Dermatitis—Causes and Treatments

Dermatitis, also referred to as eczema, is a term used to describe a broad variety of skin irritations that involve inflammation and red itchy rashes. The condition is not life-threatening and cannot be passed from one person to another through any sort of contact, though it can have a familial component.

Seen commonly in children, dermatitis is often outgrown by adulthood. However, it can also be persistent or recurrent, starting early in infancy and affecting an individual right into adulthood. Certain types are associated with infants, for example, "cradle cap," whereas others are particularly bothersome for the elderly, such as "winter itch."

Inflamed red itchy skin is the most general description of the symptoms accompanying dermatitis. However, blisters, scabbing, scaling, flaking or oozing of the skin may also be present. The type of rash an individual with this condition experiences depends on the particular kind of dermatitis from which he or she may be suffering.]

Types of dermatitis

There are a variety of names used to describe the different types of dermatitis. These categories can be based on the location, cause or appearance of the condition. Sometimes these terms are used interchangeably, which can lead to some confusion, but in treating it's helpful to identify the basic type before choosing a treatment plan. Here are the most common types described:

Atopic dermatitis: Long-lasting disease of the skin that that may have a hereditary component in individuals who also have hay fever and asthma. Atopic dermatis is the most common form of eczema. Skin irritation includes dry, itchy, red, and cracked skin behind the ears, on cheeks, arms, and legs.

Contact dermatitis: A skin rash resulting from repeated and direct contact with an allergen such as poison ivy or other irritant-containing substance such as cleaning products. The rash is very itchy but usually confined to the area of allergenic contact. It can start with a mild redness and itch then progress to a severe itch with blisters and severe swelling.

Hard water dermatitis: (not technically a type—but, worth of mention in the discussion of dermatitis) A common cause of dry skin and often a significant contributor to seborrheic dermatitis (and cradle cap), atopic dermatitis (eczema) and contact dermatitis outbreaks. The culprit is alkaline (high pH) water that contains high levels of iron, magnesium and/or calcium ions.

Nummular dermatitis: An extremely itchy red rash characterized by its coin-shaped patches on the skin. The discoid patches may contain oozing blisters, scaling, and scabs. It most often affects the backs of arms and lower legs, as well as the buttocks.

Perioral dermatitis: A red bumpy rash with blisters and scaling that occurs around the mouth and chin region. It can resemble and be confused with acne or the skin condition rosacea.

Pompholyx: Chronic dermatitis with itchy blisters that develop on the sides of the fingers, palms of the hands, and soles of the feet.

Seborrheic dermatitis/cradle cap: Most often affects the scalp and face but may be found on other areas of the body where hair is present. It can present with dry, yellow, greasy, or scaly patches of the skin sometimes starting as dandruff.

Stasis dermatitis/venous eczema: An inflammation of the skin caused by the pooling of blood underneath the skin in the ankles or varicose veins in the lower legs. The inflammation will start in the ankle and can work its way up to just under the knee. A non-painful but itchy, red scaly rash can develop. Increased scratching of the rash can cause painful ulcers to develop.

Allergies and dermatitis

In simple terms, dermatitis is the skin's way of reacting to an allergen, irritating substance, scratching, or severe dryness. Because of the broad spectrum of potential causes of most forms of this skin disease, an exact cause may go unidentified or be impossible to determine.

Dermatitis that is caused by an allergen or irritant is called contact dermatitis. Approximately 20% of contact dermatitis cases are the result of allergic reactions; the other 80% are caused by irritants such as chemicals in the workplace. It can be difficult to differentiate an allergenic dermatitis from an irritant dermatitis because the rashes are very similar in appearance, and some chemicals can be allergens, too. An irritant-caused dermatitis will generally show up on the skin within minutes of coming into contact with the irritant, and the rash is usually more painful than itchy. A dermatitis caused by an allergic reaction can take 24—48 hours to appear, but sometimes will take even longer to develop, with repeated contact with the allergen required before sensitization takes place and a rash appears.

• Poison ivy, poison oak, poison sumac
• Pollen
• Nickel (found in hairpins, earrings, and zippers)
• Latex (rubber) products
• Pet dander
• Fish
• Peanuts
• Wheat
• Eggs
• Milk
• Soy products
• Mango

Allergens are characterized by their ability to invoke an overreaction from your immune system that causes inflammation. In dermatitis caused by an allergy, the inflammation is present within the layers of the skin. The offending allergen could be any one of or several substances found in the environment, originating from animals, foods, plants, or manmade substances. There have been thousands of substances identified as potential allergens, but fewer than 30 are responsible for the majority of allergic and contact dermatitis cases.

Common dermatitis irritants:

• Dust
• Sand
• Wool and synthetic fibers
• Detergents and soaps
• Personal hygiene cosmetics, hair dyes, fragrances and perfumes
• Chemicals such as chlorine, solvents, formaldehyde, or mineral oil
• Adhesives

An irritant could be any substance that causes skin irritation after direct contact. The substance usually has to be present in high concentrations or for a prolonged period of time to cause a dermatitis reaction, but not in all cases.

Diet and dermatitis

Some researchers believe that poor nutrition is an important contributing factor to many types of dermatitis. But while links between specific dietary deficiencies and imbalances are apparent, the underlying mechanisms for these associations have yet to be fully established.

It is known that meat and dairy products contain a proinflammatory fatty acid called arachidonic acid (AA). As part of the body's natural healing process, this acid is converted into the potent mediators of inflammation known as leukotrienes, prostaglandins, and thromboxanes. Inflammation is one of the body's natural responses to a threat, but poor diet can lead to an imbalance between proinflammatory and anti-inflammatory molecules, contributing to inflammation that is out of proportion to the threat. Chronic inflammation can manifest downstream in a host of health problems, including skin disorders such as dermatitis.

Diets containing trans fats (hydrogenated vegetable oils) or high in saturated animal fats have also been linked to thickening of the blood, putting greater pressure on the arteries, which can further add to skin inflammation associated with dermatitis. Foods high in saturated fats may also contain high levels of toxins associated with skin irritation.

Studies have shown significant improvements in dermatitis patients who lower their intake of trans fats and saturated animal fats, particularly when supplemented with the group of essential fatty acids known as omega-3 fatty acids. Essential fatty acids (EFA's) counterbalance pro-inflammatory molecules such as AA in the inflammatory cascade, which can lessen dermatitis symptoms such as itching and scaling of the skin. The best sources of fatty acids are cold-pressed vegetable oils like extra-virgin olive oil, freshly ground flaxseed, and wild-harvested cold-water fish and other seafood.

Many patients who adopt a vegetarian, vegan, or Mediterranean diet that is high in EFA's and fresh fruits and vegetables see marked improvement in their symptoms. Here are 10 additional nutritional steps to healthier skin:

• Investigate any food allergies or sensitivities by using a food diary. Record foods that you ingest on a daily basis and any reactions you may have, paying particular attention to the skin. Eliminate all foods you may suspect for at least a couple weeks, then slowly re-introduce them one by one, watching closely for any reactions. If there are no reactions, they may be considered safe. If you experience reactions they should be completely eliminated from your diet.
• The eight most common food allergy culprits are dairy products, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish. Many other foods that can evoke an allergenic response, however, such as acidic fruits (including tomatoes) and innumerable others.
• Limit fatty red meats and consider buying organic, grass-fed, leaner meats.
• Avoid trans fats whenever possible, as they are pro-inflammatory.
• Sugar is another common ingredient in our diets that can cause skin irritation, so all sugary foods such as soft drinks and juice should be limited.
• Avoid or limit alcoholic beverages.
• Most processed foods contain chemicals that lengthen their shelf life; many of these are considered toxins that can cause skin irritation, and they should be limited or altogether avoided.
• Increase your intake of EFA's through cold-pressed virgin vegetable oils and seafood.
• Drink a liter and a half of water daily to aid in flushing toxins from your tissues.
• Your healthy diet should consist of at least five helpings of fresh veggies per day, brown rice, lean meats, wild-harvested fish (unless you are allergic), and plenty of water.

Steroid treatments for dermatitis

Steroidal topical ointments are the most commonly prescribed treatment for dermatitis. All steroid ointments, except hydrocortisone cream, need to be prescribed by your doctor. They come in various strengths and are rated I (strongest) through VII (weakest).

These creams work by constricting the blood vessels in the upper layer of the dermis. This constriction reduces the itching and inflammation associated with dermatitis. When the itching and inflammation subside, so do most of the other symptoms. The stronger the cream, the more the blood vessels will be constricted.

Steroid creams are effective in reducing the symptoms of dermatitis; however, they do not come without side effects. Working closely with your doctor and being fully aware of these side effects is the best way to minimize your risk and get the best results from this type of treatment. Some of the most common side effects are:

• Tachyphylaxis: When the skin builds up a tolerance to the strength of steroid you are using, it can lead to an inability of the blood vessels to constrict, and you may then require a stronger prescription. This can occur after four or more days of continued applications three times per day. Stopping use for four or more days will generally allow your blood vessels to regain their ability to constrict.
• Steroid rosacea: Fair-skinned people are the most commonly affected by this side effect. It occurs when a tolerance to the steroid is built up in the skin, leading to a return of the facial flushing and the need for a stronger prescribed cream. Any attempt to cut back or stop the steroid generally leads to a return of the flushing.
• Skin atrophy: Repeated use of steroid cream in the same area leads to progressive thinning of the skin. The skin can become lax, wrinkled, shiny and depressed below normal levels. Stopping the steroid will reverse most of these effects, but it can take months for the skin to re-thicken.
• Striae/stretch marks: These occur when steroid cream is applied to areas of the body where skin touches skin, e.g., armpits or groin. Once stretch marks of the skin appear they are irreversible, and oftentimes become irritated to the point where they need their own treatment. The best approach when this happens is to stop the use of steroidal cream to arrest further damage.
• Topical steroid allergy: Testing has revealed that 4—5% of people with dermatitis who are prescribed steroidal creams experience an allergy to components of the cream itself. Those using multiple prescriptions or over-the-counter medications who have chronic skin conditions are at greater risk for an allergic response to topical steroids. It is recommended that the use of these creams be stopped if you experience an allergic reaction.
• Alteration of immunity: Steroids alter the way your immune system works, so the skin can become more vulnerable to bacterial or fungal infection with their use. If the cream is then applied to skin overtop a bacterial or fungal infection, it can cause it to become more irritated.
• Glaucoma: There are isolated reports of links between steroids (even topical kinds) and glaucoma. Glaucoma is an infection inside the eye which causes increased pressures on the optic nerve and if left untreated can lead to blindness.

Probiotic treatment for dermatitis

Probiotics are "good" bacterial organisms, such as Lactobacillus and Bifidobacterium, that live in our digestive tracts and help ward off diseases, manufacture vitamins, and improve nutrient uptake. Our beneficial gut flora can be killed or weakened due to overuse of antibiotics, infection, competition with pathogens, or other stresses. When this happens our bodies become more vulnerable to disease. Fortunately, probiotics can be supplemented into our diets to aid the body in preserving healthy levels of good bacteria.

In a 2005 Australian study of 56 children suffering from severe atopic dermatitis (AD), those given equal amounts of probiotics twice daily for a period of eight weeks were found to have milder atopic dermatitis in comparison with those taking the placebo. According to the authors, the contribution the study made to scientific understanding was threefold: it was the first to show benefit with probiotics in under-two-year-olds with moderately severe AD; the beneficial effects were still apparent two months after the supplementation was ceased; and their observations provided further evidence for a role of probiotics in the management of this skin condition.

Here in the States, Dr. Sharon Glick, Director of Pediatric Dermatology at Kings County Hospital Center and SUNY Downstate Medical Center, both in Brooklyn, New York, performed her own small study on nine children under the age of eight with severe atopic dermatitis. She likewise found that the group taking probiotics had a greater reduction in symptoms than those taking the placebo. To her surprise, those that had the more severe cases improved more quickly than those with less severe cases.

Dr. Glick and others believe that those suffering with atopic dermatitis have increased levels of intestinal permeability. This means that the intestines' ability to function as a barrier to toxins and irritants of all kinds is compromised, which may contribute to the development of atopic dermatitis. According to Dr. Glick, probiotics have been shown to reverse increased intestinal permeability, modulate the mucosal immune response, and decrease inflammation in infants with food allergies. Instituting the probiotics thereby boosts the intestines' ability to function as a barrier, resulting in the reduction of atopic dermatitis symptoms.

To date, most of the studies evaluating the effect of probiotics on atopic dermatitis have been done on children, not adults; therefore, it is not known whether adults suffering from AD would derive the same positive results. Indications are good that there is a role for probiotics in the clinical management of food allergy and atopic dermatitis, but more research is needed to establish which beneficial organism work best and for whom.

Clearly, taking probiotics is a great way to generally boost your immune system and protect your digestive system. If you suffer from atopic dermatitis, it is suggested you talk to your dermatologist about adding probiotics to your treatment plan.

Traditional Chinese treatments

Traditional Chinese Medicine (TCM) is an alternative healing practice that can be effective for treating dermatitis. A course of TCM may include herbal preparations in oral, topical, or injectable form; acupuncture; auriculotherapy (ear acupuncture), and other treatments. The emphasis in Chinese herbal medicine is on combinations of different herbs based on the individual and their specific condition. The three basic functions that Chinese herbal medicines perform are detoxification and elimination, health building, and health management and maintenance. The aim is to correct imbalances throughout the body, not just in the skin.

One of the first Western studies evaluating the use of Chinese herbal medicine to treat dermatitis was conducted in London on both children and adults. Patients were given a daily herbal mixture of ten different herbs for a period of two months. The researchers found that compared to the control patients, those taking the herbs had significant improvement of scaling, redness, inflammation, itching, and other symptoms. Most importantly, they followed up with those patients who continued to use the herbal medicine, and a year later found that their improvements had continued. Those who discontinued use had declined and experienced a return of symptoms. Lastly, they found that those continuing their use of the herbs were able to minimize their dose and eventually discontinue the treatments without reoccurrence of symptoms.

As effective as Chinese herbal medicine can be, it is important to note that there have been cases of serious side effects. Liver and kidney toxicity have been reported as a result of taking a regimen of Chinese herbal medicine. There have been cases of both liver and kidney failure, resulting in transplants and even death. Unfortunately, because of the high variance in the herbs used in these cases, it has not been determined which herbs caused the toxicity.

The herbs used in traditional Chinese medicine are not regulated by the US FDA, so contamination and impurity are potential concerns. Nonetheless, many dermatologists and other medical providers in the US are becoming increasingly familiar with Chinese herbal medicine due to high demand for effective alternative healing modalities. When making a decision about whether to use this form of alternative medicine, it is important to work closely with a qualified practitioner and make certain you are being screened for any toxicity that may arise.

The leaves of the tea plant, a native to the Orient, have also been found helpful for treating dermatitis. A study in Japan showed that drinking tea can lead to moderate improvement in symptoms. Over 100 patients with recalcitrant (not responding to treatment) dermatitis symptoms were instructed to drink tea three times daily so the total amount equaled one liter. (The type used was oolong tea, a specialty tea produced by partial oxidation of the tea leaf, intermediate between the process for green and black teas.) Positive results were shown after one or two weeks, with moderate improvement coming after a month. Tea does contain caffeine, which can increase anxiety levels in certain people. Anxiety has been noted to trigger dermatitis outbreaks, so tea should be taken cautiously, or decaffeinated version sought out. Decaffeinated teas may contain a lower concentration of the antiallergic constituents, however.

Western herbal medicine treatments

Whesterners have also used herbs for centuries to heal and cleanse the body. Many herbalists and homeopathic doctors believe that herbs can help cleanse toxins from our systems, strengthening our bodies and allowing us to head off a case of dermatitis.

Herbs are thought to be effective through several different healing pathways. For example, burdock and red clover are liver tonics, which when taken orally can help the liver to filter toxins from the blood. When the liver is filtering effectively the skin is healthier. Calendula flowers, licorice root, and ginkgo all have antiseptic and anti-inflammatory properties. They can be applied topically in lotion, oil or ointment form to the affected area to reduce itching and inflammation. The gel from Aloe vera plants, the juice of plantain leaves (Plantago officinalis) or a poultice of the leaves themselves can also be applied topically to the affected areas to help soothe skin irritations associated with dermatitis.

Other natural herbal treatments can be prepared to help relieve the itching associated with dermatitis. Recipes for topical pastes may include:

• Green clay and goldenseal root in equal parts
• Equal parts salt, water, clay, and peppermint oil
• Calamine lotion
• Coal tar lotions, shampoos, bath oils

To help soothe irritated skin you can steep a chamomile tea bag in hot water for several minutes, allow it to cool slightly, then place it on the irritated skin for a couple of minutes. This may provide some relief to the area and can be repeated as necessary.

Topical evening primrose oil (EPO) is another herbal extract found helpful by some for dermatitis conditions. Studies have not fully established its efficacy, however, with disappointing results in some and encouraging results in others. Among other variables, it is quite possible that the method in which EPO is applied greatly affects outcome. In a study done in Germany, the authors found that an emulsion of EPO in water worked best to speed healing of the skin layers.

Supplement treatments

Our diets don't always provided all the necessary supplementation our bodies require to be effective in fighting off infections. Certain supplements have been found safe and helpful for improving dermatitis.

The vitamin B group as a whole is responsible for assisting in the metabolism of proteins and fats in our food. It also plays a vital role in countering stress and overall support of a healthy nervous system. A compromise in any one of these areas can trigger dermatitis. Taking a high-quality supplement containing the full vitamin B-complex, by supporting these everyday functions, may help prevent dermatitis attacks.

Those that suffer from dermatitis have also been shown to have lower levels of the particular B vitamin known as folic acid, or vitamin B9. Increasing folic acid intake may help to improve symptoms. B9 can be taken in supplement form but is also found in abundance in legumes such as lentils; dark green leafy vegetables such as spinach, parsley, turnip and mustard greens; broccoli, beets, asparagus, and romaine lettuce; and calf's liver.

Vitamin E and selenium are antioxidant nutrients that support metabolic processes and healthy skin. They delay the process of oxidation of fatty acids, which play a key role in healthy skin. Vitamin E can be found in raw nuts and seeds, virgin vegetable oils, and soybeans. Selenium can be found in onions, cabbage, broccoli, celery, and whole grains. Both can be taken orally through supplementation.

A lack of zinc has been associated with dry skin and lack of circulation, both of which can play a role in worsening dermatitis. Brewer's yeast, pumpkin seeds, and whole grains are foods rich in zinc. It is also available in supplemental form.

Some dermatologists and nutritional experts have suggested that balancing the ratio of omega-3 to omega-6 fatty acids in the diet is key in treating dermatitis. Studies have been conducted on the effect of supplementing with plant extracts such as evening primrose oil (EPO) and borage oil. These particular oils are high in the essential fatty acid known as gamma linolenic acid (GLA). Although there was a very plausible mechanism to explain why supplementation with this essential fatty acid might help resolve atopic dermatitis, and numerous studies have been conducted, the results have become muddled in publication. Ultimately, it appears neither borage oil nor evening primrose oil on their own are fully effective, although some individuals may certainly find them helpful.

10 Lifestyle changes to help dermatitis

The best treatment for dermatitis is to first identify the type you are suffering from. Each type is unique to itself and therefore its treatment may also be. However, even if your type is unknown there are some general lifestyle changes you can make and skin care guidelines you can follow that may improve your condition.

• Keep your skin moisturized. Dry skin leads to cracking, and when your skin is cracked it loses its ability to act as a protective barrier, even against dermatitis.
• Over-the-counter topical antihistamines can greatly reduce the itching associated with dermatitis. When the itching stops the inflammation is reduced, and the symptoms associated with the dermatitis will subside.
• Identify and avoid contact with anything that can irritate and dry the skin leading to dermatitis conditions.
• Treat other rashes, e.g., fungal infections, even though they may seem unrelated to the dermatitis.
• Limit scratching and keep fingernails short to avoid skin abrasions from scratching.
• You can try using a cold compress to ease the itch and reduce the inflammation.
• Avoid activities that cause sweating and overheating, as they can trigger the start of the scratching cycle.
• Wear loose-fitting cotton clothing, as it tends to be more comfortable for the skin.
• Use fragrance-free detergents, and double-rinse clothing to remove any residual detergent.
• Reduce stress, as it is thought to be a common cause for dermatitis flare-ups.

Natural topical treatment of dermatitis

Pyrithione zinc is among the most natural and effective forms of treatment of various types of dermatitis without a prescription or the use of steroid creams. It can usually restore the skin's appearance within 10 to 14 days.

The active ingredient in DermaHarmony soap is pyrithione zinc. Pyrithione zinc has a number of qualities that may be helpful in alleviating dermatitis symptoms. It is an antiseborrheic, which means that it helps to prevent or relieve excessive secretions of the sebaceous glands. These glands lie beneath the skin their function is to soften and lubricate the skin and hair. When sebaceous glands become overactive, an outbreak of dermatitis can be experienced.

Pyrithione zinc also has antifungal and antibacterial properties, which may help reduce skin inflammation associated with dermatitis. Topical zinc pyrithione is generally recognized as a safe and effective treatment for reduction in the symptoms associated with dermatitis.

If you suffer specifically from a seborrheic dermatitis, most often referred to as dandruff or cradle cap, DermaHarmony's Soap and Shampoo is a safe and effective treatment.

Read on for the answers you seek, then give us a call at 1-800-827-3730 if you would like additional guidance.