Virtual Care > Virtual Care: Dermatitis - Skin Rash and Inflammation
What is Dermatitis (Eczema)?
Dermatitis, commonly called eczema, refers to a number of conditions that inflame the skin. Many types of dermatitis require care by a licensed health care provider.
Common Types of Dermatitis (Eczema)
- Atopic Dermatitis is a hereditary, chronic skin disorder that frequently begins in infancy or in very young children. It may last until the child reaches adolescence or adulthood. Not infrequently, these patients may also suffer from asthma or hay fever.
- Contact Dermatitis is a physiological reaction that occurs after skin comes in contact with certain substances. Most of these reactions are caused by irritants to the skin. The remaining cases are caused by allergens, which trigger an allergic response. An allergic reaction may not start until several days after exposure. Adults are most commonly affected by allergic contact dermatitis, but it can affect all ages.
- Dermatitis Herpetiformis (DH) is an uncommon, intensely itchy skin disease that causes eruptions of clusters of small blisters and small bumps. It is caused by a reaction to gluten in foods. Dermatitis herpetiformis typically occurs to those in their 40s and 50s, although it can occur at any age. It affects more men than women, and is a lifelong condition.
- Generalized Exfoliative Dermatitis (GED) is a severe inflammation of the entire skin surface due to a reaction to certain drugs, a pre-existing skin condition and, sometimes, cancer. In about 25 percent of people, there is no identifiable cause. It is characterized by redness and scaling of the skin that begins in patches and spreads. The skin begins to slough off, leading to problems with temperature regulation, protein and fluid loss and an increased metabolic rate.
- Seborrheic Dermatitis is an inflammation of the upper skin layers, characterized by red, itchy skin that sheds scales. Seborrheic dermatitis may be a hereditary condition and is often aggravated by hormonal changes and cold weather conditions. Persons with oily skin or hair are also more at risk for developing seborrheic dermatitis. It is most common during:
- Infancy. Also called cradle cap because of its scaly appearance on the scalp, seborrheic dermatitis can also occur in the diaper area. It usually clears up on its own within the infant’s first year.
- Middle age. At this age, the condition is usually more intermittent and occurs on the central face or scalp. The scalp variant is called dandruff.
- Old age. The condition is usually more intermittent and becomes less common after age 60.
Always consult a licensed health care provider for a diagnosis, but these common dermatitis symptoms will alert you to a problem:
- Atopic Dermatitis: Symptoms may include:
- Dry, scaly skin
- Small bumps that open and weep when scratched
- Redness and swelling of the skin
- A thickening of the skin (with chronic eczema)
- Contact Dermatitis: The most severe reaction is at the contact site. Symptoms may include:
- Mild redness and swelling of the skin
- Blistering of the skin
- Scaling and temporary thickening of skin
- Dermatitis Herpetiformis: Symptoms may include:
- Clusters of itchy, small blisters, mostly on the elbows, lower back, buttocks, knees, and back of the head
- Itching and burning are often severe
The gut may also have the same allergy to gluten. This is known as celiac disease or gluten sensitive enteropathy (GSE). A person can have both GSE and DH together or only one. Some cases of GSE become cancerous. Because of this, if you have celiac disease, it is important to have an evaluation by a licensed health care provider who specializes in the stomach and intestines (a gastroenterologist).
- Generalized Exfoliative Dermatitis: Symptoms may include:
- Extreme redness of the skin
- Crusting lesions
- Thickened skin
- Swollen lymph nodes
- Secondary infections (viral or bacterial)
- Loss of fluids and proteins through the damaged skin that can lead to dehydration and protein deficiencies
- Seborrheic Dermatitis: Symptoms may include:
- Itching scalp
- Dry or greasy scales on the scalp
- A yellow or red scaly rash along the hairline, behind the ears, in the ear canal, on the eyebrows, around the nose, in creases on the arms, legs, or groin, and/or on the chest.
- Atopic Dermatitis: Although there is no cure for eczema, treatment goals are to reduce itching and inflammation of the skin, moisturize the skin and prevent infection. Your licensed health care provider may prescribe topical cortisone cream.
- Contact Dermatitis: The best treatment is to identify and avoid the substances that may have caused the allergic reaction. Here are common treatment recommendations for mild to moderate reactions:
- Thoroughly wash skin with soap and water as soon as possible after the exposure. Wash clothing and all objects that touched plant resins (poison ivy/oak) to prevent re-exposure.
- Use wet, cold compresses to soothe and relieve inflammation if blisters are broken.
- Use barrier creams to block certain substances if there is a chance of re-exposure in the future.
- Topical and oral drugs may be recommended by your licensed health care provider to relieve itching.
If the reaction is significant and the substance that caused it cannot be determined, your licensed health care provider may conduct a series of patch tests to help identify the irritant.
- Dermatitis Herpetiformis: This may be controlled well with treatment based on:
- Your age, overall health and medical history
- Extent of the condition
- Your tolerance for specific medications, procedures and therapies
- Expectation for the course of the condition
- Your opinion or preference
The symptoms of dermatitis herpetiformis may clear when all gluten is eliminated from the diet, although healing may take several weeks to months. Treatment may also include drug therapy.
- Generalized Exfoliative Dermatitis : Severe cases of GED may require hospitalization while the person is treated with antibiotics, intravenous (IV) fluids and nutritional supplements. Treatment will vary depending on the cause:
- If certain drugs are causing the condition, eliminating them usually clears it up.
- If another skin condition causes GED, treating the other skin condition usually clears it up.
- If cancer is causing the condition, treating the cancer usually clears up GED
Other treatments may include:
- Heated blankets (to keep warm)
- Cool baths
- Petroleum jelly applied to skin, followed by gauze
- Systemic corticosteroids (for severe cases)
- Rehydration (putting fluids back into the body)
- Comprehensive wound care to prevent infection
This condition can be life-threatening and, many times, requires hospitalization. The outlook (prognosis) depends on the cause. In the case of drug reactions, the condition usually lasts two to six weeks after the drug is stopped.
- Seborrheic Dermatitis: Although the condition responds to treatment, it may recur. Treatment depends on the inflammation's location and is usually effective in alleviating symptoms. Treatments may include:
- Corticosteroid cream or lotion
- Antifungal topicals
- Medicated shampoo for adults, as prescribed by your licensed health care provider
Visit with a Virtual Care health care provider on the phone or online for help with your symptoms.
Reviewed by: Chris Huerter, M.D., CHI Health Clinic Dermatology