Conditions

Dermatitis

Dermatitis (this term is sometimes used interchangeably with eczema) is a general term meaning "inflammation of the skin." There are many different types of dermatitis.

• Contact dermatitis, probably the most common type, is caused by physical contact with an irritant of some sort.
  
• Allergic contact dermatitis is a variant of the contact dermatitis caused by an allergic reaction rather than simple physical irritation.
  
• Photoallergic contact dermatitis is a form of the disorder in which the combination of exposure to an allergen plus exposure to light results in a reaction.
  
• Atopic dermatitis is and itching skin problem whose cause is unknown.
  
• Other, less common, forms of dermatitis include: neurodermatitis, nummular dermatitis, exfoliative dermatitis, and stasis dermatitis.
  
• Eczema (a term sometimes used interchangeably with atopic dermatitis) and psoriasis are also forms of dermatitis; however, they are discussed under their own headings.

Signs and Symptoms:

Contact dermatitis (also applies to allergic contact dermatitis & photoallergic contact dermatitis):

• Reddening of the skin (usually only in the area of contact and often with a marked outline)
• Blisters (possible)
• Swelling (possible)
• Itching (possible)
• Pain (possible)
• Weeping areas (possible)
• Abscesses (possible)

Atopic dermatitis is characterized by a severe itch of unknown origin. It can lead to breaks in the skin caused by scratching and can pave the way for bacterial or fungal infection. (See eczema for further information.)

Neurodermatitis appears to have a strong psychological component. Itching leads to scratching, which in turn causes the development of lesions and more itching.

Nummular dermatitis:

• Coin-shaped patches of skin
• Scaling areas
• Crusting areas
• Symptoms may come and go with no explanation.
• Symptoms appear predominantly in the dry winter months.

Exfoliative dermatitis (also known as general dermatitis) can cover wide areas of the body, and often no cause is found, though some cases may be caused by reactions to medications. The skin can be severely affected, to the point that whole areas can slough off. This can occur quickly or slowly, with varying degrees of itching and/or pain. Scaling and peeling of the skin can be severe enough to be life-threatening. In severe cases, an underlying illness such as lymphoma can be involved.

Stasis dermatitis is a problem of the lower legs in which the return of blood to the heart is impaired. This causes swelling around the ankle(s), and the skin becomes thickened to the point of being taut and leathery. Eventually, the lack of blood flow can allow infections and, in many cases, open ulceration to develop.

Diagnosis:

Most forms of dermatitis are diagnosed with a physical examination. However, your doctor may order tests for allergies and other possible causes before issuing a diagnosis.

Treatment Options:

In addition to avoiding the triggering agent (if applicable), treatment may include one or more of the following:

• Control of symptoms
• Control of external stresses that may exacerbate the condition
• Drugs (corticosteroids, nonsteroidal immunomodulators, antihistamines, and antibiotics)
• Ultraviolet light, including photochemotherapy that combines psoralen and UVA light (PUVA).

Compresses are a good choice for controlling symptoms. Cool wet compresses can reduce inflammation and itching. The patient should replace the soaked cloth after 30 minutes. Burrow's solution (Domeboro) added to the compress reduces bacterial growth. Doak Tar and Complex 15 lotions or colloidal oatmeal (Aveeno) baths help to decrease itching.

Traditional Treatments:

• Treatment begins with the search for the cause. This can be difficult, or even impossible in some cases, but should be attempted as it is difficult to clear up dermatitis without addressing the cause.
• Steroids, whether oral or topical, are a mainstay of treatment for most types of dermatitis. Examples include cortisone, fluocinolone, prednisone, and trimcinolone. The use of these drugs must be carefully monitored.
  If steroids alone are not adequate, and antifungal and/or antibacterial drug may be tried. These can be taken topically or orally.
• Antihistamines such as diphenhydramine (Benadryl) or hydroxyzine (Atarax, Vistaril) may be effective in controlling the itching of many forms of dermatitis. These too may be taken orally or applied topically.
• For some types of dermatitis (not the photoallergic variety), exposure to ultraviolet light may help the skin clear considerably, especially on the hands and feet.
• In severe cases, the drug isotretinoin (Accutane) may be tried. This drug can have serious side effects, however.
• For stasis dermatitis, treatment includes elevation of the affected extremities above the level of the heart to assist in returning fluids to the heart.

Complementary and Alternative Therapies:

Removing the factors that cause dermatitis is the most important step to treating the conditions. Following nutritional guidelines and using herbal support, as needed, may be effective in reducing inflammation, hypersensitivity reactions, and relieving dermatitis.

Hypersensitivity reactions may be associated with stress and anxiety. Mind-body techniques such as meditation, tai chi, yoga, and stress management may help reduce reactivity.

Nutritional Supplementation:

• Take a B-complex supplement that supplies 50mg of each of the major B vitamins three times a day for one month. Then cut back to two doses daily. The B vitamins are important for healthy skin.
• Betaine HCL is a form of hydrochloric acid. People with dermatitis often have low levels of hydrochloric acid.
  Warning: Do not take Betaine HCL if you suffer from stomach acidity.
• OptiMSM is a patented form of methylsulfonylmethane that reduces inflammation and contains a natural analgesic. Follow label directions.
• Cod liver oil is an effective natural ani-inflammatory. Take 1 teaspoon twice a day.
• Evening primrose oil and flaxseed oil contain essential fatty acids that are useful for moisturizing the skin and reducing inflammation. Take 1 teaspoon of either, three times daily.
• Kelp contains iodine and other minerals needed for healing tissues. Take 1,000 mg daily or as directed on label.
• Vitamin A and the carotenes are very important for the health of the skin. Take 10,000 IU of vitamin A two or three times daily for two weeks, then cut back to 10,000 IU daily. Also take a mixed carotene complex containing alpha-, beta- and gamma- carotene, as well as lycopene. Take 5mg three times daily.
  Warning: If you are pregnant, or intend to get pregnant, or if you have liver disease, consult your doctor before taking supplemental vitamin A. Pregnant women should not take more than 25,000 IU of supplemental vitamin A per week from all sources.
• Vitamin C taken in 1,000 mg doses, two to four times daily, inhibits histamine release. Vitamin C, from rose hips or palmitate, are citrus-free and hypoallergenic.
• Zinc promotes healing. Take 15mg three times daily, before meals. If you take over 30mg of zinc on a daily basis for more than one month, you should also take 1 or 2mg of copper each day to maintain a proper mineral balance.
  

Alternative Therapies:

• Blackthorn, blueberry leaf, hawthorn berry, and rue contain flavonoids that are excellent for reducing inflammation.
  Chamomile can be taken internally or used to soothe the skin. It reduces inflammation. Warning: Do not take chamomile if you are allergic to ragweed.
• Poultices combining chaparral, dandelion, and yellow dock root can be helpful.
• The following herbs can be used in tea or capsule form: dandelion, goldenseal, myrrh, pau d'arco, and red clover. Alternate among them for best results. Warning: Do not take goldenseal on a daily basis for more than one week at a time and do not use goldenseal during pregnancy. If you have a history of cardiovascular disease, diabetes, or glaucoma, consult a doctor before using goldenseal.
• To relieve itching and promote healing, mix goldenseal root powder with vitamin E oil, then add a little honey until it is the consistency of a loose paste. Apply this mixture to the affected area.
• Gotu Kola contains powerful antioxidants and promotes the formation of lipids and proteins that are essential for healthy skin.
• Grapeseed extract contains oligomeric proanthocyanadins (OPCs), which reduce the inflammation and rid the body of toxins.
• Oregon grape root detoxifies the body and reduces inflammation.
• Other herbs that may help dermatitis are ­ sarsaparilla, prickly ash bark, and topical applications of ­ Chickweed, marigold, comfrey, and menthol.
• The homeopathic remedy Psorinum is good for dermatitis behind the ears, scalp and/or in the bends of the joints. Your skin may get worse if you drink coffee, and you may have a tendency toward respiratory problems such as asthma.
• The homeopathic remedy Sulfur is good for skin that is dry and scaly, and feels worse with warmth and in springtime and dam weather.
• Vinca minor, is a homeopathic remedy that is helpful for skin that is very sensitive, red and sore, with intense itching.

General Recommendations:

• Keep your skin clean but avoid harsh soaps.
• Use only hypoallergenic skincare products.
• Wear loose, comfortable clothing made of natural fibers.
• Strictly avoid picking at or scratching your skin. This only makes the dermatitis worse and increases the possibility of infection.
• Try a gluten-free diet for six weeks, then add gluten-containing foods back to the diet one at a time, and see if the condition changes.
• A gluten-free diet is often of therapeutic benefit in controlling dermatitis.
• For dermatitis of the scalp, make a strong, concentrated tea of rosemary, comfrey, tea tree oil (add the tea tree oil after the tea is made), dried nettles, and witch hazel. Apply it to the scalp after shampooing with a fragrance-free shampoo. Leave it on the scalp for ten or fifteen minutes. (avoid contact with eyes)
• Massage tea tree oil antiseptic cream into the skin after contact with water or irritants.

Warnings:

• Do not take goldenseal on a daily basis for more than one week at a time and do not use goldenseal during pregnancy.
• If you have a history of cardiovascular disease, diabetes, or glaucoma, consult a doctor before using goldenseal.
• If you are pregnant, or intend to get pregnant, or if you have liver disease, consult your doctor before taking supplemental vitamin A.
• Pregnant women should not take more than 25,000 IU of supplemental vitamin A per week from all sources.
• Do not take Betaine HCL if you suffer from stomach acidity.
• Do not take chamomile if you are allergic to ragweed.