My Skin, My Health

Dermatitis is a general term that describes a common skin irritation. It has many causes and forms and usually involves itchy, dry skin or a rash. Or it might cause the skin to blister, ooze, crust, or flake off. Three common types of this condition are atopic dermatitis (eczema), seborrheic dermatitis, and contact dermatitis.

Is there a difference between eczema and dermatitis?

Although the terms “dermatitis” and “eczema” may overlap in how they’re used, specific types of skin conditions are better known by just one of the names. For example, many doctors use the terms “atopic dermatitis” and “eczema” interchangeably but wouldn’t use the term “contact dermatitis” in place of “eczema.”

Dermatitis means inflammation of the skin. Eczema is inflamed skin that has other symptoms like itching, a flaky or scaly rash, and dry skin.

Dermatitis isn't contagious, but it can make you feel uncomfortable and self-conscious.

Types

· Atopic dermatitis (eczema)

· Contact dermatitis

· Cradle cap

· Diaper rash

· Seborrheic dermatitis

· Leaking sores of atopic dermatitis

· Atopic dermatitis on the ankles

· Atopic dermatitis on the legs

· Atopic dermatitis behind the knees

· Seborrheic dermatitis on the face

Each type of dermatitis tends to occur in a different part of your body.

Signs and symptoms may include:

· Itchiness (pruritus)

· Dry skin

· Rash on swollen skin that varies in color depending on your skin color

· Blisters, perhaps with oozing and crusting

· Flaking skin (dandruff)

· Thickened skin

· Bumps in hair follicles

Symptoms in children can include;

· a rash in the creases of the elbows, knees, or both

· scaly patches of skin at the site of the rash

· lightened or darkened skin spots

· rashes on the neck and face, especially around the eyes

When to see a doctor

See your doctor if;

· You're so uncomfortable that you're losing sleep or are distracted from your daily routines

· Your skin becomes painful

· You suspect that your skin is infected

· You've tried self-care steps but your signs and symptoms persist

Eczema stages

Eczema can be broken down into three stages:

1. Chronic: This is the most common stage of eczema, and it often develops in children before they’re 12 months old. Chronic eczema generally lasts over a lifetime with occasional flare-ups, although childhood eczema may improve with age.

2. Acute: Short-term eczema may be the result of skin sensitivities after coming into contact with an irritating substance. Acute cases last just a few weeks as your skin heals.

3. Subacute: This is part of the healing phase of eczema, which can still flare back up into a full rash if left untreated.

Causes

A common cause of dermatitis is contact with something that irritates your skin or triggers an allergic reaction for example, poison ivy, perfume, lotion, and jewelry containing nickel. Other causes of dermatitis include dry skin, a viral infection, bacteria, stress, genetic makeup, and a problem with the immune system.

Eczema is also caused by underlying inflammation. The development of this inflammatory skin condition involves substances that create negative immune reactions. These include various allergens as well as hereditary and environmental factors.

While eczema isn’t a contagious disease, it does tend to run in families. You may be especially at risk if a parent or other relative has a history of allergies and related eczema symptoms.

Digestive issues and food sensitivities can also play a role, although their links to eczema aren’t as well established.

Risk factors

Common risk factors for dermatitis include:

· Age: Dermatitis can occur at any age, but atopic dermatitis (eczema) is more common in children than adults, and it usually begins in infancy.

· Allergies and asthma: People who have a personal or family history of eczema, allergies, hay fever, or asthma are more likely to develop atopic dermatitis.

· Occupation: Jobs that put you in contact with certain metals, solvents, or cleaning supplies increase your risk of contact dermatitis. Being a health care worker is linked to hand eczema.

· Health conditions: Health conditions that put you at increased risk of seborrheic dermatitis include congestive heart failure, Parkinson's disease, and HIV/AIDS.

Complications

Scratching the itchy rash associated with dermatitis can cause open sores, which may become infected. These skin infections can spread and may very rarely become life-threatening.

In people with brown and Black skin, dermatitis might cause the affected area to darken or lighten (post-inflammatory hyperpigmentation or hypopigmentation). It might take months or years to return to your usual skin color.

Prevention

While there’s no known cure for eczema, you can help reduce the occurrence of flare-ups through the following preventive measures.

1. Avoid your triggers

The best way you can prevent an eczema flare-up is to avoid your triggers when possible. These include any known allergens, as well as sensitivities to chemicals or fabrics.

2. Avoid dry skin by adopting these habits when bathing

· Take shorter baths and showers.

· Limit your baths and showers to 5 to 10 minutes. Use warm, rather than hot, water.

· Bath oil also may be helpful.

· Use a gentle, unscented nonsoap cleansers.

Some soaps can dry your skin.

3. Dry yourself gently

After bathing, gently pat your skin dry with a soft towel.

4. Moisturize your skin

While your skin is still damp, seal in moisture with an oil, cream, or lotion.

5. Protect your skin

Protecting your skin’s barrier with a moisturizing lotion is important, especially after bathing. Use a lotion that’s free of preservatives and fragrances.

Another way you can protect your skin is by avoiding the temptation to scratch any eczema rashes that do develop. This can help prevent cracks and cuts, which can lead to a risk of infection.

6. Control the heat and humidity

While eczema itself can sometimes be dry, this skin condition is typically worsened by heat and humidity. Consider keeping your home a bit drier and cooler as a way of managing and preventing flare-ups.

Some people, however, experience flare-ups during the dry winter months. If this is you, using a humidifier can help ease your eczema symptoms.

Body heat can also play a role. Wearing breathable fabrics such as cotton can help heat escape from your body. Taking cool showers after workouts may also help.

7. Stress and hormones can also cause flare-ups or make them worse.

8. Wear protective clothing if you are doing a task that involves irritants or caustic chemicals.

9. If you have open wounds, be sure to protect your skin with bandages.

Diagnosis

To diagnose dermatitis, your doctor will likely talk with you about your symptoms and examine your skin. You may need to have a small piece of skin removed (biopsied) for study in a lab, which helps rule out other conditions.

Patch testing

Your doctor may recommend patch testing on your skin. In this test, small amounts of different substances are applied to your skin and then covered. The doctor looks at your skin during visits over the next few days to look for signs of a reaction. Patch testing can help diagnose specific types of allergies causing your dermatitis.

Treatment

Eczema treatment has four main goals:

Control the itch.
Heal the skin.
Prevent flares.
Prevent infections.

The treatment for dermatitis varies, depending on the cause and your symptoms. In addition to the lifestyle and home remedies recommendations below, dermatitis treatment might include one or more of the following:

· Applying to the affected skin certain creams or ointments that affect your immune system (calcineurin inhibitors)

· Exposing the affected area to controlled amounts of natural or artificial light (phototherapy)

· Using oral corticosteroids (pills) for severe disease

· Using wet dressings, a medical treatment for severe atopic dermatitis that involves applying a corticosteroid and wrapping it with wet bandages.

· Depending on the cause of your eczema flare-up, you may need to take oral allergy medications, topical corticosteroid creams, or both.

· While steroid creams you apply to your skin are intended for short-term use, you may need to use allergy medicines you take by mouth year-round to help prevent associated symptoms.

· Another option is immunosuppressant drugs, which slow down immune responses in the case of severe eczema.

· Antihistamines

Over-the-counter (OTC) antihistamines may help reduce the incidence of eczema. Pain relievers like Tylenol or ibuprofen can help you manage your discomfort and inflammation.

Some oral antihistamines that may be used to treat AD include cetirizine, chlorpheniramine, diphenhydramine, doxylamine, fexofenadine, loratadine

Additionally, these medications may help prevent the urge to scratch rashes, especially in children.

· Allergy shots

For severe allergies that don’t respond well to medications, a doctor may recommend allergen immunotherapy, or “allergy shots.” These shots are composed of small amounts of the substances to which you’re allergic.

Your doctor will increase your dosage slowly over the course of several months. The idea here is to help build immunity to your allergen triggers so that you experience fewer flare-ups overall.

Lifestyle and home remedies

These self-care habits can help you manage dermatitis and feel better;

· Moisturize your skin. Routinely applying a moisturizer can help your skin.

· Use anti-inflammation and anti-itch products. Hydrocortisone cream might temporarily relieve your symptoms. Oral antihistamines, such as diphenhydramine, may help reduce itching. These types of products are available without a prescription.

· Apply a cool wet cloth. This helps soothe your skin.

· Take a comfortably warm bath. Sprinkle your bath water with baking soda or a finely ground oatmeal that's made for the bathtub (colloidal oatmeal). Soak for 5 to 10 minutes, pat dry, and apply unscented moisturizer while your skin is still damp. A lotion of 12% ammonium lactate or 10% alpha-hydroxy acid helps with flaky, dry skin.

· Use medicated shampoos. For dandruff, use OTC shampoos containing selenium sulfide, zinc pyrithione, coal tar, or ketoconazole.

· Take a dilute bleach bath. This may help people with severe atopic dermatitis by decreasing the bacteria on the skin. For a dilute bleach bath, add 1/2 cup (about 118 milliliters) of household bleach, not concentrated bleach, to a 40-gallon (about 151-liter) bathtub filled with warm water. Measures are for a U.S. standard-sized tub filled to the overflow drainage holes. Soak for 5 to 10 minutes and rinse off before patting dry. Do this 2 to 3 times a week.

· Many people have had success using a dilute vinegar bath rather than a bleach bath. Add 1 cup (about 236 milliliters) of vinegar to a bathtub filled with warm water.

· Avoid rubbing and scratching. Cover the itchy area with a dressing if you can't keep from scratching it. Trim your nails and wear gloves at night.

· Choose mild laundry detergent. Because your clothes, sheets, and towels touch your skin, choose mild, unscented laundry products.

· Avoid known irritants or allergens. Try to identify and remove allergens and other factors in your environment that irritate your skin. Avoid rough and scratchy clothing.

· Manage your stress. Emotional stressors can cause some types of dermatitis to flare. Consider trying stress management techniques such as relaxation or biofeedback.

· Oatmeal baths are one type of natural treatment that can soothe the itchiness and discomfort of eczema rashes. Be sure to use lukewarm water and follow up with a moisturizer immediately after.

· There’s some evidence that both probiotics and prebiotics may stabilize your microbiome to help treat inflammation. However, more research is needed to support this approach in eczema treatment.

Alternative medicine

Many alternative therapies, including those listed below, have helped some people manage their dermatitis. But the evidence for their effectiveness is mixed. And sometimes herbal and traditional remedies cause irritation or an allergic reaction.

· Dietary supplements, such as vitamin D and probiotics, for atopic dermatitis

· Rice bran broth (applied to the skin), for atopic dermatitis

· 5% tea tree oil shampoo, for dandruff

· Aloe, for seborrheic dermatitis

· Chinese herbal therapy

If you're considering dietary supplements or other alternative therapies, talk with your doctor about their pros and cons.

Eczema elimination diet and foods to eat

Foods to eat

For people with eczema, eating certain foods can trigger the body to release immune system compounds that cause inflammation, which, in turn, contributes to an eczema flare-up. An anti-eczema diet is similar to an anti-inflammatory diet.

Examples of anti-inflammatory foods include:

· Fish, a natural source of omega-3 fatty acids that can fight inflammation in the body. Examples of fish high in omega-3s include salmon, albacore tuna, mackerel, sardines, and herring.

· Foods high in probiotics, which are bacteria that promote good gut health. Examples include yogurt with live and active cultures, miso soup, and tempeh. Other fermented foods and drinks, such as kefir, kombucha, and sauerkraut, also contain probiotics.

· Foods high in inflammation-fighting flavonoids. Examples of these include colorful fruits and vegetables, such as apples, broccoli, cherries, spinach, and kale.

Eating more of these foods and cutting down on any trigger foods could help to reduce eczema flare-ups.

Elimination diet or foods to avoid

Food-sensitive eczema reactions will typically occur about 6 to 24 hours after a person eats a particular food. Sometimes, these reactions may be delayed even longer.

To determine what foods may be causing the reaction, a doctor will often recommend an elimination diet. This diet involves avoiding some of the most common foods known to cause eczema.

Before eliminating any foods, a person will need to slowly add each food type into their diet and monitor their eczema for 4 to 6 weeks to determine if they are sensitive to any particular food.

If a person’s symptoms get worse after adding a particular food to the diet, they may wish to consider avoiding it in the future. If a person’s symptoms do not improve when eliminating a food, they probably do not need to remove it from their diet.

Some common foods that may trigger an eczema flare-up and could be removed from a diet include;

· citrus fruits

· dairy

· eggs

· gluten or wheat

· soy

· spices, such as vanilla, cloves, and cinnamon

· tomatoes

· some types of nuts

People with dyshidrotic eczema, which typically affects the hands and feet, may experience benefits from eating foods that do not contain nickel. Nickel is found in trace amounts in the soil and can, therefore, be present in foods.

Foods that are high in nickel include;

· beans

· black tea

· canned meats

· chocolate

· lentils

· nuts

· peas

· seeds

· shellfish

· soybeans

Some people with eczema also have oral allergy syndrome or sensitivity to birch pollen. This means they may have reactions to other foods, including green apples, carrots, celery, hazelnuts, pears

People with eczema are more prone to oral allergy syndrome and should speak to their doctor if they have a pollen allergy or experience mild allergic reactions to the above foods.

Making these changes and monitoring the results can help a person determine whether changing their diet can help them better manage their condition.

If a person does eliminate a large food group, such as wheat-containing products, they may wish to talk to their doctor about supplements to ensure they are not missing out on any essential vitamins and minerals.

Eczema and Exercise

The challenge of enjoying exercise without making your eczema worse can be a delicate balancing act. How do you avoid overheating, irritation and flare-ups when you’re just trying to work up a sweat?

The regulation of body temperature is important for people with eczema. For many of us, being subjected to quick changes in temperature such as through exercise can bring about the dreaded skin flare and itch.

Sweat and eczema: controlling that itch

Taking part in exercise whether it’s a walk on a Saturday morning, a dance class, or an evening bicycle ride home from work gives the body a workout, and we all sweat to moderate our temperature. As sweat evaporates, it cools the surface of the skin.

Perspiration is largely made up of water together with urea, lactate, and minerals such as sodium. For people with eczema, exercise can dry out the skin through the loss of fluids, and the sodium in sweat can further dehydrate the skin as well as sting and irritate it.

For many people with eczema, exercise can trigger frenzied scratching as the skin surface temperature soars. But it doesn’t have to be this way. Being prepared can counteract many problems early.

Tips for exercising with eczema

· Drink plenty of water before, during, and after exercise

No one needs to glug gallons of water before setting off, but drinking fluids regularly will replace the water lost when sweating. Anyone with eczema has inherently dry skin and is susceptible to weaker skin barrier function. Therefore, drinking water (especially around exercise) to keep the body and skin hydrated is recommended.

· Carefully consider your clothing options

It’s important to choose the right clothing to minimize skin irritation as the body heats up. Synthetic moisture “wicking” clothing options draw sweat into the garments, but they may feel rough and irritate eczema. Loose-fitting 100 percent cotton clothing might buck the trend for body-hugging sports clothing, but they are likely to more comfortable. Mind the edges, too. Synthetics like polyester and Spandex around the waistline, neckline, or cuffs are best avoided. Ultimately, of course, it comes down to personal choice. Look for light, breathable fabrics that don’t rub or scratch the skin during exercise.

· Respond to your eczema during exercise

Taking regular breaks during exercise isn’t cheating; it’s an opportunity to rest, rehydrate and cool down if you’re sensing the start of a flare with your eczema. Being realistic about the state of your eczema when you want to exercise means choosing a level of intensity to match.

· Keep cool

Given the potential to overheat, bear in mind both surroundings and other ways to slow the temperature rise. Keep a towel nearby to wipe off sweat during exercise and exercise in indoor facilities that are well ventilated.

· Moisturize before and after exercise

In much the same way that taking on water counteracts water loss while exercising, applying emollients will protect your skin in advance of and following exercise. A heavier ointment might feel hot and counterproductive and trap in sweat, so cream or lighter application of ointment an hour before exercise allows time for it to have absorbed fully.

· Just say no to hot showers and baths

There is nothing quite as satisfying as a hot bath or shower after exercise to relax the muscles — except, of course if you have eczema. Washing off sweat rather than letting it dry on the skin is a good idea, but resist the temptation to sizzle under the shower after a workout. Start with a warm shower and gradually make it cooler over minutes and in stages.

Gyms, health clubs, and fitness centers might supply their shower gels and products but use your products instead. It’s not worth risking a reaction for the sake of convenience. You can always decant your products into a travel-size container or get smaller quantities from your physician.

DOs and DON’Ts in Managing Eczema

· avoid triggers of the rash, including stress.

· moisturize your skin daily, even when you have no symptoms. Use an odor-free oil-based cream or ointment (not lotion), best applied just after bathing while the skin is still damp. Use hypoallergenic products when possible. For severe itching, also use a very mild over-the-counter steroid cream (1% hydrocortisone). Bathe with warm, not hot, water and mild soap.

· take all pills prescribed by your health care provider. Don’t stop taking the medicines unless your health care provider approves.

· avoid foods that cause your eczema to worsen.

· exercise daily, but avoid excessive sunlight exposure and skin damage with a sunblock (SPF 15 or greater).

· wash clothing and linens in fragrance-free soap; double rinse when possible.

· call your health care provider if you have signs of infection (worsening redness, pus); wheezing or trouble breathing; or a severe stomachache or bone pain when taking steroid pills.

DON’T

· let your skin or home become too dry. A home humidifier may help.

· forget your daily skin regimen even if you feel well. Plan ahead for trips by saving some of your usual products.

· drive, cook, or operate machinery while using antihistamines if they make you sleepy.

Frequently asked questions (FAQs)

· Does eczema go away?

There’s no known cure for eczema, and the rashes won’t simply go away if left untreated. For most people, eczema is a chronic condition that requires careful avoidance of triggers to help prevent flare-ups.

Age is also thought to play a role, about 60 percent of people who have eczema develop it as infants. If you develop eczema as a child, then you may experience improved symptoms as you get older.

· How long do eczema flare-ups last?

The healing time from eczema ultimately depends on the underlying cause.

If you have a flare-up from a contact eczema trigger, the rash will likely go away within a few weeks upon treatment. (A contact eczema trigger is a substance that brings on a flare when it comes in contact with your skin.)

Allergic triggers may result in longer-lasting flares.

Takeaway

For most people, eczema is a lifelong condition that consists of occasional flare-ups.

Once treated, it can take several weeks for rashes to clear up. Since these rashes develop from negative immune reactions, there’s also a risk that more flare-ups will occur unless you reduce your exposure to triggers.

While eczema can sometimes develop during adulthood, the onset is more common in children. There’s also a good chance that childhood eczema improves with age.