Dermatitis

What is dermatitis?

Dermatitis is an inflammation of the skin. The word dermatitis is used to describe a number of different skin rashes that are caused by infections, allergies, and irritating substances. The rashes range from mild to severe and can cause the following skin conditions, depending on their cause:

• Itchiness
• Painful ulcers
• Reddening
• Thickening
• Swelling
• Marking
• Crusting
• Scaling
• Creasing
• Blisters

This article will describe contact and atopic dermatitis, which are two common types of dermatitis.

What is contact dermatitis?

Contact dermatitis occurs when the skin comes in contact with a substance that causes a delayed allergic reaction (allergic contact dermatitis) or when there is an injury to the skin's surface (irritant contact dermatitis).

Skin can become allergic to a substance after many exposures or after just one exposure. For instance, most people will have an allergic reaction to poison ivy after one exposure. Common sources of allergic contact dermatitis include cosmetics, rubber derivatives, dyes, adhesives, nickel, and other metals.

Substances that can irritate the skin include detergents, soaps, cleaners, waxes, and chemicals. These substances can wear down the oily, protective layer on the skin's surface and lead to irritant contact dermatitis. This condition is most common among people who regularly work with strong chemicals, such as restaurant, maintenance, and chemical workers.

What are the symptoms of contact dermatitis?

Allergic contact dermatitis:

• Skin reddening
• Blisters that ooze (fluid from blisters is not contagious, it will not spread the skin rash to other parts of the body or to other people)
• Itching which can become intense
• Swelling in eyes, face, and genital areas (severe cases)

Irritant contact dermatitis:

• Mild swelling
• Stiff, tight-feeling skin
• Dry, cracking skin
• Blisters
• Painful ulcers

Symptoms vary, depending on the cause of dermatitis.

How can I know if I have contact dermatitis?

If you have a skin rash that won't go away, visit your health care provider. If the doctor suspects allergic contact dermatitis, he or she may perform patch tests. In this test, the doctor places small samples of chemicals on an area of skin to see if a rash develops. The diagnosis of contact dermatitis cannot be done with blood tests. You should mention all the products that are in contact with your skin, even if you use certain products only once a month or if the product was used after the rash started.

Note: there are no tests for irritant contact dermatitis. Tell your healthcare provider about any irritating substances or chemicals that you regularly come into contact with (including cosmetics, lotions, and nail polish).

With either type of contact dermatitis, you can avoid substances you suspect to see if the rash goes away.

How is contact dermatitis treated?

The form of treatment will depend on the cause of your dermatitis. Common treatments include:

• Cortisone-type creams (In severe cases, drugs containing cortisone may be given by mouth)
• Antihistamines (a medicine to relieve itching)
• Dry skin care (lotions and creams)
• Oatmeal baths (to relieve itching)

How can I prevent contact dermatitis?

For allergic contact dermatitis:

• Avoid contact with substances that cause the skin rash
• Wash any area that comes into contact with allergic substances
• Learn to recognize poison oak and poison ivy plants

For irritant contact dermatitis:

• Wear cotton gloves under rubber gloves for all wet work. You can also use petroleum jelly to protect your skin. Reapply the petroleum jelly two or three times a day and after washing your hands.
• Avoid contact with substances that irritate your skin.
• Use mild soaps.
• Use hand creams and lotions frequently.

What is atopic dermatitis?

Atopic dermatitis is a skin condition that may be passed on from parents to children. It can occur at any time in life, but usually first appears when children are infants, and may not diminish until early adulthood. More than half of infants with atopic dermatitis grow out of the condition by school age, though flare-ups can occur throughout life.

The condition is most common among families who have a history of environmental allergies. Though food allergies may cause flare-ups, removing suspected foods (such as eggs, milk, fish, wheat, and peanuts) from your child's diet is not likely to cure the problem. If you suspect that a food is worsening the rash, discuss this with your health care provider.

Atopic dermatitis can also worsen when the skin comes into contact with irritating substances such as harsh soaps and scratchy, tight-fitting clothing. Scratching can also promote infections that require treatment.

What are the symptoms of atopic dermatitis?

In infancy:

• Red, very itchy dry patches of skin.
• Rash on the cheeks that often begins at 2 to 6 months of age.
• Rash oozes when scratched. Symptoms can become worse if the child scratches the rash.

In adolescence and early adulthood:

• Rash on creases of hands, elbows, wrists, and knees, and sometimes on the feet, ankles, and neck
• Dry, scaly, brownish-gray skin rash
• Thickened skin with discoloration
• Skin rash may bleed and crust after scratching

How is atopic dermatitis treated?

Atopic dermatitis is a chronic condition, which means that it cannot be cured. Treatments, however, are very effective in reducing the symptoms of itching and dry skin.

Your health care provider can prescribe lotions and oral medications (those taken by mouth). These treatments include corticosteroid creams and antihistamines. Follow instructions for using the medications.

To help your child, you can also:

• Avoid long, hot baths, which can dry the skin. Use lukewarm water instead and give your child sponge baths
• Apply lotion immediately after bathing while the skin is still moist. This will help trap moisture in the skin
• Keep the room temperature as regular as possible. Changes in room temperature and humidity can dry the skin
• Keep your child dressed in cotton. Wool, silk, and manmade fabrics such as polyester can irritate the skin.

Use mild laundry soap and make sure that clothes are well rinsed.

• Watch for skin infections. Contact your healthcare provider if you notice an infection
• Avoid rubbing or scratching the rash
• Use moisturizers several times daily. In infants, with atopic dermatitis, moisturizing on a regular basis (with each diaper change for example) is extremely helpful.