Dermatitis, also referred to as eczema, is a term used to describe a broad variety of skin irritations that involve inflammation and red itchy rashes. The condition is not life-threatening and cannot be passed from one person to another through any sort of contact, though it can have a familial component.
Seen commonly in children, dermatitis is often outgrown by adulthood. However, it can also be persistent or recurrent, starting early in infancy and affecting an individual right into adulthood. Certain types are associated with infants, for example, "cradle cap," whereas others are particularly bothersome for the elderly, such as "winter itch."
Inflamed red itchy skin is the most general description of the symptoms accompanying dermatitis. However, blisters, scabbing, scaling, flaking or oozing of the skin may also be present. The type of rash an individual with this condition experiences depends on the particular kind of dermatitis from which he or she may be suffering.
Thursday, March 25, 2010
Types of dermatitis.
There are a variety of names used to describe the different types of dermatitis. These categories can be based on the location, cause or appearance of the condition. Sometimes these terms are used interchangeably, which can lead to some confusion, but in treating it's helpful to identify the basic type before choosing a treatment plan. Here are the most common types described:
Atopic dermatitis – Long-lasting disease of the skin that that may have a hereditary component in individuals who also have hay fever and asthma. Atopic dermatis is the most common form of eczema. Skin irritation includes dry, itchy, red, and cracked skin behind the ears, on cheeks, arms, and legs.
Contact dermatitis – A skin rash resulting from repeated and direct contact with an allergen such as poison ivy or other irritant-containing substance such as cleaning products. The rash is very itchy but usually confined to the area of allergenic contact. It can start with a mild redness and itch then progress to a severe itch with blisters and severe swelling.
Hard water dermatitis – (not technically a type — but, worth of mention in the discussion of dermatitis) A common cause of dry skin and often a significant contributor to seborrheic dermatitis (and cradle cap), atopic dermatitis (eczema) and contact dermatitis outbreaks. The culprit is alkaline (high pH) water that contains high levels of iron, magnesium and/or calcium ions.
Nummular dermatitis – An extremely itchy red rash characterized by its coin-shaped patches on the skin. The discoid patches may contain oozing blisters, scaling, and scabs. It most often affects the backs of arms and lower legs, as well as the buttocks.
Perioral dermatitis – A red bumpy rash with blisters and scaling that occurs around the mouth and chin region. It can resemble and be confused with acne or the skin condition rosacea.
Pompholyx – Chronic dermatitis with itchy blisters that develop on the sides of the fingers, palms of the hands, and soles of the feet.
Seborrheic dermatitis/cradle cap – Most often affects the scalp and face but may be found on other areas of the body where hair is present. It can present with dry, yellow, greasy, or scaly patches of the skin sometimes starting as dandruff.
Stasis dermatitis/venous eczema – An inflammation of the skin caused by the pooling of blood underneath the skin in the ankles or varicose veins in the lower legs. The inflammation will start in the ankle and can work its way up to just under the knee. A non-painful but itchy, red scaly rash can develop. Increased scratching of the rash can cause painful ulcers to develop.
Atopic dermatitis – Long-lasting disease of the skin that that may have a hereditary component in individuals who also have hay fever and asthma. Atopic dermatis is the most common form of eczema. Skin irritation includes dry, itchy, red, and cracked skin behind the ears, on cheeks, arms, and legs.
Contact dermatitis – A skin rash resulting from repeated and direct contact with an allergen such as poison ivy or other irritant-containing substance such as cleaning products. The rash is very itchy but usually confined to the area of allergenic contact. It can start with a mild redness and itch then progress to a severe itch with blisters and severe swelling.
Hard water dermatitis – (not technically a type — but, worth of mention in the discussion of dermatitis) A common cause of dry skin and often a significant contributor to seborrheic dermatitis (and cradle cap), atopic dermatitis (eczema) and contact dermatitis outbreaks. The culprit is alkaline (high pH) water that contains high levels of iron, magnesium and/or calcium ions.
Nummular dermatitis – An extremely itchy red rash characterized by its coin-shaped patches on the skin. The discoid patches may contain oozing blisters, scaling, and scabs. It most often affects the backs of arms and lower legs, as well as the buttocks.
Perioral dermatitis – A red bumpy rash with blisters and scaling that occurs around the mouth and chin region. It can resemble and be confused with acne or the skin condition rosacea.
Pompholyx – Chronic dermatitis with itchy blisters that develop on the sides of the fingers, palms of the hands, and soles of the feet.
Seborrheic dermatitis/cradle cap – Most often affects the scalp and face but may be found on other areas of the body where hair is present. It can present with dry, yellow, greasy, or scaly patches of the skin sometimes starting as dandruff.
Stasis dermatitis/venous eczema – An inflammation of the skin caused by the pooling of blood underneath the skin in the ankles or varicose veins in the lower legs. The inflammation will start in the ankle and can work its way up to just under the knee. A non-painful but itchy, red scaly rash can develop. Increased scratching of the rash can cause painful ulcers to develop.
Allergens.
Allergens are characterized by their ability to invoke an overreaction from your immune system that causes inflammation. In dermatitis caused by an allergy, the inflammation is present within the layers of the skin. The offending allergen could be any one of or several substances found in the environment, originating from animals, foods, plants, or manmade substances. There have been thousands of substances identified as potential allergens, but fewer than 30 are responsible for the majority of allergic and contact dermatitis cases.
12 common allergens:
Poison ivy, poison oak, poison sumac
Nickel (found in hairpins, earrings, and zippers)
Latex (rubber) products
Pet dander
Fish
Peanuts
Wheat
Eggs
Milk
Soy products
Mango
Dermatitis that is caused by an allergen or irritant is called contact dermatitis. Approximately 20% of contact dermatitis cases are the result of allergic reactions; the other 80% are caused by irritants such as chemicals in the workplace. It can be difficult to differentiate an allergenic dermatitis from an irritant dermatitis because the rashes are very similar in appearance, and some chemicals can be allergens, too. An irritant-caused dermatitis will generally show up on the skin within minutes of coming into contact with the irritant, and the rash is usually more painful than itchy. A dermatitis caused by an allergic reaction can take 24–48 hours to appear, but sometimes will take even longer to develop, with repeated contact with the allergen required before sensitization takes place and a rash appears.
12 common allergens:
Poison ivy, poison oak, poison sumac
Nickel (found in hairpins, earrings, and zippers)
Latex (rubber) products
Pet dander
Fish
Peanuts
Wheat
Eggs
Milk
Soy products
Mango
Dermatitis that is caused by an allergen or irritant is called contact dermatitis. Approximately 20% of contact dermatitis cases are the result of allergic reactions; the other 80% are caused by irritants such as chemicals in the workplace. It can be difficult to differentiate an allergenic dermatitis from an irritant dermatitis because the rashes are very similar in appearance, and some chemicals can be allergens, too. An irritant-caused dermatitis will generally show up on the skin within minutes of coming into contact with the irritant, and the rash is usually more painful than itchy. A dermatitis caused by an allergic reaction can take 24–48 hours to appear, but sometimes will take even longer to develop, with repeated contact with the allergen required before sensitization takes place and a rash appears.
The eight most common food allergy culprits are dairy products.
Eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish. Many other foods that can evoke an allergenic response, however, such as acidic fruits (including tomatoes) and innumerable others.
Limit fatty red meats and consider buying organic, grass-fed, leaner meats.
Avoid trans fats whenever possible, as they are pro-inflammatory.
Sugar is another common ingredient in our diets that can cause skin irritation, so all sugary foods such as soft drinks and juice should be limited.
Avoid or limit alcoholic beverages.
Most processed foods contain chemicals that lengthen their shelf life; many of these are considered toxins that can cause skin irritation, and they should be limited or altogether avoided.
Increase your intake of EFA's through cold-pressed virgin vegetable oils and seafood.
Drink a liter and a half of water daily to aid in flushing toxins from your tissues.
Your healthy diet should consist of at least five helpings of fresh veggies per day, brown rice, lean meats, wild-harvested fish (unless you are allergic), and plenty of water.
Some researchers believe that poor nutrition is an important contributing factor to many types of dermatitis. But while links between specific dietary deficiencies and imbalances are apparent, the underlying mechanisms for these associations have yet to be fully established.
It is known that meat and dairy products contain a proinflammatory fatty acid called arachidonic acid (AA). As part of the body's natural healing process, this acid is converted into the potent mediators of inflammation known as leukotrienes, prostaglandins, and thromboxanes. Inflammation is one of the body's natural responses to a threat, but poor diet can lead to an imbalance between proinflammatory and anti-inflammatory molecules, contributing to inflammation that is out of proportion to the threat. Chronic inflammation can manifest downstream in a host of health problems, including skin disorders such as dermatitis.
Diets containing trans fats (hydrogenated vegetable oils) or high in saturated animal fats have also been linked to thickening of the blood, putting greater pressure on the arteries, which can further add to skin inflammation associated with dermatitis. Foods high in saturated fats may also contain high levels of toxins associated with skin irritation.
Studies have shown significant improvements in dermatitis patients who lower their intake of trans fats and saturated animal fats, particularly when supplemented with the group of essential fatty acids known as omega-3 fatty acids. Essential fatty acids (EFA's) counterbalance pro-inflammatory molecules such as AA in the inflammatory cascade, which can lessen dermatitis symptoms such as itching and scaling of the skin. The best sources of fatty acids are cold-pressed vegetable oils like extra-virgin olive oil, freshly ground flaxseed, and wild-harvested cold-water fish and other seafood.
Many patients who adopt a vegetarian, vegan, or Mediterranean diet that is high in EFA's and fresh fruits and vegetables see marked improvement in their symptoms. Here are 10 additional nutritional steps to healthier skin:
Investigate any food allergies or sensitivities by using a food diary. Record foods that you ingest on a daily basis and any reactions you may have, paying particular attention to the skin. Eliminate all foods you may suspect for at least a couple weeks, then slowly re-introduce them one by one, watching closely for any reactions. If there are no reactions, they may be considered safe. If you experience reactions they should be completely eliminated from your diet.
Limit fatty red meats and consider buying organic, grass-fed, leaner meats.
Avoid trans fats whenever possible, as they are pro-inflammatory.
Sugar is another common ingredient in our diets that can cause skin irritation, so all sugary foods such as soft drinks and juice should be limited.
Avoid or limit alcoholic beverages.
Most processed foods contain chemicals that lengthen their shelf life; many of these are considered toxins that can cause skin irritation, and they should be limited or altogether avoided.
Increase your intake of EFA's through cold-pressed virgin vegetable oils and seafood.
Drink a liter and a half of water daily to aid in flushing toxins from your tissues.
Your healthy diet should consist of at least five helpings of fresh veggies per day, brown rice, lean meats, wild-harvested fish (unless you are allergic), and plenty of water.
Some researchers believe that poor nutrition is an important contributing factor to many types of dermatitis. But while links between specific dietary deficiencies and imbalances are apparent, the underlying mechanisms for these associations have yet to be fully established.
It is known that meat and dairy products contain a proinflammatory fatty acid called arachidonic acid (AA). As part of the body's natural healing process, this acid is converted into the potent mediators of inflammation known as leukotrienes, prostaglandins, and thromboxanes. Inflammation is one of the body's natural responses to a threat, but poor diet can lead to an imbalance between proinflammatory and anti-inflammatory molecules, contributing to inflammation that is out of proportion to the threat. Chronic inflammation can manifest downstream in a host of health problems, including skin disorders such as dermatitis.
Diets containing trans fats (hydrogenated vegetable oils) or high in saturated animal fats have also been linked to thickening of the blood, putting greater pressure on the arteries, which can further add to skin inflammation associated with dermatitis. Foods high in saturated fats may also contain high levels of toxins associated with skin irritation.
Studies have shown significant improvements in dermatitis patients who lower their intake of trans fats and saturated animal fats, particularly when supplemented with the group of essential fatty acids known as omega-3 fatty acids. Essential fatty acids (EFA's) counterbalance pro-inflammatory molecules such as AA in the inflammatory cascade, which can lessen dermatitis symptoms such as itching and scaling of the skin. The best sources of fatty acids are cold-pressed vegetable oils like extra-virgin olive oil, freshly ground flaxseed, and wild-harvested cold-water fish and other seafood.
Many patients who adopt a vegetarian, vegan, or Mediterranean diet that is high in EFA's and fresh fruits and vegetables see marked improvement in their symptoms. Here are 10 additional nutritional steps to healthier skin:
Investigate any food allergies or sensitivities by using a food diary. Record foods that you ingest on a daily basis and any reactions you may have, paying particular attention to the skin. Eliminate all foods you may suspect for at least a couple weeks, then slowly re-introduce them one by one, watching closely for any reactions. If there are no reactions, they may be considered safe. If you experience reactions they should be completely eliminated from your diet.
Steroid ointments.
Steroidal topical ointments are the most commonly prescribed treatment for dermatitis. All steroid ointments, except hydrocortisone cream, need to be prescribed by your doctor. They come in various strengths and are rated I (strongest) through VII (weakest).
These creams work by constricting the blood vessels in the upper layer of the dermis. This constriction reduces the itching and inflammation associated with dermatitis. When the itching and inflammation subside, so do most of the other symptoms. The stronger the cream, the more the blood vessels will be constricted.
Steroid creams are effective in reducing the symptoms of dermatitis; however, they do not come without side effects. Working closely with your doctor and being fully aware of these side effects is the best way to minimize your risk and get the best results from this type of treatment. Some of the most common side effects are:
Tachyphylaxis – When the skin builds up a tolerance to the strength of steroid you are using, it can lead to an inability of the blood vessels to constrict, and you may then require a stronger prescription. This can occur after four or more days of continued applications three times per day. Stopping use for four or more days will generally allow your blood vessels to regain their ability to constrict.
Steroid rosacea – Fair-skinned people are the most commonly affected by this side effect. It occurs when a tolerance to the steroid is built up in the skin, leading to a return of the facial flushing and the need for a stronger prescribed cream. Any attempt to cut back or stop the steroid generally leads to a return of the flushing.
Skin atrophy – Repeated use of steroid cream in the same area leads to progressive thinning of the skin. The skin can become lax, wrinkled, shiny and depressed below normal levels. Stopping the steroid will reverse most of these effects, but it can take months for the skin to re-thicken.
Striae/stretch marks – These occur when steroid cream is applied to areas of the body where skin touches skin, e.g., armpits or groin. Once stretch marks of the skin appear they are irreversible, and oftentimes become irritated to the point where they need their own treatment. The best approach when this happens is to stop the use of steroidal cream to arrest further damage.
Topical steroid allergy – Testing has revealed that 4–5% of people with dermatitis who are prescribed steroidal creams experience an allergy to components of the cream itself. Those using multiple prescriptions or over-the-counter medications who have chronic skin conditions are at greater risk for an allergic response to topical steroids. It is recommended that the use of these creams be stopped if you experience an allergic reaction.
Alteration of immunity – Steroids alter the way your immune system works, so the skin can become more vulnerable to bacterial or fungal infection with their use. If the cream is then applied to skin overtop a bacterial or fungal infection, it can cause it to become more irritated.
Glaucoma – There are isolated reports of links between steroids (even topical kinds) and glaucoma. Glaucoma is an infection inside the eye which causes increased pressures on the optic nerve and if left untreated can lead to blindness.
These creams work by constricting the blood vessels in the upper layer of the dermis. This constriction reduces the itching and inflammation associated with dermatitis. When the itching and inflammation subside, so do most of the other symptoms. The stronger the cream, the more the blood vessels will be constricted.
Steroid creams are effective in reducing the symptoms of dermatitis; however, they do not come without side effects. Working closely with your doctor and being fully aware of these side effects is the best way to minimize your risk and get the best results from this type of treatment. Some of the most common side effects are:
Tachyphylaxis – When the skin builds up a tolerance to the strength of steroid you are using, it can lead to an inability of the blood vessels to constrict, and you may then require a stronger prescription. This can occur after four or more days of continued applications three times per day. Stopping use for four or more days will generally allow your blood vessels to regain their ability to constrict.
Steroid rosacea – Fair-skinned people are the most commonly affected by this side effect. It occurs when a tolerance to the steroid is built up in the skin, leading to a return of the facial flushing and the need for a stronger prescribed cream. Any attempt to cut back or stop the steroid generally leads to a return of the flushing.
Skin atrophy – Repeated use of steroid cream in the same area leads to progressive thinning of the skin. The skin can become lax, wrinkled, shiny and depressed below normal levels. Stopping the steroid will reverse most of these effects, but it can take months for the skin to re-thicken.
Striae/stretch marks – These occur when steroid cream is applied to areas of the body where skin touches skin, e.g., armpits or groin. Once stretch marks of the skin appear they are irreversible, and oftentimes become irritated to the point where they need their own treatment. The best approach when this happens is to stop the use of steroidal cream to arrest further damage.
Topical steroid allergy – Testing has revealed that 4–5% of people with dermatitis who are prescribed steroidal creams experience an allergy to components of the cream itself. Those using multiple prescriptions or over-the-counter medications who have chronic skin conditions are at greater risk for an allergic response to topical steroids. It is recommended that the use of these creams be stopped if you experience an allergic reaction.
Alteration of immunity – Steroids alter the way your immune system works, so the skin can become more vulnerable to bacterial or fungal infection with their use. If the cream is then applied to skin overtop a bacterial or fungal infection, it can cause it to become more irritated.
Glaucoma – There are isolated reports of links between steroids (even topical kinds) and glaucoma. Glaucoma is an infection inside the eye which causes increased pressures on the optic nerve and if left untreated can lead to blindness.
Probiotic treatment .
Probiotics are "good" bacterial organisms, such as Lactobacillus and Bifidobacterium, that live in our digestive tracts and help ward off diseases, manufacture vitamins, and improve nutrient uptake. Our beneficial gut flora can be killed or weakened due to overuse of antibiotics, infection, competition with pathogens, or other stresses. When this happens our bodies become more vulnerable to disease. Fortunately, probiotics can be supplemented into our diets to aid the body in preserving healthy levels of good bacteria.
Clearly, taking probiotics is a great way to generally boost your immune system and protect your digestive system. If you suffer from atopic dermatitis, it is suggested you talk to your dermatologist about adding probiotics to your treatment plan.
Clearly, taking probiotics is a great way to generally boost your immune system and protect your digestive system. If you suffer from atopic dermatitis, it is suggested you talk to your dermatologist about adding probiotics to your treatment plan.
TCM.
Traditional Chinese Medicine (TCM) is an alternative healing practice that can be effective for treating dermatitis. A course of TCM may include herbal preparations in oral, topical, or injectable form; acupuncture; auriculotherapy (ear acupuncture), and other treatments. The emphasis in Chinese herbal medicine is on combinations of different herbs based on the individual and their specific condition. The three basic functions that Chinese herbal medicines perform are detoxification and elimination, health building, and health management and maintenance. The aim is to correct imbalances throughout the body, not just in the skin.
One of the first Western studies evaluating the use of Chinese herbal medicine to treat dermatitis was conducted in London on both children and adults. Patients were given a daily herbal mixture of ten different herbs for a period of two months. The researchers found that compared to the control patients, those taking the herbs had significant improvement of scaling, redness, inflammation, itching, and other symptoms. Most importantly, they followed up with those patients who continued to use the herbal medicine, and a year later found that their improvements had continued. Those who discontinued use had declined and experienced a return of symptoms. Lastly, they found that those continuing their use of the herbs were able to minimize their dose and eventually discontinue the treatments without reoccurrence of symptoms.
As effective as Chinese herbal medicine can be, it is important to note that there have been cases of serious side effects. Liver and kidney toxicity have been reported as a result of taking a regimen of Chinese herbal medicine. There have been cases of both liver and kidney failure, resulting in transplants and even death. Unfortunately, because of the high variance in the herbs used in these cases, it has not been determined which herbs caused the toxicity.
The herbs used in traditional Chinese medicine are not regulated by the US FDA, so contamination and impurity are potential concerns. Nonetheless, many dermatologists and other medical providers in the US are becoming increasingly familiar with Chinese herbal medicine due to high demand for effective alternative healing modalities. When making a decision about whether to use this form of alternative medicine, it is important to work closely with a qualified practitioner and make certain you are being screened for any toxicity that may arise.
The leaves of the tea plant, a native to the Orient, have also been found helpful for treating dermatitis. A study in Japan showed that drinking tea can lead to moderate improvement in symptoms. Over 100 patients with recalcitrant (not responding to treatment) dermatitis symptoms were instructed to drink tea three times daily so the total amount equaled one liter. (The type used was oolong tea, a specialty tea produced by partial oxidation of the tea leaf, intermediate between the process for green and black teas.) Positive results were shown after one or two weeks, with moderate improvement coming after a month. Tea does contain caffeine, which can increase anxiety levels in certain people. Anxiety has been noted to trigger dermatitis outbreaks, so tea should be taken cautiously, or decaffeinated version sought out. Decaffeinated teas may contain a lower concentration of the antiallergic constituents.
One of the first Western studies evaluating the use of Chinese herbal medicine to treat dermatitis was conducted in London on both children and adults. Patients were given a daily herbal mixture of ten different herbs for a period of two months. The researchers found that compared to the control patients, those taking the herbs had significant improvement of scaling, redness, inflammation, itching, and other symptoms. Most importantly, they followed up with those patients who continued to use the herbal medicine, and a year later found that their improvements had continued. Those who discontinued use had declined and experienced a return of symptoms. Lastly, they found that those continuing their use of the herbs were able to minimize their dose and eventually discontinue the treatments without reoccurrence of symptoms.
As effective as Chinese herbal medicine can be, it is important to note that there have been cases of serious side effects. Liver and kidney toxicity have been reported as a result of taking a regimen of Chinese herbal medicine. There have been cases of both liver and kidney failure, resulting in transplants and even death. Unfortunately, because of the high variance in the herbs used in these cases, it has not been determined which herbs caused the toxicity.
The herbs used in traditional Chinese medicine are not regulated by the US FDA, so contamination and impurity are potential concerns. Nonetheless, many dermatologists and other medical providers in the US are becoming increasingly familiar with Chinese herbal medicine due to high demand for effective alternative healing modalities. When making a decision about whether to use this form of alternative medicine, it is important to work closely with a qualified practitioner and make certain you are being screened for any toxicity that may arise.
The leaves of the tea plant, a native to the Orient, have also been found helpful for treating dermatitis. A study in Japan showed that drinking tea can lead to moderate improvement in symptoms. Over 100 patients with recalcitrant (not responding to treatment) dermatitis symptoms were instructed to drink tea three times daily so the total amount equaled one liter. (The type used was oolong tea, a specialty tea produced by partial oxidation of the tea leaf, intermediate between the process for green and black teas.) Positive results were shown after one or two weeks, with moderate improvement coming after a month. Tea does contain caffeine, which can increase anxiety levels in certain people. Anxiety has been noted to trigger dermatitis outbreaks, so tea should be taken cautiously, or decaffeinated version sought out. Decaffeinated teas may contain a lower concentration of the antiallergic constituents.
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