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Diseases and Conditions
Dermatitis/Eczema
From MayoClinic.com
Special to CNN.com

Introduction

Your skin is constantly exposed to the elements, making it susceptible to a variety of problems, including the common condition dermatitis.

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

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

Signs and symptoms

There are several types of dermatitis, including:

  • Contact dermatitis
  • Neurodermatitis
  • Seborrheic dermatitis
  • Stasis dermatitis
  • Atopic dermatitis
  • Perioral dermatitis

Each has distinct signs and symptoms. Common signs and symptoms include redness, swelling, itching and skin lesions.

Causes

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, weeds such as poison ivy, and neomycin, a common ingredient in topical antibiotic creams. It takes a greater amount of an irritant over a longer time 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 dermatitis.
  • Neurodermatitis typically develops in areas where something, such as a tight garment, rubs or scratches your skin. This irritation may lead you to rub or scratch your skin repeatedly in that area. Common locations include ankles, wrist, outer forearm or arm, and the back of your neck.
  • Seborrheic dermatitis causes a red rash with a yellowish and somewhat "oily" scale. 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 physical stress, travel or in people who have neurological conditions, such as Parkinson's disease. In infants, this disorder is known as cradle cap.
  • Stasis dermatitis can occur when fluid accumulates in the tissues just beneath your skin, and typically involves the lower leg. The extra fluid interferes with your blood's ability to nourish your skin and places extra pressure against the skin from underneath. Varicose veins and other chronic conditions that slow the return of venous blood in your legs often cause this 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 is likely due to a combination of dry, irritable skin together with 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, topical corticosteroids or some dental products containing fluoride 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 signs and 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.

Complications

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 on your skin, 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.

Scarring is another potential complication from dermatitis.

Treatment

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 further aggravating your skin 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 longer. 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 addictive.
  • 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 infection.
  • Stasis dermatitis. Treatment consists of correcting the condition that causes fluid to accumulate in your legs or 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. If your skin cracks open, your doctor may prescribe wet dressings with mildly astringent properties to contract your skin and reduce secretions and prevent infection. If itching is severe, your doctor may suggest you take antihistamines. A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affects the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods of time, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed, or if someone can't tolerate other treatments.
  • 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 recurrence. Your doctor may prescribe a very mild corticosteroid cream in the initial phase of treatment to reduce signs and symptoms of perioral dermatitis. When stronger corticosteroids are used, the condition may return temporarily when the medication is stopped.

For all types of dermatitis, occasional use of over-the-counter antihistamines can reduce itching.

Prevention

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. Most people who are prone to eczema don't need to bathe daily. Try going a day or two without a shower or bath. When you do bathe, limit yourself to 15 to 20 minutes, and use warm, rather than hot, water.
  • Use only certain soaps or synthetic detergents. Choose mild soaps, such as Basis, Dove or Oil of Olay, that clean without excessively removing natural oils. Deodorant and antibacterial soaps may be more drying to your skin. 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.

Self-care

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.

  • Eczema treatment: Does sun exposure help or hurt?
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  • Scalp psoriasis vs. seborrheic dermatitis: How are they different?
  • December 08, 2005

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