Dermatitis/Eczema

Dermatitis and eczema are terms that are often used interchangeably. In some cases, the term eczematous dermatitis is used. Dermatitis can be acute or chronic or both. Psychological stress can provoke or aggravate dermatitis, presumably by suppressing normal immune mechanisms. Dermatitis is not contagious but if left untreated, can lead to secondary infections due to breakdown of the natural skin barrier.

Types of Eczema

• 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 body fluids, 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, also called eczema craquele.

• 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.

• Seborrheic dermatitis and drandruff are due to irritation from toxic substances produced by yeasts that live on the scalp, face, and sometimes elsewhere.

• Infective dermatitis seems to be provoked by impetigo (bacterial infection) or fungal infection.

• Gravitational eczema arises on the lower legs of the elderly, due to swelling and poorly functioning leg veins.

• Otitis externa – dermatitis affecting the external ear canal

• Meyerson nevus – dermatitis affecting melanocytic nevi (moles)

Diagnosis

The diagnosis of eczema can usually be made visually. In some cases, where the diagnosis or cause is not obvious, a biopsy and/or patch testing (a form of allergy testing) can be helpful.

Treatment

The most important aspect of treatment is to identify and address the source of the condition. Once the source has been identified, your physician can make skin care recommendations and prescribe medications that can help to correct and control your condition.

Self-care tips that may be suggested:

• Bathing - use lukewarm water. Showers are better. Do not use standard bar soap. Use a mild substitute cleansing bar or liquid that your dermatologist recommends.

• Protect the skin from irritating chemicals or known allergens.

• Clothing - wear soft cotton clothes that are comfortable and not tight. Avoid wool if possible.

• Moisturizers - apply non-perfumed moisturizers liberally and as often as necessary, particularly after bathing. Dermatologists can recommend appropriate products.

Treatment options include:

• Topical steroids

• Non-steroidal topical medications including tacrolimus (Protopic®), Pimecrolimus (Elidel®) and Eucrisa®

• Ketoconazole or Ciclopirox cream (primarily for seborrheic dermatitis)

• Antibiotics (topical and oral)

• Oral antihistamines to control itching

• Systemic steroids and other oral immunosuppressing agents

• Phototherapy and laser

• Dupixent®