Dermatitis

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

Dermatitis on hands and fingers. (Custom Medical Stock Photo. Reproduced by permission.)

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