General Information: Dermatitis - inflammation of skin.

Two of the most common types of dermatitis are atopic dermatitis and contact dermatitis.

Atopic Dermatitis

Atopic" dermatitis is a particular type of skin inflammation that is marked by dryness, associated itching, and a characteristic pattern of rash on the body. The condition is fairly common, and may occur in as many as 5% of children.

The exact cause of atopic dermatitis is unknown. In many patients, there is a family history of allergic conditions, such as hives, hay fever, asthma or atopic dermatitis itself. Rarely, atopic dermatitis in infants may be related to food sensitivity, such as sensitivity to milk, but this is often difficult to determine and manage. In the majority of cases, however, no allergic factors can be found.

Atopic dermatitis usually starts in infancy from the ages of 2 to 6 months. The skin is dry and the rash is quite itchy, so infants may be restless and rub against the sheets, or scratch if able. The rash may involve the face or it may cover a large part of the body. As the child gets older, the rash may become more localized. In early childhood, the rash is commonly on the legs, feet, hands and arms. As a person becomes older, the rash may be limited to the bend of the elbows, knees, on the back of the hands, feet, and on the neck and face. As the rash becomes more established, the dry itchy skin may become thickened, leathery and sometimes darker in coloration. The more the person scratches, the worse the rash is and the thicker the skin gets. Most children with atopic dermatitis outgrow the condition before school age; some continue to have problems as an adolescent or even as an adult.

Many things may affect the severity of the condition. All patients have sensitive and dry skin. Many will find that during the winter months when the humidity is very low, the dryness and itchiness will be worse. On the other hand, some people are easily irritated by sweat and will find that they have more problems during the summer months. Most patients note an increase in itching at times when there are sudden changes in temperature. Other irritants easily affect the skin of a patient with atopic dermatitis. Use of harsh soaps and detergents and exposure to wool are common problems. Atopic dermatitis can be exacerbated by bacteria, yeast, or viruses. This is called "secondary infection”.

Bacterial secondary infection is the most common, and often occurs as the result of scratching. The rash gets very red with pus-filled pimples and scabs. If this occurs, your doctor will prescribe an antibiotic to control the infection. A more serious complication can be caused by certain viruses. The "cold sore" virus (herpes simplex) may cause a severe rash. If this is suspected, immediately contact your doctor. Molluscum is another virus that tends to spread rapidly in patients with atopic dermatitis

What can I expect from treatment?

Unfortunately, there is no "magic cure" that will always eliminate atopic dermatitis. The main objective in treating atopic dermatitis is to decrease the skin eruption and relieve the itching. There are a number of different forms of medication that are used for atopic dermatitis, and medications that are best suited to control the problem will be chosen. Primarily "topical medications" (medications that are applied to the skin) will be used. Because the skin is usually excessively dry, lubricants will be prescribed that will effectively decrease the dryness. If soap is tolerated, a mild soap is recommended. Cortisone derived ointments or creams may also be suggested, and are very important in decreasing the itching and controlling the inflammation. Your doctor will suggest a cortisone treatment that is most appropriate for the severity and location of the dermatitis that is to be treated. When the area is clear, it is best to discontinue the use of the cortisone preparation, but continue the vigorous use of lubrication to try to prevent new areas of dermatitis from occurring. Of course, if itching or a new rash begins, the cortisone preparation may have to be reintroduced. Newer, non-cortisone, preparations may be prescribed for long-term care.

Certain internal medicines, called "antihistamines" may help to control itching. Other internal medicines, called “antibiotics” may be used if the rash becomes infected. Full body phototherapy with ultraviolet light can be used to control more severe cases of atopic dermatitis. We use narrow-band UVB light sources, which is the most safe and effective type of light source available. Additionally, our practice features the PHAROS EX-308 excimer laser. This painless, convenient, and effective treatment modality can be used to treat localized areas of atopic dermatitis. By targeting only affected areas of skin, the laser spares the patient’s healthy tissue from exposure. This is ideal for patients, especially children, for whom steroids and full-body booth UV phototherapy may not be desirable treatment options.

Other Important Forms of Treatment

1. Avoid contact with substances you know cause itching. These may include soaps, detergents, certain perfumes, dust, grass weeds, wools and other types of scratchy clothing. In the winter, for example, cotton underwear or a cotton shirt may be worn under the sweater. Do not use fabric softeners such as Bounce, Snuggles or Cling-free. Use a laundry detergent with the word “free” in it, such as Tide-free, All-free, Cheer-free, or Arm and Hammer-free. The "free" means that it doesn't have dyes and fragrances in it. Also, double rinse all clothes and sheets.

2. You may bathe daily or every other day. ALWAYS use lubrication immediately after bathing. Use a thick moisturizer such as Linage® Moisturizer (available at our office), Eucerin Plus Cream, Cetaphil Cream, Aquaphor, or Petroleum Jelly (Vaseline). Avoid hot water and bubble baths. Try to take a shower. When drying with the towel, pat, do not rub. Use a mild soap (such as unscented Dove Bar Soap or Cetaphil cleanser) only where needed.

3. Try to keep the temperature and humidity in the home fairly constant. Use a bedroom air conditioner in the summer and a vaporizer in winter. It is very important that the vaporizer or humidifier be cleaned well and frequently, since molds may grow and cause allergic manifestations.

4. Try to avoid scratching. Atopic dermatitis is often called "the itch that rashes" and it is known that scratching plays a very important role in making the dermatitis worse. Keeping the nails short and well-filed, and using other measures to help to keep the child from itching are helpful.

Contact Dermatitis

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating or allergy-causing substance (irritant or allergen). Reactions may vary in the same person over time. A history of any type of allergies increases the risk for this condition.

Irritant dermatitis, the most common type of contact dermatitis, involves inflammation resulting from contact with acids, alkaline materials such as soaps and detergents, solvents, or other chemicals. The reaction usually resembles a burn.

Allergic contact dermatitis, the second most common type of contact dermatitis, is caused by exposure to a substance or material to which you have become extra sensitive or allergic. The allergic reaction is often delayed, with the rash appearing 24 - 48 hours after exposure. The skin inflammation varies from mild irritation and redness to open sores, depending on the type of irritant, the body part affected, and your sensitivity.

Overtreatment dermatitis is a form of contact dermatitis that occurs when treatment for another skin disorder causes irritation.

Common allergens associated with contact dermatitis include:

Contact dermatitis may involve a reaction to a substance that you are exposed to, or use repeatedly. Although there may be no initial reaction, regular use (for example, nail polish remover, preservatives in contact lens solutions, or repeated contact with metals in earring posts and the metal backs of watches) can eventually cause cause sensitivity and reaction to the product.

Some products cause a reaction only when they contact the skin and are exposed to sunlight (photosensitivity). These include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime. A few airborne allergens, such as ragweed or insecticide spray, can cause contact dermatitis.

Symptoms

Exams and Tests

The diagnosis is primarily based on the skin appearance and a history of exposure to an irritant or an allergen.

According to the American Academy of Allergy, Asthma, and Immunology, "patch testing is the gold standard for contact allergen identification." Allergy testing with skin patches may isolate the suspected allergen that is causing the reaction.

Patch testing is used for patients who have chronic, recurring contact dermatitis. It requires three office visits and must be done by a clinician with detailed experience in the procedures and interpretation of results. On the first visit, small patches of potential allergens are applied to the skin. These patches are removed 48 hours later to see if a reaction has occurred. A third visit approximately 2 days later is to evaluate for any delayed reaction. You should bring suspected materials with you, especially if you have already tested those materials on a small area of your skin and noticed a reaction.

Other tests may be used to rule out other possible causes, including skin lesion biopsy or culture of the skin lesion

Treatment

Initial treatment includes thorough washing with lots of water to remove any trace of the irritant that may remain on the skin. You should avoid further exposure to known irritants or allergens.

In some cases, the best treatment is to do nothing to the area.

Corticosteroid skin creams or ointments may reduce inflammation. Carefully follow the instructions when using these creams, because overuse, even of low-strength over-the-counter products, may cause a troublesome skin condition. In severe cases, systemic corticosteroids may be needed to reduce inflammation. These are usually tapered gradually over about 12 days to prevent recurrence of the rash. Wet dressings and soothing anti-itch (antipruritic) or drying lotions may be recommended to reduce other symptoms.

Outlook (Prognosis)

Contact dermatitis usually clears up without complications within 2 or 3 weeks, but may return if the substance or material that caused it cannot be identified or avoided. A change of occupation or occupational habits may be necessary if the disorder is caused by occupational exposure.