Dermatitis

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Introduction

What is dermatitis?

Dermatitis is an inflammation of the skin that can take several forms. The most common form is atopic dermatitis, seen most often in infants during the first year of life; this is sometimes referred to as eczema, dermatitis, or atopy. Atopic dermatitis most often manifests as itchy, dry scaly patches, usually on the cheeks, as well as on the scalp, forehead, and the rest of the face. In older children, the location of dermatitis shifts to the creases of the elbows and knees or other joint crevices. Atopic dermatitis usually afflicts children.

Two other forms of dermatitis are contact dermatitis (an inflammatory reaction to a specific substance) and seborrheic dermatitis (caused by overproduction of sebum or oils by the sebaceous glands). Seborrheic dermatitis, commonly called dandruff, is the most common form of dermatitis in adults. This article will focus on contact and atopic dermatitis.

Contact dermatitis usually resolves on its own without complications, but it may return if the triggering substances cannot be pinpointed and avoided. Atopic dermatitis can take longer to resolve, but there are effective treatments for it, and the disease is almost always manageable, if not curable, over time.

Contact dermatitis and atopic dermatitis are not life-threatening conditions. Follow treatment instructions and contact a medical professional with any concerns. In rare instances, dermatitis can be part of a very severe allergic reaction, or anaphylaxis, which is life threatening. Seek immediate medical care (call 911) if you, or someone you are with, develop symptoms of anaphylaxis, including difficulty breathing, difficulty swallowing, rapid heart rate (tachycardia), and rapid, marked swelling near the site.

Seek prompt medical care if you are being treated for dermatitis but mild symptoms recur or are persistent, or if you show signs of developing hives or a secondary bacterial infection.

Symptoms

What are the symptoms of dermatitis?

Symptoms of contact dermatitis and atopic dermatitis are similar. Contact dermatitis manifests as a red, scaly itchy rash anywhere on the skin that was exposed to the offending substance. In moderate to severe cases, you may also develop blisters filled with clear liquid. Some people develop hives, for which you should seek prompt medical care.

Dermatitis is seldom life threatening on its own, but it can be a symptom of a severe allergic reaction, or anaphylaxis, which is an emergency situation.

Atopic dermatitis, which most often develops in infants, results in an itchy facial rash with blisters, intense redness, and a burning sensation. In chronic cases, the skin may thicken and develop small cracks.

Common symptoms of dermatitis

You may experience dermatitis symptoms recurrently if the irritant is not identified and avoided. At times, any of these symptoms can be moderately to intensely uncomfortable, but unless you experience a severe allergic reaction leading to anaphylactic shock, dermatitis is not life threatening. Symptoms include:

  • Blisters filled with clear liquid

  • Itchy skin

  • Redness, warmth or swelling

  • Scaly skin

Serious symptoms that might indicate a life-threatening condition

In some rare cases, contact dermatitis may be a sign of a severe allergic reaction, leading to possible anaphylactic shock, which can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Difficulty breathing

  • Difficulty swallowing

  • Rapid heart rate (tachycardia)

  • Rapid, marked swelling near the site

Causes

What causes dermatitis?

There are two major types of contact dermatitis: first, an allergic reaction to a common household or environmental substance, and, second, an inflammatory reaction to a harsh chemical irritant.

Causes of contact dermatitis

Substances that can cause contact dermatitis include:

  • Fabrics

  • Household chemicals such as soaps, cosmetic ingredients, cleaning products

  • Industrial or workplace chemicals

  • Metals (especially nickel)

  • Plants

Causes of atopic dermatitis

The causes of atopic dermatitis are not well understood. This condition results as a unique combination of three factors: first, environmental influences, such as irritants and potential allergens; second, your immune system and, in particular, your immune system’s sensitivity to irritants in the environment; and, third, your family history of atopic dermatitis. Some common triggers that can induce atopic dermatitis include:

  • Cold weather and dry air

  • Emotional stress

  • Excessive washing of the skin

  • Exposure to fumes or harsh chemicals, such as alkaline materials, solvents, or acids

  • Exposure to household irritants, such as certain soaps, detergents, fabrics, and cleaning products

  • Sudden temperature changes (hot to cold or the reverse)

  • Wool sensitivity

What are the risk factors for dermatitis?

A number of factors increase the risk of developing dermatitis. Not all people with risk factors will get dermatitis. Risk factors for dermatitis include:

  • Family history of allergies

  • Family history of asthma

  • Family history of dermatitis (specifically, atopic dermatitis)

  • Individual allergen sensitivity

  • Working or living in an environment that exposes you to your particular triggers

Reducing your risk of dermatitis

You may be able to lower your risk of dermatitis by:

  • Avoiding excessive skin washing

  • Avoiding the use of harsh chemicals

  • Identifying and avoiding your specific allergens or irritants

  • Managing stress

  • Protecting yourself from temperature extremes, especially extreme cold

  • Using a humidifier

Treatments

How is dermatitis treated?

The first step in treating contact dermatitis is to wash the area with water to get rid of all traces of the irritant. Sometimes it is best to do nothing more because even low-strength, over-the-counter products can worsen the condition. You may be able to reduce your itching with wet dressings, drying lotions, or anti-itch (antipruritic) creams or lotions. In cases of inflammation, corticosteroid creams or ointments may be an effective treatment. In the most severe inflammatory cases, you may need a systemic corticosteroid.

Atopic dermatitis is a chronic condition that is not curable. However, in most people (usually children), it can resolve over time by identifying and avoiding case-specific environmental triggers (certain fabrics and household products), using a home humidifier, being careful to not over-wash or scrub the skin, and avoiding chlorinated swimming pools. Itching can be relieved with ice bags or cool, wet compresses, an oatmeal bath, or oatmeal soap. In the most severe cases, your doctor may prescribe a corticosteroid for the inflammation and an antihistamine for the itching. Finally, some people find phototherapy (application of artificial ultraviolet light) helpful for treating symptoms.

Treatments for contact dermatitis

The first step in treating contact dermatitis is to wash the area thoroughly with water, avoid further contact with the irritant, and then see if the condition clears up on its own. Medications should be used only if needed, as some treatments can actually aggravate the condition. Treatments include:

  • Corticosteroids, such as hydrocortisone cream (Cort-Dome, Dermacort, Hytone, Synacort), betamethasone dipropionate (Diprosone), flurandrenolide (Cordran), fluticasone propionate (Cultivate), and triamcinolone acetonide (Aristocort, Kenalog). High- and very high-strength corticosteroids for atopic dermatitis include betamethasone dipropionate (Diprosone, Diprolene), fluocinonide (Lidex), triamcinolone (Kenalog), and clobetasol propionate (Temovate).

  • Pimecrolimus cream (Elidel)

  • Tacrolimus ointment (Protopic)

Treatments for atopic dermatitis

Medications are not the first choice for treating atopic dermatitis, a chronic condition that is not curable but which can be controlled. However, in the most severe cases, your doctor may prescribe a corticosteroid for the inflammation and an antihistamine for itching. Treatment strategies include:

  • Minimization of exposure to your specific environmental triggers

  • Oatmeal bath or oatmeal soap to relieve itch

  • Oral antihistamines for itching (in severe cases only), such as cetirizine hydrochloride (Zyrtec), diphenhydramine (Benadryl), fexofenadine (Allegra), hydroxyzine (Vistaril), and loratadine (Claritin)

  • Oral corticosteroids (in severe cases only), such as prednisone (Deltasone), prednisolone (Delta-Cortef, Prelone), and methylprednisolone (Medrol)

  • Phototherapy (application of artificial ultraviolet light)

  • Topical corticosteroids (in severe cases only), such as hydrocortisone cream (Cort-Dome, Dermacort, Hytone, Synacort), betamethasone dipropionate (Diprosone), flurandrenolide (Cordran), fluticasone propionate (Cultivate), and triamcinolone acetonide (Aristocort, Kenalog). High- and very high-strength corticosteroids for atopic dermatitis include betamethasone dipropionate (Diprosone, Diprolene), fluocinonide (Lidex), triamcinolone (Kenalog), and clobetasol propionate (Temovate)

  • Use of ice bags or cool, wet compresses with aluminum acetate solution to relieve itch

    What you can do to improve your dermatitis

    In addition to reducing your exposure to your dermatitis triggers, you can also reduce symptoms by:

    • Avoiding chlorinated swimming pools

    • Being careful not to wash excessively or scrub the skin

    • Taking oatmeal baths or using oatmeal soap to relieve itch

    • Using a home humidifier

    • Using ice bags or cool wet compresses with aluminum acetate solution to relieve itch

    What are the potential complications of dermatitis?

    Complications of untreated or poorly controlled dermatitis are rarely serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of dermatitis include bacterial infections that can develop on irritated skin, requiring treatment with antibiotics. Also, in very rare cases, contact dermatitis may be a sign of a severe allergic reaction, leading to possible anaphylactic shock, which can be life threatening.

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2018 Dec 28
    1. Skin rashes and other changes. FamilyDoctor.org. http://familydoctor.org/online/famdocen/home/tools/symptom/545.printerview.html
    2. Types of Eczema. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/eczema
    3. Federman DG, Reid M, Feldman SR, et al. The primary care provider and the care of skin disease: the patient's perspective. Arch Dermatol 2001; 137:25.
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