Eczema and dermatitis

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The terms eczema and dermatitis are interchangeable, covering a wide variety of conditions from the child with atopic eczema to the adult with an allergy to cement. If patients are told they have dermatitis they may assume that it is related to their employment with the implication that they may be eligible for compensation. It is not unusual for industrial workers to ask "Is it dermatitis, doctor?", meaning "is it due to my job?"

Clinical appearance

Eczema is an inflammatory condition of the skin characterised by groups of vesicular lesions with a variable degree of exudate and scaling. In some cases dryness and scaling predominate, with little inflammation. In more acute cases there may be considerable inflammation and vesicle formation, in keeping with the Greek for "to boil out", from which the word eczema is derived. Sometimes the main feature may be blisters that become very large.

Eczema commonly itches and the clinical appearance may be modified by scratching, which with time may produce lichenification (thickening of the skin with increased skin markings). Also as a result of scratching the skin surface may be broken and have excoriations, exudate, and secondary infection.

Pathology

The characteristic change is oedema between the cells of the epidermis, known as spongiosus, leading to formation of vesicles. The whole epidermis becomes thickened with an increased keratin layer. A variable degree of vasodilatation in the dermis and an inflammatory infiltrate may be present.

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