Beauty & Plastic Surgery Dermatitis

Dermatitis is a general term that
describes an inflammation of the skin. There are different types of
dermatitis, including seborrheic dermatitis and atopic dermatitis
(eczema). Although the disorder can have many causes and occur in many
forms, it usually involves swollen, reddened and itchy skin.

Dermatitis is a common condition that usually isn't life-threatening or
contagious. But, it can make you feel uncomfortable and self-conscious. A
combination of self-care steps and medications can help you treat
dermatitis.

Symptoms

There are several types of dermatitis, including:

* Contact dermatitis, a rash that results from either repeated
contact with irritants or contact with allergy-producing substances,
such as poison ivy
* Neurodermatitis, a chronic itchy skin condition localized to certain areas of the skin
* Seborrheic dermatitis, a common scalp and facial condition that often causes dandruff
* Stasis dermatitis, a skin condition that's caused by a buildup of fluid under the skin of the legs
* Atopic dermatitis, more commonly known as just eczema or atopic eczema, a chronic itchy rash that tends to come and go
* Perioral dermatitis, a bumpy rash around the mouth

Each has distinct signs and symptoms. Common signs and symptoms include:

* Redness
* Swelling
* Itching
* Skin lesions

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 your skin is infected
* You've tried self-care steps without success

Causes

A number of health conditions, allergies, genetic factors, physical and mental stressors, and irritants can cause dermatitis.

Contact dermatitis
This condition results from direct contact with one of many irritants or allergens.

Common irritants include:

* Laundry soap
* Skin soaps or detergents
* Cleaning products

Possible allergens include:

* Rubber
* Metals, such as nickel; jewelry
* Perfume and fragrances
* Cosmetics
* Weeds, such as poison ivy
* Neomycin, a common ingredient in topical antibiotic creams

It takes a greater amount of contact with an irritant over a longer time
to cause dermatitis than it takes for an allergen. Once you're
sensitized to an allergen, just brief exposure to a small amount of it
can cause dermatitis. Once you develop sensitivity to an allergen, you
typically have it for life.

Neurodermatitis
This type of dermatitis typically develops when something has created an
itchy sensation in a specific area of your skin. This irritation may
lead you to rub or scratch your skin repeatedly in that area. Common
locations include ankles, wrist, outer forearm or arm, and the back of
your neck.

Possible causes include:

* Dry skin
* Chronic irritation
* Eczema
* Psoriasis

Seborrheic dermatitis
This condition causes a red rash with yellowish and somewhat "oily"
scales, usually on the scalp. It's common in people with oily skin or
hair, and it may come and go depending on the season of the year. It's
likely that hereditary factors play a role in this condition.

Possible causes include:

* Physical stress
* Travel
* Neurological conditions, such as Parkinson's disease

In infants, this disorder is known as cradle cap.

Stasis dermatitis
Stasis dermatitis can occur when fluid accumulates in the tissues just
beneath the skin — typically on your lower legs — due to a sluggish
return of blood from the leg veins back to the heart. The extra fluid
interferes with your blood's ability to nourish your skin and places
extra pressure against your skin from underneath.

Possible causes include:

* Varicose veins
* Other chronic conditions or recurrent infections that affect circulation in your legs

Atopic dermatitis
This condition often occurs with allergies and frequently runs in
families in which members have asthma or hay fever. It usually begins in
infancy and may vary in severity during childhood and adolescence. It
tends to become less of a problem in adulthood, unless you're exposed to
allergens or irritants in the workplace.

Possible causes include a combination of:

* Dry, irritable skin
* A malfunction in the body's immune system
* A genetic tendency for allergic conditions such as asthma or hay fever

Stress can exacerbate atopic dermatitis, but it doesn't cause it.

Perioral dermatitis
This type of dermatitis may be a form of the skin disorder rosacea,
adult acne or seborrheic dermatitis, involving the skin around the mouth
or nose.

Possible causes include:

* Makeup
* Moisturizers
* Topical corticosteroids
* Dental products containing fluoride

Complications

* Impetigo. The open sores and fissures that can occur with
dermatitis may become infected. A mild form of infection is impetigo,
usually due to staphylococci bacteria. Having atopic dermatitis
predisposes you to this infection.
* Cellulitis. If you notice red streaks on your skin, you may have
cellulitis, a bacterial infection of tissues under the skin. Cellulitis
appears as intensely inflamed skin that's swollen, red, tender and warm
to the touch, with spreading, indistinct margins. Cellulitis that occurs
in someone whose immune system is compromised is potentially
life-threatening. See your doctor as soon as possible if you think you
have cellulitis.

Scarring and changes in skin color are other potential complications from dermatitis.

Preparing for your appointment

If you have signs and symptoms of dermatitis, make an appointment with
your doctor. He or she may refer you to a doctor who specializes in the
diagnosis and treatment of skin conditions (dermatologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

Information to gather in advance

* List the signs and symptoms you've been experiencing, and for how
long. Also list any irritants or triggers that seem to cause your
symptoms.
* Write down your key medical information, including other
conditions for which you've been treated and any prescription or
over-the-counter medications you're taking, including vitamins and
supplements. Also note whether you or anyone in your family has a
history of allergies or asthma.
* List possible sources of skin irritation, such as dust and
chemicals used on your job or as part of hobby work. Also note the types
of soaps, shampoos, cosmetics and detergents you use.
* Write down questions to ask your doctor. Creating your list of
questions in advance can help you make the most of your time with your
doctor.

Below are some basic questions to ask your doctor about dermatitis. If
any additional questions occur to you during your visit, don't hesitate
to ask.

* What is the most likely cause of my signs and symptoms?
* Are there any other possible causes?
* What tests are needed to make a diagnosis?
* What treatment options are available for this condition?
* What are the most common triggers for my type of dermatitis?
* What self-care steps are likely to improve my symptoms?
* What products or ingredients should I avoid?
* Do you have any written materials about this condition that I can bring home? Can you recommend any Web sites?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to talk
about in-depth. Your doctor may ask:

* When did you first develop these signs and symptoms?
* Does anything in particular seem to trigger your symptoms?
* Do your symptoms come and go, or are they fairly constant?
* How often do you shower or bathe?
* What products do you use on your skin, including soaps, lotions and cosmetics?
* What household cleaning products do you use?
* Are you exposed to any possible irritants from your job or hobbies?
* How much do your symptoms affect your quality of life, including your ability to sleep?
* What treatments have you tried so far? Have any treatments helped?
* Have you been diagnosed with any other medical conditions, including skin conditions?
* What medications are you currently taking, including those you
take by mouth as well as creams or ointments that you apply to your skin
(topical treatments)?
* Do you have a family history of allergies or asthma?

What you can do in the meantime
In the time leading up to your appointment, try to resist the urge to
scratch itchy areas on your skin. Breaking the itch-scratch cycle is a
key part of healing dermatitis. You may find some relief from
over-the-counter creams that contain at least 1 percent hydrocortisone.

In addition, nonprescription oral antihistamines, such as
diphenhydramine (Benadryl, others), may reduce itching. Antihistamines
can cause significant drowsiness, so be sure to read the label and use a
nondrowsy formula during the day.

Avoid products that seem to trigger your rash. Wearing nonlatex gloves
while washing dishes, shampooing your hair or handling other products
that irritate your skin may help. In addition, try to shower or bathe
only once every day or two, using warm water and mild soaps.

Tests and diagnosis

Your doctor may diagnose dermatitis after talking to you about your signs and symptoms and examining your skin.

Patch testing
In the case of contact dermatitis, your doctor may conduct patch testing
on your skin to see which substances inflame your skin. In this test,
your doctor applies small amounts of various substances to your skin
under an adhesive covering. During return visits over the next several
days, your doctor examines your skin to see if you've had a reaction to
any of the substances. This type of testing is most useful for
determining if you have specific contact allergies.

Treatments and drugs

Dermatitis treatment varies, depending on the cause. Corticosteroid
creams, wet compresses and avoiding irritants are the cornerstones of
most dermatitis treatment plans. To minimize side effects, such as thin
skin, and to increase effectiveness, topical corticosteroids are
generally used only short-term until rashes are under control.

For some types of dermatitis, nonsteroidal medications may help relieve
signs and symptoms. And for all types of dermatitis, occasional use of
over-the-counter antihistamines can reduce itching.

Contact dermatitis
Treatment consists primarily of identifying the cause of the rash and then avoiding it.

Treatment options include:

* Creams containing hydrocortisone
* Other, stronger steroidal creams
* Wet dressings applied over steroid creams

Neurodermatitis
Getting you to stop scratching and to avoid further aggravating your skin are the treatment objectives.

Treatment options include:

* Covering the affected area to prevent you from scratching it
* Hydrocortisone and similar lotions and creams
* Wet compresses
* In some cases, antidepressants or anti-anxiety medications

In addition, counseling can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching.

Seborrheic dermatitis
Medicated shampoos are usually the first treatment choice.

Treatment options include:

* Shampoos that contain tar, pyrithione zinc, salicylic acid or ketoconazole as the active ingredient
* Hydrocortisone creams and lotions for nonscalp seborrheic dermatitis
* Nonsteroidal medications called immunomodulators

Immunomodulators, such as tacrolimus (Protopic) and pimecrolimus
(Elidel), affect the immune system and have anti-inflammatory and mild
antifungal properties.

Due to possible concerns about the effect of prolonged use of these
medications on the immune system, the Food and Drug Administration
recommends that Elidel and Protopic be used only when other treatments
have failed, or if someone can't tolerate other treatments.

Stasis dermatitis
Treatment consists of correcting the condition that causes fluid to accumulate in your legs or ankles for extended periods.

Treatment options include:

* Wearing elastic support hose
* Having varicose vein surgery
* Using wet dressings to soften the thickened yet fragile skin and to control infection

Atopic dermatitis
In addition to relieving redness and itching, treatments for this
condition are aimed at healing infection-prone cracks in your skin.

Treatment options include:

* Hydrocortisone-containing lotions
* Wet dressings with mildly astringent properties
* Immunomodulator drugs, such as tacrolimus (Protopic) and pimecrolimus (Elidel)

In addition, light therapy, which involves exposing your skin to
controlled amounts of natural or artificial light, may be used to help
prevent recurrences of atopic dermatitis.

Perioral dermatitis
In general, doctors try to avoid treating this condition with strong
corticosteroids. When these potent medications are stopped, perioral
dermatitis may return and even worsen.

Treatment options include:

* The oral antibiotic tetracycline, often taken for several months
* A mild corticosteroid cream

Lifestyle and home remedies

These steps can help you manage dermatitis:

* Apply an anti-itch cream or calamine lotion to the affected area. A
nonprescription hydrocortisone cream, containing at least 1 percent
hydrocortisone, can temporarily relieve your itch. A nonprescription
oral antihistamine, such as diphenhydramine (Benadryl, others), may be
helpful if your itching is severe.
* Apply cool, wet compresses. Covering the affected area with
bandages and dressings can help protect your skin and prevent
scratching.
* Take a comfortably cool bath. Sprinkle your bath water with baking
soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal
that's made for the bathtub (Aveeno, others).
* Avoid scratching whenever possible. Cover the itchy area with a
dressing, if you can't keep from scratching it. Trim nails and wear
gloves at night.
* Wear smooth-textured cotton clothing. This will help you avoid irritating the affected area.
* Use a mild, unscented laundry detergent when washing clothes,
towels and bedding. Try using the extra-rinse cycle on your wash
machine.

Alternative medicine

A number of natural options have been studied as possible treatments for
dermatitis. Although none are as potent as steroid medications, natural
approaches generally aren’t associated with the same risk of side
effects. These therapies also don’t carry the risk that symptoms may
return and even worsen once you stop using them.

You may wish to talk with your doctor about natural therapies for dermatitis, including:

* Evening primrose oil. This oil is a form of linoleic acid that's
available as an over-the-counter supplement. Evening primrose oil may
benefit atopic dermatitis by improving deficient levels of essential
fatty acids. Results from studies of this supplement in the treatment of
atopic dermatitis have been conflicting.
* Omega-3 fatty acids. These nutrients, found in fish oil and
flaxseed, have anti-inflammatory properties and may help improve skin
rashes.
* Chamomile creams. Studies have found that topical chamomile is
about as potent as a product containing 0.25 percent hydrocortisone.
Chamomile-based creams may help relieve dermatitis.
* Calendula creams. Calendula has skin-soothing properties and may
protect against contact dermatitis. However, it may trigger an allergic
reaction on broken skin, so is not safe to use when your skin is
cracked.

Prevention

Preventing contact dermatitis means avoiding coming into contact with
those substances, such as poison ivy or harsh soaps, that may cause it.

Try to identify and avoid triggers that worsen the inflammation. Rapid
changes of temperature, sweating and stress can worsen some forms of
dermatitis. Avoid direct contact with wool products, such as rugs,
bedding and clothes, as well as harsh soaps and detergents. If you must
handle products that irritate your skin, wear nonlatex gloves.

Avoiding dry skin may be one factor in helping you prevent future bouts
of dermatitis. These tips can help you minimize the drying effects of
bathing on your skin:

* Bathe less frequently. Most people who are prone to dermatitis
don't need to bathe daily. Try going a day or two without a shower or
bath. When you do bathe, limit yourself to 15 to 20 minutes, and use
warm, rather than hot, water.
* Use only mild soaps. Choose soaps, such as Basis, Dove or Olay,
that clean without excessively removing natural oils. Deodorant and
antibacterial soaps may be more drying to your skin. Use soap only on
your face, underarms, genital areas, hands and feet. Use clear water
elsewhere.
* Dry yourself carefully. Brush your skin rapidly with the palms of
your hands, or gently pat your skin dry with a towel after bathing.
* Moisturize your skin. Seal in moisture, while your skin is still
damp, with an oil or cream. Pay special attention to your legs, arms,
back and the sides of your body. If your skin is already dry, consider
using a lubricating cream made for dry skin, such as Eucerin.