ECZEMA / DERMATITIS

The Providers at Knoxville Institute of Dermatology are experts in the diagnosis and treatment of eczema. Eczema, often referred to as dermatitis or atopic dermatitis, is the name for a group of conditions that cause the skin to become inflamed, red and itchy. Children often develop atopic dermatitis with patches appearing on the scalp, forehead and cheeks. It is important to understand the type of eczema as well as the triggers to formulate the best treatment plan in both children and adults. Contact our office for an evaluation if you or your child are struggling with eczema.

What is dermatitis?

Dermatitis refers to a group of inflammatory conditions. It affects the outer layer of the skin, the epidermis. Dermatitis affects about one in every five people at some time in their lives. It results from a variety of different causes and has various patterns. The terms dermatitis and eczema are often used interchangeably. In some cases the term eczematous dermatitis is used. Dermatitis can be acute or chronic or both.

• Acute eczema (or dermatitis) refers to a rapidly evolving red rash which may be blistered and swollen.
• Chronic eczema (or dermatitis) refers to a longstanding irritable area. It is often darker than the surrounding skin, thickened (lichenified) and much scratched.

An in-between state is known as subacute eczema. Psychological stresses can provoke or aggravate dermatitis, presumably by suppressing normal immune mechanisms.

What types of dermatitis are there?

• Atopic dermatitis is particularly prevalent in children; inherited factors seem important, as there is nearly always a family history of dermatitis or asthma.
• Irritant contact dermatitis is provoked by handling water, detergents, solvents or harsh chemicals, and by friction. Irritants cause more trouble in those who have a tendency to atopic dermatitis.
• Allergic contact dermatitis is due to skin contact with substances that most people don’t react to: most commonly nickel, perfume, rubber, hair dye or preservatives. A dermatologist my identify the responsible agent by patch testing.
• Dry skin: especially on the lower legs, may cause asteatotic dermatitis, also called eczema craquele.
• Nummular dermatitis (also called ‘discoid eczema’) may be set off initially by an injury to the skin: scattered coin-shaped irritable patches persist for a few months.
• Seborrheic dermatitis and dandruff are due to irritation from toxic substances produced by malassezia yeasts that live on the scalp, face and sometimes elsewhere.
• Infective dermatitis seems to be provoked by impetigo (bacterial infection) or fungal infection.
• Stasis dermatitis arises on the lower legs of the elderly, due to swelling and poorly functioning leg veins.

What are treatments for dermatitis?

An important aspect of treatment is to identify and tackle any contributing factors (see above).

• Bathing Bathe using lukewarm water. Replace standard soap with a substitute such as a mild detergent soap-free cleanser: your dermatologist can advise you.
• Clothing Wear soft smooth cool clothes; coarse fibers (wool or synthetic) are best avoided (microfine merino wool may be suitable)
• Irritants Protect your skin from dust, water, solvents, detergents, injury.
• Emollients Apply an emollient liberally and often, particularly after bathing, and when itchy. Ask your doctor or dermatologist to recommend some to try; avoid perfumed products when possible.
• Topical steroids Apply a topical steroid cream or ointment to the itchy patches for a 5 to 15 day course. A suitable one will be prescribed by your doctor or dermatologist. Make sure you understand when and where to apply it, and how often you may repeat the course. Steroids should usually be applied once or twice daily to the red and itchy areas only. Sometimes two or more topical steroids will be supplied, either for different parts of the body, or for differing grades of dermatitis.
• Antibiotics Your doctor may recommend antibiotics if infection is complicating or causing the dermatitis. The infection is most often with Staphylococcus aureus or Streptococcus pyogenes.
• Antihistamines Antihistamine tablets may help reduce the itch, and are particularly useful at night.
• Other treatments Systemic treatments and phototherapy may also be recommended for severe cases.

What is the best long-term control?

Dermatitis is often a long-term problem. When you notice your skin getting dry, moisturize your skin again and carefully avoid the use of soap. If the itchy rash returns, use both the moisturizer and the steroid cream or ointment. If it fails to improve within two weeks, see your doctor for further advice.