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 may 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
Allergic contact dermatitis occurs
upon exposure to an allergen causing a hypersensitivity reaction in
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 people.
Contact dermatitis is twice as common in females
Allergic contact dermatitis
Allergic contact dermatitis affects about 7% of people
at some point in time.
Irritant contact dermatitis
Irritant contact dermatitis is common,
especially among people who do certain jobs; exact rates are
1 Signs and symptoms
4.3 Common types
4.4 Less common types
6.3.1 Colloidal oatmeal
6.4 Light therapy
6.5 Alternative medicine
10 Society and culture
13 External links
Signs and symptoms
Dermatitis of the hand
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
Irritant contact dermatitis
Irritant contact dermatitis is usually more painful than
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 scaling of facial areas, sometimes with itching, but without hair
loss. In newborns, the condition causes a thick and yellowish
scalp rash, often accompanied by a diaper rash. In severe cases,
symptoms 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.
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.
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.
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
Patch tests are used in the diagnosis of allergic contact
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
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
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.
Diagnosis of types may be indicated by codes defined according to
International Statistical Classification of Diseases and Related
Health Problems (ICD).
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
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)
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. (
ICD-10 L21; L21.0)
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. (
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 infection. (ICD-10
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.
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
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, usually for five to ten
minutes in warm water. Soaps should be avoided as they tend to
strip the skin of natural oils and lead to excessive dryness.
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
Oatmeal contains avenanthramide (anthranilic acid amides), which can
have an anti-inflammatory effect.
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
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
tolerated. 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
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
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% are affected.
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
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