Dermatitis — Clinical Case (Wikimedia Commons)

Diagnosis: Dermatitis

Although eczema is a common condition, severe forms of the disease can significantly affect health and quality of life. One common problem is the inability to sleep through the night because of extrem. Clinical photograph sourced from Wikimedia Commons (CC BY 2.0). Attribution: NIAID.

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