Inflammatory skin disorders

Inflammatory skin disorders are the most common problem with the integumentary system. These disorders can be either acute or chronic. The patient usually has some itching and redness from these disorders. The following sections discuss the common inflammatory skin disorders.

##Seborrheic dermatitis

Seborrheic dermatitis is one of the most common chronic inflammatory conditions of the sebaceous glands. It alters the amount and quality of the sebum, resulting in dry or moist, greasy-appearing scales and yellowish crusts on the scalp, eyebrows, eyelids, and sides of the nose, behind the ears, and in the middle of the chest. The condition has many different forms, including cradle cap in infants and dandruff in adults. Seborrheic dermatitis of the scalp can be treated with tar- or sulfur-based shampoos; inflammations of the skin usually are treated with topical corticosteroids, such as generic triamcinolone diacetate or betamethasone valerate, or fluocinolone acetonide (Synalar). Seborrheic keratosis (age spots) is characterized by benign, slightly raised, tan to black lesions that occur with aging.

Contact dermatitis

Contact dermatitis is an acute inflammatory response to a skin irritant or exposure to a substance that causes an allergic reaction. An individual who is allergic to latex gloves or who has been exposed to poison ivy shows the signs and symptoms of contact dermatitis. The individual complains of redness (erythema), edema, pruritus, and vesicles. The patient should be encouraged to wash the affected area immediately after exposure to remove the irritant. Medical treatment includes the application of a corticosteroid cream or the use of oral corticosteroid medications (e.g., prednisone, methylprednisolone [Medrol]) if the symptoms are severe.

Eczema (atopic dermatitis)

Eczema, also known as atopic dermatitis, is a group of conditions that make the skin irritated, inflamed, red, and itchy. It is more common in children but can occur at any age. Eczema is a chronic condition that may become worse occasionally and then subside. Eczema is a group of conditions with an inherited tendency. It is often seen in combination with asthma or hay fever. Most children who develop eczema outgrow it by their 10th birthday. Some adults continue to have symptoms throughout their lifetime. The disease can often be controlled with proper treatment.

The cause of eczema is unknown, but it is more common in families with a history of allergies and asthma. Flare-ups can occur in response to specific substances, conditions, or triggers. Temperature, exposure to certain chemicals, fabric texture, pet dander, and stress are all examples of possible irritants. Some of the common signs and symptoms of eczema include itchy skin; rash on the face, back of the knees, hands, wrists, or feet; and a dry, thickened, or scaly appearance of the skin that starts out pink or red but can turn brownish with time.

A pediatrician, dermatologist, or primary care provider will observe the rash and ask specific questions about the signs and symptoms. Sometimes the provider will perform allergy tests to try to pinpoint a specific trigger or irritant. Most frequently, observation and the patient history are sufficient to diagnose eczema. The treatment of eczema is focused on relieving itching and preventing scratching of the skin, which can lead to infection. Using a provider-recommended lotion or cream to keep the skin moist is the most common treatment. Applying topical treatments when the skin is damp (i.e., after a bath or shower) may help the skin to retain moisture. Cold compresses and 1% hydrocortisone cream are also common treatments.

If over-the-counter (OTC) remedies are not providing relief, creams and ointments that contain corticosteroids can be prescribed to lessen inflammation of the skin. Antibiotics may also be prescribed if an area becomes infected after vigorous itching. Additional treatments include antihistamines and ultraviolet (UV) light therapy. For patients with moderate to unresponsive eczema, cyclosporine or topical immunomodulators (TIMs) may be prescribed to help prevent flare-ups.

Autoimmune skin disorders

Some of the common skin disorders are autoimmune disorders. Autoimmune disorders occur when the immune system mistakenly attacks the body. There are several autoimmune disorders that affect the skin. The common autoimmune disorders of the skin are discussed in the following sections.

Psoriasis

Psoriasis is an autoimmune disease that affects the life cycle of skin cells. Psoriasis causes skin cells to build up rapidly on the surface of the skin. The extra skin cells form thick, silvery scales and itchy, dry, red patches that are sometimes painful. There may be times when symptoms get better, alternating with times when the psoriasis worsens.

Psoriasis is caused by a malfunction in the immune cells called T lymphocytes (T cells). T lymphocytes normally travel through the body looking for pathogens (bacteria and viruses) to destroy. But in people who have psoriasis, the T lymphocytes attack healthy skin cells. This T-cell overactivity causes the skin to produce too many new skin cells and the immune system to produce too many T cells.

It is unclear why the immune system of people with psoriasis acts this way. It can become a vicious circle of rapid skin cell production, which leads to the characteristic psoriasis plaques. Anyone can develop psoriasis, but risk factors include a family history of psoriasis, stress, a history of recurring streptococcal infections, obesity, and smoking. Signs and symptoms of psoriasis can vary, but plaques have a characteristic appearance:

• Red patches of skin covered in silvery scales
• Dry, cracked skin that may bleed and small patches of scaly spots
• Itching, burning, and pain in and around plaques
• Thick, pitted, or ridged finger and toenails
• Swollen and stiff joints

Some people may only have a few spots of psoriasis; others may have large skin eruptions that may cover large areas of the body. Psoriasis may erupt, then get better, and continue this cycle for years.

Some of the most common forms of psoriasis are plaque, nail, scalp, and psoriatic arthritis, which also affects the joints.

Discoid lupus erythematosus

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus. It is a chronic autoimmune disease of the skin that presents as sores with inflammation and scarring favoring the face, ears, and scalp (sun-exposed areas) and, at times, other body areas. The sores are usually coin-shaped red lesions with inflamed patches with a scaly or crusty appearance. These lesions can cause disfiguring scars. If the lesions are on the scalp, there may be permanent hair loss after the lesions have healed.

Diagnosis is made with a physical examination with a complete history and laboratory evaluation. Patients with cutaneous lupus may not have any abnormal laboratory test results. A skin biopsy of a lesion may be done. Discoid lupus is very photosensitive, so prevention of sun exposure is very important. Treatments include using sunscreen and avoiding sun exposure; corticosteroid creams or ointments may be used in conjunction with injections.