Dermatitis

Dermatitis is an umbrella term for inflammation of the skin that typically presents with itching, redness, dryness, and a rash that may ooze, crust, flake, or blister. It is not contagious. In everyday clinical usage, “dermatitis” is often used interchangeably with “eczema,” though clinicians may distinguish subtypes based on cause and pattern.

Core forms and features

Several common forms account for most cases:

• Atopic dermatitis (AD, often called eczema) is a chronic, relapsing condition driven by a combination of skin-barrier dysfunction and immune dysregulation. It typically begins in childhood but can affect all ages.

• Contact dermatitis results from direct skin exposure to an irritant (irritant contact dermatitis) or to an allergen that triggers an immune reaction (allergic contact dermatitis). Patch testing can identify culprit allergens; avoidance is central to management.

• Seborrheic dermatitis causes scaly, sometimes greasy patches on oil-rich areas such as the scalp (dandruff), face, and chest. Other forms seen in practice include dyshidrotic dermatitis (pompholyx) with pruritic hand/foot vesicles, nummular dermatitis with coin‑shaped plaques, and stasis dermatitis on the lower legs due to chronic venous insufficiency.

Causes, triggers, and risk factors

Dermatitis arises from a mix of intrinsic and extrinsic factors: genetic skin‑barrier variants, immune overactivity, irritants (water, detergents, acids/alkalis, solvents), allergens (metals such as nickel, fragrances, preservatives, rubber additives, plants like poison ivy), microbes/yeasts, sweat, friction, and environmental dryness or cold. Personal or family history of atopy, frequent “wet work,” and occlusive gloves heighten risk, especially for hand dermatitis.

Diagnosis and differentiation

Diagnosis is clinical—history and exam establish the pattern, distribution, and suspected triggers. For suspected allergic contact dermatitis, standardized patch testing helps confirm sensitizers and guides avoidance. When infections complicate dermatitis, cultures or empiric therapy may be needed. Distinguishing dermatitis from mimickers (psoriasis, tinea, scabies, cutaneous drug eruptions) is important for targeted therapy.

Management: foundational care and medicines

• Foundational care: gentle cleansing, regular use of moisturizers/emollients, and trigger avoidance are core across subtypes. Wet‑wrap therapy can help severe flares.

• Topicals: first‑line prescriptions include topical corticosteroids and steroid‑sparing agents (topical calcineurin inhibitors). Newer options include topical phosphodiesterase‑4 inhibitors and topical Janus kinase (JAK) inhibitors; recent U.S. updates have expanded pediatric use of ruxolitinib cream.

• Phototherapy and systemic therapy: for moderate–severe atopic dermatitis or refractory cases, options include phototherapy and targeted systemic agents. Current U.S. guidelines strongly recommend biologics that inhibit type‑2 cytokine pathways (e.g., dupilumab, tralokinumab) and oral JAK inhibitors (upadacitinib, abrocitinib); guideline updates in 2025 also note additional options (e.g., lebrikizumab, nemolizumab) for adults. Systemic corticosteroids are generally discouraged for chronic management.

Occupational relevance and public health importance

Contact dermatitis is the most frequently reported occupational skin disease, accounting for the vast majority of work‑related skin disorders in the United States. Healthcare workers, hairdressers, and metal workers face elevated risk due to “wet work” and chemical exposures; hands are most commonly affected. Population surveys estimate that nearly one in ten U.S. workers report dermatitis in a given year, with higher rates in healthcare occupations—underscoring the importance of workplace skin‑protection programs.

Why it matters

Dermatitis significantly affects quality of life through sleep disturbance, pain/itch, visible rash, and productivity loss. Fortunately, most cases improve with skin‑care routines and appropriate treatments; for persistent, widespread, or recurrent rashes, timely referral to a dermatologist or allergy/immunology specialist for advanced therapies or patch testing can be life‑changing. Evidence‑based guidelines and newer targeted treatments have expanded options and improved outcomes for many patients.

Sources

• Mayo Clinic. Dermatitis – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/dermatitis-eczema/symptoms-causes/syc-20352380

• MedlinePlus (NIH). Eczema/Dermatitis. https://medlineplus.gov/eczema.html

• Cleveland Clinic. Dermatitis: Types, Treatments, Causes & Symptoms. https://my.clevelandclinic.org/health/diseases/4089-dermatitis

• Encyclopaedia Britannica. Dermatitis. https://www.britannica.com/science/dermatitis

• AAAAI (American Academy of Allergy, Asthma & Immunology). Contact Dermatitis Overview. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/contact-dermatitis-overview

• AAD (American Academy of Dermatology). Updated guidelines for atopic dermatitis: topical therapies. https://www.aad.org/news/updated-atopic-dermatitis-guidelines-topical-therapies

• AAD Clinical Guideline Summary (2025 update): Phototherapy and systemic therapies for atopic dermatitis. https://www.guidelinecentral.com/guideline/7890/

• NIOSH/CDC. About Skin Exposures and Effects – Contact Dermatitis. https://www.cdc.gov/niosh/skin-exposure/about/index.html

• NIOSH/CDC Stacks. Prevalence of dermatitis in the working population, United States (NHIS‑OHS 2010). https://stacks.cdc.gov/view/cdc/193610

• PubMed. Atopic Dermatitis: Diagnosis and Treatment (review). https://pubmed.ncbi.nlm.nih.gov/32412211/

• PMC. Emerging Treatments and New Vehicle Formulations for Atopic Dermatitis. https://pmc.ncbi.nlm.nih.gov/articles/PMC11597258/

• Reuters. FDA approves ruxolitinib cream for pediatric atopic dermatitis (2–11 years). https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-approves-incytes-eczema-treatment-pediatric-patients-2025-09-18/

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