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Common Conditions -
Rashes and Eczema
There are a multitude of rash types taking up
hundreds of pages in dermatology textbooks. We
will do the detective work to piece together the
history and appearance of the rash and make the
correct diagnosis, leading to effective therapy.
What causes eczema?
In the atopic form of dermatitis, often referred
to as eczema, there is a genetic tendency of the
skin to itch. The skin is sensitive to a wide
range of things: dry air conditions, strong
soaps, wool clothing, and fragrance.
Contact dermatitis is caused by something
irritating (irritant contact dermatitis) the
skin or a skin allergy (allergic contact
dermatitis). Irritation can be caused by sweat,
friction, soap getting caught under a ring, etc.
Common allergens are nickel (present in most
metals), hair dye, plants (poison ivy),
preservatives, rubber or latex, and fragrance,
etc.
Seborrheic dermatitis (dandruff) is caused by a
yeast commonly present on the scalp and face
that overgrows and causes flaking and sometimes
itching.
Some forms of eczema have no known cause.
Dyshidrotic dermatitis (a type of hand
dermatitis) was believed to be due to abnormal
sweating but is not believed to be due to this.
What is
eczema?
Eczema or dermatitis means inflammation of the
skin. Dermatitis in the skin results in dry,
red, scaly patches that often itch. There are
many types of eczema and the causes are diverse
and include heredity, irritation, allergy,
dryness and excessive sweat. The usual
treatments for eczema include anti-inflammatory
creams, moisturizers, avoidance of factors that
make it worse and occasionally oral
anti-histamines or anti-inflammatory
medications. Some forms of eczema are chronic
and can only be controlled as opposed to cured.
Dermatitis is not contagious.
Are there different types of eczema?
There are many types of dermatitis. Atopic
dermatitis is an inherited form, often referred
to as eczema that causes red itchy patches in
children. Common locations for this rash are
infants’ cheeks, inner elbows and back of knees
in toddlers and hands in adults. In more severe
forms it can involve much of the body.
Contact dermatitis means either an irritation or
an allergic reaction to something that comes
into contact with the body. Sometimes you can
figure out what the problem is by the location
or shape of the rash, as well as a history of
recent new products, travel or pastimes.
Nummular dermatitis is usually caused by dry
weather causing irritation of the skin that
comes up in round or oval patches, commonly on
the legs.
Asteototic dermatitis is similar to nummular
dermatitis except that the spots don’t have a
specific shape and there is cracking on the
surface of the rash.
Dyshidrotic dermatitis occurs on the hands
and/or feet and comes out as little blister and
cracks along the sides of the fingers.
How can I treat
eczema?
Most dermatitis is treated with creams, gels,
lotions or ointments: topical steroids
(cortisone) or immunomodulators.
Topical steroids, which come in 6 different
strengths, reduce the redness, swelling and
itching because they have anti-inflammatory
properties. Often a higher strength topical
steroid will be used to improve the dermatitis
quickly and then either used intermittently to
maintain clearance or a lesser strength steroid
will be used to maintain. Side effects if used
for long periods of time can include thinning of
the skin or increased susceptibility to
infections due to absorption of the medication
into the bloodstream.
Topical immunomodulators (tacrolimus,
pimecrolimus) are non-steroidal
anti-inflammatory creams or ointments. These are
often used to avoid excessive use of steroids to
their minimize side effects. These are very
effective but warnings by the FDA on rare
possible side effects of long term use have
decreased their usage.
Moisturizers are an important part of adjunctive
treatment since dryness is a prominent part of
most forms of dermatitis. Also avoidance of
clothing that rubs or causes excessive sweating,
fragrance (use fragrance free-laundry detergent
and fabric softener), and any allergens are
important.
Occasionally dermatitis is severe enough to
warrant oral medications, such as oral
cortisone. This occurs when there is a large
percentage of body surface area involved or when
there is severe blistering, rapid spreading,
oozing, interruption of sleep, or resistance to
topical medications.
Is eczema curable?
Yes and no. About 75% of children who have
eczema actually “grow out of it” by the time
they are teenagers. Contact dermatitis can be
kept at bay by avoidance of the offending
agents. Most forms of dermatitis tend to wax and
wane with the seasons and require treatment to
keep them under control. The more severe the
case, the more aggressive and frequent the
therapy is required to maintain normal skin.
What does eczema look like?
Atopic dermatitis looks like red, dry patches
which aren’t necessarily well defined.
Contact dermatitis is often found in areas that
are exposed to the allergen or irritant as
patches of red scaling or blisters in the shape
of the exposure. For instance, in poison ivy,
there are often linear streaks of blisters that
correspond to where the plant touched the body.
In nickel dermatitis there may be a round patch
of dermatitis on the wrist where the metal part
of a watch has touched the skin or near the
center of the waist where the metal snap from
pants rubs on the abdomen.
In seborrheic dermatitis there is redness and
flaking on the scalp, in the eyebrows and often
at the sides of the nose.
In nummular dermatitis there are often round or
coin shaped red scaly patches often on the legs.
How can I find out more?
http://www.nlm.nih.gov/medlineplus/ency/article/000853.htm
http://www.medicinenet.com/atopic_dermatitis/article.htm
http://www.aaaai.org/patients/allergic_conditions/atopic_dermatitis.stm
http://www.mayoclinic.com/health/dermatitis-eczema/DS00339/DSECTION=7
http://www.skincarephysicians.com/eczemanet/whatis.html
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