The power of making a correct diagnosis is the key to all success in the treatment of skin diseases; without this faculty, the physician can never be a thorough dermatologist, and therapeutics at once cease to hold their proper position, and become empirical. Louis A Duhring (1845–1913)
Skin disorders are common. They account for 10.8% of all problems1 encountered in general practice, the most common being contact dermatitis, malignant skin neoplasms, solar keratoses/sunburn, lacerations, warts and acne.
This chapter focuses on the common dermatoses.
The terms ‘dermatitis’ and ‘eczema’ are synonymous1 and denote an inflammatory epidermal rash, acute or chronic, characterised by vesicles (acute stage), redness, weeping, oozing, crusting, scaling and itch. Dermatitis can be divided into exogenous causes (allergic contact, primary irritant contact, photo-allergic and phototoxic) and endogenous, which implies all forms of dermatitis not directly related to external causative factors. Endogenous types are atopic, nummular (discoid), vesicular hand/foot (dyshidrotic), pityriasis alba, lichen simplex chronicus and seborrhoeic.
Dermatitis is primarily due to an impairment of the barrier function of the skin, making it more susceptible to irritation by soap and other contact irritants, the weather, temperature and non-specific triggers.
The term ‘atopic’ refers to a hereditary background or tendency to develop one or more of a group of conditions, such as allergic rhinitis, asthma, eczema, skin sensitivities and urticaria. It is not synonymous with allergy.
An estimated 10% of the population are atopics, with allergic rhinitis being the most common manifestation.2
Features of classic atopic dermatitis:3
usually a family history of atopy
about 3% of infants are affected, signs appearing between 3 months and 2 years
often known trigger factors (see Table 123.1) are evident
dust mite allergy is not always obvious, especially for peri-orbital rash
lichenification may occur with chronic atopic dermatitis
flexures are usually involved (see FIG. 123.1)
dryness is usually a feature
Trigger factors for atopic dermatitis
|Favorite Table|Download (.pdf) Table 123.1
Trigger factors for atopic dermatitis
|Dust mite (common) |
|Sand (e.g. in sandpits) |
|Extremes of hot and cold |
|Rapid temperature changes |
|Soap, shampoo and water/frequent washing, especially in winter |
|Chlorinated water |
|Bubble baths |
|Infection (viral, bacterial, fungal) |
|Stress/emotional factors |
|Skin irritants: |
• wool (e.g. sheepskin covers)
• brushed nylon or silk clothing
• rough clothing
• chemical disinfectants
• petrochemical products
|Scratching and rubbing |
|Poor general health |
|Foodstuffs (consider): |
• cow’s milk
• food colourants
• oranges and other citrus fruits
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