Eczema – Medical Disability Guidelines

ICD-9-CM:691.8 - Atopic Dermatitis, Other; Besniers Prurigo; Eczema: Atopic, Flexural, Intrinsic (allergic); Neurodermatitis: Atopic, Diffuse (of Brocq)692.0 - Contact Dermatitis and Other Eczema Due to Detergents692.1 - Contact Dermatitis and Other Eczema Due to Oils and Greases692.2 - Contact Dermatitis and Other Eczema Due to Solvents of Chlorocompound Group, Cyclohexane Group, Ester Group, Glycol Group, Hydrocarbon Group or Ketone Group692.3 - Contact Dermatitis and Other Eczema due to Drugs and Medicines in Contact with Skin; Dermatitis (Allergic) (Contact) Due to: Arnica, Fungicides, Iodine, Keratolytics, Mercurials, Neomycin, Pediculocides, Phenols, Scabicides or Any Drug Applied to Skin692.4 - Contact Dermatitis and Other Eczema due to Other Chemical Products; Dermatitis Due to: Acids, Adhesive Plaster, Alkalis, Caustics, Dichromate, Insecticide, Nylon, Plastic or Rubber692.5 - Contact Dermatitis and Other Eczema due to Food in Contact with Skin; Dermatitis, Contact, Due to: Cereals, Fish, Flour, Fruit, Meat or Milk692.6 - Contact Dermatitis and Other Eczema due to Plants [except Food]; Dermatitis due to: Lacquer Tree, Poison Ivy, Poison Oak, Poison Sumac, Poison Vine, Primrose, Ragweed or Other Plants in Contact with the Skin692.82 - Contact Dermatitis and Other Eczema Due to Other Radiation; Infrared Rays, Light except from Sun, Radiation NOS, Tanning Bed, Ultraviolet Rays except from Sun, X-rays692.83 - Contact Dermatitis and Other Eczema Due to Metals; Jewelry692.84 - Contact Dermatitis and Other Eczema, Due to Animal (Cat) (Dog) Dander; Due to Animal (Cat) (Dog) Hair692.89 - Contact Dermatitis and Other Eczema, Other; Dermatitis Due to: Cold Weather, Dyes, Hot Weather, Preservatives

Eczema is a general term describing a variety of skin disorders, all of them with inflamed patches of skin and scaling or tiny oozing blisters (vesicles). Eczema means "weeping," though drainage is usually seen only in the early stages of the various eczematous conditions. Eczematous disorders include contact dermatitis, contact allergic dermatitis, atopic dermatitis, hand eczema, nummular eczema, seborrheic dermatitis, lichen simplex chronicus, asteatotic eczema, and stasis dermatitis.

Eczema is a response to one or a combination of genetic factors and external triggers, but it can also occur for no known reason. Causes of eczematous disorders can be irritants, allergens, trauma (e.g., scratching), cold temperatures, and blood flow stoppage (stasis). Allergens that trigger eczema may be airborne (e.g., industrial substances), ingested (foods or drugs), or in contact with skin (e.g., poison ivy). Eczema may be associated with varicose veins and venous insufficiency in the lower extremities.

Incidence and Prevalence: Eczema is the most common skin problem for which people seek medical treatment, affecting about 10% of the US population ("Eczema").

Source: Medical Disability Advisor

The elderly are most at risk for statis dermatitis, which includes poor circulation and varicose veins. Those who live in dry climates or have dry indoor heating are most prone to asteatotic eczema ("winter itch").

Atopic eczema has a significant genetic factor. In approximately 70% of cases, the individual or a relative also has allergic asthma, hay fever, or food allergies ("Eczema").

Source: Medical Disability Advisor

History: The most common complaint of eczema is itchiness (pruritus), redness, and tiny bumps or blisters. If untreated, the skin can become thick, scaly, and dry, with areas of hair loss and color changes. The individual may relate a history of work or recreational activities in which the skin is exposed to water, moisture, sun, or new personal care products.

Physical exam: In general, eczema presents with redness, warmth, swelling (edema), tenderness, weeping, crusting, scratches and cracks (excoriations), and thickened and scaling skin with a diffuse border.

Skin changes associated with atopic dermatitis are variable and include excoriations; wet, raised bumps (papules); thickened, red, gray, or scaly skin (lichenification); red, fluid-filled bumps (vesicles); and crusted lesions.

Contact dermatitis presents as areas of reddened (erythematous) and swollen (edematous) skin that later develop small and large blisters (vesicles and bullae, respectively). The pattern, shape, and location of the contact dermatitis rash help identify the causative substance. Hand eczema may present with dryness and cracking of the skin, with some redness and swelling. A variation of this condition, dyshidrotic eczema, has small, very itchy bumps along the fleshy parts of the palms and sides of the fingers. Nummular eczema has round scaly patches that look similar to ringworm and are found on the trunk, the back of the arms and hands, and the shins. Stasis dermatitis often exhibits dark red discoloration and swelling of the skin on the lower leg, ankle, and top of the foot. Stasis dermatitis lesions can become irritated and inflamed and in many cases can result in skin ulcers.

Asteatotic eczema (winter itch) presents with fine cracks over the front surface of the thighs and shins and possibly a dry, shiny appearance. Scabies presents with the classic eczematous lesions found primarily on the ankles, webs of fingers and toes, scalp, wrists, bellybutton (umbilicus), genitals, or the nipples. Seborrheic dermatitis presents as red, itchy, scaly areas, primarily on the face, scalp, groin, anogenital region, and/or below the breasts. Lichen simplex chronicus is a late stage of eczema and consists of thickened, scaly skin due to chronic rubbing or scratching. Common areas for lichen simplex chronicus are the back of the neck, tops of the feet, and ankles.

Tests: Though most eczemas are diagnosed through the history and physical exam, a scraping of the lesion should be examined under the microscope to rule out certain other skin disorders. Skin biopsy is done when persistent eczema does not respond to treatment. Skin patch tests, provocative challenges, and some immunological testing may be required. Elevated total IgE denotes an underlying allergy.

Source: Medical Disability Advisor

Treatment of contact dermatitis consists primarily of identifying the offending agent and avoiding it. Topical corticosteroids, oral antihistamines, or astringent lotions may be used. Oral corticosteroids may be required for severe cases and those involving the genitals or face. Hand eczema may improve if vinyl gloves are worn at any time the hands come in contact with irritants. After washing, the hands should be thoroughly patted dry. Unscented hand cream should be applied throughout the day. Nummular eczema may be treated with corticosteroid ointment, antihistamines, antibiotics, and coal tar solution. Winter itch responds well to moisturizers or emollients, particularly those containing urea or alpha-hydroxy acids. Temporary relief from stasis eczema can be achieved with mild corticosteroid ointments. Swelling of the legs may be controlled through use of compression bandages or special stockings. Seborrheic dermatitis is treated with persistent and frequent cleansing to remove scale and the possible application of a corticosteroid.

In general, irritating fabrics (wool, silk, and rough synthetics) should be avoided. Absorbent, nonirritating fabric (cotton) should be worn next to the skin. Soothing ointment should be applied to any affected area, and it should be covered with a dressing to prevent scratching.

Source: Medical Disability Advisor

Source: Medical Disability Advisor

Source: Medical Disability Advisor

Source: Medical Disability Advisor

Regarding diagnosis:

Regarding treatment:

Regarding prognosis:

Source: Medical Disability Advisor

Source: Medical Disability Advisor

See the original post here:
Eczema - Medical Disability Guidelines