Dermatitis: all links so far

dermatitis

• Contact dermatitis: a client’s story (upcoming)

• Dermatitises (skin inflammations) explained

• Eczema anyone?

• Rashy breakout around your mouth? A client’s question

• Reactions to products: Is it eczema?

• Scaly, dry skin on your eyelids? It could be eczema

 

Scaly, dry skin on your eyelids? It could be eczema

I have eczema on my eyelids. What strength hydrocortisone cream should I be using? Should I be concerned about using it so close to my eyes?

Hydrocortisone is a topical steroid cream that helps with dermatitises like eczema, which is a skin inflammation. Steroids are anti-inflammatory thus helping to reduce the redness and swelling from dermatitises (and any inflammation).

Prescription steroid creams are always going to be stronger than OTC brands. That’s why they are prescribed by a doctor. In the over the counter variety, you will most likely find 1.0% topical cortisone creams. Prescription products are usually around 2.5%.

You definitely don’t want to get this or any cream in your eyes. And unfortunately, eczema commonly manifests on the upper eyelids and under and around the eyes. So you must use extreme caution if you are going to use a medicated cream around your eyes.

During the day you wouldn’t want to put anything on your eyelids. Due to the fold in the eyelid skin, the chances of the cream migrating into your eye is pretty high. At night you could use the cream or ointment sparingly to help treat the upper eyelid area. If using prescription strength, consult with your doctor to get his or her professional advice. No matter where you purchased the cream, strictly follow the instructions on the cortisone product label.

FYI: both of these photographs show extreme cases of eczema around the eye area. In my practice I see eczema quite often. And many times it is just a small piece of skin that is affected. Sometimes my client isn't even aware she is developing eczema; other times clients are fully aware.

If using a topical cortisone cream on the skin irritation doesn’t seem to be doing the trick, I highly recommend going to see your dermatologist. And while you’re there, have a full-body mole check!

For more information, see:

• Eczema anyone?
• Dermatitises (skin inflammations) explained
• Allergic Reactions to Products & The 72-Hour Test

Reactions to products: Is it eczema?

I’m 23 years old and have very sensitive skin. Any product I use wears out its welcome after three months. About three weeks ago I began waking up with lines on the bridge of my nose. Two weeks ago I noticed lines forming under my eyes, and this week the skin under my eyes looks dry (but isn’t) and is full of lines and wrinkles. It even seems a little loose. What is happening?

My skin was smooth with tiny, barely visible lines three weeks ago; now it’s as if it has aged 10 years overnight! Why would this happen, and will my skin ever go back to the way it was before? Could this be an allergic reaction?

Based on your symptoms, I would say this is a classic allergic reaction. Crepey skin, especially when you find wrinkles overnight, is definitely a symptom of an intolerance to something used, and is probably a dermatitis called eczema. The eyes are so sensitive, and many times an allergic reaction to a new skin care product will occur near the eyes, even if the offending product was used on the entire face.

Depending on the severity of the reaction, you may need to see your dermatologist and get a prescription cream to help calm your skin down. First you could try a topical cortisone cream (found at any drug or grocery store) and see if this helps. You must, however, read the directions and be very careful about how close to your eyes you apply the cream. The doctor will be able to prescribe a higher strength steroid cream if the over the counter type isn’t effective enough.

Look at the ingredients of the offending product and see if you can find anything you know you are allergic to. Sometimes just fragrance in products can cause reactions like the kind mentioned above. Your skin, once calmed down, should resume its natural, normal state. How long this will take varies with the individual. But surely within a week or perhaps a bit longer, you will have your old skin back.

Recently I went to purchase some new products—an experience that turned out to be a living nightmare! First, I got my skin analyzed and was told that I have normal, combination skin. I purchased a papaya exfoliant, clay mask, and a moisturizing mask for dehydrated skin.

After several weeks of exfoliating and masking, to my horror I woke up one day with welts all over my face, redness, burning, and itching. My eyes we re almost swollen shut! I have never reacted like this to anything before. Needless to say, I am mortified that my skin may have been permanently ruined.

My doctor has prescribed methylprednisolone [cortisone] for six days. It has brought the swelling down a bit, but I still have redness and itchiness, not to mention that my skin feels very taut and dry—appearing to have wrinkled up (I didn’t have any wrinkles before this!!!!).

Everything I have tried on my face to alleviate the burning and itching has not worked, except for petroleum jelly, which soothed it considerably. I am worried and don’t know what to do next. I am thinking of going to an allergist.

 

Would you have any advice for me? Is my skin ruined forever? Please respond as soon as possible because I desperately need your expert advice. I am afraid of the cortisone I am taking, but feel I have no choice since my symptoms are severe. I am desperate!

Your reactions sound like a dermatitis, probably eczema: red, itchy skin that feels like it is burning, along with severe dryness and crinkling. A topical cortisone cream will probably relieve the symptoms, but that doesn’t tell you why you had the reaction in the first place. If you are game, you could also take The 72-Hour Test (see below) to help narrow down which product caused the problems. It may have been all of the products, but maybe not.

Of course, you may not be willing to develop those reactions in order to figure out which products you can or cannot use. In that case, an allergist will probably be able to figure it out for you. There may be common allergens contained in one or all of those products that the specialist can tell you about. If you are going to do the 72-Hour Test, I highly recommend you wait until your skin has completely recovered and even wait a few more weeks to be sure you aren’t still in reaction mode.

This client told me that after about a week of severe redness, itching, swelling, and pain her skin did finally calm down. She made an appointment to see an allergist, but wasn’t able to get in to see someone for almost four months.

For more information, see:

• Allergic Reactions to Products & The 72-Hour Test
• Dermatitises (skin inflammations) explained
• Sensitive Skin: Q & A

Eczema anyone?

I have eczema, and my skin is extremely sensitive. I was wondering if I should exfoliate.

By definition, eczema is inflamed and irritated skin. You don’t want to do anything active like exfoliating or masking, but do use either a prescription cream (if you have one) or an over the counter cortisone cream until the irritation has gone away.

Even water can irritate skin that has eczema. As wild as that sounds, it’s true. This just exemplifies how sensitive skin with dermatitis is. So doing less while you have this malady is probably the best course of treatment. Don’t neglect your skin care routine, but try to avoid any areas that are sensitive even to your normal skin care products. Use your topical cortisone cream and wait for it to clear up.

The stress factor has to be taken into consideration when judging the time it should take for eczema to clear up. Eczema, like so many things, is a symptom of a bigger problem; the dry skin is just what you are able to see. The skin truly is a window into your internal health. So pay attention! And have patience.

I always tell my clients to use the cortisone cream for at least three days, even if after a day or two the condition improves or clears up. Kind of like a round of antibiotics (usually ten days), the doctor will tell you to keep taking the pills even if you start to feel better before the ten days are up. This way your body will get a full dose of the drug and get over the bug completely with a lesser chance of it lingering— if you take the full round.

I say the same is true for topical cortisone on eczema. If you keep using it for a few days after your problems have cleared up you will better ensure a full recovery without a recurrence. So use the topical treatment for at least 72 hours and then a few more days after the eczema seems cleared up—just to be sure. If you are using a prescription product, follow your doctor’s instructions.

For more information, see:

• Dermatitises (skin inflammations) explained
• Scaly, dry skin on your eyelids? It could be eczema
• Rashy breakout around your mouth? A client’s question

Dermatitises (skin inflammations) explained

Dermatitis is an umbrella term describing a general condition of inflammation (itis) of the skin (derma). If you think you have a form of dermatitis, go see your dermatologist. He or she will be able to prescribe medication (usually topical) that can help get rid of this often annoying skin condition. Let’s look at the different types of dermatitis.

I first want to say that all of the photos in this post are very bad cases of each individual dermatitis. Many of you will only have shades of what you see below. I put the worst-case scenarios here so you can see what each skin condition looks like. Minor examples simply wouldn’t exemplify these skin irritations like the bad cases do. My hope is that you never have the type of severe cases shown here!

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Allergic contact dermatitis. This dermatitis goes by the names contact dermatitis, allergic dermatitis, and allergic contact dermatitis. No matter which name you prefer, the symptoms are the same.

Allergic contact dermatitis is an inflammation of the skin caused by contact with a particular allergen. It can cause a rash or even blisters, usually confined to a specific area that often has clearly defined borders. These allergens can be anything from ingredients in cosmetics, metals found in jewelry like nickel, and plants such as poison ivy, oak, and sumac. Even some chemicals used in clothing manufacturing or laundry detergent can cause skin inflammation.

Many of my clients have intolerances to nickel in jewelry, sometimes called earlobe dermatitis. This shows up as crusty, scaly skin on the earlobes. Nickel is usually a component of inexpensive jewelry, not solid gold, platinum, or silver. As long as cheap earrings are worn, the dermatitis will persist. Because this irritated skin can be unsightly, once you realize you have an intolerance to nickel, you will choose not to wear the cheaper type of jewelry—out of necessity.

Rubber is another common allergen causing allergic contact dermatitis. Latex, like rubber gloves, and spandex, usually found in elastic wastebands in pants, bra straps, and underwear can cause this type of skin allergy. Exposure to some rubber found in shoes can also cause parts of your feet and toes to have problems.

Ingredients in skin care products can cause allergic reactions in some people. Irritations and reactions are two different things. Allergic contact dermatitis will show up as a rash or a scaly, even crusty patch of skin, whereas an irritation from a product may simply cause an unpleasant sensation.

I have a client who came into my office with a strange red patch of skin near the right side of her mouth. It wasn’t a blemish or anything that resembled problem skin, but it was persistent and bothering my client. After questioning her, I found out she talks on a cell phone—a lot. She said her phone got wet one day and ever since then she has noticed this skin irritation. Bingo! No doubt there was some type of reaction with the wet metal constantly pushing against her skin, and finally she developed allergic contact dermatitis. Even without water being a factor, just constantly pressing a phone against your skin is enough to cause a reaction—if you are susceptible.

Truly, there are numerous offenders that can cause allergic contact dermatitis. The best way to treat it is to keep the offending substance away from the skin. As long as the allergen is present, the skin will continue to react. If you think you are having an allergic reaction to jewelry, clothing, skin care products, or something else, make an appointment to see your dermatologist. Then you will know for sure what you can and cannot wear, use, or be exposed to.

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Backs of a toddler’s legs with eczema.

Eczema. Sometimes called atopic dermatitis, eczema is yet another form of skin inflammation. Eczema comes in many shapes and sizes. Most commonly, I have seen it on the eyelids. Next (and this is where I tend to get eczema) is the cheeks and outer nose area.

It can show up as red, blistering skin, and oozing or weeping can even occur if it is left untreated. Eczema usually looks and feels scaly, can be red or brownish in color, and there tends to be a thickening of the skin where the dermatitis exists. When found around the eye area, the lines and wrinkles there seem to increase overnight. The skin is red and irritated and almost always the affected skin itches.

Technically, the origin of eczema is unknown. Many times skin conditions are thrown into the “unknown cause” category. But the truth is, something is causing the condition, although it may be too difficult to figure out what. The word unknown usually says to me that something other than an allopathic medical explanation is needed.

I try to look from a wholistic viewpoint—looking at the body as a whole, not just the symptoms it is producing. This includes looking at lifestyle and the possible stress it may be causing in your body. Physical symptoms can be caused by many things, including something as intangible as mental stress. Therefore, I believe eczema is stress-induced. In other words, it happens due to stress—whether it be internal body stress or emotional stress from the outside world. (Yes, I spell holistic with a “w” because truly it means the whole body.)

Red, scaly, itchy skin = ezcema.

If the body is unable to produce gamma linolic acid (GLA), sometimes eczema is the result. Taking evening primrose oil, which is rich in GLA, can help to alleviate symptoms of this type of dermatitis. You may want to give this supplement a try and see if it helps you. Evening primrose oil is so good for your body in general, if it helps specifically with eczema, so much the better! You could even open one of the capsules and massage a drop or two onto the affected area for some relief.

Aloe vera gel is another treatment you can try. The soothing nature of the gel can ease your irritated skin as well as help to heal the area. It wouldn’t be my first choice to help with dermatitis, but if it’s all you have at the moment, it will probably help to some degree.

Commonly, topical cortisone creams and ointments are prescribed for eczema. You can also purchase cortisone over the counter (OTC), although the strength will be less than the prescription kind. If cortisone helps, the skin condition could have been eczema; if cortisone doesn’t help, it probably is something other than a dermatitis.

For more information on this common form of dermatitis, read Eczema anyone? (see link below).

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Perioral dermatitis. A client wrote, “I get this red, scaly, bumpy stuff under and around my nostril area.” This is a good description of perioral dermatitis. It is a red, sometimes bumpy rash around the nostrils and sometimes down around the mouth. Peri means around or about, and oral indicates the mouth. So perioral means surrounding the mouth, although this condition pertains to the redness around the nostril area as well.

Applying a topical cortisone cream or ointment to the affected area is going to give you the best results. This type of dermatitis can be very persistent and sometimes hard to completely clear up, and you may want to get a dermatologist’s prescription for the stronger form of cortisone.

I was reading a medical book explaining some different treatments for perioral dermatitis. One of the recommendations, tetracycline (an oral antibiotic), was said to be a good treatment—one of the best. Unfortunately, dermatitis is stress-induced. Therefore, if you continue to be under stress and even if your perioral dermatitis cleared up after taking the antibiotics, more than likely it will return when your body’s immune system is weakened by the stress. Antibiotics, by their very nature, distress and suppress the immune system, so taking tetracycline seems to me like it might keep you moving in a vicious circle.

In this same manual I was reading, perioral dermatitis was listed under Sebaceous Gland Disorders, saying that this type of dermatitis also includes unusual sebaceous activity along with the rashy dermatitis of the outer skin. This makes sense due to the usual location of perioral dermatitis—around the nostril area and sometimes going down to the outer edges of the mouth. The nose has so many active oil glands and the folds of the nostrils can become clogged with oil, so this is an easy place for problems to occur.

As I mentioned, tetracycline or even minocycline (another antibiotic) are prescribed to treat perioral dermatitis. And just like with acne (another condition these oral antibiotics are commonly prescribed for), taking medicine orally does next to nothing to help figure out the actual cause of the problem. And it is by finding the cause that you will find your greatest and most long-term relief.

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Seborrheic dermatitis. This condition is an inflammation of the upper layers of the skin, causing a red, scaly, itchy rash in various locations on the body. The eyebrows, eyelids, scalp, sides of the nose, and even the skin behind the ears are the most common places to find this form of dermatitis. Other areas where the skin folds (under the arms, breasts, and buttocks) may also be affected. This condition may cause not only flakiness but greasy or oily-looking skin. Dandruff (flakiness on the scalp) is actually seborrheic dermatitis.

Weather seems to affect this condition. You may find seborrheic dermatitis worsens in the winter, and improves in the warmer months.

Seborrheic dermatitis is most common in people who have oily skin and oil-prone hair, although it is not limited to these oily types. Sometimes even infants can develop seborrheic dermatitis due to the hormone changes after birth. Babies can also develop what looks like diaper rash, but really may be a case of seborrheic dermatitis.

Treatment consists of a hydrocortisone ointment (as in most cases of dermatitis) as well as a medicated shampoo for cases of seborrheic dermatitis affecting the scalp. As with any and all cases of dermatitis, consulting with your dermatologist is the best course of treatment. He or she will be able to guide you to the best medications and can track the progress of your skin.

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Keep in mind, when it comes to treating dermatitises, what works for one person may be irritating to someone else. Using creams, salves, or oral medications on skin inflammations may bring relief for some, but be prepared that your experience may be different. Please contact your dermatologist if you have a skin condition that doesn’t respond to your home treatment and just won’t go away. Dermatitises are treatable but only if you get treatment!

For more information, see:

• Rashy breakout around your mouth? A client’s question 
• Evening Primrose Oil for PMS and more
• Eczema anyone?

Rashy breakout around your mouth? A client’s question

I have this red, rashy breakout around my mouth, but it’s only on one side. What is causing this?

Believe it or not, I see this quite often. Whenever there is breakout on one side of the face, it’s time to ask yourself a few questions. First, do you talk on the phone a lot? If so, on which side of your face do you hold the phone? And further, do you let the phone rest on your face?

Telephones get dirty quickly. Even if you are the only person using a particular phone (a land line, for instance), oil and debris collect on the receiver, and especially if you rest the phone on your face, this will easily get transferred to your skin. Sometimes the oil will cause breakouts, and sometimes constant handling of the phone can cause contact dermatitis, a skin inflammation that is caused by contact with offending materials. If your “rash” is indeed dermatitis and not a true breakout (congested oil that has become infected), I will be posting an article specifically for help with all types of dermatitises at a later date.

Cell phones are contributors to irritations on the skin. They are almost always resting on your face and therefore can create problems, especially if you talk on a cell telephone throughout the day. I continue to see clients who have this one-sided breakout/irritation from using their cell phones.

• Step one in solving your problem is to keep the phone off your face. This won’t be easy, but without stopping contact, I’m afraid your problem will continue.
• Step 2, clean your phone (repeatedly if necessary). One of my clients was experiencing contact dermatitis caused by her cell phone. I recommended she keep baby wipes handy to clean her phone with. You’ll be amazed at how much junk gets piled up after just one day of using the telephone.
• Step 3, keep your hands off your face. Constantly feeling the breakout with your fingers will just encourage it to stay there.

For the time being, don’t use an abrasive scrub on this area, but do use a clay mask to help encourage any congestion to vacate the premises. Keeping the area clean, which includes keeping the phone off your face, is your best bet for helping the problem go away.

If the phone doesn’t seem to be the culprit, what is your body position when you sleep? Do you lie on your right or left side, on your back, or even face down? I have found some people can get a small amount of breakout if they sleep on their side—especially always one particular side. It is the side that is crushed against the pillow all night long that suffers. Changing how you position your body to sleep may be a huge leap, but if you are sure this is what is causing your breakouts, the true solution is to change your habits.

The only explanation I have come up with for this type of pillowcase breakout is that lying with your face against the pillow all night inhibits elimination. If you have always slept on your side and just now think this is causing some skin problems, perhaps it is simply new laundry soap.

To help with the breakout around your mouth, no matter the cause, use clay mask on the area at night. Be sure to let the clay dry before you get into bed, otherwise the clay will stick to your pillowcase instead of your skin. Do this for several consecutive nights and see if it clears the problem.

I can hear you saying, “But you said to always keep the clay mask moist on my face.” Yes, that is true when you are applying clay to your entire face, you don’t want that much surface area to become dried out. However, when dotting the clay mask on small spots or blemishes then going to bed, you have no choice but to let the clay dry. Because you are only applying the mask on tiny spots, this shouldn’t cause your skin to become excessively dry.

One more note: If you tend to go to bed without removing your makeup, this can always cause problems with congestion and breakout, around your mouth or wherever.

For more information, see:

• Dermatitises (skin inflammations) explained 
• Eczema anyone?
• Help for Breakouts