Dermatitis affects about one in every five people at some time in their lives. It results from a variety of different causes and has various patterns. Acute eczema (or dermatitis) refers to a rapidly evolving red rash which may be blistered and swollen. Chronic eczema (or dermatitis) refers to a longstanding irritable area. It is often darker than the surrounding skin, thickened and much scratched. Psychological stresses can provoke or aggravate dermatitis
Atopic dermatitis is particularly prevalent in children; inherited factors seem important, as there is nearly always a family history of dermatitis or asthma.
Irritant contact dermatitis is provoked by handling water, detergents, solvents or harsh chemicals, and by friction. Irritants cause more trouble in those who have a tendency to atopic dermatitis.
Allergic contact dermatitis is due to skin contact with substances that most people don't react to: most commonly nickel, perfume, rubber, hair dye or preservatives. A dermatologist may identify the responsible agent by patch testing. Dry skin: especially on the lower legs, may cause asteatotic dermatitis. Nummular dermatitis (also called 'discoid eczema') may be set off initially by an injury to the skin: scattered coin-shaped irritable patches persist for a few months. Seborrhoeic dermatitis and dandruff are due to irritation from toxic substances produced by malassezia yeasts that live on the scalp, face and sometimes elsewhere. Infective dermatitis seems to be provoked by impetigo (bacterial infection) or fungal infection.
Gravitational dermatitis arises on the lower legs of the elderly, due to swelling and poorly functioning leg veins. Treatment of dermatitis: An important aspect of treatment is to identify and tackle any contributing factors. Replace standard soap with a substitute such as a mild detergent soap-free cleanser. Clothing Wear soft smooth cool clothes; wool is best avoided. Protect your skin from dust, water, solvents, detergents, injury. Emollients Apply an emollient liberally and often, particularly after bathing, and when itchy. Avoid perfumed products when possible. Topical steroids are commonly used for the treatment. It should not be used for prolonged periods. Pimecrolimus and tacrolimus are new anti-inflammatory cream shown to be very effective for atopic dermatitis, with fewer side effects than topical steroids. Your doctor will recommend antibiotics if infection is complicating or causing the dermatitis. Antihistamines Antihistamine tablets may help reduce the irritation, and are particularly useful at night. Severe cases may need oral treatment.
Dermatitis is often a long-term problem. When you notice your skin getting dry, moisturise your skin again and carefully avoid the use of soap. If it fails to improve within two weeks, see your doctor for further advice. Donot apply steroid creams without consulting doctor.
Atopic eczema is a chronic, itchy skin condition that is very common in children but may occur at any age. Atopic eczema usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic eczema, asthma and hay fever (allergic rhinitis). Often these conditions run within families with a parent, child or sibling also affected. Atopic eczema arises because of a complex interaction of genetic and environmental factors. These include defects in skin barrier function making the skin more susceptible to irritation by soap and other contact irritants, the weather, temperature and non-specific triggers. There is quite a variation in the appearance of atopic eczema between individuals. From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas. The presence of infection or an additional skin condition, the creams applied, the age of the person, their ethnic origin and other factors can alter the way eczema looks and feels. There are however some general patterns to where the eczema is found on the body according to the age of the affected person. Eczema in this age group often affects the extensor (outer) aspects of joints, particularly the wrists, elbows, ankles and knees. As the child becomes older the pattern frequently changes to involve the flexor surfaces of the same joints (the creases) with less extensor involvement. The affected skin often becomes lichenified i.e. dry and thickened from constant scratching and rubbing, In some children the extensor pattern of eczema persists into later childhood. Treatment of atopic eczema may be required for prolonged period. It nearly always requires: Reduction of exposure to trigger factors (where possible), regular emollients (moisturisers), Intermittent topical steroids, and topical calcineurin inhibitors. Longstanding and severe eczema may be treated with an immunosupressive agent.
Dry skin refers to skin that feels dry to touch. Dry skin is lacking moisture in the outer horny cell layer (stratum corneum) and this results in cracks in the skin surface. Dry skin is also called xerosis, xeroderma or asteatosis (lack of fat).Dry skin that starts in early childhood may be one of about 20 types of ichthyosis (fish-scale skin). There is often a family history of dry skin. Dry skin is commonly seen in people with atopic dermatitis. Nearly everyone > 60 years has dry skin. Dry skin that begins later may be seen in people with certain diseases and conditions: Hypothyroidism, chronic renal disease, malnutrition and weight loss, treatment with certain drugs such as oral retinoids, and diuretics. People exposed to a dry environment may experience dry skin: low humidity, excessive air conditioning, excessive bathing, and contact with soap, detergents and solvents. Dry areas of skin may become itchy; indicating a form of eczema/dermatitis has developed. The mainstay of treatment of dry skin and ichthyosis is moisturisers/emollients. They should be applied immediately after bath and not before bath. They should be applied liberally and often enough to: reduce itch, improve barrier function, prevent entry of irritants, bacteria, reduce transepidermal water loss. Use lukewarm, not hot, water. Replace standard soap with a substitute such as a synthetic detergent cleanser, water-miscible emollient, bath oil, colloidal oatmeal etc. A tendency to dry skin may persist life-long, or it may improve once contributing factors are controlled.
Seborrhoeic dermatitis/ Dandruff
Seborrhoeic dermatitis is a common, chronic or relapsing form of eczema/dermatitis that mainly affects the scalp and face. Dandruff is an uninflamed form of seborrhoeic dermatitis. Dandruff presents as bran-like scaly patches scattered within hair-bearing areas of the scalp. The cause of seborrhoeic dermatitis is not completely understood. It is associated with proliferation of various species of the skin commensal Malassezia in its yeast form. Infantile seborrhoeic dermatitis affects babies under the age of 3 months and usually resolves by 6–12 months of age. Adult seborrhoeic dermatitis tends to begin in late adolescence. Prevalence is greatest in young adults and in the elderly. Seborrhoeic dermatitis affects scalp, face (creases around the nose, behind ears, within eyebrows) and upper trunk. Typical features include: Winter flares, improving in summer following sun exposure, combination oily and dry mid-facial skin. Scaly patches or diffuse scale in the scalp Treatment of seborrhoeic dermatitis often involves several of the following options. Topical antifungal agents, mild topical corticosteroids are prescribed for 1–3 weeks to reduce the inflammation of an acute flare, or topical calcineurin inhibitors.