Dermatitis

Dermatitis is a long-term (chronic) skin disorder that involves scaly and itchy rashes.

Causes, incidence, and risk factors

Atopic dermatitis is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term swelling and redness (inflammation) of the skin. People with atopic dermititis may lack certain proteins in the skin, which leads to greater sensitivity.

 People with atopic dermatitis often have asthma or seasonal allergies. There is often a family history of allergic conditions such as asthma, hay fever, or eczema. People with atopic dermatitis often test positive to allergy skin tests.  However, atopic dermatitis is not caused by allergies. The condition tends to get worse when the person is exposed to certain triggers.

 The following can make atopic dermatitis symptoms worse:

• Allergies to pollen, mold, dust mites, or animals
• Cold and dry air in the winter
• Colds or the flu
• Contact with irritants and chemicals
• Contact with rough materials, such as wool
• Dry skin
• Emotions and stress
• Exposure to too much water, such as taking too many baths or showers and swimming too often
• Feeling too hot or too cold, as well as sudden temperature changes
• Fragrances or dyes added to skin lotions or soaps

Symptoms

Typical skin changes may include:

• Blisters with oozing and crusting
• Dry skin all over the body or areas of bumpy skin on the back of the arms and front of the thighs
• Ear discharge or bleeding
• Raw areas of the skin from scratching
• Skin coloring changes — more or less color than the normal skin tone (See: Skin abnormally dark or light)
• Skin redness or inflammation around the blisters
• Thickened or leather-like areas, called lichenification, which can occur after long-term irritation and scratching

Both the type of rash and where the rash appears can depend on the age of the patient:

• In children younger than age 2, skin lesions begin on the face, scalp, hands, and feet. They are often crusting, bubbling, or oozing rashes that itch.
• In older children and adults, the rash is more commonly seen on the inside of the knees and elbows, as well as the neck, hands, and feet. 
• During a severe outbreak, rashes may occur anywhere on the body.

 Itching, which is sometimes intense, almost always occurs. Itching may start even before the rash appears. Atopic dermatitis is often called the “itch that rashes” because the itching starts, and then the skin rash appears from the scratching.

Signs and tests

A physical exam will be  done. A skin biopsy can be  done to confirm the diagnosis or rule out other causes of dry, itchy skin.

Diagnosis is based on the:

• Appearance of the skin
• Personal and family history

Allergy skin testing may be  helpful for people with:

• Hard-to-treat atopic dermatitis
• Other allergy symptoms
• Skin rashes that form only on certain areas of the body after exposure to a specific chemical

Skin Care At Home

Taking care of your skin at home may reduce the need for medications. Avoid scratching the rash or skin:

• Relieve the itch by using a moisturizer, topical steroid cream, or other prescribed cream and taking antihistamines to reduce severe itching.
• Keep your child’s fingernails cut short. Consider light gloves if nighttime scratching is a problem.

Keep the skin moist (called lubricating or moisturizing the skin). Use  ointments (such as petroleum jelly), creams, or lotions 2 – 3 times a day. Moisturizers should be  free of alcohol, scents, dyes, fragrances, or other chemicals. A humidifier in the home will also help.

Avoid anything that makes your symptoms worse. This may include:

• Irritants such as wool and lanolin
• Strong soaps or detergents, as well as chemicals and solvents
• Sudden changes in body temperature and stress, which may cause sweating and worsen the condition
• Triggers that cause allergy symptoms

 When washing or bathing:

• Keep water contact as brief as possible and use gentle body washes and cleansers instead of regular soaps. Short, cooler baths are better then long, hot baths.
• Do  not scrub or dry the skin too hard or for too long.
• After bathing, it is important to apply lubricating creams, lotions, or ointment on the skin while it is damp. This will help trap moisture in the skin.
  

Medications

Antihistamines taken by mouth may help with itching or if you have allergies. Often you can buy them without a prescription.

• Some antihistamines can cause sleepiness, but they may help with scratching while sleeping.
• Newer antihistamines cause little or no sleepiness. Some are available over the counter.
• Most causes of atopic dermatitis are treated with medications that are placed directly on the skin or scalp (called topical medicines):
• At first, a mild cortisone (or steroid) cream or ointment is usually prescribed. If this doesn’t work, you may need a stronger steroid medicine.
• Medicines called topical immunomodulators (TIMs) may be  prescribed for anyone over 2 years old.
• Creams or ointments that contain coal tar or anthralin may be  used for thickened areas.
• Barrier repair creams containing ceramides

Other treatments that may be  used include:

• Antibiotic creams or pills if the skin is infected
• Drugs that suppress the immune system, such as cyclosporine, methotrexate, or mycophenolate mofetil

Expectations (prognosis)

Atopic dermatitis is a long-term condition, but you can control it with treatment, by avoiding irritants, and by keeping the skin well-moisturized.

In children, the condition often clears beginning at around age 5 – 6, but flare-ups will often occur. In adults, it is generally a long-term or returning condition.