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Dermatitis update: clinical manifestations, pathogenesis and current therapeutic approaches

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Abstract

Dermatitis affects up to 10 % of the population, and yet its nomenclature still remains inconsistent. Classifications can be made according to morphology, localization, triggers, kinetics, or pathophysiology. The eczematous inflammatory reaction involves the migration of activated T-lymphocytes into the epidermis (epidermotropismus) and pathological changes to the epidermal keratinocytes occur, with spongiosis, acanthosis, and parakeratosis. Dermatitis is characterized by a polymorphous clinical picture. Contact dermatitis (toxic irritant and allergic) and atopic dermatitis (neurodermatitis) account for the majority of dermatitis cases. Seborrheic dermatitis and nummular (dysregulatory microbial) dermatitis are also common. A qualified overall assessment of the targeted patient history and clinical picture are crucial to correctly diagnosing the type of dermatitis. This is followed by further diagnostics to confirm the dermatitis type, identify potential triggers, and exclude differential diagnoses. Since most forms of dermatitis can be caused by allergy, a qualified allergy diagnostic work-up is often necessary. Dermatitis management primarily comprises avoiding/dealing with the causes, alongside symptomatic treatment. In terms of treatment, local and systemic therapies with an anti-inflammatory, immunosuppressant, antipruritic, hydrating, keratolytic, antiproliferative, antimicrobial, antifungal, or dehydrating/astringent effect are available.

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References

  1. Werfel T, Aberer W, Ahrens F, Augustin M, Biedermann T, Diepgen T et al. Leitlinie Neurodermitis [atopisches Ekzem; atopische Dermatitis]. J Dtsch Dermatol Ges 2016;14:e1–75

    PubMed  Google Scholar 

  2. Brasch J, Becker D, Aberer W, Bircher A, Kränke B, Jung K et al. Guideline contact dermatitis: S1-Guidelines of the German Contact Allergy Group (DKG) of the German Dermatology Society (DDG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. Allergo J Int 2014;23:126–38

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rueff F, Przybilla B. Toxische und allergische Kontaktdermatitis. In: Plewig G, Landthaler M, Burgdorf W, Hertl M, Ruzicka T eds. Braun-Falco’s Dermatologie, Venerologie und Allergologie. Berlin - Heidelberg: Springer; 2012

    Google Scholar 

  4. Trautmann A, Disch R, Brocker E B, Akdis C A, Gillitzer R. How does eczema arise? J Dtsch Dermatol Ges 2003;1: 8–11

    Article  PubMed  Google Scholar 

  5. Kempf W, Hantschke M, Kutzner H, Burgdorf WHC. Epidermis - Spongiose, Akanthose und Hyperparakeratose. In: Kempf W, Hantschke M, Kutzner H, Burgdorf eds. Dermatopathologie. Berlin - Heidelberg: Springer; 2007

    Google Scholar 

  6. Weidinger S, Novak N. Atopic dermatitis. Lancet 2016;387:1109–22

    Article  PubMed  Google Scholar 

  7. Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet 2006;38:441–6

    Article  CAS  PubMed  Google Scholar 

  8. Rodriguez E, Baurecht H, Herberich E, Wagenpfeil S, Brown SJ, Cordell HJ et al. Meta-analysis of filaggrin polymorphisms in eczema and asthma: robust risk factors in atopic disease. J Allergy Clin Immunol 2009;123: 1361–70.e7

    Article  CAS  PubMed  Google Scholar 

  9. Weidinger S, Rodriguez E, Stahl C, Wagenpfeil S, Klopp N, Illig T et al. Filaggrin mutations strongly predispose to early-onset and extrinsic atopic dermatitis. J Invest Dermatol 2007;127:724–6

    Article  CAS  PubMed  Google Scholar 

  10. Pichard DC, Freeman AF, Cowen EW. Primary immunodeficiency update: Part I. Syndromes associated with eczematous dermatitis. J Am Acad Dermatol 2015;73:355–64; quiz 365-6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wedi B. Allergic Contact Dermatitis. In: Mahmoudi M, ed. Allergy and Asthma -Practical Diagnosis and Management. Cham: Springer; 2016. p. 193–207

    Chapter  Google Scholar 

  12. Lachapelle JM. Allergic contact dermatitis: clinical aspects. Rev Environ Health 2014;29:185–94

    PubMed  Google Scholar 

  13. Mahler V, Geier J, Schnuch A. Neue Entwicklungen zum Thema Epikutantest - aktuelle Daten aus der Deutschen Kontaktallergie-Gruppe (DKG) und Informationsverbund Dermatologischer Kliniken (IVDK). J Dtsch Dermatol Ges 2014;12:583–93

    Article  PubMed  Google Scholar 

  14. Kickinger-Lörsch A, Bruckner T, Mahler V. Nickel and cobalt release from metal alloys of tools - a current analysis in Germany. Contact Dermatitis 2015;73:289–95

    Article  PubMed  Google Scholar 

  15. Mahler V. Kontaktallergien bei Senioren. Hautarzt 2015;66:665–73

    Article  CAS  PubMed  Google Scholar 

  16. Lachapelle JM. Environmental airborne contact dermatoses. Rev Environ Health 2014;29:221–31

    CAS  PubMed  Google Scholar 

  17. Swinnen I, Goossens A. An update on airborne contact dermatitis: 2007-2011. Contact Dermatitis 2013;68:232–8.

    Article  PubMed  Google Scholar 

  18. Häusermann P, Harr T, Bircher AJ. Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome? Contact Dermatitis 2004;51:297–310

    Article  PubMed  Google Scholar 

  19. Winnicki M, Shear NH. A systematic approach to systemic contact dermatitis and symmetric drug-related intertriginous and flexural exanthema (SDRIFE): a closer look at these conditions and an approach to intertriginous eruptions. Am J Clin Dermatol 2011;12:171–80

    Article  PubMed  Google Scholar 

  20. Löffler H, Effendy I, Happle R. Die irritative Kontaktdermatitis. Hautarzt 2000;51:203–18

    Article  PubMed  Google Scholar 

  21. Wilm A, Berneburg M. Photoallergy. J Dtsch Dermatol Ges 2015;13:7–12; quiz 13

    PubMed  Google Scholar 

  22. Neumann NJ, Schauder S. Phototoxic and photoallergic reactions. Hautarzt 2013;64:354–62

    Article  CAS  PubMed  Google Scholar 

  23. Monteiro AF, Rato M, Martins C. Drug-induced photosensitivity: Photoallergic and phototoxic reactions. Clin Dermatol 2016;34:571–81

    Article  PubMed  Google Scholar 

  24. Kim WJ, Ko HC, Kim MB, Kim DW, Kim JM, Kim BS. Features of Staphylococcus aureus colonization in patients with nummular eczema. Br J Dermatol 2013;168:658–60

    Article  CAS  PubMed  Google Scholar 

  25. Bruno MC, Vilela MA, Oliveira CA. Study on dermatoses and their prevalence in groups of confirmed alcoholic individuals in comparison to a non-alcoholic group of individuals. An Bras Dermatol 2013;88:368–75

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jiamton S, Tangjaturonrusamee C, Kulthanan K. Clinical features and aggravating factors in nummular eczema in Thais. Asian Pac J Allergy Immunol 2013;31:36–42

    CAS  PubMed  Google Scholar 

  27. Tanaka T, Satoh T, Yokozeki H. Dental infection associated with nummular eczema as an overlooked focal infection. J Dermatol 2009;36:462–5

    Article  PubMed  Google Scholar 

  28. Shiotani A, Sakurane M, Furukawa F. Helicobacter pylori- positive patients with pruritic skin diseases are at increased risk for gastric cancer. Aliment Pharmacol Ther 2004;20:80–4

    Article  PubMed  Google Scholar 

  29. Aschoff R, Kempter W, Meurer M. Seborrhoisches Ekzem. Hautarzt 2011;62:297–307

    Article  CAS  PubMed  Google Scholar 

  30. Naldi L, Rebora A. Clinical practice. Seborrheic dermatitis. N Engl J Med 2009;360:387–96

    Article  CAS  PubMed  Google Scholar 

  31. Minkov M. Langerhans-cell histiocytosis. Monatsschrift Kinderheilkunde 2012;160:958–66

    Article  Google Scholar 

  32. Buchbinder D, Nugent DJ, Fillipovich AH. Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments. Appl Clin Genet 2014;7:55–66

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Oluwole OO, Zic JA, Douds JJ, Ann Thompson M, Greer JP. Cutaneous manifestations and management of hematologic neoplasms. Semin Oncol 2016;43:370–83

    Article  PubMed  Google Scholar 

  34. Norman RA. Xerosis and pruritus in the elderly: recognition and management. Dermatol Ther 2003;16:254–9

    Article  PubMed  Google Scholar 

  35. Wienert V, Marshall M. Pathophysiologie und Klinik des postthrombotischen Syndroms. Gefässchirurgie 2015;20:484–9

    Article  Google Scholar 

  36. Feser A, Mahler V. Periokuläre Ekzeme: Ursachen, Differenzialdiagnosen und Therapie. J Dtsch Dermatol Ges 2010;8:159–66

    Article  PubMed  Google Scholar 

  37. Mahler V. Hand dermatitis - differential diagnoses, diagnostics, and treatment options. J Dtsch Dermatol Ges 2016;14:7–26; quiz 27-8

    PubMed  Google Scholar 

  38. Lerbaek A, Kyvik KO, Ravn H, Menné T, Agner T. Clinical characteristics and consequences of hand eczema - an 8-year follow-up study of a population-based twin cohort. Contact Dermatitis 2008;58:210–6

    Article  PubMed  Google Scholar 

  39. Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J et al. Guidelines for diagnosis, prevention and treatment of hand eczema. J Dtsch Dermatol Ges 2015;13:e1–22

    Article  PubMed  Google Scholar 

  40. Mahler V, Glöckler A, Worm M, Spornraft-Ragaller P, Bauer A, Dickel H et al. Proteinkontaktdermatitis. Allergologie 2013;36:219–26

    Google Scholar 

  41. Brans R, Hübner A, Gediga G, John SM. Prevalence of foot eczema and associated occupational and non-occupational factors in patients with hand eczema. Contact Dermatitis 2015;73:100–7

    Article  PubMed  Google Scholar 

  42. Antonov D, Schliemann S, Elsner P. Hand dermatitis: a review of clinical features, prevention and treatment. Am J Clin Dermatol 2015;16:257–70

    Article  PubMed  Google Scholar 

  43. Lazzarini R, Duarte I, Marzagao C. Contact dermatitis of the feet: a study of 53 cases. Dermatitis 2004;15:125–30

    Article  PubMed  Google Scholar 

  44. Lukács J, Schliemann S, Elsner P. Association between smoking and hand dermatitis - a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2015;29:1280–4

    Article  PubMed  Google Scholar 

  45. Sorensen JA, Clemmensen KK, Nixon RL, Diepgen TL, Agner T. Tobacco smoking and hand eczema - is there an association? Contact Dermatitis 2015;73:326–35

    Article  PubMed  Google Scholar 

  46. Seebode C, Schiller S, Emmert S, Giehl K. Palmoplantar dermatoses: when should genes be considered? Hautarzt 2014;65:499–512

    Article  CAS  PubMed  Google Scholar 

  47. Wienert V. Interdisziplinäre Leitlinie: Analekzem (Entwicklungsstufe S1). Coloproctology 2003;25:190–3

    Article  Google Scholar 

  48. Lenhard BH. Systematik und Therapie des Analekzems. Akt Dermatol 2016;42:194–97

    Article  Google Scholar 

  49. Dietrich A, Ruzicka T, Hermans C. Differential diagnosis of anal eczema. Hautarzt 2015;66:400–7

    Article  CAS  PubMed  Google Scholar 

  50. Kügler K, Brinkmeier T, Frosch PJ, Uter W. Anogenitaldermatosen - allergische und irritative Auslösefaktoren Analyse von Daten des IVDK und Literaturübersicht. J Dtsch Dermatol Ges 2005;3:979–86

    Article  PubMed  Google Scholar 

  51. Claus S, Terliesner N, Simon J, Treudler R. Congenital erythroderma. J Dtsch Dermatol Ges 2016;14:435–7

    PubMed  Google Scholar 

  52. Schnuch A, Aberer W, Agathos M, Brasch J, Frosch PJ, Fuchs T et al. Leitlinien der Deutschen Dermatologischen Gesellschaft (DDG) zur Durchführung des Epikutantests mit Kontaktallergenen. Hautarzt 2001;52:864–6

    Article  CAS  PubMed  Google Scholar 

  53. Becker D. Allergic contact dermatitis. J Dtsch Dermatol Ges 2013;11:607–19

    PubMed  Google Scholar 

  54. Geier J, Weisshaar E, Lessmann H, Becker D, Dickel H, Häberle M et al. für die Arbeitsgruppe „Bewertung der Allergene bei BK 5101“ der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie in der Deutschen Dermatologischen Gesellschaft: Bewertung von Epikutantestreaktionen auf „Problemallergene“ mit vermehrt fraglichen oder schwach positiven Reaktionen. Dermatol Beruf Umwelt 2010;58:34–8

    Article  Google Scholar 

  55. Mowad CM, Anderson B, Scheinman P, Pootongkam S, Nedorost S, Brod B. Allergic contact dermatitis: Patient management and education. J Am Acad Dermatol 2016;74:1043–54

    Article  PubMed  Google Scholar 

  56. Luger T, Loske K, Elsner P, Kapp A, Kerscher M, Korting HC et al. Topische Dermatotherapie mit Glukokortikoiden- Therapeutischer Index. J Dtsch Dermatol Ges 2004;2:629–34

    Article  PubMed  Google Scholar 

  57. Cury Martins J, Martins C, Aoki V, Gois AF, Ishii HA, da Silva EM. Topical tacrolimus for atopic dermatitis. Cochrane Database Syst Rev 2015;7:CD009864

    Google Scholar 

  58. Fukaya M, Sato K, Sato M, Kimata H, Fujisawa S, Dozono H et al. Topical steroid addiction in atopic dermatitis. Drug Healthc Patient Saf 2014;6:131–8

    Article  PubMed  PubMed Central  Google Scholar 

  59. Singer S, Schwarz T, Berneburg M. Wirkmechanismen und Anwendungsgebiete der Phototherapie. In: Singer S, Schwarz T, Berneburg M, eds. Phototherapie: Eine Einführung in die Wirkmechanismen und Anwendungsgebiete. Wiesbaden: Springer; 2016. p. 9–30

    Chapter  Google Scholar 

  60. Tartar D, Bhutani T, Huynh M, Berger T, Koo J. Update on the immunological mechanism of action behind phototherapy. J Drugs Dermatol 2014;13:564–8

    CAS  PubMed  Google Scholar 

  61. Amann PM, Merk HF, Baron JM. Retinoids in dermatopharmacology. Hautarzt 2014;65:98–105

    Article  CAS  PubMed  Google Scholar 

  62. King T, McKenna J, Alexandroff A B. Alitretinoin for the treatment of severe chronic hand eczema. Patient Prefer Adherence 2014;8:1629–34

    PubMed  PubMed Central  Google Scholar 

  63. Niedner R. Therapie mit systemischen Glukokortikoiden. Hautarzt 2001;52:1062–74

    Article  CAS  PubMed  Google Scholar 

  64. Mrowietz U, Konsensus-Konferenz Ciclosporin. Leitlinien mit Ciclosporin in der Dermatologie. Erarbeitet durch die Konsensus-Konferenz Ciclosporin. Hautarzt 2001;52: 201–4

    Article  CAS  PubMed  Google Scholar 

  65. Roekevisch E, Spuls PI, Kuester D, Limpens J, Schmitt J. Efficacy and safety of systemic treatments for moderate- to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol 2014;133:429–38

    Article  CAS  PubMed  Google Scholar 

  66. Diepgen TL. Occupational skin diseases. J Dtsch Dermatol Ges 2012;10:297–313; quiz 314-15

    PubMed  Google Scholar 

  67. Radon K, Nowak D, Vogelberg C, Ruëff F. Career advice for young allergy patients - a systematic review. Dtsch Ärztebl Int 2016;113:519–24

    PubMed  PubMed Central  Google Scholar 

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  1. Department of Dermatology & Allergy, Comprehensive Allergy Center, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Bettina Wedi

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  1. Bettina Wedi
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Correspondence to Bettina Wedi.

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Wedi B. Dermatitis update: clinical manifestations, pathogenesis and current therapeutic approaches. Allergo J Int 2016;25:219–32

DOI: 10.1007/s40629-016-0133-1

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Wedi, B. Dermatitis update: clinical manifestations, pathogenesis and current therapeutic approaches. Allergo J Int 25, 219–232 (2016). https://doi.org/10.1007/s40629-016-0133-1

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  • DOI: https://doi.org/10.1007/s40629-016-0133-1

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