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Dermatitis, nonspecific
What is Nonspecific Dermatitis?
Nonspecific dermatitis is a diagnosis of
exclusion reached more specific causes of dermatitis cannot be diagnosed. It
is an epidermal rash, which can be either acute or chronic, and that does not
conform to the typical distributions of defined entities (e.g. atopic
dermatitis) and does not have a clear cause (e.g. contact dermatitis). Itching is usually the main complaint. The appearance varies, depending on
whether the dermatitis is seen during the acute or chronic stage. In the
acute stage, vesicles are present. Chronically, lichenification
(thickening of skin) develops. The subacute stage is sometimes described
as "juicy papules". The rash has an indistinct border. Crust and
scale may be present as well. Within the category of nonspecific entities,
numerous entities have been described including: dyshidrotic eczema and xerotic
eczema.
Dyshidrotic eczema.
Dyshidrotic eczema effects the palms, soles, and lateral digits.
Xerotic eczema. Xerotic
eczema is also sometimes called "winter itch". It is cashed by dry
skin and low humidity, and favors the lower extremities.
With what can it
be confused?
The main differential diagnosis is specific forms of
dermatitis, such as contact dermatitis. Infectious causes such as
fungal (dermatophyte), viral (herpes simplex virus, varicella-zoster virus) and
bacterial (impetigo) must be ruled out. Chronic dermatitis must be
distinguished from psoriasis, drug eruption, and chronic fungal
infection,
How is it
diagnosed?
Itching, often severe and able to disturb sleep, is usually
what prompts the patient to seek medical care. No specific cause can be
found, and the distribution is not one of a defined entity.
See:
Pathology:
Dermatitis, nonspecific
How is it treated?
Corticosteroids are the mainstay of treatment, either
topical, intralesional, or systemic. Typical topical preparations, in
order of increasing potency, are hydrocortisone 1%, triamcinolone 0.1%, and
fluocinonide 0.05%. Intralesional injection with triamcinolone
(Kenalog-10) can be done for lichenified lesions. Skin atrophy is a
potential complication. Widespread dermatitis is best treated with
short term oral steroids (e.g. prednisone). Symptoms of widespread
dermatitis can be treated with baths, with or without additives such as
colloidal oatmeal (e.g. Aveeno) or tar (e.g. Cutar). Astringent dressings
(e.g. Domeboro) are also beneficial. Pruritus can be relived with
antihistamines such as hydroxyzine or diphenhydramine. Antibiotics (anti-Staph
spectrum) are required in the event of secondary infection.
What is the prognosis?
Secondary infection with Staphylococcus aureus is
common.
Date created:
04/02/2007
Last updated:
01/03/2009
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