Eczema and Dermatitis
There are many types of eczema. Several of the more common varieties that adults get follow (also see Infantile eczema).
Contact dermatitis: This condition is caused by a reaction to certain substances that may touch the skin. If you are highly allergic, for example to poison ivy, the dermatitis develops within 48 hours after contact. The skin becomes red and itchy, even beyond the point of contact, and tiny blisters develop. These may join to form large blisters, which then break and crust over. If minute traces of chemicals from the plant are accidentally transferred from one part of the body to another, contact dermatitis may develop on the second part also.
Some forms of contact dermatitis are much less pronounced. For example, allergy to contact with nickel (on the underside of a wrist watch or earrings, for example) produces a red, flaky, itchy patch of skin, which may take weeks or even months to develop.
If an irritant remains in constant contact with your skin, the dermatitis will spread.
Seborrheic eczema: This type of eczema affects adults and young infants in different ways. In adults, the creases from the sides of the nose to the corners of the mouth may become red, flaky and itchy. In men, this inflammation may extend to the beard area and the hairy parts of the chest and back. The condition may also affect other skin creases such as the groin, armpits, and under the breasts. If it is found in a fold of skin and is moist, it is also known as intertrigo. Seborrheic eczema in a mild form also causes dandruff.
The cause of seborrheic eczema is not known. It tends to run in families, and usually comes and goes over several years.
Housewife's hand eczema: People who are constantly using dishwashing liquids, detergents, household cleaners, and shampoos often damage the skin on their hands. The skin becomes dry, rough and reddened, particularly over the knuckles. It may thicken, crack, flake and itch. A similar type of eczema occurs among people whose hands are exposed to irritant chemicals on their jobs.
Irritant eczema: The skin of an elderly person tends to be dry, particularly on the legs. This can lead to mild redness, flaking and irritation. If you take hot showers, you may get this type of eczema.
Dyshidrosis: In this type of eczema, itchy blisters erupt on the palms of the hands and the soles of the feet. Some of the blisters may burst and weep, and the surrounding areas may become inflamed and tender. Other blisters do not burst, but die down to form a flat brown spot under the skin. An attack of this type of eczema usually lasts two to four weeks and then clears up of its own accord, though attacks tend to recur. At its worst, this type of eczema can be incapacitating.
Discoid eczema: Discs of red, flaking, weeping, itching skin appear, most commonly on the arms and legs. The condition lasts for several months, then usually clears up on its own, permanently. Its cause is not known.
Dermatitis herpetiformis: This rare disorder produces recurrent crops of blisters on the buttocks, back, scalp and limbs, and on the backs of the hands arid feet. The blisters usually itch severely and may persist for months or years. If the condition begins in childhood, it tends to recur in adult life, although there may be periods of normal health between attacks. Dermatitis herpetiformis is often caused by allergy to wheat protein (gluten) that may also damage the intestine, resulting in chronic diarrhea. In other cases, the cause is unknown.
What are the risks?
Eczema and dermatitis are not generally dangerous to your health, but they can be a nuisance. However, if blisters burst or if you scratch them, they may become infected.
What should be done?
If you have housewife's hand eczema, contact dermatitis of which you know the cause, or a mild form of any other eczema (except dermatitis herpetiformis), try the self-help measures that follow. If they fail, if your eczema is severe, or if you suspect you have dermatitis herpetiformis, see your physician.
What is the treatment?
Self-help: Eczema on the hand will improve if you wear rubber gloves over white cotton gloves for short periods when in contact with irritants such as dishwater. Dry your hands thoroughly after washing them, and apply an unseen ted hand cream several times a day. If you avoid whatever is causing contact dermatitis, the condition should disappear within a few weeks. You may speed up the process by using a steroid cream that contains 0.5 per cent hydrocortisone. However, do not use steroids unless you are certain of the cause of your dermatitis and your skin is no longer exposed to the irritant.
If you suspect that the cause is a food allergy, you may want to try an exclusion diet to discover the food that may be responsible. However, you should consult your physician before starting such a diet because it may lead to a deficiency disease. He or she may also arrange for tests to determine whether an allergy actually is the cause.
Professional help: Depending on the type of eczema, your physician may prescribe a steroid cream to speed up the natural healing process, or he or she may try to discover the underlying cause. This may involve tests on the blood and skin to determine whether you are allergic to a particular substance.
If your physician suspects you have a contact dermatitis, he or she will discuss the possible causes with you. Then patch tests (applying suspected irritants to the skin) can be used to try to identify the specific cause. Even when the cause is unknown, treatment with steroids is effective (except with dermatitis herpetiformis). Unfortunately, prolonged use of steroids produces adverse side-effects.
Dermatitis herpetiformis caused by allergy to gluten can usually be controlled by a gluten-free diet. If the underlying cause is not known, treatment with the drug dapsone generally improves the rash.
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