Dermatitis Symptom Spectrum: From Acute Flares to Chronic Lichenification

Dermatitis (eczema) encompasses a family of inflammatory skin disorders sharing core features but with distinct morphologies and distributions.

Universal Symptoms

• Erythema (redness)
• Pruritus (itching) — often intense, sleep-disrupting
• Edema, papules, microvesicles
• Oozing, crusting (acute)
• Scaling, lichenification (thickening from chronic rubbing)
• Fissures, pain (especially hands, feet)
• Burning/stinging sensation

Subtype-Specific Patterns

• Atopic dermatitis: Flexural (antecubital, popliteal), chronic/relapsing, personal/family atopy (asthma, allergic rhinitis).
• Allergic contact dermatitis: Geometric, localized to allergen exposure (nickel, fragrance, poison ivy).
• Irritant contact dermatitis: Hands, face — cumulative damage from soaps, solvents, wet work.
• Seborrheic dermatitis: Scalp, face (nasolabial folds, eyebrows), chest — greasy yellow scale.
• Nummular dermatitis: Coin-shaped plaques on extremities.
• Stasis dermatitis: Lower legs with venous insufficiency — hemosiderin deposition, lipodermatosclerosis.
• Dyshidrotic (pompholyx): Deep-seated vesicles on palms/soles.

Diagnostic Approach

• Clinical history + morphology + distribution = diagnosis in >90%.
• Patch testing (NACDG series) for suspected contact allergy.
• Skin biopsy if atypical, refractory, or mycosis fungoides considered.
• KOH prep for fungal mimic.

Treatment Pillars

• Barrier repair: emollients (ceramides, petrolatum) — foundation.
• Anti-inflammatory: topical corticosteroids (matched to site/severity), TCIs, PDE4 inhibitors (crisaborole), JAK inhibitors (ruxolitinib cream).
• Trigger avoidance.
• Systemic (severe): dupilumab, JAK inhibitors, traditional immunosuppressants.

Chronic dermatitis requires a maintenance mindset — not just flare treatment.