Diagnosis: Dermatitis
Watercolour drawing of the breasts of a widow, aged 32 years, who had chronic eczema of the nipples. In the right breast the disease had lasted for eight months, and in the left for five months. In th. Clinical photograph sourced from Wikimedia Commons (CC BY 4.0). Attribution: Mark, Leonard Portal.
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).
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.
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.
Psoriasis, Dermatophytosis, Scabies, Cutaneous T-cell lymphoma, Nummular dermatitis
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