Dermatitis

Signs and Symptoms

• Itching, pain, stinging, or burning
• Blisters, thick or scaly skin, sores from scratching
• Swelling, redness

What Causes It?

• Contact dermatitis. Caused by allergic reactions (for example, to poison oak or ivy, or soaps, or detergents).
• Seborrheic dermatitis. May be caused by oily skin or hair, or brought on by stress.
• Atopic dermatitis (eczema). Exact cause is unknown, but may be due to a combination of dry skin and an autoimmune reaction. People who have eczema often have other allergies.

What to Expect at Your Doctor's Office

Your doctor will try to determine the cause of your dermatitis and make sure you have dermatitis and not a similar disease, such as psoriasis, skin cancer, or some psychological conditions. Your doctor may be able to make a diagnosis by examining you, or by doing a patch test to see what substances you might be allergic to.

Treatment Options

Treatment varies depending on the type of dermatitis you have. For eczema, applying wet, cool compresses may help relieve itching. Taking a cool bath with baking soda or colloidal oatmeal added to the water may also help.

Drug Therapies

• Hydrocortisone creams, to reduce redness and itching in contact dermatitis and eczema.
• Medicated shampoos, to relieve seborrheic dermatitis.
• Antihistamines, to relieve itching associated with eczema.
• Topical calcineurin inhibitors (TCIs), such as pimecrolimus (Elidel) and tacrolimus (Protopic), may be used to treat eczema. These drugs help suppress an overactive immune system.
• Antibiotics may be prescribed to treat skin infections.
• Emollient creams to hydrate dry skin.

Complementary and Alternative Therapies

There are several complementary and alternative therapies (CAM) and strategies that can help treat dermatitis. For example, many people with eczema have food allergies, so eating a healthy diet may help reduce inflammation and allergic reactions. Dermatitis associated with stress and anxiety may improve with mind-body techniques, such as meditation, tai chi, yoga, and stress management. If you are pregnant, or thinking of becoming pregnant, do not use any CAM therapies unless you have been directed to do so by your physician.

Check with your doctor before giving a supplement to a child.

• Avoid exposure to environmental or food allergens. Common foods that cause allergic reactions are dairy, soy, citrus, peanuts, wheat (and sometimes all gluten-containing grains), fish, eggs, corn, and tomatoes.
• Eat fewer saturated fats (meats, especially poultry, and dairy), refined foods, and sugar. These foods contribute to inflammation in the body.
• Eat more fresh vegetables, whole grains, and essential fatty acids (cold-water fish, nuts, and seeds).
• Fish oil. In one study, people taking fish oil equal to 1.8 g of EPA (one of the omega-3 fatty acids found in fish oil) had significant reduction in symptoms of eczema after 12 weeks. Researchers think that may be because fish oil helps reduce leukotriene B4, an inflammatory substance that plays a role in eczema. If you take anticoagulants (blood-thinning medications), talk to your doctor before taking fish oil. If you are taking high-dose fish oil, make sure you use a brand that removes most of the vitamin A. Too much vitamin A over time can be toxic. The dose used in this study is very high; speak with your doctor to find the right dosage for you.
• Probiotics (bifidobacteria and lactobacillus) may boost the immune system and control allergies, especially in children. In fact, studies show that taking probiotics during pregnancy, or early infancy, can protect against the development of dermatitis. However, the scientific studies are mixed. More research is needed to know for sure if probiotics will help reduce eczema symptoms. People with severely weakened immune systems should speak with their doctors before taking probiotics.
• Evening primrose oil. In some studies, evening primrose oil helps reduce the itching associated with eczema. However, other studies have found no benefit. People who take anticoagulants (blood thinners) should talk to their doctor before taking evening primrose oil. Use caution if ou have a history of seizures or schizophrenia.
• Borage oil, like evening primrose oil, contains the essential fatty acid GLA, which acts as an anti-inflammatory. Evidence is mixed, with some studies showing that GLA helps reduce eczema symptoms and others showing no effect. People who take anticoagulants (blood thinners) should talk to their doctor before taking evening primrose oil. People who have a history of liver problems should talk to their doctor before taking borage oil.
• Vitamin C can act as an antihistamine. In one study, it helped reduce symptoms of eczema, but more studies are needed. Rose hips or palmitate are citrus free and hypoallergenic.
• Bromelain, an enzyme derived from pineapple, helps reduce inflammation. Bromelain can have a blood-thinning effect. Talk to your doctor if you are taking blood-thinning medications.
• Flavonoids, antioxidants found in dark berries and some plants, have anti-inflammatory properties, strengthen connective tissue, and may help reduce allergic reactions. The following flavonoids may be taken in dried extract form: Catechin, quercetin, hesperidin, and rutin.
• Vitamin D, to boost immunity. In one study, researchers linked Vitamin D deficiency with an increased risk of food allergies and dermatitis.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. Always tell your doctor about any herbs you may be taking. When applying herbs to the skin it is important to make sure that you have no open wounds as serious infection can result.

• Topical creams and salves containing one or more of the following herbs may help relieve itching and burning, and promote healing. The best evidence is for chamomile (Matricaria recutita). Chickweed (Stellaria media), marigold (Calendula officinalis), and licorice (Glycyrrhia glabra) may be helpful, although there is little scientific evidence to support the benefits. One study did find a licorice cream was more effective than placebo.
• Witch hazel (Hamamelis virginiana) cream can relieve itching. Liquid witch hazel can help with "weeping" or oozing dermatitis.
• St. John's wort (Hypericum perforatum), used as a topical cream, has shown promise in one double blind study. People with eczema who used St. John's wort on one arm and a placebo cream on the other saw more improvement with the arm treated with St. John's wort.
• Other herbs that have traditionally been applied to the skin to treat dermatitis include Sarsaparilla (Smilax sp.) and marshmallow (Althea officinalis).

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of dermatitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Antimonium crudum. For cracked skin.
• Apis mellifica. For hot, swollen vesicles.
• Rhus toxicodendron. For intense itching and burning.
• Sulphur. For intense burning and itching with scaling skin.
• Urtica urens. For burning, stinging pains.

Following Up

Carefully avoid any substance that causes a skin reaction. Prevent infection and scarring by not scratching.

If your skin becomes infected, see your doctor right away, especially if you notice red streaks on your skin. That could be a sign of cellulitis, which can be life threatening for some people.

Special Considerations

Check with your doctor before using any medication if you are pregnant or nursing.

Some evidence suggests that breastfed children are less likely to develop eczema.

Studies show that psychological treatment of atopic dermatitis can reduce anxiety and decrease the amount of medication needed to control the disease.

Supporting Research

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Baek JH, Shin YH, Chung IH, et al. The link between serum vitamin D level, sensitization to food allergens, and the severity of atopic dermatitis in infancy. J Pediatr. 2014;165(4):849-54.e1.

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