Disease, Illness and Condition Library
Dermatitis
that affects millions of people annually. Medically it is referred to as inflammation of the upper layers of the skin, causing itching, blisters, redness, swelling and commonly oozing, scabbing, and scaling. Dermatitis is a general term covering different disorders that all result in red irritated skin and an itchy rash. The term eczema is sometimes used for dermatitis. Some types of dermatitis affect only specific parts of the body, whereas others can occur anywhere. Some types of dermatitis have a known cause, others do not. However dermatitis is always the skin’s way of reacting to severe dryness, scratching, a substance that is causing irritation, or an allergen. Typically, that substance comes in direct contact with the skin, but on occasion that substance is swallowed. In all cases, continuous scratching and rubbing may lead to thickening and hardening of the skin. Dermatitis may be a brief reaction to a substance. In these instances it may produce symptoms, such as itching and redness for just a few hours a day or two. Chronic dermatitis persists over a period of time. The feet and hands are particularly at risk to chronic dermatitis because the feet are in warm moist conditions created by socks and shoes that favor fungal growth and the hands are in frequent contact with many foreign substances. Chronic dermatitis may represent a contact, fungal, or other dermatitis that has been poorly diagnosed or treated, or it may be on of several chronic skin disorders of unknown origin, such as pompholyx or hyperkeratotic palmar eczema. Because chronic dermatitis produces cracks and blisters in the skin, any type of chronic dermatitis may lead to bacterial infection. Types of Dermatitis Contact Dermatitis: Contact dermatitis is skin inflammation caused by direct contact with a particular substance; the rash is very itchy, is confined to a specific area, and often has clearly defined boundaries. Contact dermatitis can be prevented by avoiding contact with the causative substance. If contact does occur, the material should be washed off immediately with soap and water. If circumstances risk ongoing exposure, gloves and protective clothing may prove helpful. Barrier creams are also available that can block certain substances, such as poison ivy and epoxy resins, from contacting eh skin. Desensitization with injections or tablets of the causative substance is not effective in preventing contact dermatitis. Treatment is not effective until there is no further contact with the substance causing the problem. Once the substance is removed, the redness usually disappears after a week. Blisters may continue to ooze and form crusts, but they soon dry. Residual scaling, itching, a temporary thickening of the skin may last for days or weeks. Atopic Dermatitis: Atopic dermatitis is chronic, itchy inflammation of the upper layers of the skin that often develops in people who have fever or asthma and in people who have family members with these conditions. No cure exists, but itching can be relieved with topical or oral drugs. Certain other measures can help. Avoiding contact with substances known to irritate the skin or foods that the person is sensitive to can prevent the rash. The skin should be kept moist, with commercial moisturizers or with petroleum jelly or vegetable oil. Moisturizers produce the greatest benefit when applied while the skin is moist or damp. To limit the use of corticosteroids in people being treated for long periods, doctors sometimes replace the corticosteroids with petroleum jelly for a week or more at a time. Corticosteroid tablets are a last resort for people with stubborn cases. Phototherapy (exposure to ultraviolet light) often helps adults. This treatment is rarely suggested for children because of its potential long term side effects, including skin cancer and cataracts. For severe cases, the immune system can be suppressed with cyclosporine taken by mouth or tacrolimus used as an ointment. Zafirlukast, a new oral drug used to prevent asthma attacks, may also be helpful in treating atopic dermatitis. Seborrheic Dermatitis: Seborrheic dermatitis is chronic inflammation of unknown causes that produces scales on the scalp and face and occasionally on other areas. The scalp can be treated with a shampoo containing pyrithione zinc, selenium sulfide, an antifungal drug, salicylic acid and sulfur, or tar. The person normally uses the medicated shampoo every other day until the dermatitis is controlled and then twice weekly. Keoconazole cream is often effective as well. In adults, zole cream is often effective as well. In adults, thick crusts and scales, if present, can be loosened with over night application of corticosteroids or salicylic acid under a shower cap. In most cases treatment must last for many weeks; if the dermatitis returns, after the treatment is discontinued, treatment can be restarted. Nummular Dermatitis: Nummular dermatitis is a stubborn, usually itchy, rash an inflammation characterized by coin shaped spots with tiny blisters, scabs, and scales of which the cause is unknown. Most with this condition can benefit from skin moisturizers. Other treatments include antibiotics taken by mouth, corticosteroids creams and injections and phototherapy (exposure to ultraviolet light). All treatments, however, are often unsatisfactory. Generalized Exfoliative Dermatitis: Generalized exfoliative dermatitis (erythrodema) is severe inflammation that causes the entire skin surface to become red, cracked, and covered with scales. Early diagnosis and treatment are important in preventing infection from developing in the affected skin and in keeping fluid and protein loss from becoming life threatening. Those suffering with severe exfoliative dermatitis often need to be hospitalized and given antibiotics (for injection), intravenous fluids (to replace the fluids lost through the skin), and nutritional supplements. Care may include the use of drugs and heated blankets to control body temperature. Cool baths followed by applications of petroleum jelly and gauze may help protect the skin. Corticosteroids (such as prednisone) given by mouth r intravenously are used only when other measure are unsuccessful or the disease worsens. Any drug or chemical that could be causing the dermatitis should be eliminated. If lymphoma is causing the dermatitis, treatment of the lymphoma is helpful. Stasis Dermatitis: Stasis dermatitis is inflammation on the lower legs from pooling of blood and fluid. Long term treatment is targeted at keeping blood from pooling in the veins around the ankles. When sitting, the person should elevate the legs above the level of the heart. Properly fitted prescription support hose (compression stockings) also prevent pooling of blood and decrease swelling. Department store support stockings are not adequate. Localized Scratch Dermatitis: Localized scratch dermatitis (lichen simplex chronicus, neurodermatitis) is chronic, itchy inflammation of the top layer of the skin. For this disorder to clear up, the person must stop all scratching an rubbing of the area. Standard treatments for itching should be followed. Using surgical tape saturated with a corticosteroid helps relieve itching an inflammation and protects the skin from scratching. The doctor may inject longer acting corticosteroids under the skin to control the itching. When development occurs around the anus or vagina, the best treatment is a corticosteroid cream. Zinc oxide paste may be applied over the cream to protect the area; the paste can be removed with mineral oil. Perioral Dermatitis: Perioral dermatitis is a red, bumpy rash around the mouth and on the chin. The disorder, whose cause is unknown, mainly affects women between the ages of 20 and 60. Treatment is with tercyclines or other antibiotics taken by mouth. If these antibiotics do not clear up the rash and the disorder is particularly severe, isotretinoin, an acne drug, may help. Corticosteroids and some oily cosmetics have a tendency to aggravate the disorder. Pompholyx: Pompholyx is chronic dermatitis characterized by itchy blisters on the palms and sides of the fingers and sometimes on the soles of the feet. Pompholyx is often times referred to as dyshidrosis, which means “abnormal sweating” but the disorder has nothing to do with sweating. Doctors do not know what causes pompholyx, but stress may be a factor a well as some ingested substances such as nickel, chromium, and cobalt. It is more common in adolescents and young adults. The blisters are often scaly, red, and oozing. Pompholyx comes an goes in attacks that last 2 to 3 weeks. Pompholyx takes weeks to go away on its own. Wet compresses with potassium permanganate or aluminum acetate (Burow’s solution) may help the blisters resolve. Strong topical corticosteroids may help itching and inflammation.
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| Common Causes of Allergic Contact Dermatitis * Cosmetics: Hair removing chemicals, nail polish, nail polish remover, deodorants, moisturizers, aftershave lotions, perfumes, sunscreens * Plants: Poison ivy, poison oak, poison sumac, ragweed, primrose, thistle * Metal Compound (in jewelery): Nickel * Drugs in Skin Creams: Antibiotics (sulfonamides, neomycin), antihistamines (diphenhydramine, promethazine), anesthetics (benzocaine), antiseptics (thimerosal), stabilizers * Chemical Used in Clothing Manufaturing: Tanning agents in shoes; rubber accelerators and antioxidants in gloves, undergarments, other apparel |
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