Eczema and Dermatitis

Eczema is the general term for many types of skin inflammations (Read about "Skin"), according to the American Academy of Dermatology. The term dermatitis is also used in many cases. The inflammation tends to be very itchy and the patient will scratch the area. That will then increase the itchiness of the area and the so-called itch-scratch cycle begins.

Types of eczema/dermatitis

There are several different types of eczema/dermatitis. They may look similar, but they have different causes and treatments, so - if you suspect eczema/dermatitis - it is important to get a correct diagnosis.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says different types of eczema/dermatitis include:

• Atopic eczema/dermatitis - The vast majority of people with eczema have what is called atopic dermatitis or atopic eczema. It is characterized by itchy inflamed skin. Atopic dermatitis or atopic eczema is also believed to be hereditary in nature, meaning it runs in families. It also seems to be connected with other disorders such as pollen allergies and asthma, in that many people with atopic eczema/dermatitis also have asthma or pollen allergies or develop one of these conditions later in life. (Read about "Pollen Allergies" "Asthma")
• Contact eczema/dermatitis - This is a localized reaction that includes redness, itching and burning where the skin has come into contact with an allergen (Read about "Allergies") or with an irritant such as an acid, a cleaning agent or other chemical.
• Seborrheic eczema/dermatitis - This is characterized by yellowish, oily, scaly patches of skin on the scalp, face and occasionally other parts of the body. Two forms you are probably familiar with are:
  • Dandruff - When seborrheic eczema/dermatitis affects the scalp in adolescents or adults, we know it more commonly as dandruff.
  • Cradle cap - When it affects the scalp in infants, this condition is often called cradle cap.
• Nummular eczema - This involves coin-shaped patches of irritated skin, most common on the arms, back, buttocks and lower legs, that may be crusted, scaling and extremely itchy.
• Neurodermatitis - This condition is also called lichen simplex chronicus. It involves scaly patches of skin on the head, lower legs, wrists or forearms caused by a localized itch (such as an insect bite) that becomes intensely irritated when scratched.
• Stasis dermatitis - This involves a skin irritation on the lower legs, generally related to circulatory problems. It may be associated with varicose veins, kidney failure, congestive heart disease, or other conditions. (Read about "Varicose Veins" "Kidney Disease" "Congestive Heart Failure")
• Dyshidrotic eczema - This involves irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn.

Atopic eczema/dermatitis

The most common form, atopic eczema/dermatitis, is a chronic disease that most often begins in childhood. NIAMS estimates that 65 percent of the people with chronic or atopic eczema/dermatitis develop symptoms in the first year of life and 95 percent in the first five years. More than half of people with it in childhood will have flare-ups as adults.

• In infants, atopic eczema or atopic dermatitis typically begins around 6 to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash (Read about "Skin Rash"), which can progress to red, scaling, oozing skin. The skin may become infected. Once the infant becomes more mobile and begins crawling, exposed areas such as knees and elbows may also be affected. An infant with atopic eczema/dermatitis may be restless and irritable because of the itching and discomfort of the disease. Many infants get better by 18 months of age, although they remain at greater than normal risk for dry skin or hand eczema later in life.
• In childhood, the rash tends to occur behind the knees and inside the elbows; on the sides of the neck; and on the wrists, ankles and hands. Often, the rash begins with papules that become hard and scaly when scratched. The skin around the lips may be inflamed and constant licking of the area may lead to small, painful cracks in the skin around the mouth. Severe cases of atopic eczema/dermatitis may affect growth and the child may be shorter than average. The disease may go into remission. The length of a remission varies and it may last months or even years. In some children, the disease gets better for a long time, only to come back at the onset of puberty when hormones, stress (Read about "Stress") and the use of irritating skin care products or cosmetics may cause the disease to flare up.

Adults can have flare-ups of dermatitis as well, and even though it is rare, first onset can happen in adulthood too.

See treatment options below.

Contact eczema/dermatitis

Contact eczema/dermatitis is the result of a reaction to coming in contact with something. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says contact eczema/dermatitis is a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (Read about "Allergies") or with an irritant such as an acid, a cleaning agent, or other chemical. An allergen is a substance that your immune system (Read about "The Immune System") recognizes as foreign. Some of the common causes of contact eczema/dermatitis, according to AAD include:

• nickel, which is in a number of metal products including chrome. Jewelry with a high amount of nickel can also cause problems.
• rubber, particularly latex (Read about "Latex Allergies")
• hair dyes
• wet diapers (Read about "Diaper Rash")
• perfumes and other fragrances
• various preservatives
• plants such as poison ivy, oak or sumac

Patch tests are often used to decide if an allergy is involved. A small amount of the suspect allergen is applied to the skin with a piece of tape. When it is removed a couple of days later a small red spot will indicate an allergy to the substance. Treatment for contact eczema/dermatitis normally involves avoiding the substance that causes the reaction.

See treatment options below.

Seborrheic eczema/dermatitis

Seborrheic eczema/dermatitis is characterized by yellowish, oily, scaly patches of skin on the scalp, face and occasionally other parts of the body. Two forms you are probably familiar with are:

• Dandruff - When seborrheic eczema/dermatitis affects the scalp in adolescents or adults, we know it more commonly as dandruff.
• Cradle cap - When it affects the scalp in infants, this condition is often called cradle cap.

The American Academy of Family Physicians says seborrheic eczema/dermatitis can impact skin on other parts of the body, for example the face and chest, as well as creases of the arms, legs and groin. We don't know the exact cause. Treatment depends on the location of the problem and the age of the person.

For adults and adolescents, dandruff shampoos are sold over-the counter. These usually contain ingredients such as salicylic acid or coal tar. If these don't control the problem, your doctor may recommend a prescription lotion. If the problem is on other parts of the body, the prescription lotion may be an option as well.

For babies with cradle cap, avoid strong shampoos. The American Academy of Pediatrics says washing the hair and gently brushing out the scales each day can help get this condition under control. It may also disappear on its own after the first few months, but sometimes a special shampoo is needed. Discuss this issue with your doctor.

See treatment options below.

Treatment options

Up to 20 percent of the people who visit dermatologists are there for eczema/dermatitis, according to the American Academy of Dermatology (AAD), and because many patients are young, treatment involves a partnership among the patient, family members and doctor. The doctor will suggest a treatment plan based on the patient's age, symptoms, general health, and specific type of eczema/dermatitis.

According to NIAMS, the doctor has three main goals in treating eczema/dermatitis:

• healing the skin and keeping it healthy
• avoiding triggers and preventing flare-ups
• treating symptoms when they do occur

Skin care

Much of caring for the skin and preventing flare-ups has to do with developing skin care routines, identifying exacerbating factors, and avoiding circumstances that trigger a flare-up and the itch-scratch cycle.

Developing and sticking with a daily skin care routine is critical to preventing flare-ups. Key factors are proper bathing and the application of lubricants, such as creams or ointments, within 3 minutes of bathing according to the American Academy of Family Physicians (AAFP). AAFP also suggests people with atopic eczema should avoid hot or long (more than 10 to 15 minutes) baths and showers. A lukewarm bath helps to cleanse and moisturize the skin without drying it excessively.

Because soaps can be drying to the skin, AAFP recommends limited use of a mild bar soap or nonsoap cleanser for many types of eczema. Bath oils are not usually helpful. Once the bath is finished, the patient should air-dry the skin or pat it dry gently (avoiding rubbing or brisk drying) and apply a lubricant immediately.

Lubrication restores the skin's moisture, increases the rate of healing and establishes a barrier against further drying and irritation. Several kinds of lubricants can be used. AAFP says creams and ointments work better at healing the skin. Whatever preparation is chosen, it should be as free of fragrances and chemicals as possible.

For seborrheic eczema/dermatitis, however, AAFP says it is better to wash every day with soap and water, and/or use medicated shampoo depending on where the condition is present. Sulfur products, topical corticosteroids, and topical antifungals, can also be used to treat seborrheic eczema/dermatitis. Talk with your doctor about what's right for you.

Avoiding triggers and preventing flare-ups

There are many things that can bring on a flare-up in anyone with eczema/dermatitis. According to NIAMS, these include:

• Stress and infections, which impact the immune system (Read about "The Immune System"), tend to cause problems.
• Allergens are substances from foods (Read about "Food Allergies"), plants or animals that inflame the skin because the immune system overreacts to the substance. Inflammation occurs even when the person is exposed to small amounts of the substance for a limited time. Allergens can cause contact eczema/dermatitis, and as the person scratches and rubs the skin in response, further damage occurs. But even atopic dermatitis can be made worse in the presence of allergens such as pollen and dog or cat dander (tiny particles from the animal's skin or hair). (Read about "Pollen Allergies" "Animal Dander")
• Irritants, which can include:
  • wool or synthetic fibers
  • soaps and detergents
  • some perfumes and cosmetics
  • substances such as chlorine, mineral oil or solvents
  • dust or sand
  • cigarette smoke

If at all possible, someone with eczema/dermatitis should try to avoid the things that cause their problem to flare-up.

Treating symptoms

If you are experiencing contact eczema/dermatitis because of coming in contact with something like poison ivy, the American Academy of Dermatology (AAD) says to wash the exposed area with cold running water. AAD says over-the-counter preparations such as calamine lotion can make skin reactions less uncomfortable, as can soaking in a lukewarm bath with an oatmeal or baking soda solution. The American Academy of Allergy, Asthma and Immunology (AAAAI) says cold compresses can also help reduce the itch of simple skin rashes (Read about "Skin Rash"), which is important because scratching and rubbing will only make things worse.

For atopic eczema/dermatitis, and some other forms of eczema/dermatitis, steroid creams have long been a treatment option. If allergies are involved, oral antihistamines may be helpful. If the rash is severe, stronger anti-inflammatory medications may be needed. Topical immunomodulators are a new class of drugs. AAD says they are steroid-free and may be appropriate for patients seeking to avoid potential side effects associated with steroids. Talk with your doctor.

Despite the symptoms caused by eczema/dermatitis, AAD says it is possible for people with the disorder to maintain a high quality of life through education, awareness and developing a partnership among patient, family and doctor.

Smallpox vaccine warning

The Centers for Disease Control and Prevention (CDC) is also warning people who have or have ever had eczema not to get a smallpox (Read about smallpox in "Biological Health Threats") inoculation unless they know they have been exposed to smallpox or at serious risk of exposure. People with eczema/dermatitis should also avoid people who have recently been inoculated. The National Eczema Association for Science and Education (NEASE) cautions that the smallpox vaccine contains a live virus that can be harmful or even fatal to those with eczema or atopic dermatitis. NEASE also says that family members of eczema sufferers should not take the vaccine unless they have been exposed to smallpox or are at serious risk of exposure, because the live virus in the vaccine can harm the afflicted family member on contact.

Related Information:

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