Eczema and Dermatitis. Information that makes sense.
Seborrheic dermatitis
Dermatitis What is it

Itching. How to relieve it.

There are many reasons for itching. In this article we will asume that you are itching because of your >Atopic Dermatitis.

The moment you find yourself thinking that the itching is going to drive you mad, you should immediately also decide if you are applying enough moisturizers.

Remember Atopic Dermatitis is not a condition that can be cured. The goal of treatment is to provide relief and control, just like it is with many other conditions like asthma and hayfever for example.
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Therefore, you should assume that you will have to apply moisturizers daily for possibly the rest of your life! Yes, the dermatitis can clear up eventually, but if it does happen, it will not be due to any actual treatment.

All of the above might sound negative, but the good news is that most people can control their eczema and itching to such an extent that it does not really represent much of a problem anymore.

Ok, so how much moisturizers should be applied? Enough so that your skin is not dry. For some people that will mean once daily applications and for others 5-6 daily applications in addition to using emollient bath additives or emollient shower gels.

If you do not like your emollient then experiment with others until you find one that works for you. There are propably more that 50 different moisturizers one the market today.

Once you can honestly say that you are applying your moisturizers frequently enough, so that your skin is not dry, then other treatments options comes into play.

The first line treatment for flare-ups of Atopic Dermatits and other forms of eczema is topical corticosteroids. Other treatment modalities like Tacrolimus and Pimecrolimus has also come to the fore recently.

Please see the article on How to apply steroid creams correctly for details about the treatment of flare-ups. Remember, moisturizers first and foremost and only then do the other treatment options come into play.


Corticosteroid creams. How to use them correctly.

This article is especially applicable to Atopic Dermatitis, but you can follow these general rules for any form of dermatitis.

Always use the lowest potency corticosteroid application at the lowest frequency of application that will just control your eczema.

So how do I find the correct potency of corticosteroid and correct frequency of application? Generally speaking when you initially start treating your eczema start with one of the higher potency corticosteroids. Once you have achieved control start reducing the number of applications. If you can reduce the number of applications to once or twice weekly, while still retaining control over your eczema, then you can try a lower potency corticosteroid application.

Once you have this "new" lower potency corticosteroid application, again start with daily applications and if the eczema is still controlled after about a week you can start reducing the frequency of  application again.

If you repeat this process you will eventually end up using the lowest potency corticosteroid application at the lowest frequency of application that will just control your eczema.

When the dermatitis flares up, as it will, then go back to daily application of your current potency corticosteroid. If the flare-up is severe your doctor might start you on the higher potency daily application again.

Once the eczema is controlled again you can again start the above "reducing" regime so that you will again end up on the lowest potency corticosteroid application at the lowest frequency of application that will just control your eczema!

And remember, never let up on the moisturizers!!


Diaper Dermatitis. What causes it?

The term Diaper Dermatitis refers to a red rash in the nappy area. Diaper Dermatitis is also known by the following synonymous terms: Napkin dermatitis, Irritant diaper dermatitis, Diaper rash, Nappy rash and Diaper eczema.

 

It is important to realize that Diaper Dermatitis is not a specific diagnosis, but simply refers to a red rash in the nappy area that can be caused by a variety of different skin conditions.

The commoner causes of nappy rash are as follows:

  • Primary irritant dermatitis
  • Seborrheic dermatitis
  • Atopic dermatitis
  • Candida infection
  • Allergic Contact Dermatitis
  • Psoriasis
  • Acrodermatitis Enteropathica (Zinc deficiency)

The are in addition to the above 7 conditions at least another 15 conditions that can present as a Diaper Dermatitis.

 

The overwhelming majority of cases of Diaper Dermatitis are however, caused by Primary irritant dermatitis. This is the result of the irritant effect of urine and faeces on the skin.

 

Exposure to urine and faeces affects the skin in the following ways:

  • Urea in urine has a mild irritant effect on skin
  • Moistness increases the skins frictional co-efficient and as a result the skin becomes increasingly susceptible to chafing.
  • An alkaline enviroment has a direct irritant effect on the skin.  The raised Ph is caused by faecal enzymes that reacts with urea in urine to produce ammonia.
  • Various enzymes in faeces degrades fats and proteins in the skin.
  • Irritated skin becomes very susceptible to Candida and bacterial infection.

The basic treatment of Diaper Dermatitis is therefore to minimize exposure to urine and faeces. That means more regular nappy changes and using more absorbent nappies. Zinc containing barrier creams can help to protect the skin against irritants. Low potency topical corticosteroids can be used on inflamed areas and moisturizers must be used frequently.


How to apply steroid creams correctly

This article is especially applicable to Atopic Dermatitis, but you can follow these general rules for any form of dermatitis.

Always use the lowest potency corticosteroid application at the lowest frequency of application that will just control your eczema.

So how do I find the correct potency of corticosteroid and correct frequency of application? Generally speaking when you initially start treating your eczema start with one of the higher potency corticosteroids. Once you have achieved control start reducing the number of applications. If you can reduce the number of applications to once or twice weekly, while still retaining control over your eczema, then you can try a lower potency corticosteroid application.

Once you have this "new" lower potency corticosteroid application, again start with daily applications and if the eczema is still controlled after about a week you can start reducing the frequency of  application again.

If you repeat this process you will eventually end up using the lowest potency corticosteroid application at the lowest frequency of application that will just control your eczema.

When the dermatitis flares up, as it will, then go back to daily application of your current potency corticosteroid. If the flare-up is severe your doctor might start you on the higher potency daily application again.

Once the eczema is controlled again you can again start the above "reducing" regime so that you will again end up on the lowest potency corticosteroid application at the lowest frequency of application that will just control your eczema!

And remember, never let up on the moisturizers!!


Atopic Dermatitis. How is it diagnosed?

Atopic dermatitis cannot be diagnosed with a test, like diabetes for example. Atopic dermatitis can only be diagnosed clinically. That means that in order for you to be diagnosed with Atopic dermatitis your doctor or dermatologist must see certain signs on your skin.

 

Sometimes even these clinical signs are not enough to diagnose Atopic Dermatitis and in such cases additional clinical features are required. The most important additional features are a personal or family history of atopy (Atopic Dermatitis, Asthma or Hay fever), itching and a history of the skin disease coming and going over a period of months to years.

 

  • The typical skin signs
  • a Personal or family history of atopy (Atopic Dermatitis, Asthma or Hay fever)
  • Itching
  • Chronicity of the condition

The typical skin signs of Atopic dermatitis varies with age. In infants the face, scalp, front part of the legs and back part of the arms are most often affected. In adults the disease seems to switch to the opposite side of the limbs where it is the back part of the legs (especially the skin folds behind the knee), the front part of the arms (especially the skin folds at the elbow) and other flexural areas that are characteristically affected. These are not hard-and-fast rules and any area of the skin can be affected.

 

In addition to the above mentioned major features of Atopic Dermatitis the following minor features can also help in making the diagnosis of Atopic Dermatitis. 

  • Xerosis (Skin dryness)
  • Denny-Morgan skin folds (a prominent skin fold in the lower eyelid)
  • Centro-facial pallor (The skin of the central part of the face appears lighter than the periphery)
  • Peri-orbital darkening (Darkening of the skin around the eyes)
  • Pityriasis alba (a slight powdery-white scaling on the cheeks)
  • Keratosis Pilaris (can be felt as a roughness on the upper-outer arms especially)
  • a Raised IgE – antibody level on a blood test
  • an Increased number of eosinophils (a type of white blood cell) in the blood
  • Seasonality of the condition
  • a Positive skin prick test to various substances
  • Itching when sweating
  • Prominent skin folds along the front of the neck
  • Prominent dryness on the shins that can have a puzzle-like appearance due to large dry flakes
  • Hand en foot dermatitis
  • Nipple dermatitis
  • Red inflamed eyes
  • Cataracts
  • A sensitivity to wool

Please note that blood tests and skin prick tests cannot be used to diagnose Atopic Dermatitis! They make up just 3 of the minor features of Atopic Dermatitis and are therefore relatively unimportant when it comes to diagnosing Atopic Dermatitis.

 

It is important to realize that not any single factor alone are diagnostic of Atopic dermatitis. The diagnoses can be made with confidence only if at least 3 of the 4 major features are present together with 3 of the minor features of Atopic Dermatitis. 


Dermatitis. What is it?

The word dermatitis is a collective term referring to a whole group of different conditions. Some of these conditions have very little in common except that the word dermatitis or eczema occurs somewhere in their names! A diagnosis of dermatitis is therefore not very specific and should always be further qualified to indicate the specific type of dermatitis.

To illustrate this concept, just look at this partial list of diseases that include the term eczema in their names:

1. Atopic dermatitis
2. Allergic contact dermatitis
3. Primary irritant dermatitis
4. Eczema Herpeticum
5. Perioral-nasal-ocular dermatitis
6. Seborrheic dermatitis
7. Dishidrotic dermatitis
8. Hand and foot dermatitis
9. Hand dermatitis
10. Eczema craqulae
11. Stasis dermatitis
12. Microbial dermatitis
13. Asteatotic dermatitis
14. Nummular dermatitis

This is why the term dermatitis must always be qualified!

A further source of considerable confusion is the relationship between the terms dermatitis and eczema. There is in fact no need for any confusion because the two terms are synonyms. The word dermatitiscan be substituted with the word eczema in the above list and it will still refer to the exact same condition!

Eczema is a Latin term that literally means "to erupt". Dermatitis is a term consisting of the word "Derma-" meaning skin and "-itis" meaning inflammation. Dermatitis therefore describes an actual pathological process occurring in skin whereas the term eczema is a more superficial description of what certain forms of eczema look like. It would have been simpler if the term eczema were abandoned, because dermatitis is a more medically correct term along with terms like hepatitis (inflammation of the liver), arthritis (inflammation of the joints), conjunctivitis (inflammation of the conjunctiva, which is a part of the eye) etc.

But, like it or not, the term eczema is here to stay. Remember! Eczema and dermatitis are synonyms. You can not suffer from both eczema and dermatitis!!