary rash of 0.5 cm or more. Ripe bullae burst with the formation of erosion. Bulla has a bottom that lies on the prickly layer of the dermis, as well as a cavity and a lid. The cavity is filled with serous (yellowish) or hemorrhagic (red) exudate.
Bullae are formed as a result of degeneration (acantholysis) of the thorny layer of the epidermis and are localized on:
- The scalp, back and chest (in men);
- The mucous membranes of the mouth and the red border of the lips.
Ripe bullae burst, crusts and erosion form in their place. Bullous rashes are accompanied by itching, under the bursting bulls, loss of sensitivity is possible. With massive lesions of the oral mucosa and respiratory tract, even a lethal outcome is possible.
Red dermatitis is a chronic skin disease characterized by severe itching and monomorphic nodular eruptions - papules. The color of the papules is pink-red with a purple tint. An important diagnostic sign is an indentation at the top of the papules. Growing papules expand on the periphery and merge into 8-10 cm plaques. The plaques become gray-red and thicken. During the healing phase, areas of brown hyperpigmentation remain in place of the plaques.
Typical localization of red dermatitis:
- Flexion (inner) surface of the joints of the hands;
- Lateral surface of the body;
- The mucous membrane of the mouth and genitals.
Food dermatitis (food allergy)
It is diagnosed from the first days of life. The disease is characterized by a chronic course, in advanced cases it is incurable. The influence of food allergies on the development of asthma in children and adults has been proven.
Food dermatitis in children starts very early. The first skin symptoms in newborns with hypersensitivity to certain foods are:
- Redness on the cheeks and buttocks;
- Seborrheic scales on the head;
- Diaper rash.
Correct diagnosis of the causes of food intolerance will save the baby from many problems in the future. Before contacting an allergist, you should pay attention to the baby's quality of life and the environment.
Potential factors for provoking food allergies in children include:
- Unfavorable ecological situation;
- Genetic predisposition;
- Frequent consumption of foods containing allergens.
Food dermatitis in adults looks a little different. Hypersensitivity is manifested after a meal in the form of:
- Flatulence (increased gas production) and a feeling of heaviness in the abdomen, heartburn, indigestion;
- Itching without a rash;
- Runny nose, nasal congestion, allergic conjunctivitis;
- Fatigue, weakness and swelling of the limbs.
- Rarely - an increase in body temperature.
Forms of dermatitis
Dermatitis can occur in acute and chronic form. Some medical experts point to a subacute course. However, it is difficult to establish the boundaries of this form of the disease, the definition is based on the subjective feelings of the doctor.
The onset of the acute form is characterized by sudden itching, a slight increase in temperature, possibly rhinitis (inflammation of the nasal mucosa) - this is characteristic of allergic atopy. Symptoms associated with the underlying disease and rashes consisting of a primary rash are signs of infectious dermatitis caused by viruses, fungi, or bacteria. For acute forms of dermatitis, general symptoms of inflammation of moderate intensity are characteristic (limited redness, swelling, soreness, dysfunction, increased local temperature). As for the morphology of the rash, in the acute phase there are papules, vesicles, and less often bullae.
In the chronic course of the disease, the symptoms of inflammation are erased. Secondary rashes are found on the body.
Based on the type of secondary rash, in some cases it is possible to predict the outcome of the disease:
- Unfavorable outcome - atrophy;
- Doubtful outcome - scabs, cracks, scales, abrasions, ulcers, erosion;
- Completion of pathology - healing without a trace, hyperpigmentation, dyschromia, depigmentation, lichenification, scar.
Due to the wide spread of dermatitis of various etiopathogenesis, scientists and physicians have developed schemes and methods for the treatment of skin diseases based on drugs and physiotherapeutic agents. There are no universal treatments for dermatitis. Therefore, all therapy regimens, the necessary medications and the duration of the course of treatment are determined by the doctor individually for each patient.
All modern methods of dermatitis treatment are based on three principles:
- The principle of a comprehensive diagnosis, which includes traditional and new methods of examining the skin and the patient's body, determining the causes of the disease and the nature of the pathogenesis;
- The principle of multifactorial impact on the pathogenesis of the disease, including neutralization of the pathogenetic effect of the agent, impact on the symptoms of the disease in order to eliminate disturbing factors and adjust the body's defenses (medication and psychotherapeutic);
- The principle of continuity of treatment. Therapy for dermatitis is related to the time required for the complete regeneration (restoration) of skin tissues. It has been proven that the period of complete regeneration (cell renewal) of the skin is at least 28 days.
You may also be interested in the article on home treatment for dermatitis. But do not forget that a consultation with a doctor is required!
Diet for dermatitis and proper nutrition
In case of allergic dermatitis, a special diet and balanced nutrition are included in the patient's recovery system. Properly organized nutrition and hypoallergenic foods in the patient's diet are the key to the non-intake of new doses of allergens into the body. Before visiting a doctor, you must independently determine the minimum list of products that can be consumed without the risk of exacerbating allergic reactions.
Low allergy products:
- Protein - some types of fish (cod and sea bass), lean veal, offal (liver, tongue), low-fat cottage cheese, butter;
- Vegetable - cereals (rice, pearl barley), green salad, cucumbers, zucchini, rutabagas, fresh cabbage, spinach, vegetable oil, pears, gooseberries, white cherries and white currants;
- Drinks - fermented milk without the addition of dyes, pear and apple compotes, rhubarb decoctions, green tea of low concentration, still mineral water;
- Desserts - dried fruits from dried pears and apples, prunes.
When examined in the clinic, allergen markers can speed up the process of making a safe diet. Without the use of markers, it is recommended to gradually introduce new products into the menu with an interval of two weeks. In order to make it easier for you to navigate in the choice of products, we offer an approximate list with an average and high risk of provoking food allergies and dermatitis.
Medium allergenic products:
- Protein - lamb, horse meat, rabbit;
- Vegetable - rye, buckwheat, corn, green fruits, potatoes;
- Drinks - black tea, green apple juices, herbal teas;
- Desserts - yoghurts, mousses, curds.
Foods that often cause allergies:
- Protein - pork, fatty beef, milk, chicken eggs, fish, seafood, caviar, smoked meats, delicacies, stew;
- Vegetable - legumes, sauerkraut, pickled vegetables, all red berries, all tropical fruits, mushrooms, dried fruits (dried apricots, raisins, dates, figs);
- Drinks - sweet carbonated water, filled yoghurts, cocoa, coffee;
- Desserts - caramel, marmalade, chocolate, honey;
- Condiments, sauces (ketchup, mayonnaise, soy sauce), canned soups, and any prepared food containing dyes, emulsifiers, preservatives and other food additives.
With dermatitis without allergic stress, proper nutrition is more important. The main principle is the inclusion of low-calorie, easily digestible food in the diet. There are no universal recommendations. For more information about the products recommended for you personally, please contact your doctor and dietitian.
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).