Dermatitis means an inflammation of the skin. It is commonly manifested as redness, swelling, itching. It is different from eczema as in all eczemas are types of dermatitis of some sort but all types of dermatitis are not eczemas.
The word derma refers to the skin. Dermatitis is a medical condition relating to inflammation of or rashes on the skin. Depending on the cause, the rashes of dermatitis can range from mild to severe.
Dermatitis is a harmless condition; it is not an infectious disease. Also, it does not indicate how clean your skin is. Early treatment and care can help you treat the symptoms.
Types
There are various types of dermatitis. Here are the common ones:
Irritant contact dermatitis: Caused due to some irritant chemicals for example detergents, soaps, perfumes, etc. ICD is usually seen on the hands first as an inflammation in the skin with scaling. The first step to treating this condition is stopping the usage of agents causing it.
Allergic dermatitis: When the skin infection is due to an allergy or allergic reaction during which the body’s antibodies react with the allergens, it is called allergic dermatitis. The reaction is delayed and does not take place the first time your skin touches something it is allergic to. But your skin becomes sensitive to it and the next time it comes in contact with the allergen, the skin shows a reaction. Usually the immune system is also involved in this kind of dermatitis. It may take years to develop allergy to a particular substance.
Atopic dermatitis: It is commonly seen in young children characterised by dry skin, itching and may even lead to patches of eczema. Approximately 50% of patients develop this condition by the first year of life and additional 30% develop it within 1-5 years. Initially, it was thought that these children would outgrow this eczema by adolescence; however due to changes in our lifestyle, atopic dermatitis is seen in adults as well. Usually, the cheeks and lips are affected first in atopic dermatitis.
Seborrheic dermatitis: It is a more severe form of the common dandruff – greasy, scaly lesions seen over the scalp as well as on the chest and back and other hair bearing areas. It is more prevalent among males but usually occurs in infants within the first three months of life. Mostly affects the oily areas white to yellowish scales with or without reddened skin.
Nummular dermatitis: This results in round, coin-shaped patches on the skin (particularly where the skin is dry) but can be anywhere on the body. The patches are whitish or reddish in colour and may be itchy or crusty. This type usually affects older men but is quite uncommon. It is also not contagious.
Other types:
Id eruption: It is a dermatitis that develops due to the presence of another intense inflammatory reaction somewhere else in the body e.g. fungal infections.
Pompholyx: It is characterised by deep vesicles and in some cases blisters over the hands and feet, intensely itchy lesions.
Lichen Simplex Chronicus (LSC): This is a dermatitis that happens due some long standing skin condition associated with chronic itching. The skin becomes thick. People who have anxiety disorders are prone to it.
Symptoms
Some visible symptoms of dermatitis include:
Redness
Swelling
Itching
Pain
Burning
In severe cases, the patient can also have oozing/blistering/secondary infections.
Causes And Risk Factors
Causes
There are multiple causes of dermatitis including:
Allergies
Genetic factors
Family history
General health conditions
But on a broad basis, we see dermatitis due to some internal skin disorder or external contact irritation or allergic irritation.
Risk Factors
Risk factors for developing dermatitis are:
Atopic dermatitis
Female gender
Genetic factors like a family history of asthma or any other allergic disease.
Contact dermatitis
Work history of employment in factories dealing with chemicals, gardening work etc
Dyshidrotic dermatitis
Long term exposure to water
Excessive sweating
Hot weathers
Prevention
Keeping the skin moisturised at all times is the best way to prevent any sort of dermatitis. Using mild soaps, not letting harsh detergents come in contact with the skin is another way to prevent it. Getting any rash or skin allergy checked at the earliest to prevent the infection or condition from spreading or getting worse is also important. Many forms of dermatitis can be chronic which means that they can only be kept under control with the help of medication once the symptoms start appearing.
DIAGNOSIS
A dermatologist diagnoses dermatitis, based on clinical examinations and symptoms:
Usually, the physician asks how and when your symptoms tend to occur.
When a trigger factor is identified, steps can be taken to avoid the reaction.
You can undergo patch testing for the identification of triggers.
Sometimes, Repeated Open Application Test (ROAT) can also be used to confirm the diagnosis.
TREATMENT
The treatment depends on the type and cause of dermatitis. Keeping the skin moisturised is usually one of the mainstays of any dermatitis treatment. Along with this, antihistamines and steroids may be prescribed. The patient must adhere to the doctor’s medication to keep the condition under control. Follow-up and regular check-ups are equally important to monitor the dose of the medication from time to time. In the case of allergies, the causative factors need to be avoided at all costs. Also, avoid other triggers.
A Dermatologist will usually give one or more of the following to treat Dermatitis:
Moisturisers/emollients to apply after a bath and whenever you experience dryness or itching. This helps to improve the skin texture.
Depending on the severity, you may be prescribed a steroid ointment that is supposed to be applied externally over the affected area. It would be best if you asked your physician how and when to use the ointment.
Anti-inflammatory creams like pimecrolimus & tacrolimus have been effective in treating chronic dermatitis.
Antibiotics may be prescribed for patients who have developed infections in areas affected with dermatitis or infections that may increase the incidence of dermatitis.
Antihistamines to reduce itching and have a peaceful sleep at night.
Drugs like Azathioprine, methotrexate, and systemic steroids may have to be opted for in severe cases.
Lifestyle Management
Lifestyle changes to improve your conditions include :
Taking care of the skin
Apply moisturisers and emollients.
Lukewarm water baths
Heavy creams and deep moisturisers are recommended.
Take small baths for 10-15 mins. Do not be in contact with water for a long duration of time.
Use soap-free cleansers.
Do not rub on your skin while drying it; use patting motions.
Try to use soaps, cleansers that are free of fragrances.
Avoid irritants that affect the skin
Flare-ups usually occur after exposure to irritants like
Soaps
Paint
Chemical
Alcohol containing products
Synthetic fabrics
You must maintain a consistent temperature
Keeping your skin cool and in humid conditions is proven to be effective. Try to wear clothes that cover your skin and avoid sun contact.
Try to avoid hot tubs and steam rooms.
Limiting stress is helpful
Maintain your emotional balance and try to avoid stress. If you are facing difficulties in getting rid of stress, try to follow some of these techniques:
Counselling
Yoga
Meditation
Breathing exercises
Relaxation techniques
Stress management courses
Do not scratch and rub
Avoid the creation of the itch-scratch cycle as it might trigger flare-ups. Scratching makes skin thick and leathery, which affects the healing. Keep skin moisturised.
Prognosis And Complications
Prognosis
The prognosis varies for each type of dermatitis. But most types are usually chronic & hence may lead to lifelong suffering in the absence of proper treatment and care. It usually begins in a person’s infancy and can last through adulthood. Sometimes it can flare up in the teenage years and tend to disappear after a few years. Nothing is certain about dermatitis as it varies from one person to another.
Complications
Since it affects the skin, dermatitis can lead to possible complications such as low self-esteem or embarrassment. It can also cause psychological distress. Constant scratching of skin can at times lead to an open sore which may get secondarily infected or leave scars.
References
Cleveland Clinic. Dermatitis. [Internet] [Updated on October 29, 2020]. Available at: https://my.clevelandclinic.org/health/articles/4089-dermatitis Accessed on March 17, 2021.
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