dermatitis

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Dermatitis

 

Definition

Dermatitis is a general term used to describe inflammation of the skin.

Description

Most types of dermatitis are characterized by an itchy pink or red rash.
Contact dermatitis is an allergic reaction to something that irritates the skin and is manifested by one or more lines of red, swollen, blistered skin that may itch or seep. It usually appears within 48 hours after touching or brushing against a substance to which the skin is sensitive. The condition is more common in adults than in children.
Contact dermatitis can occur on any part of the body, but it usually affects the hands, feet, and groin. Contact dermatitis usually does not spread from one person to another, nor does it spread beyond the area exposed to the irritant unless affected skin comes into contact with another part of the body. However, in the case of some irritants, such as poison ivy, contact dermatitis can be passed to another person or to another part of the body.
Stasis dermatitis is characterized by scaly, greasy looking skin on the lower legs and around the ankles. Stasis dermatitis is most apt to affect the inner side of the calf.
Nummular dermatitis, which is also called nummular eczematous dermatitis or nummular eczema, generally affects the hands, arms, legs, and buttocks of men and women older than 55 years of age. This stubborn inflamed rash forms circular, sometimes itchy, patches and is characterized by flares and periods of inactivity.
Atopic dermatitis is characterized by itching, scaling, swelling, and sometimes blistering. In early childhood it is called infantile eczema and is characterized by redness, oozing, and crusting. It is usually found on the face, inside the elbows, and behind the knees.
Seborrheic dermatitis may be dry or moist and is characterized by greasy scales and yellowish crusts on the scalp, eyelids, face, external surfaces of the ears, underarms, breasts, and groin. In infants it is called "cradle cap."

Causes and symptoms

Allergic reactions are genetically determined, and different substances cause contact dermatitis to develop in different people. A reaction to resin produced by poison ivy, poison oak, or poison sumac is the most common source of symptoms. It is, in fact, the most common allergy in this country, affecting one of every two people in the United States.
Flowers, herbs, and vegetables can also affect the skin of some people. Burns and sunburn increase the risk of dermatitis developing, and chemical irritants that can cause the condition include:
  • chlorine
  • cleansers
  • detergents and soaps
  • fabric softeners
  • glues used on artificial nails
  • perfumes
  • topical medications
Contact dermatitis can develop when the first contact occurs or after years of use or exposure.
Stasis dermatitis, a consequence of poor circulation, occurs when leg veins can no longer return blood to the heart as efficiently as they once did. When that happens, fluid collects in the lower legs and causes them to swell. Stasis dermatitis can also result in a rash that can break down into sores known as stasis ulcers.
The cause of nummular dermatitis is not known, but it usually occurs in cold weather and is most common in people who have dry skin. Hot weather and stress can aggravate this condition, as can the following:
  • allergies
  • fabric softeners
  • soaps and detergents
  • wool clothing
  • bathing more than once a day
Atopic dermatitis can be caused by allergies, asthma, or stress, and there seems to be a genetic predisposition for atopic conditions. It is sometimes caused by an allergy to nickel in jewelry.
Seborrheic dermatitis (for which there may also be a genetic predisposition) is usually caused by overproduction of the oil glands. In adults it can be associated with diabetes mellitus or gold allergy. In infants and adults it may be caused by a biotin deficiency.

Diagnosis

The diagnosis of dermatitis is made on the basis of how the rash looks and its location. The doctor may scrape off a small piece of affected skin for microscopic examination or direct the patient to discontinue use of any potential irritant that has recently come into contact with the affected area. Two weeks after the rash disappears, the patient may resume use of the substances, one at a time, until the condition recurs. Eliminating the substance most recently added should eliminate the irritation.
If the origin of the irritation has still not been identified, a dermatologist may perform one or more patch tests. This involves dabbing a small amount of a suspected irritant onto skin on the patient's back. If no irritation develops within a few days, another patch test is performed. The process continues until the patient experiences an allergic reaction at the spot where the irritant was applied.

Treatment

Treating contact dermatitis begins with eliminating or avoiding the source of irritation. Prescription or over-the-counter corticosteroid creams can lessen inflammation and relieve irritation. Creams, lotions, or ointments not specifically formulated for dermatitis can intensify the irritation. Oral antihistamines are sometimes recommended to alleviate itching, and antibiotics are prescribed if the rash becomes infected. Medications taken by mouth to relieve symptoms of dermatitis can make skin red and scaly and cause hair loss.
Patients who have a history of dermatitis should remove their rings before washing their hands. They should use bath oils or glycerine-based soaps and bathe in lukewarm saltwater.
Patting rather than rubbing the skin after bathing and thoroughly massaging lubricating lotion or nonprescription cortisone creams into still-damp skin can soothe red, irritated nummular dermatitis. Highly concentrated cortisone preparations should not be applied to the face, armpits, groin, or rectal area. Periodic medical monitoring is necessary to detect side effects in patients who use such preparations on rashes covering large areas of the body.
Coal-tar salves can help relieve symptoms of nummular dermatitis that have not responded to other treatments, but these ointments have an unpleasant odor and stain clothing.
Patients who have stasis dermatitis should elevate their legs as often as possible and sleep with a pillow between the lower legs.
Tar or zinc paste may also be used to treat stasis dermatitis. Because these compounds must remain in contact with the rash for as long as two weeks, the paste and bandages must be applied by a nurse or a doctor.
Coal-tar shampoos may be used for seborrheic dermatitis that occurs on the scalp. Sun exposure after the use of these shampoos should be avoided because the risk of sunburn of the scalp is increased.

Alternative treatment

Some herbal therapies can be useful for skin conditions. Among the herbs most often recommended are:
  • Burdock root (Arctium lappa)
  • Calendula (Calendula officinalis) ointment
  • Chamomile (Matricaria recutita) ointment
  • Cleavers (Galium ssp.)
  • Evening primrose oil (Oenothera biennis)
  • Nettles (Urtica dioica)
Contact dermatitis can be treated botanically and homeopathically. Grindelia (Grindelia spp.) and sassafras (Sassafras albidum) can help when applied topically. Determining the source of the problem and eliminating it is essential. Oatmeal baths are very helpful in relieving the itch. Bentonite clay packs or any mud pack draws the fluid out and helps dry up the lesions. Cortisone creams are not recommended.
Stasis dermatitis should be treated by a trained practitioner. This condition responds well to topical herbal therapies, however, the cause must also be addressed. Selenium-based shampoos, topical applications of flax oil and/or olive oil, and biotin supplementation are among the therapies recommended for seborrheic dermatitis.

Prognosis

Dermatitis is often chronic, but symptoms can generally be controlled.

Prevention

Contact dermatitis can be prevented by avoiding the source of irritation. If the irritant cannot be avoided completely, the patient should wear gloves and other protective clothing whenever exposure is likely to occur.
Immediately washing the exposed area with soap and water can stem allergic reactions to poison ivy, poison oak, or poison sumac, but because soaps can dry the skin, patients susceptible to dermatitis should use them only on the face, feet, genitals, and underarms.
Clothing should be loose fitting and 100% cotton. New clothing should be washed in dye-free, unscented detergent before being worn.
Injury to the lower leg can cause stasis dermatitis to ulcerate (form open sores). If stasis ulcers develop, a doctor should be notified immediately.
Yoga and other relaxation techniques may help prevent atopic dermatitis caused by stress.
Avoidance of sweating may aid in preventing seborrheic dermatitis.
A patient who has dermatitis should also notify a doctor if any of the following occurs:
  • fever develops
  • skin oozes or other signs of infection appear
  • symptoms do not begin to subside after seven days' treatment
  • he/she comes into contact with someone who has a wart, cold sore, or other viral skin infection

Resources

Other

"Allergic Contact Dermatitis." The Skin Site. April 10, 1998 (January 11, 2006). http://www.skinsite.com/info_allergic.htm.

Key terms

Allergic reaction — An inappropriate or exaggerated genetically determined reaction to a chemical that occurs only on the second or subsequent exposures to the offending agent, after the first contact has sensitized the body.
Corticosteriod — A group of synthetic hormones that are used to prevent or reduce inflammation. Toxic effects may result from rapid withdrawal after prolonged use or from continued use of large doses.
Patch test — A skin test that is done to identify allergens. A suspected substance is applied to the skin. After 24-48 hours, if the area is red and swollen, the test is positive for that substance. If no reaction occurs, another substance is applied. This is continued until the patient experiences an allergic reaction where the irritant was applied to the skin.
Rash — A spotted, pink or red skin eruption that may be accompanied by itching and is caused by disease, contact with an allergen, food ingestion, or drug reaction.
Ulcer — An open sore on the skin, resulting from tissue destruction, that is usually accompanied by redness, pain, or infection.

der·ma·ti·tis

, pl.

der·ma·tit·i·des

(der'mă-tī'tis, -tit'i-dēz),
Inflammation of the skin.
[derm- + G. -itis, inflammation]

dermatitis

(dûr′mə-tī′tĭs)
n.
Inflammation of the skin.

dermatitis

Inflammation of the skin. See Allergic contact dermatitis, Atopic dermatitis, Caterpillar dermatitis, 'Club Med, ' Contact dermatitis, Diaper dermatitis, Estrogen dermatitis, Herpetic dermatitis, Hot tub dermatitis, Neurodermatitis, Seborrheic dermatitis, Stasis dermatitis.

der·ma·ti·tis

, pl. dermatitides (dĕrmă-tītis, -titi-dēz)
Inflammation of the skin.
[derm- + G. -itis, inflammation]

dermatitis

(der?ma-tit'is ) (-tit'i-dez?) plural.dermatitidesplural.dermatitises [ dermato- + -itis]
An inflammatory rash marked by itching and redness. See: eczema

Etiology

Dermatitis has many causes, , including contact with skin irritants (such as the oil that causes poison ivy or oak); venous stasis, with edema and vesicle formation near the ankles; habitual scratching, as is found in neurodermatitis; dry skin, as in winter itch; and ultraviolet light, as in photosensitivity reactions.

Treatment

When a source of dermatitis is identifiable (such as in contact dermatitis due to a detergent or topical cosmetic), the best treatment is to avoid the irritating substance and to cleanse the affected area immediately with mild soap and water. Once skin inflammation is established, topical corticosteroid ointments or systemic steroids (during extreme exacerbations), topical immunomodulator agents (in patients above age 2), weak tar preparations and ultraviolet B light therapy (to increase the thickness of the stratum corneum) and antihistamines may be used, with antibiotics reserved for secondary infections. Dermatologists may prescribe occlusive dressings intermittently to help clear lichenified skin.

Patient care

The patient should avoid known skin irritants. Tepid baths, cool compresses, and astringents sometimes help relieve inflammation and itch. Moisturizing creams or lotions following bathing help to retain skin moisture, but perfumed products should be avoided. Drug therapy is administered and evaluated for desired effects and adverse reactions. The patient is taught to apply topical medications and is educated about their most common side effects. Scratching is discouraged and the fingernails kept short to limit excoriation. The patient should be made aware that drowsiness may occur with antihistamine use and that driving or operating mechanical equipment should be avoided until the extent of this effect is known. Health care professionals should be careful not to show any negative feelings when touching lesions during assessment or treatment but should follow standard precautions. Skin changes alter body image, and the patient will need assistance in accepting and coping with what he or she may view as disfigurement. Children and adolescents may require and benefit from counseling to help them deal with emotional components of their condition.

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ACTINIC DERMATITIS

actinic dermatitis

A chronic red or eczematous rash, usually on the face or exposed skin surfaces, that typically results from exposure and sensitization to ultraviolet rays. Adults over age 50 may be affected. See: illustration Synonym: photosensitivity dermatitis

allergic contact dermatitis

Contact dermatitis.
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ATOPIC DERMATITIS

atopic dermatitis

Chronic dermatitis of unknown cause found in patients with a history of allergy. The disease usually begins after the first 2 months of life, and those affected may experience exacerbations and remissions throughout childhood and adulthood. In many cases, there is a family history of allergy or atopy: if both parents have atopic dermatitis, the chances are nearly 80% that their children will have it, as well. Atopic dermatitis is typically found in flexural creases of the body, e.g., the antecubital and popliteal fossae. The skin lesions consist of reddened, cracked, and thickened skin that can become exudative and crusty from scratching. Scarring or secondary infection may occur. Most patients have an elevated level of immunoglobulin E in their serum. See: illustration

Treatment

The patient should avoid soaps and ointments. Bathing is kept to a minimum, but bath oils may help to prevent drying of the skin. Clothing should be soft textured and should not contain wool. Fingernails should be kept short to decrease damage from scratching. Antihistamines may help reduce itching at night. Heavy exercise should be avoided because it induces perspiration. A nonlipid softening lotion followed by a corticosteroid in a propylene glycol base may effectively treat acute exacerbations; when large areas of the body are involved, oral steroids may be needed. Because of the adverse effects associated with corticosteroids, topical immunosuppressants such as tacrolimus that decrease T cell activity have been developed. Antistaphylococcal antibiotics may be needed to control secondary infection, introduced when scratching causes microfissures in the skin.

illustration

berloque dermatitis

, berlock dermatitis
A type of phytophotodermatitis with postinflammatory hyperpigmentation at the site of application of perfumes or colognes containing oil of bergamot.
Synonym: bergamot phototoxicity.

dermatitis calorica

Inflammation due to heat, as in sunburn, or cold.

cercarial dermatitis

Swimmer's itch.
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CONTACT DERMATITIS: Allergic reaction to topical anesthetic

contact dermatitis

Dermatitis due to contact with allergens or an irritating substance. Allergic contact dermatitis is caused by a T-cell–mediated hypersensitivity reaction to natural or synthetic environmental allergens. These combine with skin proteins, altering the normal autoantigens so that new, foreign antigens are created. Nonallergic contact dermatitis, also known as irritative contact dermatitis, is usually caused by exposure to a detergent, soap, or other skin irritant. Synonym: allergic contact dermatitis dermatitis venenata (1) See: illustration

Symptoms

Skin changes, which appear 4 to 48 hr after exposure, depending on the degree of sensitivity to the allergen, consist of erythema, local edema, and blisters. The blisters may weep in severe cases. Most patients complain of intense itching. Signs and symptoms of the disease usually last 10 to 14 days. Re-exposure to the cause will trigger a relapse.

Treatment

Tepid baths, cool compresses, topical astringents (such as solutions of aluminum acetate), antihistamines, and corticosteroids all provide some relief.

illustration

contagious pustular dermatitis

A cutaneous disease of sheep and goats transmitted to humans by direct contact. The lesion on humans is usually solitary and on the hands, arms, or face. This maculopapular area may progress to a pustule up to 3 cm in diameter and may last 3 to 6 weeks. The etiological agent is Parapoxvirus, , a genus of poxvirus.
Synonym: orf

diaper dermatitis

Diaper rash.

exfoliative dermatitis

Generalized dermatitis, often followed by scaling. It may be caused by leukemias or lymphomas that infiltrate the skin; extensive psoriasis; drug reactions (such as vancomycin); allergies, seborrhea, or atopy. The condition is often associated with systemic findings, including lymphadenopathy, hepatic and splenic enlargement, fever, anemia, eosinophilia, and decreases in serum albumin.

When the skin involvement is extensive, the patient may become depressed because of the cosmetic changes.

Treatment

Therapy is directed at treating the underlying cause.

factitial dermatitis

A self-inflicted irritation or injury to the skin.

dermatitis herpetiformis

A chronic dermatitis characterized by erythematous, papular, vesicular, bullous, or pustular lesions with a tendency to grouping and with intense itching and burning.

Etiology

It is associated with allergy to gluten and is often found in patients with celiac disease (gluten-sensitive enteropathy).

Symptoms

The lesions develop suddenly and spread peripherally. The disease is variable and erratic, and an attack may be prolonged for weeks or months. Secondary infection may follow trauma to the inflamed areas.

Treatment

Oral dapsone provides substantial relief of symptoms in a few days. Sulfapyridine also may be used.

dermatitis hiemalis

Winter itch.

dermatitis infectiosa eczematoides

A pustular eruption during or following a pyogenic disease.

livedo-like dermatitis

Nicolau syndrome.

meadow dermatitis

A blistering rash that appears on the exposed skin of hikers, florists, gardeners, and those who work outdoors in bright sunlight. It is a phototoxic reaction caused by exposure to light-sensitizing chemicals in some plants (such as parsley, rue, bergamot, and fig).

dermatitis medicamentosa

Drug rash.

dermatitis multiformis

A form of dermatitis with pustular lesions.

dermatitis papillaris capillitii

Formation on the scalp and neck of papules interspersed with pustules. The rash ultimately produces scarlike elevations resembling keloids.

photoallergic contact dermatitis

Photoallergy.

photosensitivity dermatitis

Actinic dermatitis.

poison ivy dermatitis

Dermatitis resulting from irritation or sensitization of the skin by urushiol, the toxic resin of plants of the genus Toxicodendron (Rhus). There is no absolute immunity; susceptibility varies greatly, even in the same individual.

Those sensitive to poison ivy may also react to contact with other plants, such as the mango rind and cashew oil. These plants contain chemicals that cross-react with the sap present in poison ivy, poison oak, and poison sumac.

Symptoms

Some time elapses between skin contact with the poison and first appearance of symptoms, varying from a few hours to several days and depending on the sensitivity of the patient and the condition of the skin. Moderate itching or a burning sensation is soon followed by small blisters; later manifestations vary. Blisters usually rupture and are followed by oozing of serum and subsequent crusting.

Prevention

Some barrier creams have been used to prevent poison ivy dermatitis. They are sprayed on the skin prior to anticipated contact with the plant.

Treatment

In mild dermatitis, antihistamines and a lotion to relieve itching are usually sufficient. In severe dermatitis, cool, wet dressings or compresses, potassium permanganate baths, and topical corticosteroids are often effective. In some instances intramuscular or oral corticosteroid therapy is used. If plant leaves are burned and the smoke inhaled, or if plant leaves are ingested, the patient should be directed to an emergency care center. Demulcents, fluids, morphine, and a high-protein, low-fat diet may be prescribed.

Patient care

Prevention is important in those with known sensitivity and in those with no previous contact with or reaction to the plant. Instruction of the patient focuses on helping the patient to recognize the plant, to avoid contact with it, and to wear long-sleeved shirts and long pants in wooded areas. If contact occurs, the patient should wash with soap and water immediately to remove the toxic oil. Contaminated clothing and pets also should be promptly and thoroughly washed because contact with such items may cause poison dermatitis in other members of the household.

illustration

primary dermatitis

Dermatitis that is a direct rather than an allergic response.

radiation dermatitis

Dermatitis due to radiation exposure.
Synonym: radioepidermitis; radioepithelitis; radiodermatitis

rhus dermatitis

Contact dermatitis caused by the toxic resin in poison ivy or oak.
See: poison ivy dermatitis; Toxicodendron

schistosome dermatitis

Swimmer's itch.

dermatitis seborrheica

An acute or subacute dermatitis of unknown cause, beginning on the scalp and/or face and in skin folds (any area where sebaceous glands are active) and characterized by rounded, irregular, or circinate lesions covered with yellow or brown-gray greasy scales. Synonym: pityriasis capitis; seborrhea corporis; seborrhea sicca

Symptoms

The scalp may be dry with abundant grayish branny scales, or oozing and crusted (eczema capitis). The rash may spread to the forehead and postauricular regions. The forehead shows scaly and infiltrated lesions with dark red bases and localized loss of hair. The eyebrows and eyelashes may have dry, dirty white scales. Inflamed skin and scales may be present on the nasolabial folds or the vermilion border of the lips. On the sternal region, the lesions are greasy to the touch. Eruptions may also appear in interscapular, axillary, and genitocrural regions. Cold winter weather may worsen the condition.

Treatment

When the condition is limited to the scalp, frequent shampooing and use of mild keratolytic agents are indicated. Selenium-containing shampoos are helpful. Generalized seborrheic dermatitis requires careful attention, including scrupulous skin hygiene, frequent washing and shampooing with selenium sulfide suspension to remove scales, keeping the skin as dry as possible, and using dusting powders. Fluorinated corticosteroids may be applied topically to hairless areas, and systemic cortisone preparations may be required. The differential diagnosis includes psoriasis; it should be ruled out and neurologic conditions recognized as possible predisposing factors.

Patient care

The health care provider explains to the patient that the condition has remissions and exacerbations and that hormone imbalances, nutritional status, infection, and emotional stress influence its course. The patient is taught to apply prescribed corticosteroids to the body and face. Fluorinated corticosteroids should be used with caution near the eyelids, on the face, and in the groin. To avoid developing a secondary Candida yeast infection in body creases or folds, the patient is advised to cleanse these areas carefully, to dry gently but thoroughly, and to ensure that the skin is well aerated. He or she is taught to treat seborrheic scalp conditions (dandruff) with proper and frequent shampooing, alternating two or three different types of shampoo to prevent the development of resistance to a particular product. External irritants and excessive heat and perspiration should be avoided. Rubbing and scratching the skin are discouraged because they prolong exacerbations and increase the risk for secondary infection and excoriation, esp. since scaly, pruritic lesions present in skin areas with high bacteria counts. Oral antibiotics (such as tetracycline) may be prescribed (as for acne vulgaris) in small doses over a prolonged period to reduce bacterial colonization. The patient is advised to take tetracycline at least 1 hr before or 2 hr after meals, since the drug is poorly absorbed with food. The patient also is taught about the adverse effects of the drug (photosensitivity, birth defects, nausea, vomiting, and candidal vaginitis) and their management. Adherence to the treatment regimen is stressed to achieve optimal results. Psychological support or counseling is provided as necessary to deal with related body image concerns.

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STASIS DERMATITIS

stasis dermatitis

Eczema of the legs with edema, pigmentation, and sometimes chronic inflammation. It is usually due to impaired return of blood from the legs. Compression stockings help the rash to resolve gradually. See: illustration
illustration

dermatitis venenata

1. Contact dermatitis.
2. Any inflammation caused by local action of various animal, vegetable, or mineral substances contacting the surface of the skin.

dermatitis verrucosa

A chronic fungal infection of the skin characterized by the formation of wartlike nodules. These may enlarge and form papillomatous structures that sometimes ulcerate.

Etiology

This condition may be due to one of several fungi, including Hormodendrum pedrosoi or Phialophora verrucosa.

dermatitis

Inflammation of the skin from any cause. Dermatitis is not a specific disease, but any one of a large range of inflammatory disorders featuring redness, blister formation, swelling, weeping, crusting and itching.

dermatitis

an inflammation of the skin.

eczema

An inflammatory disease of the skin characterized by a rash of red spots, rough scaling, dryness and soreness of the skin sometimes leading to the formation of blisters. It often gives rise to itching or to a burning sensation. It may occur on the skin of the face where parts of spectacles rest. Frames should be cleaned regularly to avoid causing skin irritation. Syn. contact dermatitis.

der·ma·ti·tis

, pl. dermatitides (dĕrmă-tītis, -titi-dēz)
Inflammation of the skin.
[derm- + G. -itis, inflammation]

Patient discussion about dermatitis

Q. What are the causes of dermatitis herpetiformis?

A. no one knows what triggers the body immune system to attack the body. but there is a theory it's has to be connected to your genetics of your immune system and getting infected by an unknown virus. they think most of the autoimmune diseases are caused by unknown viruses that have similar proteins to the tissues in your body and when the immune system reacts to it- it also attack the body.

Q. I have atopic dermatitis and its been out of control : ( i was wondering any suggestions what to do? This past year i have experienced 2 bacterial infections due to my open soars as well as a viral infection in which i was hospitalized. im so fusterated and scared i dont know what to do.. i personally dont think that creams and ointments work all that well. From what i have gathered eczema comes from the inside out? :S i also have allergies i tend to be allergic to everything environmental, animals dust, mold, as well as oral allergy syndrom to alot of foods. which is very difficult. i have been to numerous doctors and specialsist and they dont know what to do. the next step is to put me on an oral medication, sure it prevents it from coming but there are also alot of disadvantages to taking the pill. They also wanted me to go for uvb lights which are knowen to treat psriosis, which personalyy i dont feel it helps me ..realie.. eczema and psriosis are 2 totally diff skin diseases.. someone . PLEASEE HELP .. : )

A. I like the apple cider idea and hope that works for you. But I have a client who has suffered the same as you with her dermatitis and was also hospitalized with mirca staph infection. Her dr. has agreed to refer her to a mayo clinic I will come back and let you know what they do and if it works. God bless you hun and stay strong!!
it might be a while but I will come bk and let u know what they say :)

Q. My son has atopic dermatitis that is treated with topical cream. Is he in a greater risk for other diseases? My 1 year old son has atopic dermatitis. We treat him with topical cream and he is getting better. What kind of a diseases is this? Is he in a greater risk for other diseases because of his skin lesions?

A. Atopic dermatitis is an immunological disease. As a guy that has many allergies I can say that i believe the best treatment is not topical cream. You need to find what causes the allergy and to exclude it from your life. This way you prevent the disease not just treat its symptoms.

More discussions about dermatitis