Dermatitis - Dr. Weil's Condition Care Guide

What is dermatitis?

Dermatitis is an umbrella term referring to any kind of skin inflammation. There are many types of dermatitis including eczema (atopic dermatitis), contact dermatitis and seborrheic dermatitis. Eczema is a rash that usually runs in families and often starts in infancy.  Contact dermatitis is due to contact with allergens or irritation from chemicals in a variety of different household products. Washing hands very frequently can also lead to dermatitis. Cradle cap in babies and dandruff in adults are forms of seborrheic dermatitis.

What are the symptoms of dermatitis?

Commonly, dermatitis involves redness and swelling in the skin. Symptoms of dermatitis differ depending on the cause. Atopic dermatitis (eczema) usually begins in infancy and manifests as an itchy reddish rash often associated with peeling, flaky skin in areas where the skin bends or flexes. Common locations for eczema include skin behind the ears, in the crook of the elbows and behind the knees. Because eczema can be so itchy, it is often complicated by the effects of aggressive scratching: oozing fluid that crusts over and occasionally complicated by bacterial or fungal infections.

In the case of contact or allergic dermatitis, itchiness and a reddish rash appears in the area where the allergen or irritant came into direct contact with the skin. In more severe forms of contact dermatitis, blistering and oozing may develop (as in the case of poison ivy).

Seborrheic dermatitis often manifests in crusting or flaking in the skin where oil glands are abundant. Cradle cap in infants affect the scalp and areas above the eyebrows. Older adults can also have seborrheic dermatitis affecting the skin above the eyebrows. The skin affected by seborrheic dermatitis is not often itchy or irritated, but can occasionally become itchy and irritated. Seborrheic dermatitis may become inactive for stretches of time and then flare up again; for unknown reasons, the condition may improve in the summer, especially after outdoor activities.  Stress can cause flare-ups.

What are the causes of dermatitis?

The causes of dermatitis depend on the type. Various factors such as stress, diet, and physical exposures/triggers can make symptoms worse.

Atopic dermatitis (eczema) usually has a genetic predisposition and involves dysfunction in the immune system. There may be infectious and environmental factors (including stress) that worsen eczema.

Contact dermatitis is caused by direct contact with allergens or irritants ranging from poison ivy, nickel used in jewelry, as well as chemicals. Contact dermatitis can also result from irritation from cleaning products, perfumes, cosmetics, preservatives found in many lotions and creams as well as such toxic substances as battery acid, pepper spray and bleach.  Health care workers can develop contact dermatitis as a result of an allergy to the latex in the gloves they wear.  Contact dermatitis due to skin irritation can manifest as diaper rash, acid burn, dry, cracked hands stemming from prolonged contact with water, and irritated skin around the mouth caused by lip licking.

The cause of seborrheic dermatitis is unknown but may be due to a combination of factors including the yeast that normally lives on skin, your genes, overall health, and living in a cold, dry climate. Risks for seborrheic dermatitis are highest among individuals with HIV, acne, rosacea or psoriasis, Parkinson’s disease, epilepsy, alcoholism, depression, an eating disorder and those recovering from a stroke or heart attack. Taking the drugs interferon, lithium and psoralen also increases the risk of this form of dermatitis.

How is dermatitis diagnosed?

Diagnosis involves examination of the rash or other skin symptom and an investigation into what may have caused the symptoms. You may be asked about substances you come into contact with at home, at work and recreationally as well as the skin care products and cosmetics you use and any pets you may have. In rare cases, the cause may be an allergen you inhaled or consumed with food. Birth control pills and spermicides can also contain allergens, and in rare cases some people develop skin problems in response to the mercury in dental fillings. When the substances get into your body via these routes, the disorder is called “systemic contact dermatitis”.

If an allergy is suspected as the cause of your skin problem, a dermatologist may recommend patch testing, which involves placing small patches containing the suspected substance on your skin, usually on your back, for two days to see if it triggers a reaction, usually a red spot or swelling on the skin under the patch.

Seborrheic dermatitis is diagnosed via a skin examination plus medical history.

Eczema is diagnosed based on the location of the rash, family history, and timing of the rash (especially if it started in infancy).

What is the conventional treatment for dermatitis?

Treatment for dermatitis is intended to help relieve symptoms by reducing the intensity, duration and frequency of flares. Treatment often involves avoidance of suspected or known triggers. In order to determine a trigger: avoid or remove a suspected substance for at least 2-3 weeks.  If the rash or other skin symptom resolves, it is very likely that the suspected substance is a trigger and should be avoided in the future. In most cases, rashes clear up within one to three weeks of avoiding the trigger substance. If symptoms persist or are disruptive to quality of life an antihistamine, moisturizer or corticosteroid cream may be recommended to help bring skin symptoms under control. You apply these agents to your skin according to your doctor’s instructions. The usual treatment for mild reactions is application twice a day for a week and then once a day for a second week.

For more severe reactions such as facial swelling or a widespread rash over much of your body, oral prednisone (a steroid) may be prescribed along with wet dressings for soothing oozing or crusting skin. You make these dressings at home following your physician’s directions. Baths containing sprinklings of uncooked oatmeal or colloidal oatmeal (finely ground oatmeal made for baths) can help relieve any itching.

Other treatments may include antibiotics if you have an infection related to your skin problem or light therapy (phototherapy with ultraviolet light).

Treatment for seborrheic dermatitis often relies on over-the- counter dandruff shampoos to start followed, if necessary by medicated shampoos as well as corticosteroid creams or ointments to control inflammation. (These can cause skin thinning if used continuously.) Antifungal shampoos may also be recommended and alternated with another product called Temovate twice a week. Antibacterial cream or gels may also be recommended for use once or twice a day. Light therapy plus the drug psoralen can also be helpful.

What does Dr. Weil recommend for dermatitis?

Avoiding substances that trigger outbreaks of dermatitis is key to preventing rashes and other skin symptoms due to allergies or irritating chemicals or metals.

For skin problems in general, Dr. Weil recommends dietary changes and supplements that help to reduce inflammation.  Following an anti-inflammatory diet involves removing or significantly limiting food that contribute to inflammation including processed foods containing hydrogenated fats and animal sources of protein that are not organic and humanely sourced including dairy, eggs, pork, beef, and poultry. Increasing or adding naturally anti-inflammatory foods is another important part of this diet. These anti-inflammatory foods include wild cold-water fish (like salmon, small tuna, herring anchovies and herring), freshly ground flax seeds, walnuts, fortified eggs, and leafy green vegetables. In addition, turmeric, garlic and ginger are also anti-inflammatory in nature.

Supplements that help to reduce inflammation include fish oil that has been purified to remove most mercury, containing omega 3 fatty acids, DHA and EPA.  A good starting dose of this is 2000-3000 mg of EPA+ DHA combined.  Do not exceed this dose if you are on blood thinners like aspirin or Coumadin.  Evening primrose oil or black currant oil are good sources of gamma-linolenic acid (GLA), which improves the health of the skin. Take 500 mg of either twice a day. Be patient when taking this supplement.  You won’t see results for six to eight weeks.

Skin inflammation sometimes starts internally, involving the intestinal immune system.   For this reason, taking probiotics can help with some forms of eczema.  Studies have shown that people who are allergic to cow’s milk with eczema have specifically benefitted from taking probiotics containing Lactobacillus GG (Culturelle) and Lactobacillus rhamnosus

Seborrheic dermatitis may improve after 4 weeks using 5% tea tree oil shampoo applied 3 minutes daily prior to rinsing.

Because skin conditions are often worsened by stress, dermatitis often responds very well to hypnosis.  Dr. Weil recommends consulting a hypnotherapist experienced in treating these disorders. You can find one in your area by logging on to the web site of American Society of Clinical Hypnosis at: http://www.asch.net/