Monday, July 27, 2015

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!

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.

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).

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.

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.

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: