Dermatitis — Clinical Case (Wikimedia Commons)

Diagnosis: Dermatitis

Illustration from Anatomy Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.. Clinical photograph sourced from Wikimedia Commons (CC BY 3.0). Attribution: OpenStax College.

Clinical Presentation

Acute: erythema, vesicles, weeping, crusting. Subacute: erythema, scale, excoriation. Chronic: lichenification, hyperkeratosis, fissuring. Distribution provides diagnostic clues — flexural (atopic), linear/geometric (contact), scalp/nasolabial (seborrheic).

Clinical History

Personal/family atopy history for atopic dermatitis. Occupational and hobby exposures for contact dermatitis. Chronic venous insufficiency for stasis dermatitis. Impact on quality of life and sleep should be assessed.

Treatment

Emollients as foundation. Topical corticosteroids (strength matched to site/severity). Calcineurin inhibitors for sensitive areas. Dupilumab for moderate-severe atopic dermatitis. Phototherapy for widespread disease.

Differential Diagnosis

Psoriasis, Dermatophytosis, Scabies, Cutaneous T-cell lymphoma, Nummular dermatitis

Key Learnings

The 'outside-in' vs 'inside-out' paradigm: contact dermatitis is triggered externally while atopic dermatitis has underlying barrier dysfunction. Patch testing differentiates allergic from irritant contact dermatitis.

Tags: dermatitis, eczema, inflammatory, pruritic