RHINITIS

RHINITIS

RHINITIS
It is an inflammation of the mucous membranes of the nose. It is an infectious disorder that easily spreads from one person to another by droplet infection through sneezing, coughing and talking.

AREAS OF RHINITIS

TYPES AND AETIOLOGY
1. Allergic 1 GE- mediated response causing release vaso-active substance from mast cells.
2. Non-allergic rhinitis- cause by rhinovirus

SIGNS AND SYMPTOMS

• Wet running /dripping nose
• Headaches
• Fever
• Chills
• Nasal congestion
• Insomnia
• Nasal pressure and stiffness
• Sore throat
• Cough
• Sneezing

MANAGEMENT

If complications do not set in, rhinitis is self limiting and the patient recovers after 7 days.

1. Rest; Bed rest is recommended to prevent chills and spread of the condition to others.
2. Intake of copious fluids helps [3-4L a day]. This helps liquefy secretions and ease nasal congestion.
3. Warm saline gaggles and moist inhalation cause vasoconstriction of nasal blood vessels.

PREVENTIVE MEASURES

COVER YOUR NOSE WITH CLEAN TISSUE

Covering the mouth when coughing and sneezing
Avoid smoke, perfumes and dust
Proper personal hygiene

DRUGS
1. Antiflammatory drugs such as analgesics, e.g. aspirin to improve inflammation and reduce pain.
2. Antihistamines-phenergan
3. Vitamins c-promotes healing

COMPLICATIONS
• Sinusitis
• otitis media
• bronchitis
• pneumonia


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INFLUENZA (GRIPPE OR FLU)

INFLUENZA

INFLUENZA [GRIPPE OR FLU]

Influenza is an acute usually self-limiting febrile contagious infection of the respiratory tract caused by myxovirus influenzae.

MODE OF TRANSMISSION

Influenza can be transmitted through droplet infection or contact with contaminated objects such as drinking cup or inhalation of infected droplets during coughing, sneezing and talking.

PATHOPHYSIOLOGY

TYPES OF INFLUENZA

On entering the respiratory tract, the influenza virus irritates the epithelial cells of the respiratory tract causing inflammation and desquamation, resulting in sudden onset of chills, malaise and other symptoms. Influenza occurs in isolated cases of epidemics and pandemics [spreading over wide area, worldwide]. Three groups of influenza virus have been identified namely; types A, B and C.

Type A; this has the highest incidence of influenza case, and has subtypes that cause periodic epidemics every third year . Its incubation period is 24-48 hours.

SIGNS AND SYMPTOMS OF INFLUENZA

SYMPTOMS

1.       Fever [chills] [38.3-40]

2.       Headache

3.       Malaise

4.       Myalgia [pain in muscles] back and limbs

5.       Dry, non productive cough

6.       Anorexia s

7.       Nausea and Vomiting

8.       Sometimes the patient may suffer [Laryngitis, hoarseness, conjunctivitis, rhinitis, and rhinorrhoea]

SYMPTOMS

DIAGNOSIS

1.       Throat and nose culture

2.       Full blood count

3.       Observation of signs and symptoms

MANAGEMENT; MEDICAL

INFLUENZA VACCINE

No specific management is required; mainly symptomatic.

1.       Annual influenza vaccine

2.       People who are allergic to eggs, feathers and chicken should always avoid them

3.       Amantadine can be given to reduce duration of symptoms

4.       Aspirin or acetaminophen to relief fever and muscle pain

5.       Expectorants- for cough

NURSING MANAGEMENT

USE TISSUE WHEN SNEEZING

1.       Ensure patent has adequate bed rest

2.       Give copious fluids [2-3L daily] to liquefy bronchial secretion

3.       Administer  oxygen 2-3L PRN

4.       Ensure oral hygiene to improve patient appetite  [give mouth wash]

5.       Warm  bath and  compresses are given to relief muscle pain

6.       Barrier nursing and reverse barrier to prevent client from infection and visitors  from infection from clients.

7.       Teach proper hand washing and disposal of secretion [disinfect before  disposal]

8.       Educate patient on immunization against influenza

9.       Teach breathing and coughing exercises

10.   Observe and report for signs and symptoms of pneumonia

 OTHER RELATED CONDITIONS

Common cold

Avian influenza

Fever

Pneumonia

Swine influenza

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HEPATITIS B

Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) which affects the liver. It causes both acute and chronic infections. Many people have no symptoms during the initial infection. Some develop a rapid onset of sickness with vomiting, yellow skin, feeling tired, dark urine and abdominal pain.Often these symptoms last a few weeks and rarely does the initial infection result in death. It may take 30 to 180 days for symptoms to begin. In those who get infected around the time of birth 90% develop chronic hepatitis B while less than 10% of those infected after the age of five do. Most of those with chronic disease have no symptoms; however, cirrhosis and liver cancer may eventually develop. These complications results in the death of 15 to 25% of those with chronic disease.

healthy and diseased liver

Risk factors include: working in healthcare, blood transfusions, dialysis, living with an infected person, travel in countries where the infection rate is high, and living in an institution. The hepatitis B viruses cannot be spread by holding hands, sharing eating utensils, kissing, hugging, coughing, sneezing, or breastfeeding. The infection can be diagnosed 30 to 60 days after exposure. Diagnosis is typically by testing the blood for parts of the virus and for antibodies against the virus. Five hepatitis viruses are known A, B, C, D, and E.
The infection has been preventable by vaccination since 1984. Vaccination is recommended by the World Health Organization in the first day of life if possible. Two or three more doses are required at a latter time for full effect. This vaccine works about 95% of the time. About 180 countries gave the vaccine as part of national programs as of 2006. It is also recommended that all blood be tested for hepatitis B before transfusion and condoms be used to prevent infection.

hepatitis B virus

About a third of the world population has been infected at one point in their lives, including 240 million to 350 million who have chronic infections. Over 750,000 people die of hepatitis B each year.

 

MODE  OF TRANSMISSION

Transmission of hepatitis B virus results from exposure to infectious blood or body fluids containing blood. Possible forms of transmission include sexual contact, blood transfusions and transfusion with other human blood products, re-use of contaminate needles and syringes, and vertical transmission from mother to child (MTCT) during childbirth. Without intervention, a mother who is positive for HBsAg confers a 20% risk of passing the infection to her offspring at the time of birth. This risk is as high as 90% if the mother is also positive for HBeAg. HBV can be transmitted between family members within households, possibly by contact of nonintact skin or mucous membrane with secretions or saliva containing HBV.

 Signs and symptoms

Acute infection with hepatitis B virus is associated with acute viral hepatitis – an illness that begins with general ill-health, loss of appetite, nausea, vomiting, body aches, mild fever, and dark urine, and then progresses to development of jaundice. It has been noted that itchy skin has been an indication as a possible symptom of all hepatitis virus types. The illness lasts for a few weeks and then gradually improves in most affected people. A few people may have more severe liver disease (fulminant hepatic failure), and may die as a result.
Chronic infection with hepatitis B virus either may be asymptomatic or may be associated with a chronic inflammation of the liver (chronic hepatitis), leading to cirrhosis over a period of several years. This type of infection dramatically increases the incidence of hepatocellular carcinoma (liver cancer).Chronic carriers are encouraged to avoid consuming alcohol as it increases their risk for cirrhosis and liver cancer.
 The clinical features are feverand skin rash. The symptoms often subside shortly after the onset of jaundice, but can persist throughout the duration of acute hepatitis B.

hepatitis B virus

Diagnosis

 Hepatitis B viral antigens and antibodies are detectable in the blood following acute infection.

Hepatitis B viral antigens and antibodies are detectable in the blood of a chronically infected person.

The tests, called assays, for detection of hepatitis B virus infection involve serum or blood tests that detect either viral antigens (proteins produced by the virus) or antibodies produced by the host. Interpretation of these assays is complex.
The hepatitis B surface antigen (HBsAg) is most frequently used to screen for the presence of this infection. It is the first detectable viral antigen to appear during infection. However, early in an infection, this antigen may not be present and it may be undetectable later in the infection as it is being cleared by the host. The infectious virion contains an inner "core particle" enclosing viral genome. The icosahedral core particle is made of 180 or 240 copies of core protein, alternatively known as hepatitis B core antigen, or HBcAg. During this 'window' in which the host remains infected but is successfully clearing the virus, IgM antibodies specific to the hepatitis B core antigen (anti-HBc IgM) may be the only serological evidence of disease. Therefore most hepatitis B diagnostic panels contain HBsAg and total anti-HBc (both IgM and IgG).
Shortly after the appearance of the HBsAg, another antigen called hepatitis B e antigen (HBeAg) will appear. Traditionally, the presence of HBeAg in a host's serum is associated with much higher rates of viral replication and enhanced infectivity; however, variants of the hepatitis B virus do not produce the 'e' antigen, so this rule does not always hold true. During the natural course of an infection, the HBeAg may be cleared, and antibodies to the 'e' antigen (anti-HBe) will arise immediately afterwards. This conversion is usually associated with a dramatic decline in viral replication.

end stage of hepatitis B

Ground glass hepatocytes as seen in a chronic hepatitis B liver biopsy. H&E stain.

If the host is able to clear the infection, eventually the HBsAg will become undetectable and will be followed by IgG antibodies to the hepatitis B surface antigen and core antigen (anti-HBs and anti HBc IgG). The time between the removal of the HBsAg and the appearance of anti-HBs is called the window period. A person negative for HBsAg but positive for anti-HBs either has cleared an infection or has been vaccinated previously.
Individuals who remain HBsAg positive for at least six months are considered to be hepatitis B carriers. Carriers of the virus may have chronic hepatitis B, which would be reflected by elevated serum alanine aminotransferase (ALT) levels and inflammation of the liver, if they are in the immune clearance phase of chronic infection. Carriers who have seroconverted to HBeAg negative status, in particular those who acquired the infection as adults, have very little viral multiplication and hence may be at little risk of long-term complications or of transmitting infection to others.
PCR tests have been developed to detect and measure the amount of HBV DNA, called the viral load, in clinical specimens. These tests are used to assess a person's infection status and to monitor treatment. Individuals with high viral loads, characteristically have ground glass hepatocytes on biopsy.

 Prevention

Vaccines for the prevention of hepatitis B have been routinely recommended for infants since 1991 in the United States. Most vaccines are given in three doses over a course of months. A protective response to the vaccine is defined as an anti-HBs antibody concentration of at least 10 mIU/ml in the recipient's serum. The vaccine is more effective in children and 95 percent of those vaccinated have protective levels of antibody. This drops to around 90% at 40 years of age and to around 75 percent in those over 60 years. The protection afforded by vaccination is long lasting even after antibody levels fall below 10 mIU/ml. Vaccination at birth is recommended for all infants of HBV infected mothers. A combination of hepatitis B immune globulin and an accelerated course of HBV vaccine prevents perinatal HBV transmission in around 90% of cases.

hep B vaccine

All those with a risk of exposure to body fluids such as blood should be vaccinated, if not already. Testing to verify effective immunization is recommended and further doses of vaccine are given to those who are not sufficiently immunized.
In assisted reproductive technology, sperm washing is not necessary for males with hepatitis B to prevent transmission, unless the female partner has not been effectively vaccinated. In females with hepatitis B, the risk of transmission from mother to child with IVF is no different from the risk in spontaneous conception.
Those at high risk of infection should be tested as there is effective treatment for those who have the disease. Groups that screening is recommended for include those who have not been vaccinated and one of the following: people from areas of the world where hepatitis B occurs in more than 2%, those with HIV, intravenous drug users, men who have sex with men, and those who live with someone with hepatitis B.

Duration of vaccination

In 10- to 22-year follow-up studies there were no cases of hepatitis B among those with a normal immune system who were vaccinated, only rare chronic infections have been documented.

 Treatment

Acute hepatitis B infection does not usually require treatment and most adults clear the infection spontaneously. Early antiviral treatment may be required in fewer than 1% of people, whose infection takes a very aggressive course (fulminant hepatitis) or who are immunocompromised. On the other hand, treatment of chronic infection may be necessary to reduce the risk of cirrhosis and liver cancer. Chronically infected individuals with persistently elevated serum alanine aminotransferase, a marker of liver damage, and HBV DNA levels are candidates for therapy. Treatment lasts from six months to a year, depending on medication and genotype.
Although none of the available drugs can clear the infection, they can stop the virus from replicating, thus minimizing liver damage. As of 2008, there are seven medications licensed for treatment of hepatitis B infection in the United States. These include antiviral drugs lamivudine (Epivir), adefovir (Hepsera), tenofovir (Viread), telbivudine (Tyzeka) and entecavir (Baraclude), and the two immune system modulators interferon alpha-2a and PEGylated interferon alpha-2a (Pegasys). The use of interferon, which requires injections daily or thrice weekly, has been supplanted by long-acting PEGylated interferon, which is injected only once weekly. However, some individuals are much more likely to respond than others, and this might be because of the genotype of the infecting virus or the person's heredity. The treatment reduces viral replication in the liver, thereby reducing the viral load (the amount of virus particles as measured in the blood). Response to treatment differs between the genotypes. Interferon treatment may produce an e antigen seroconversion rate of 37% in genotype A but only a 6% seroconversion in type D. Genotype B has similar seroconversion rates to type A while type C seroconverts only in 15% of cases. Sustained e antigen loss after treatment is ~45% in types A and B but only 25–30% in types C and D.

 Epidemiology

 Prevalence of hepatitis B virus as of 2005.

In 2004, an estimated 350 million individuals were infected worldwide. National and regional prevalence ranges from over 10% in Asia to under 0.5% in the United States and northern Europe.
Routes of infection include vertical transmission (such as through childbirth), early life horizontal transmission (bites, lesions, and sanitary habits), and adult horizontal transmission (sexual contact, intravenous drug use)
The primary method of transmission reflects the prevalence of chronic HBV infection in a given area. In low prevalence areas such as the continental United States and Western Europe, injection drug abuse and unprotected sex are the primary methods, although other factors may also be important. In moderate prevalence areas, which include Eastern Europe, Russia, and Japan, where 2–7% of the population is chronically infected, the disease is predominantly spread among children. In high-prevalence areas such as China and South East Asia, transmission during childbirth is most common, although in other areas of high endemicity such as Africa, transmission during childhood is a significant factor. The prevalence of chronic HBV infection in areas of high endemicity is at least 8% with 10-15% prevalence in Africa/Far East.  As of 2010, China has 120 million infected people, followed by India and Indonesia with 40 million and 12 million, respectively. According to World Health Organization (WHO), an estimated 600,000 people die every year related to the infection.
In the United States about 19,000 new cases occurred in 2011 down nearly 90% from 1990.

 History

The earliest record of an epidemic caused by hepatitis B virus was made by Lurman in 1885.  An outbreak of smallpox occurred in Bremen in 1883 and 1,289 shipyard employees were vaccinated with lymph from other people. After several weeks, and up to eight months later, 191 of the vaccinated workers became ill with jaundice and were diagnosed as suffering from serum hepatitis. Other employees who had been inoculated with different batches of lymph remained healthy. Lurman's paper, now regarded as a classical example of an epidemiological study, proved that contaminated lymph was the source of the outbreak. Later, numerous similar outbreaks were reported following the introduction, in 1909, of hypodermic needles that were used, and, more importantly, reused, for administering Salvarsan for the treatment of syphilis. The virus was not discovered until 1966 when Baruch Blumberg, then working at the National Institutes of Health (NIH), discovered the Australia antigen (later known to be hepatitis B surface antigen, or HBsAg) in the blood of Australian aboriginal people. Although a virus had been suspected since the research published by MacCallum in 1947, D.S. Dane and others discovered the virus particle in 1970 by electron microscopy, By the early 1980s the genome of the virus had been sequenced, and the first vaccines were being tested

 

World Hepatitis Day, observed July 28, aims to raise global awareness of hepatitis B and hepatitis C and encourage prevention, diagnosis and treatment. It has been led by the World Hepatitis Alliance since 2007 and in May 2010, it got global endorsement from the World Health Organization.

References

1.      "Hepatitis B Fact sheet N°204". who.int. July 2014. Retrieved 4 November 2014.

2.      Raphael Rubin; David S. Strayer (2008). Rubin's Pathology : clinicopathologic foundations of medicine ; [includes access to online text, cases, images, and audio review questions!] (5. ed. ed.). Philadelphia [u.a.]: Wolters Kluwer/Lippincott Williams & Wilkins. p. 638. ISBN 9780781795166.

3.      "Hepatitis B FAQs for the Public — Transmission". U.S. Centers for Disease Control and Prevention (CDC). Retrieved 2011-11-29.

4.      Chang MH (June 2007). "Hepatitis B virus infection". Semin Fetal Neonatal Med 12 (3): 160–167. doi:10.1016/j.siny.2007.01.013. PMID 173361

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PREVENT CHOLERA HERE

Cholera is an infectious disease that causes severe watery diarrhoea, which lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

dirty environment

Cholera was prevalent in the U.S. in the 1800s before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world, where cholera affects an estimated 3 to 5 million people and causes more than 100,000 deaths each year.

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

• Municipal water supplies
• Ice made from municipal water
• Foods and drinks sold by street vendors
• Vegetables grown with water containing human wastes
• Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhoea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhoea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

• Rapid heart rate
• Loss of skin elasticity (the ability to return to original position quickly if pinched)
• Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
• Low blood pressure
• Thirst
• Muscle cramps

If not treated, dehydration can lead to shock and death in a matter of hours.

          Prevention

 

Although there is a vaccine against cholera, the CDC and World Health Organization don't normally recommend it because it may not protect up to half of the people who receive it and it lasts only a few months. However, you can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected or bottled water. Be sure to use the bottled, boiled, or chemically disinfected water for the following purposes:

• Drinking
• Preparing food or drinks
• Making ice
• Brushing your teeth
• Washing your face and hands
• Washing dishes and utensils that you use to eat or prepare food
• Washing fruits and vegetables

To disinfect your own water, boil it for one minute or filter it and add two drops of bleach or one-half of an iodine tablet per liter of water.

 You should also avoid raw foods, including the following:

• Unpeeled fruits and vegetables
• Unpasteurized milk and milk products
• Raw or undercooked meat or shellfish
• Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment.  They reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

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WebMD Medical Reference

SUFFERING FROM ECZEMA OR DERMATITIS?

Dermatitis or eczema is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches. The term eczema is also commonly used to describe atopic dermatitis or atopic eczema.

eczema

 

The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin swelling, itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries. Scratching open a healing lesion may result in scarring and may enlarge the rash.
Treatment is typically with moisturizers and steroid creams. If these are not effective, creams based on calcineurin inhibitors may be used. The disease was estimated as of 2010 to affect 230 million people globally (3.5% of the populati0n)

eczema

The term "eczema" refers to a set of clinical characteristics. Clasynonyms used to describe the same condition. A type of eczema may be described by location (e.g. hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema for the most common type of eczema (atopic dermatitis) interchangeably.

ssification of the underlying diseases has been unsystematic, with many

eczema

Terms

There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called dermatitis eczema and eczematous dermatitis. An eczema diagnosis often implies atopic dermatitis (which is very common in children and teenagers) but, without proper context, may refer to any kind of dermatitis..

Types of Eczema

• Atopic dermatitis is an allergic disease believed to have a hereditary component, and often runs in families whose members also have asthma. Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising.
• Contact dermatitis is an allergic (resulting from a delayed reaction to an allergen, such as poison ivy, nickel, or Balsam of Peru), and irritant (resulting from direct reaction to a detergent, such as sodium lauryl sulfate, for example).

Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable, provided the offending substance can be avoided and its traces removed from one's environment.

• Xerotic eczema (craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population.
• Seborrhoeic dermatitis or Seborrheic dermatitis ("cradle cap" in infants) is a condition sometimes classified as a form of eczema that is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. The condition is harmless except in severe cases of cradle cap. In newborns it causes a thick, yellow, crusty scalp rash called cradle cap, which seems related to lack of biotin and is often curable.

Less common

• Dyshidrosis : only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by itching, which gets worse at night. A common type of hand eczema, it worsens in warm weather.
•  Discoid eczema: is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go.
• Venous eczema : occurs in people with impaired circulation, varicose veins, and edema, and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin, and itching. The disorder predisposes to leg ulcers.
• Dermatitis herpetiformis : causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease, can often be put into remission with appropriate diet, and tends to get worse at night.
• Neurodermatitis: is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps.
• Autoeczematization: is an eczematous reaction to an infection with parasites, fungi, bacteria, or viruses. It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection.
• There are also eczemas overlaid by viral infections and eczemas resulting from underlying disease (e.g. lymphoma). Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.

Signs and symptoms

Rash symptomatic of dermatitis

Dermatitis symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring. Also, the area of the skin on which the symptoms appear tends to be different with every type of dermatitis, whether on the neck, wrist, forearm, thigh or ankle. Although the location may vary, the primary symptom of this condition is itchy skin. More rarely, it may appear on the genital area, such as the vulva or scrotum. Symptoms of this type of dermatitis may be very intense and may come and go. Irritant contact dermatitis is usually more painful than itchy.
Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin. Typical affected skin areas include the folds of the arms, the back of the knees, wrists, face and hands.
Dermatitis herpetiformis symptoms include itching, stinging and a burning sensation. Papules and vesicles are commonly present. The small red bumps experienced in this type of dermatitis are usually about 1 cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp. Less frequently, the rash may appear inside the mouth or near the hairline.
The symptoms of seborrheic dermatitis on the other hand, tend to appear gradually, from dry or greasy scaling of the scalp (dandruff) to hair loss. In severe cases, pimples may appear along the hairline, behind the ears, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back. In newborns, the condition causes a thick and yellowish scalp rash, often accompanied by a diaper rash.
Perioral dermatitis refers to a red bumpy rash around the mouth.

 

 

 Cause

Complex eczema treated with a combination of antifungal and corticosteroid creams at the same time.

The cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors.

Environmental

The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma. The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.
While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites, with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration.

Genetic

A number of genes have been associated with eczema, one of which is filaggrin. Genome-wide studies found three new genetic variants associated with eczema:
Eczema occurs about three times more frequently in celiac disease and about two times more frequently in relatives of those with celiac disease, potentially indicating a genetic link between the two conditions.

Diagnosis

Diagnosis of eczema is based mostly on the history and physical examination. However, in uncertain cases, skin biopsy may be useful. Those with eczema may be especially prone to misdiagnosis of food allergies.
Patch tests are used in the diagnosis of allergic contact dermatitis.

Prevention

There is no good evidence that a mother's diet during pregnancy, the formula used, or breastfeeding changes the risk. There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.
People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.

Management

There is no known cure for eczema, with treatment aiming to control symptoms by reducing inflammation and relieving itching.

Lifestyle Modification

Bathing once or more a day is recommended. It is a misconception that bathing dries the skin in people with eczema.
There has not been adequate evaluation of changing the diet to reduce eczema. There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets. Benefits have not been shown for other elimination diets, though the studies are small and poorly executed. Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.
People can also wear clothing designed to manage the itching, scratching and peeling. Soaps and detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness.

Moisturizers

Moisturizing agents (also known as emollients) are recommended at least once or twice a day. Oilier formulations appear to be better and water based formulations are not recommended. It is unclear if moisturizers that contain ceramides are more or less effective than others. Products that contain dyes, perfumes, or peanuts should not be used. Occlusive dressings at night may be useful.

Medications

 

There is little evidence for antihistamine and they are thus not generally recommended. Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.

Corticosteroids

 

If symptoms are well controlled with moisturizers, steroids may only be required when flares occur. Corticosteroids are effective in controlling and suppressing symptoms in most cases. Once daily use is generally enough. For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.
Long term use of topical steroids may result in skin atrophy, stria or telangiectasia. Their use on delicate skin (face or groin) is therefore typically with caution. They are, however, generally well tolerated.

Immunosuppressants

Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use. Their use is reasonable in those who do not respond to or are not tolerant of steroids. Treatments are typically recommended for short or fixed periods of time rather than indefinitely. Tacrolimus .1% has generally proved more effective than picrolimus, and equal in effect to mid-potency topical steroids.
When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressants are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine and methotrexate.

Light therapy

Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good.  Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer.

Prognosis

Most cases are well managed with topical treatments and ultraviolet light. About 2% of cases however are not. In more than 60% the condition goes away by adolescence.

Epidemiology

Globally eczema affected approximately 230 million people as of 2010 (3.5% of the population). The lifetime clinician-recorded prevalence of eczema has been seen to peak in infancy, with female predominance of eczema presentations occurring during the reproductive period of 15–49 years. In the UK about 20% of children have the condition, while in the United States about 10% are affected.
Although little data on the rates of eczema over time exists prior to the Second World War (1939–45), the rate of eczema has been found to have increased substantially in the latter half of the 20th Century, with eczema in school-aged children being found to increase between the late 1940s and 2000. In the developed world there has been rise in the rate of eczema over time. The incidence and lifetime prevalence of eczema in England has been seen to increase in recent times.
Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males, and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%.

History

The term "atopic dermatitis" was coined in 1933 by Wise and Sulzberger. Sulfur as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.

References

1.                              "Eczema". ACP medicine. Retrieved 9 January 2014.

2.                              Bershad, SV (1 November 2011). "In the clinic. Atopic dermatitis (eczema)". Annals of internal medicine 155 (9): ITC51–15; quiz ITC516. doi:10.1059/0003-4819-155-9-201111010-01005 (inactive 2014-10-26). PMID 22041966.