Friday, June 17, 2016

Dermatitis / Eczema



Your skin is constantly exposed to the elements, making it susceptible to
a variety of problems. Every year, more than 12 million people in the
United States visit a doctor because of a skin rash, such as dermatitis.

Dermatitis, also called eczema, is an inflammation of the skin. It can
have many causes and occur in many forms. Generally, dermatitis describes
swollen, reddened and itchy skin.

Dermatitis is a common condition. It's not life-threatening, and it isn't
contagious. But it can make you feel uncomfortable and self-conscious. A
combination of self-care steps and medications can help you treat
dermatitis and its symptoms.

Signs and symptoms

There are several types of dermatitis, including:

Contact dermatitis
Seborrheic dermatitis
Stasis dermatitis
Atopic dermatitis
Perioral dermatitis
Each has distinct signs and symptoms.


A number of health conditions, allergies, genetic factors, physical and
mental stress, and irritants can cause dermatitis.

Contact dermatitis results from direct contact with one of many irritants
or allergens. Common irritants include laundry soap, skin soaps or
detergents, and cleaning products. Possible allergens include rubber,
metals such as nickel, jewelry, perfume, cosmetics, hair dyes, weeds such
as poison ivy, and neomycin, a common ingredient in topical antibiotic
creams. It takes a larger amount over a longer time for an irritant to
cause dermatitis than it takes for an allergen. If you're sensitized to an
allergen, just brief exposure to a small amount of it can cause

Neurodermatitis can occur when something such as a tight garment rubs or
scratches your skin. This irritation may lead you to rub or scratch your
skin repeatedly. Common locations include ankles, wrist, outer forearm or
arm, and the back of your neck.

Seborrheic dermatitis is often an inherited tendency. It's common in
people with oily skin or hair, and it may come and go depending on the
season of the year. It may occur during times of stress or in people who
have neurologic conditions such as Parkinson's disease.

Stasis dermatitis can occur when fluid accumulates in the tissues just
beneath your skin. The extra fluid initially thins out your skin and
interferes with your blood's ability to nourish your skin. Varicose veins
and other chronic conditions in your legs can cause fluid buildup.

Atopic dermatitis often occurs with allergies and frequently runs in
families in
which other family members have asthma or hay fever. It usually begins in
infancy and may vary in severity during childhood and adolescence. It
tends to become less of a problem in adulthood, unless you're exposed to
allergens or irritants in the workplace. The exact cause of this disorder
is unknown, but it may be due to a malfunction in the body's immune
system. Stress can exacerbate atopic dermatitis, but it doesn't cause it.

Perioral dermatitis may be a form of the skin disorder rosacea, adult acne
or seborrheic dermatitis involving the skin around the mouth or nose. The
exact cause is unknown, but makeup, moisturizers or some dental products
may play a role.

When to seek medical advice

See your doctor if:

You're so uncomfortable that you're losing sleep or are distracted from
your daily routines.
Your skin becomes extremely painful.
You suspect your skin is infected.
You've tried self-care steps without success.

Screening and diagnosis

Your doctor may diagnosis dermatitis after talking to you about your
symptoms and examining your skin. In the case of contact dermatitis, your
doctor may conduct patch testing on your skin to see which substances
inflame your skin. In this test, your doctor applies small amounts of
various substances to your skin under an adhesive covering. During return
visits, your doctor examines your skin to see if you're allergic to any of
the substances.


Sometimes, the open sores and fissures that can occur with dermatitis can
become infected. A milder form of infection is impetigo, usually due to
staphylococci bacteria. Having atopic dermatitis also predisposes you to
this infection.

If you notice red streaks up your arm, you may have cellulitis, a
bacterial infection of tissues under the skin. Cellulitis appears as
intensely inflamed skin that's swollen, red, tender and warm to the touch,
with spreading, indistinct margins. Cellulitis that occurs in someone
whose immune system is compromised is potentially life-threatening. See
your doctor as soon as possible if you think you have cellulitis.


Treatment of dermatitis varies, depending on the cause:

Contact dermatitis. Treatment consists primarily of identifying what's
causing your irritation and then avoiding it. Sometimes, creams containing
hydrocortisone or wet dressings that provide moisture to your skin may
help relieve redness and itching. It can take as long as two to four weeks
for this type of dermatitis to clear up.

Neurodermatitis. Getting you to stop scratching and to avoid aggravating
your skin further are the treatment objectives. Accomplishing this may
mean you have to wear a dressing that's difficult to remove and leave it
on for a week or more. Hydrocortisone lotions and creams may help soothe
your skin. You also may find that wet compresses provide relief. Sedatives
and tranquilizers also may help you stop scratching, but your doctor will
want to monitor your use of these substances because they can be

Seborrheic dermatitis. You'll need to frequently shampoo, then carefully
rinse your scalp. Your doctor may recommend a specific shampoo. Commonly
used shampoos contain tar, zinc pyrithione, salicylic acid or ketoconazole
as the active ingredient. Hydrocortisone creams and lotions may soothe
your skin and relieve itching. You also may need treatment for a secondary

Stasis dermatitis. Treatment consists of correcting the condition that
causes fluid to accumulate in your ankles for extended periods. This may
mean wearing elastic support hose or even having varicose vein surgery.
You may also use wet dressings to soften the thickened, yet fragile, skin
and to control infection.

Atopic dermatitis. Treatment typically consists of applying
hydrocortisone-containing lotions to ease signs and symptoms. The newest
treatment for this condition is a class of medications called
immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel).
These medications affect the immune system and may help maintain normal
skin texture and reduce flares of atopic dermatitis. Doctors may recommend
using these medications in conjunction with hydrocortisone preparations or
in place of them because they may cause fewer side effects. If your skin
cracks open, doctors sometimes prescribe wet dressings with mildly
astringent properties to contract the skin and reduce secretions and
prevent infection. If itching is severe, your doctor may suggest you take

Perioral dermatitis. Treatment for this condition is usually with the oral
antibiotic tetracycline. You may need to continue this treatment for
several months to prevent a reoccurrence. Your doctor may prescribe a very
mild corticosteroid cream to reduce signs and symptoms of perioral
dermatitis. Sometimes when stronger corticosteroids are used, the
condition returns when the medication is stopped and it may be more severe
than it was originally.
For all types of dermatitis, occasional use of over-the-counter
antihistamines can reduce itching.


Preventing contact dermatitis means avoiding coming into contact with
those substances, such as poison ivy or harsh soaps, that may cause it.

Avoiding dry skin may be one factor in helping you prevent future bouts of
dermatitis. These tips can help you minimize the drying effects of bathing
on your skin:

Bathe less frequently. Two or three times a week is often enough for most
people. Limit yourself to 15 minutes, and use warm, rather than hot,

Use only certain soaps or synthetic detergents. Choose mild soaps such as
Dove or Basis that clean without excessively removing natural oils. Soap
substitutes (synthetic detergents) in bar, gel and liquid forms are less
drying than deodorant and antibacterial soaps. Use soap only on your face,
underarms, genital areas, hands and feet. Use clear water elsewhere. Dry
yourself carefully. Brush your skin rapidly with the palms of your hands,
or gently pat your skin dry with a towel after bathing.
Moisturize your skin. Seal in moisture, while your skin is still damp,
with an oil or cream. Pay special attention to your legs, arms, back and
the sides of your body. If your skin is already dry, consider using a
lubricating cream made for dry skin, such as Eucerin.


These steps can help you manage dermatitis:

Avoid scratching whenever possible. Cover the itchy area with a dressing,
if you can't keep from scratching it. Trim nails and wear gloves at night.
Dress appropriately. Doing so may help you avoid excessive sweating. Wear
smooth-textured cotton clothing. This will help you avoid irritation.
Avoid other irritants. These include wool carpeting, bedding and clothes,
and harsh soaps and detergents.

By Mayo Clinic staff

Eczema and Dermatitis

Eczema is a general term used to describe a number of different skin
conditions. It usually appears as reddened skin that becomes moist and
oozing, occasionally resulting in small, fluid-filled bumps. When eczema
becomes chronic (persists for a long time), the skin tends to thicken,
dry out and become scaly with coarse lines.

The two main types of eczema are atopic dermatitis and contact dermatitis.

Atopic dermatitis often occurs in infants and children who have
allergies or a family history of allergy or eczema, although the problem
is not necessarily caused by an allergy. Atopic dermatitis usually
develops in three different phases. The first occurs between 2 and 6
months of age, with itching, redness, and the appearance of small bumps
on the cheeks, forehead or scalp. This rash may then spread to the arms
or trunk. In many cases, the rash disappears or improves by 2 or 3 years
of age.

The second phase of this skin problem occurs most often between the ages
of 4 and 10 years, and is characterized by circular, slightly raised,
itchy and scaly eruptions on the face or trunk. These are less oozy and
more scaly than the first phase of atopic dermatitis, and the skin tends
to appear somewhat thickened. The most frequent locations for this rash
are in the bends of the elbows, behind the knees, and on the backs of
the wrists and ankles. This type of eczema is very itchy, and the skin
generally tends to be very dry. The third phase, characterized by areas
of itching skin and a dry, scaly appearance, begins at about age 12 and
occasionally continues on into early adulthood.

Although there is no cure for atopic dermatitis, it generally can be
controlled and often will go away after several months or years. The
most effective treatment is to prevent the skin's becoming dry and
itchy. To do this:

Avoid frequent long, hot baths, which tend to dry the skin
Use skin moisturizers (e.g., creams or ointments) regularly and
frequently to decrease the dryness and itchiness
Avoid harsh or irritating clothing (wool or coarse-weave material)
If there is oozing or exceptional itching, use tepid (lukewarm)
compresses on the area, followed by the application of prescribed
Your pediatrician usually will suggest a medicated cream or ointment to
control inflammation and itching. These preparations often contain a
form of cortisone and should be used only under the direction of your
doctor. In addition, other lotions or bath oils might be prescribed.
It's important to continue to apply the medications for as long as your
pediatrician directs. Stopping too soon will cause the condition to
recur. In addition to the skin preparations, your child may need to take
an antihistamine by mouth to control the itching, and antibiotics if the
skin becomes infected.
The other type of eczema, contact dermatitis, is caused by contact with
an irritating substance. One form of this condition results from
repeated contact with irritating substances such as citrus juices,
bubble baths, strong soaps, certain foods and medicines, and woolen or
rough-weave fabrics. In addition, one of the most common irritants is
the child's own saliva. Contact dermatitis doesn't itch as much as
atopic dermatitis and usually will clear when the irritant is no longer

Contact dermatitis can develop after skin contact with substances to
which the child is allergic. The most common of these are:

Certain flavorings or additives to toothpastes and mouthwashes (these
cause a rash around the mouth)
Glues and dyes used in the manufacture of shoes (they produce a reaction
on the tops of the toes and feet)
Dyes used in clothing (these cause rashes in areas where the clothing
rubs or where there is increased perspiration)
Nickel jewelry or snaps on jeans or pants
Plants, especially poison ivy, poison oak and poison sumac
Medications such as neomycin ointment
This rash usually appears within several hours after contact (one to
three days with poison ivy). It is somewhat itchy and may even have
small blisters.
The treatment of allergic contact dermatitis is similar to the treatment
of eczema, although your pediatric dermatologist or allergist also will
want to find the cause of the rash by taking a careful history or by
conducting a series of patch tests. These tests are done by placing a
small patch of a common irritant (allergen) against your child's skin.
If the skin reacts with redness and itching, that substance should be

If your child appears to have a rash that looks like eczema, your
pediatrician will need to examine it to make the correct diagnosis and
prescribe the proper treatment. In some cases, the pediatrician may
arrange for a pediatric dermatologist to examine your child.

Alert your pediatrician if any of the following occurs:

Your child's rash is severe and is not responding to home treatment
There is any evidence of fever or infection (such as blisters, redness,
yellow crusts, pain or oozing of fluid)
The rash spreads or another rash develops

Ext. 1219


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