Dermatitis

Overview

Dermatitis is a general term that describes a skin irritation. Dermatitis is a common condition that has many causes and occurs in many forms. It usually involves itchy, dry skin or a rash on swollen, reddened skin. Or it may cause the skin to blister, ooze, crust or flake off. Examples of this condition are atopic dermatitis (eczema), dandruff and contact dermatitis.

Dermatitis isn't contagious, but it can make you feel uncomfortable and self-conscious. Moisturizing regularly helps control the symptoms. Treatment may also include medicated ointments, creams and shampoos.

Symptoms

Each type of dermatitis may look a little different and tends to occur on different parts of your body. Signs and symptoms of different types of dermatitis include:

  • Atopic dermatitis (eczema). Usually beginning in infancy, this red, itchy rash usually occurs where the skin flexes — inside the elbows, behind the knees and in front of the neck. The rash may leak fluid when scratched and crust over. People with atopic dermatitis may experience improvement and then seasonal flare-ups.
  • Contact dermatitis. This red, itchy stinging rash occurs where your skin has come into contact with substances that irritate the skin or cause an allergic reaction. You may develop blisters.
  • Seborrheic dermatitis. This condition causes scaly patches, red skin and stubborn dandruff. It usually affects oily areas of the body, such as the face, upper chest and back. Seborrheic dermatitis can be a long-term condition with periods of improvement and then seasonal flare-ups. In infants, this condition is called cradle cap.
  • Follicular eczema. With this type, the affected skin thickens and develops bumps in hair follicles. This condition is common in African Americans and in people with dark-brown skin.

When to see a doctor

See your doctor if:

  • You're so uncomfortable that you are losing sleep or are distracted from your daily routines
  • Your skin becomes painful
  • You suspect your skin is infected
  • You've tried self-care steps but your signs and symptoms persist
Atopic dermatitis on the legs

Atopic dermatitis can cause small, red bumps, which can be very itchy. When scratched, the bumps may leak fluid and crust over. Atopic dermatitis most often occurs where your skin flexes — inside the elbows, behind the knees and in front of the neck.

Contact dermatitis on the wrist

Contact dermatitis can appear as an itchy, red rash. In this photo, the irritation is likely due to a watchband or to soap residue trapped beneath the band.

Seborrheic dermatitis on the face

Seborrheic dermatitis causes a red rash with yellowish and somewhat "oily" scales. In addition to the scalp, seborrheic dermatitis can occur on the sides of the nose, in and between the eyebrows, and in other oil-rich areas.

Causes

Causes of the most common types of dermatitis include:

  • Atopic dermatitis (eczema). This type is likely related to dry skin, a gene variation, an immune system dysfunction, a skin infection, exposure to food, airborne, or contact allergens, or a combination of these.
  • Contact dermatitis. This type results from contact with something that irritates your skin or causes an allergic reaction. Irritants or allergens include poison ivy, perfumes, jewelry containing nickel, cleaning products, and the preservatives in many creams and lotions.
  • Seborrheic dermatitis. This type is caused by a yeast (fungus) that is in the oil secretion on the skin.

Risk factors

Common risk factors for dermatitis include:

  • Age. Dermatitis can occur at any age, but atopic dermatitis (eczema) usually begins in infancy.
  • Allergies and asthma. People who have a personal or family history of eczema, allergies, hay fever or asthma are more likely to develop atopic dermatitis.
  • Occupation. Jobs that put you in contact with certain metals, solvents or cleaning supplies increase your risk of contact dermatitis. Being a health care worker is linked to hand eczema.
  • Health conditions. Health conditions that put you at increased risk of seborrheic dermatitis include congestive heart failure, Parkinson's disease and HIV/AIDS.

Complications

Scratching the itchy rash associated with dermatitis can cause open sores, which may become infected. These skin infections can spread and may very rarely become life-threatening.

Prevention

Wear protective clothing if you are doing a task that involves irritants or caustic chemicals.

Avoid dry skin by adopting these habits when bathing:

  • Take shorter baths and showers. Limit your baths and showers to 5 to 10 minutes. Use warm, rather than hot, water. Bath oil also may be helpful.
  • Use a gentle, nonsoap cleanser. Choose unscented nonsoap cleansers. Some soaps can dry your skin.
  • Dry yourself gently. After bathing, gently pat your skin dry with a soft towel.
  • Moisturize your skin. While your skin is still damp, seal in moisture with an oil, cream or lotion. Try different products to find one that works for you. Ideally, the best one for you will be safe, effective, affordable and unscented. Two small studies showed that applying a protective moisturizer to the skin of infants at high risk of atopic dermatitis reduced the incidence of the condition by up to 50 percent.

Diagnosis

Your doctor will likely talk with you about your symptoms and examine your skin. You may need to have a small piece of skin removed (biopsied) for study in a lab, which helps rule out other conditions.

Patch testing

Your doctor may recommend patch testing on your skin. In this test, small amounts of different substances are applied to your skin and then covered. The doctor looks at your skin during visits over the next few days to look for signs of a reaction. Patch testing can help diagnose specific types of allergies causing your dermatitis.

Treatment

The treatment for dermatitis varies, depending on the cause and your symptoms. In addition to the lifestyle and home remedies recommendations below, dermatitis treatment includes one or more of the following:

  • Applying to the affected skin corticosteroid creams, gels or ointments
  • Applying to the affected skin certain creams or ointments that affect your immune system (calcineurin inhibitors)
  • Exposing the affected area to controlled amounts of natural or artificial light (phototherapy)
  • Using oral corticosteroids (pills) or injectable dupilumab, for severe disease

Lifestyle and home remedies

These self-care habits can help you manage dermatitis and feel better:

  • Moisturize your skin. Routinely applying a moisturizer with high oil content can help your skin.
  • Use nonprescription anti-inflammation and anti-itch products. Over-the-counter (OTC) hydrocortisone cream can temporarily relieve redness and itching. Oral antihistamines, such as diphenhydramine, may help reduce itching.
  • Apply a cool wet cloth. This helps soothe your skin.
  • Take a comfortably warm bath. Sprinkle your bath water with baking soda or colloidal oatmeal — a finely ground oatmeal that's made for the bathtub. Soak for 5 to 10 minutes, pat dry and apply unscented moisturizer while your skin is still damp. A lotion of 12 percent ammonium lactate or 10 percent alpha-hydroxy acid helps with flaky, dry skin.
  • Use medicated shampoos. For dandruff, use OTC shampoos containing selenium sulfide, zinc pyrithione, coal tar or ketoconazole.
  • Take a dilute bleach bath. This may help people with severe atopic dermatitis by decreasing the bacteria on the skin. For a dilute bleach bath, add 1/2 cup (about 118 milliliters) of household bleach, not concentrated bleach, to a 40-gallon (about 151-liter) bathtub filled with warm water. Measures are for a U.S. standard-sized tub filled to the overflow drainage holes. Soak for 5 to 10 minutes and rinse off before patting dry. Do this two to three times a week.

    Many people have had success using a dilute vinegar bath rather than a bleach bath. Add 1 cup (about 236 milliliters) of vinegar to a bathtub filled with warm water.

  • Avoid rubbing and scratching. Cover the itchy area with a dressing if you can't keep from scratching it. Trim your nails and wear gloves at night.
  • Wear cotton clothing. Smooth-textured cotton clothing can help you avoid irritating the affected area. Avoid wool, as itching can flare after removing wool clothing that directly touches the skin.
  • Choose mild laundry detergent. Because your clothes, sheets and towels touch your skin, choose mild, unscented laundry products.
  • Avoid the known irritant or allergen. For contact dermatitis especially, try to minimize contact with the substance that caused your rash.
  • Manage your stress. Emotional stressors can cause some types of dermatitis to flare up. Consider trying stress management techniques such as relaxation or biofeedback.

Alternative medicine

Many alternative therapies, including those listed below, have helped some people manage their dermatitis. But evidence for their effectiveness isn't conclusive.

  • Dietary supplements, such as vitamin D and probiotics, for atopic dermatitis
  • Rice bran broth (applied to the skin), for atopic dermatitis
  • 5 percent tea tree oil shampoo, for dandruff
  • Aloe, for seborrheic dermatitis
  • Chinese herbal therapy

If you're considering dietary supplements or other alternative therapies, talk with your doctor about their pros and cons.

Preparing for an appointment

You may first bring your concerns to the attention of your family doctor. Or you may see a doctor who specializes in the diagnosis and treatment of skin conditions (dermatologist).

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

Before your appointment, list your answers to the following questions:

  • What are your symptoms, and when did they start?
  • Does anything seem to trigger your symptoms?
  • What medications are you taking, including those you take by mouth as well as creams or ointments that you apply to your skin?
  • Do you have a family history of allergies or asthma?
  • What treatments have you tried so far? Has anything helped?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in depth. Depending on what type of dermatitis you have, your doctor may ask:

  • Do your symptoms come and go, or are they fairly constant?
  • How often do you shower or bathe?
  • What products do you use on your skin, including soaps, lotions and cosmetics?
  • What household cleaning products do you use?
  • Are you exposed to any possible irritants from your job or hobbies?
  • Have you been under any unusual stress or depressed lately?
  • How much do your symptoms affect your quality of life, including your ability to sleep?

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