Download on Dermatitis
By Rhonda Klein, MD, MPH, FAAD
Dermatitis is a common – and chronic – skin condition commonly seen in families where other members have components of what is called the atopic triad – allergies, hay fever and/or asthma. Dermatitis is an umbrella term used to describe a group of medical conditions that cause red, inflamed and itchy skin – the most common one being atopic dermatitis or eczema. If you’re reading this, chances are you, or a loved one are one of the 31.6 million Americans with some form of the condition.*
Before you follow your friend’s, sister’s, babysitter’s, uncle’s advice on how to treat a flare up, take a read through Dr. Klein’s take on the topic.
Diagnosis
It’s important to have a board certified Dermatologist make this diagnosis, so that you can zero in on the specific type of dermatitis you have and tailor your treatment accordingly. There are several types of dermatitis, and it is possible to suffer from more than one form at the same time or over time.
Atopic dermatitis – aka eczema is caused by a malfunction in the immune system and problems with the skin barrier.
Contact dermatitis – a result of skin touching a known irritant and/or allergen.
Dyshidrotic eczema – occurs on the feet and hands as itchy blisters, usually caused by exposure to allergens.
Nummular eczema/discoid eczema/nummular dermatitis – usually caused by allergens or very dry skin and appears as round lesions that can weep fluid, especially in older populations.
Seborrheic dermatitis – white or yellow flaky, greasy patches in places with more oil-producing glands, caused by a combination of genetics, hormones and microorganisms on the skin.
Stasis dermatitis – happens when poor circulation to the legs causes the veins to swell and leak fluid, causing swelling and skin redness and itch, mostly in older populations.
Hand eczema – is not considered an independent type of eczema, but a location of other types of eczema, most frequently atopic or contact dermatitis, and is caused by a combination of genes, irritants and/or allergens.
Lichen simplex chronicus – or neurodermatitis is not considered an independent type of eczema, but rather a symptom of other types of eczema, and results in thick, scaly patches on the skin, often caused by too much scratching and rubbing.
Understanding Triggers
Identifying and then avoiding triggers is the most effective way to manage dermatitis. It’s not always easy to do though! I always encourage patients to take a careful look at what they’re eating, drinking and using on their bodies and in their homes to see if there is an identifiable pattern with flare ups.
Some of the most common triggers include:
Dry skin – which can easily escalate into scaly, rough and tight patches
Chemical irritants – everyday products like hand soap, laundry detergent and shampoo
Stress - when the body is stressed it produces too much cortisol, which can suppress the immune system and cause an inflammatory response in the skin
Hot/cold temps and sweating can lead to itchy skin symptoms – we see an influx of patients with the change of the seasons
Infection from bacteria and viruses that live in your environment (like staph, herpes, or certain types of fungi)
Allergens from the environment like seasonal pollen, dust mites, pet dander and mold
Hormones - flares may happen, especially in women, when certain hormones in the body increase or decrease
Diet
Unless you are allergic to a specific ingredient – which in itself could cause a flare – there is no reason to order that gluten-free, dairy-free, (flavor-free!) option off the menu. That said, we do commonly see that Dairy can exacerbate any inflammatory skin issue (rosacea, acne, eczema) so it might be worth a try to cut that out for a few weeks and see if you notice a difference.
Treatment
Depending on the severity of symptoms, dermatitis can be treated with topical medications, which are applied to the skin; phototherapy, a form of light treatment which we offer in the office; immunosuppressant drugs that broadly curb the immune system; and biologic drugs that target specific areas of the immune system.
There are also a bunch of “interesting” (insert eye wink) treatment hacks circulating the web and likely your social circle. You know, the super passionate lady in your Facebook mom group who “swears” she cured her son’s eczema with a banana peel. There is usually a kernel of clinical rational behind these alternative treatments (banana peels contain vitamin A, B, C and E, as well as potassium, zinc, iron and manganese, which can calm inflamed skin), however we’d prefer you come in and see us before you go rogue. Some of these alternative approaches can also backfire by introducing a potential allergen to already compromised skin.
Learn more about Eczema here.
* Hanifin J, Reed M. A Population-Based Survey of Eczema Prevalence in the United States. Dermatitis. 2007;18(2):82-91. doi:10.2310/6620.2007.06034.