DERMATITIS, also known as ECZEMA, is a group of diseases that results
in inflammation of the skin . These diseases are characterized by
itchiness , red skin , and a rash. In cases of short duration there
may be small blisters while in long-term cases the skin may become
thickened . The area of skin involved can vary from small to the
Dermatitis is a group of skin conditions that includes atopic
dermatitis , allergic contact dermatitis , irritant contact dermatitis
, and stasis dermatitis . The exact cause of dermatitis is often
unclear. Cases are believed to often involve a combination of
irritation, allergy , and poor venous return . The type of dermatitis
is generally determined by the person's history and the location of
the rash. For example, irritant dermatitis often occurs on the hands
of people who frequently get them wet. Allergic contact dermatitis,
however, can occur following brief exposures to substances a person is
Treatment of atopic dermatitis is typically with moisturizers and
steroid creams. The steroid creams should generally be of mid- to
high strength and used for less than two weeks at a time as side
effects can occur. Antibiotics may be required if there are signs of
skin infection .
Contact dermatitis is typically treated by avoiding
the allergen or irritant. Antihistamines may help with sleep and to
decrease nighttime scratching.
Dermatitis was estimated to affect 245 million people globally in
Atopic dermatitis is the most common type and generally starts
in childhood. In the United States it affects about 10-30% of
Contact dermatitis is twice as common in females than males.
Allergic contact dermatitis
Allergic contact dermatitis affects about 7% of people at some point
Irritant contact dermatitis is common, especially among
people who do certain jobs; exact rates are unclear. Play media
* 1 Signs and symptoms
* 2 Cause
* 2.1 Environmental
* 2.2 Genetic
* 3 Diagnosis
* 3.1 Classification
* 3.2 Terminology
* 3.3 Common types
* 3.4 Less common types
* 4 Pathophysiology
* 5 Prevention
* 6 Management
* 6.1 Lifestyle
* 6.3 Medications
* 6.3.2 Immunosuppressants
* 6.4 Light therapy
* 6.5 Alternative medicine
* 7 Prognosis
* 8 Epidemiology
* 9 History
* 10 Society and culture
* 11 Research
* 12 References
* 13 External links
SIGNS AND SYMPTOMS
Rash symptomatic of dermatitis
Dermatitis symptoms vary with all different forms of the condition.
They range from skin rashes to bumpy rashes or including blisters.
Although every type of dermatitis has different symptoms, there are
certain signs that are common for all of them, including redness of
the skin, swelling , itching and skin lesions with sometimes oozing
and scarring. Also, the area of the skin on which the symptoms appear
tends to be different with every type of dermatitis, whether on the
neck , wrist , forearm , thigh or ankle . Although the location may
vary, the primary symptom of this condition is itchy skin. More
rarely, it may appear on the genital area , such as the vulva or
scrotum . Symptoms of this type of dermatitis may be very intense
and may come and go.
Irritant contact dermatitis is usually more
painful than itchy.
Although the symptoms of atopic dermatitis vary from person to
person, the most common symptoms are dry, itchy, red skin. Typical
affected skin areas include the folds of the arms, the back of the
knees , wrists , face and hands .
Perioral dermatitis refers to a red
bumpy rash around the mouth.
Dermatitis herpetiformis symptoms include itching, stinging and a
Papules and vesicles are commonly present. The
small red bumps experienced in this type of dermatitis are usually
about 1 cm in size, red in color and may be found symmetrically
grouped or distributed on the upper or lower back, buttocks , elbows ,
knees , neck, shoulders , and scalp . Less frequently, the rash may
appear inside the mouth or near the hairline .
The symptoms of seborrheic dermatitis , on the other hand, tend to
appear gradually, from dry or greasy scaling of the scalp (dandruff )
to hair loss . In severe cases, pimples may appear along the
hairline, behind the ears, on the eyebrows , on the bridge of the nose
, around the nose, on the chest , and on the upper back. In newborns
, the condition causes a thick and yellowish scalp rash, often
accompanied by a diaper rash .
Dermatitis of the hand
More severe dermatitis
A patch of dermatitis that has been scratched
The cause of dermatitis is unknown but is presumed to be a
combination of genetic and environmental factors.
The hygiene hypothesis postulates that the cause of asthma , eczema,
and other allergic diseases is an unusually clean environment. It is
supported by epidemiologic studies for asthma. The hypothesis states
that exposure to bacteria and other immune system modulators is
important during development, and missing out on this exposure
increases risk for asthma and allergy.
While it has been suggested that eczema may sometimes be an allergic
reaction to the excrement from house dust mites , with up to 5% of
people showing antibodies to the mites, the overall role this plays
awaits further corroboration.
A number of genes have been associated with eczema, one of which is
filaggrin . Genome-wide studies found three new genetic variants
associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.
Eczema occurs about three times more frequently in individuals with
celiac disease and about two times more frequently in relatives of
those with celiac disease, potentially indicating a genetic link
between the conditions.
Diagnosis of eczema is based mostly on the history and physical
examination. In uncertain cases, skin biopsy may be useful. Those
with eczema may be especially prone to misdiagnosis of food allergies
Patch tests are used in the diagnosis of allergic contact dermatitis.
The term "eczema" refers to a set of clinical characteristics.
Classification of the underlying diseases has been haphazard with
numerous different classification systems, and many synonyms being
used to describe the same condition.
A type of dermatitis may be described by location (e.g., hand eczema
), by specific appearance (eczema craquele or discoid), or by possible
cause (varicose eczema ). Further adding to the confusion, many
sources use the term eczema interchangeably for the most common type:
atopic dermatitis .
European Academy of Allergology and Clinical Immunology (EAACI)
published a position paper in 2001, which simplifies the nomenclature
of allergy-related diseases, including atopic and allergic contact
eczemas. Non-allergic eczemas are not affected by this proposal.
There are several types of dermatitis including atopic dermatitis ,
contact dermatitis , stasis dermatitis , and seborrheic eczema . Many
use the term dermatitis and eczema synonymously.
Others use the term eczema to specifically mean atopic dermatitis .
Atopic dermatitis is also known as atopic eczema. In some languages,
dermatitis and eczema mean the same thing, while in other languages
dermatitis implies an acute condition and eczema a chronic one.
Atopic dermatitis is an allergic disease believed to have a
hereditary component and often runs in families whose members have
asthma . Itchy rash is particularly noticeable on head and scalp,
neck, inside of elbows, behind knees, and buttocks. It is very common
in developed countries, and rising.
Irritant contact dermatitis is
sometimes misdiagnosed as atopic dermatitis.
Contact dermatitis is of two types: allergic (resulting from a
delayed reaction to an allergen , such as poison ivy , nickel , or
Balsam of Peru ), and irritant (resulting from direct reaction to a
detergent, such as sodium lauryl sulfate , for example).
Some substances act both as allergen and irritant (wet cement, for
example). Other substances cause a problem after sunlight exposure,
bringing on phototoxic dermatitis . About three quarters of cases of
contact eczema are of the irritant type, which is the most common
occupational skin disease. Contact eczema is curable, provided the
offending substance can be avoided and its traces removed from one's
ICD-10 L23; L24; L56.1; L56.0)
Xerotic eczema (asteatotic eczema, eczema craquele, eczema
craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes
so serious it turns into eczema. It worsens in dry winter weather, and
limbs and trunk are most often affected. The itchy, tender skin
resembles a dry, cracked, river bed. This disorder is very common
among the older population.
Ichthyosis is a related disorder. (ICD-10
Seborrhoeic dermatitis or seborrheic dermatitis ("cradle cap " in
infants) is a condition sometimes classified as a form of eczema that
is closely related to dandruff . It causes dry or greasy peeling of
the scalp, eyebrows, and face, and sometimes trunk. In newborns it
causes a thick, yellow, crusty scalp rash called cradle cap, which
seems related to lack of biotin and is often curable. (
LESS COMMON TYPES
Dyshidrosis (dyshidrotic eczema, pompholyx, vesicular palmoplantar
dermatitis) only occurs on palms, soles, and sides of fingers and
toes. Tiny opaque bumps called vesicles , thickening, and cracks are
accompanied by itching, which gets worse at night. A common type of
hand eczema, it worsens in warm weather. (
* Discoid eczema (nummular eczema, exudative eczema, microbial
eczema) is characterized by round spots of oozing or dry rash, with
clear boundaries, often on lower legs. It is usually worse in winter.
Cause is unknown, and the condition tends to come and go. (ICD-10
* Venous eczema (gravitational eczema, stasis dermatitis, varicose
eczema) occurs in people with impaired circulation, varicose veins ,
and edema , and is particularly common in the ankle area of people
over 50. There is redness, scaling, darkening of the skin, and
itching. The disorder predisposes to leg ulcers . (
Dermatitis herpetiformis (Duhring's disease) causes intensely
itchy and typically symmetrical rash on arms, thighs, knees, and back.
It is directly related to celiac disease , can often be put into
remission with appropriate diet, and tends to get worse at night.
Neurodermatitis (lichen simplex chronicus , localized scratch
dermatitis) is an itchy area of thickened, pigmented eczema patch that
results from habitual rubbing and scratching. Usually there is only
one spot. Often curable through behavior modification and
Prurigo nodularis is a related disorder
showing multiple lumps. (
ICD-10 L28.0; L28.1)
Autoeczematization (id reaction, autosensitization) is an
eczematous reaction to an infection with parasites , fungi , bacteria
, or viruses . It is completely curable with the clearance of the
original infection that caused it. The appearance varies depending on
the cause. It always occurs some distance away from the original
* There are eczemas overlaid by viral infections (eczema herpeticum
or vaccinatum ), and eczemas resulting from underlying disease (e.g.,
lymphoma ). Eczemas originating from ingestion of medications, foods,
and chemicals, have not yet been clearly systematized. Other rare
eczematous disorders exist in addition to those listed here.
All eczemas are characterized by spongiosis which allows inflammatory
mediators to accumulate. Different dendritic cells subtypes, such as
Langerhans cells, inflammatory dendritic epidermal cells and
plasmacytoid dendritic cells have a role to play.
There is no good evidence that a mother's diet during pregnancy, the
formula used, or breastfeeding changes the risk. There is tentative
evidence that probiotics in infancy may reduce rates but it is
insufficient to recommend its use.
People with eczema should not get the smallpox vaccination due to
risk of developing eczema vaccinatum , a potentially severe and
sometimes fatal complication.
There is no known cure for some types of dermatitis, with treatment
aiming to control symptoms by reducing inflammation and relieving
Contact dermatitis is treated by avoiding what is causing it.
Bathing once or more a day is recommended. It is a misconception
that bathing dries the skin in people with eczema. Soaps should be
avoided as they tend to strip the skin of natural oils and lead to
excessive dryness. It is not clear whether dust mite reduction helps
There has not been adequate evaluation of changing the diet to reduce
eczema. There is some evidence that infants with an established egg
allergy may have a reduction in symptoms if eggs are eliminated from
their diets. Benefits have not been shown for other elimination
diets, though the studies are small and poorly executed.
Establishing that there is a food allergy before dietary change could
avoid unnecessary lifestyle changes.
People can wear clothing designed to manage the itching, scratching
Moisturizing agents (also known as emollients ) are recommended at
least once or twice a day. Oilier formulations appear to be better
and water-based formulations are not recommended. It is unclear if
moisturizers that contain ceramides are more or less effective than
others. Products that contain dyes, perfumes, or peanuts should not
be used. Occlusive dressings at night may be useful.
There is little evidence for antihistamine ; they are thus not
generally recommended. Sedative antihistamines, such as
diphenhydramine , may be tried in those who are unable to sleep due to
If symptoms are well controlled with moisturizers, steroids may only
be required when flares occur.
Corticosteroids are effective in
controlling and suppressing symptoms in most cases. Once daily use is
generally enough. For mild-moderate eczema a weak steroid may be used
(e.g., hydrocortisone ), while in more severe cases a higher-potency
steroid (e.g., clobetasol propionate ) may be used. In severe cases,
oral or injectable corticosteroids may be used. While these usually
bring about rapid improvements, they have greater side effects.
Long term use of topical steroids may result in skin atrophy , stria
, telangiectasia . Their use on delicate skin (face or groin) is
therefore typically with caution. They are, however, generally well
Red burning skin , where the skin turns red upon stopping
steroid use, has been reported among adults who use topical steroids
at least daily for more than a year.
Topical immunosuppressants like pimecrolimus and tacrolimus may be
better in the short term and appear equal to steroids after a year of
use. Their use is reasonable in those who do not respond to or are
not tolerant of steroids. Treatments are typically recommended for
short or fixed periods of time rather than indefinitely. Tacrolimus
0.1% has generally proved more effective than pimecrolimus, and equal
in effect to mid-potency topical steroids. There is no link to
increased risk of cancer from topical use of 1% pimecrolimus cream.
When eczema is severe and does not respond to other forms of
treatment, systemic immunosuppressants are sometimes used.
Immunosuppressants can cause significant side effects and some require
regular blood tests. The most commonly used are ciclosporin ,
azathioprine , and methotrexate .
Light therapy using ultraviolet light has tentative support but the
quality of the evidence is not very good. A number of different types
of light may be used including UVA and
UVB ; in some forms of
treatment, light sensitive chemicals such as psoralen are also used.
Overexposure to ultraviolet light carries its own risks, particularly
that of skin cancer .
Limited evidence suggests that acupuncture may reduce itching in
those affected by atopic dermatitis . There is currently no
scientific evidence for the claim that sulfur treatment relieves
eczema. It is unclear whether Chinese herbs help or harm. Dietary
supplements are commonly used by people with eczema. Neither evening
primrose oil nor borage seed oil taken orally have been shown to be
effective. Both are associated with gastrointestinal upset.
Probiotics do not appear to be effective. There is insufficient
evidence to support the use of zinc, selenium, vitamin D, vitamin E,
pyridoxine (vitamin B6), sea buckthorn oil , hempseed oil , sunflower
oil , or fish oil as dietary supplements.
Chiropractic spinal manipulation lacks evidence to support its use
for dermatitis. There is little evidence supporting the use of
psychological treatments. While dilute bleach baths have been used
for infected dermatitis there is little evidence for this practice.
Most cases are well managed with topical treatments and ultraviolet
light. About 2% of cases are not. In more than 60% of young
children, the condition subsides by adolescence .
Globally dermatitis affected approximately 230 million people as of
2010 (3.5% of the population).
Dermatitis is most commonly seen in
infancy , with female predominance of eczema presentations occurring
during the reproductive period of 15–49 years. In the UK about 20%
of children have the condition, while in the United States about 10%
Although little data on the rates of eczema over time exists prior to
the 1940s, the rate of eczema has been found to have increased
substantially in the latter half of the 20th Century, with eczema in
school-aged children being found to increase between the late 1940s
and 2000. In the developed world there has been rise in the rate of
eczema over time. The incidence and lifetime prevalence of eczema in
England has been seen to increase in recent times.
Dermatitis affected about 10% of U.S. workers in 2010, representing
over 15 million workers with dermatitis. Prevalence rates were higher
among females than among males, and among those with some college
education or a college degree compared to those with a high school
diploma or less. Workers employed in healthcare and social assistance
industries and life, physical, and social science occupations had the
highest rates of reported dermatitis. About 6% of dermatitis cases
among U.S. workers were attributed to work by a healthcare
professional, indicating that the prevalence rate of work-related
dermatitis among workers was at least 0.6%.
Ancient Greek ἔκζεμα ékzema,
from ἐκζέ-ειν ekzé-ein,
from ἐκ ek "out" + ζέ-ειν zé-ein "to boil" (
The term "atopic dermatitis" was coined in 1933 by Wise and
Sulfur as a topical treatment for eczema was fashionable
in the Victorian and Edwardian eras.
The word dermatitis is from the Greek δέρμα derma "skin" and
-ῖτις -itis "inflammation" and eczema is from Greek :
ἔκζεμα ekzema "eruption".
SOCIETY AND CULTURE
The examples and perspective in this section MAY NOT REPRESENT A
WORLDWIDE VIEW OF THE SUBJECT. You may improve this article , discuss
the issue on the talk page , or create a new article , as appropriate.
(June 2017) (Learn how and when to remove this template message )
The terms "hypoallergenic" and "doctor tested" are not regulated,
and no research has been done showing that products labeled
"hypoallergenic" are less problematic than any others.
A number of monoclonal antibodies are being studied as treatments
including dupilumab .
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