Dermatitis and Rashes

Dermatitis, commonly referred to as eczema, refers to a range of conditions that inflame the skin. Many types of dermatitis require care from a licensed healthcare provider.

Common Types of Dermatitis (Eczema)

1. Atopic Dermatitis

Atopic dermatitis is a hereditary, chronic skin disease that often begins in infancy or in very young children and can persist into adolescence or adulthood. Often, these patients also suffer from asthma or hay fever.

2. Contact Dermatitis

Contact dermatitis is a physiological reaction that occurs after the skin has come into contact with certain substances. Most of these reactions are caused by skin irritation. The remaining cases are caused by allergens that cause an allergic reaction. An allergic reaction may not begin until several days after exposure. Adults are most commonly affected by allergic contact eczema, but can affect any age group.

3. Dermatitis Herpetiformis (DH)

Dermatitis herpetiformis (DH) is a rare, highly itchy chronic autoimmune skin disease that causes small blisters and bumps. It is caused by a reaction to gluten in food. Dermatitis herpetiformis typically occurs in people in their 40s and 50s, although it can occur at any age. It affects more men than women and is a lifelong condition.

4. Generalized Exfoliative Dermatitis (GED)

Generalized exfoliative dermatitis (GED) is a severe inflammation of the entire skin surface due to a reaction to certain medications, a pre-existing skin disease and sometimes cancer. In about 25 percent of people there is no apparent cause. 

GED is characterized by redness and scaling of the skin which begins in patches and spreads. The skin begins to abrade, leading to problems with temperature regulation, protein and fluid loss, and an increased metabolic rate.

5. Seborrheic Dermatitis

Seborrheic dermatitis is an inflammation of the upper layers of the skin characterized by red, itchy skin that sheds scales. Seborrheic dermatitis can be a hereditary disease and is often aggravated by hormonal changes and cold weather conditions. Persons with oily skin or hair also have a higher risk of seborrheic dermatitis. 

It is most common during infancy, middle age, and old age. In infancy, seborrheic dermatitis is 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. In middle age, seborrheic dermatitis is usually more intermittent and occurs on the central face or scalp (the scalp variant is called dandruff). In old age, seborrheic dermatitis is usually more intermittent. It becomes less common after age 60.

Symptoms

Always consult a licensed health care provider for a diagnosis, but these common dermatitis symptoms will alert you to a problem:

1. Atopic Dermatitis

Symptoms can include: 

• Dry, scaly skin, small bumps that open and cry when scratched
• Redness and swelling of the skin
• A thickening of the skin (with chronic eczema)

2. Contact Eczema

The most severe reaction occurs at the point of contact. Symptoms may include:

• Slight redness and swelling of the skin
• Skin blistering
• Itching
• Scaling and temporary thickening of the skin

3. Dermatitis Herpetiformis (DH)

Symptoms may include:

• Clusters of itchy, small blisters, especially on the elbows, lower back, buttocks, knees and back of the head
• Itching and burning are often severe

The intestine may also have the same allergy to gluten. This is known as celiac disease or gluten-sensitive enteropathy (GSE). A person may have both GSE and DH together, or they may have only one of these conditions. Some cases of GSE become carcinogenic. Therefore, if you have celiac disease, it is important to get assessed by a licensed healthcare provider who specializes in gastroenterology.

4. Generalized Exfoliative Dermatitis

Symptoms can include:

• Extreme redness of the skin
• Scaling
• Crusting lesions
• Thickened skin
• Itching
• Swollen lymph nodes
• Fever
• Malaise
• Secondary infections (viral or bacterial)
• Loss of fluids and proteins through the damaged skin that can lead to dehydration and protein deficiencies

5. 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.

Treatment

1. Atopic Dermatitis

Although there is no cure for eczema, the aim of the treatment is to reduce itching and skin inflammation, hydrate the skin and prevent infection.

2. Contact Eczema 

The best treatment is to identify and avoid the substances that may have caused the allergic reaction. Common treatment recommendations for mild to moderate reactions: 

• Wash the skin thoroughly with soap and water as soon as possible after exposure. 
• Wash clothes and all objects that have touched plant resins with ivy / oak to prevent re-exposure. 
• Use damp, cold compresses to soothe and relieve inflammation in the event of ruptured bladders. 
• Use barrier creams to block certain substances if there is a possibility of future re-exposure. 
• Topical and oral medications may be recommended by your licensed doctor to relieve itching.

If the reaction is significant and the substance that caused it cannot be determined, your licensed healthcare provider may perform a series of patch tests to identify the irritant.

3. Dermatitis Herpetiformis

This can be controlled with treatment based on the following factors: 

• 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 herpetiform dermatitis can be cleared up if all gluten is removed from the diet, although healing can take several weeks to months.

4. Generalized exfoliative dermatitis 

Severe cases of GED may require hospitalization while the person is being treated with antibiotics, IV intravenous fluids and dietary supplements. Treatment varies depending on the cause such as:

• If certain medications cause the disease, their elimination usually clears it up.
• If another skin disease causes GED, treatment for the other skin disease 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
• Kerosene jelly applied to the skin, followed by gauze
• Systemic corticosteroids for severe cases
• Rehydration brings fluid back into the body
• Comprehensive wound care to prevent infections

This condition can be life-threatening and often requires hospitalization. The prognosis depends on the cause. In the case of drug reactions, the condition usually lasts two to six weeks after the drug is discontinued.

5. Seborrheic Dermatitis

Although the disease responds to treatment, it may recur. Treatment depends on the site of inflammation and is usually effective in relieving symptoms. 

Treatments may include: 

• Corticosteroid cream or lotion
• Antifungal topicals
• Medicated shampoo for adults, as prescribed by your licensed health care provider