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Dermatitis Nursing Guide

The content for this course was created by Bobbi Whittington, RN, BSN.

Dermatitis Overview

This course is intended as a Quick Reference for dermatitis and will cover an overview as well as nursing considerations utilizing the nursing process. 

Dermatitis Etiology and Epidemiology 

Dermatitis is an umbrella term that is used to describe multiple skin irritations and conditions that can be caused by an individual’s genetics, overactive immune system, infections, or irritating substances (Cleveland Clinic, 2020). There are three main types of dermatitis: 

  • Atopic dermatitis 
  • Contact dermatitis 
  • Exfoliative dermatitis 

Atopic dermatitis is a form of eczema and is the most common chronic inflammatory skin disease leading to abnormalities in the epidermis and the immune system. This type of dermatitis is seen in approximately 10% to 30% of children and 2% to 10% of adults. (Ferrer- Baker & Kolb, 2021). Normally, if one parent has atopic dermatitis, there is more than a 50% chance their children will develop the skin condition. 

 Contact dermatitis occurs when the skin becomes irritated or inflamed after coming into contact with a substance that triggers an allergic reaction (National Eczema Association, n.d.). There are two main types of contact dermatitis: 

  • Irritant contact dermatitis: The skin comes into contact with a chemical or physical agent, such as soaps or detergent, that damages the skin faster than it can be repair. 
  • Allergic contact dermatitis: A delayed allergic reaction that appears as a rash 1 to 2 days after exposure to the allergen such as poison ivy. 

Individuals with atopic tendencies, females, infants, and elderly are more susceptible to irritant contact dermatitis (Atwater et al., 2021). Risk factors for allergic contact dermatitis include occupation, age, and history of atopic dermatitis. 

 Exfoliative dermatitis or erythroderma is a severe erythema and scaling of greater than 90% of the body surface area (Athalye & Austad, 2021). This type of dermatitis is rare but can affect individuals at any age or race and is more common in males than females. The most common causes of exfoliative dermatitis include: 

  • Medication reaction 
  • Systemic disease 
  • Idiopathic in nature 

There are several factors that can trigger or aggravate any type of dermatitis the individual is experiencing. These factors include: 

  • Continued exposure to the allergen 
  • Stress 
  • Hot showers 
  • Pollen or pet dander 
  • Depression 
  • Irritability 

Dermatitis Diagnosis 

The diagnosis of dermatitis is made through a thorough history and physical examination of the individual. The following signs and symptoms for each type of dermatitis may include: 

  • Atopic dermatitis: Patterns of lesions vary with age of presentation: 
    • Infants develop red scaling and dry areas over cheeks. 
    • Children develop red scaling and thickened skin in joint areas. 
    • Adults develop markings on their hands and eyelids. 
  • Contact dermatitis: Patterns depend on the inflammatory response phase: 
    • Acute phase includes erythema, edema, oozing, vesicles, or pustules. 
    • Subacute phase includes crusts, scales, and hyperpigmentation. 
    • Chronic phase includes thick, leathery skin from rubbing and scratching. 
  • Exfoliative dermatitis: Presents with the following: 
    • Bright red patches covering most of the skin surface 
    • Fever 
    • Edema 
    • Hair loss 

A complete history which should include: 

  • Medical history 
  • Current medications 
  • Onset of lesions 
  • Severity of pruritus 
  • Presence of triggers 

The diagnosis if dermatitis is based on the clinical presentation of the individual. The healthcare provider may order a basic metabolic panel and complete blood count. 

Dermatitis Management 

Management and treatment of dermatitis will depend on which type the individual has. Treatment will generally include: 

  • Determine the trigger and avoid it 
  • Daily skin care 
  • Avoid hot water 
  • Topical corticosteroids as ordered 
  • Antihistamines as ordered 
  • Bed rest 
  • Analgesics as ordered 
  • Non-pharmacological interventions for pain 
  • Increase fluid intake 

Dermatitis Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for dermatitis include the following: 

Assessment 

Assess signs and symptoms, such as: 

  • History of dermatitis 
  • Lesions 
  • Papules 
  • Vesicles 
  • Rash 
  • Pruritis 
  • Fever 

Nursing Diagnosis/Risk For 

  • Impaired skin integrity related to contact with irritant or allergens, evidenced by: 
    • Inflammation 
    • Dry skin 
    • Lesions 
    • Pruritus 
  • Risk for infection related to impaired skin integrity, evidenced by: 
    • Verbalization of pain 
    • Redness 
    • Swelling 
  • Disturbed body image related to visible skin lesions, evidenced by: 
    • Verbalization of changes in body appearance 
    • Fear of reaction of others 
    • Verbalization of negative feelings of skin lesions 

Interventions 

  • Monitor skin lesions for infection 
  • Educate individual and family on hand hygiene 
  • Administer prescribed topical ointments or antibiotics 
  • Allow individual to verbalize their feelings 
  • Identify and educate on ways to redirect attention from lesions 
  • Administer wound care as ordered 
  • Refer to dermatology as needed 

Expected Outcomes 

  • Remains free from infections 
  • Maintains optimal skin integrity 
  • Verbalizes understanding of good hand hygiene 
  • Continues daily activities and social interactions 
  • Demonstrates effective coping 

Individual/Caregiver Education 

  • Condition, treatment, and expected outcomes 
  • Avoid triggers that cause flare-ups 
  • Apply topical medications as ordered 
  • Avoid prolonged exposure to the sun 
  • Proper skin care 
  • Notify healthcare provider or seek immediate medical care for: 
    • Symptoms are unrelieved by treatment 
    • Bleeding at the affected site 
  • Recommended follow-up with healthcare provider 

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Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2024

Course Contributor 

The content for this course was created by Bobbi Whittington, RN, BSN. 

Bobbi started her nursing career as a CNA in long term care and developed a passion for working with older adults in the post-acute setting. She obtained her LPN certificate in 1997 from South Central Area Vocational Technical School in Missouri. Continuing her education, she earned her Associate degree in nursing in 2007 from Texas County Technical Institute in Missouri then obtained her Bachelor of Science degree in nursing from Chamberlain College of Nursing in 2013. Bobbi has over 24 years clinical and managerial experience in the skilled nursing industry. 

References 

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