This disease presents as an inflammation of the skin, which can take different forms and have different causes.
The common types of dermatitis are:
- Eczema (also known as atopic dermatitis): a persistent (chronic) dermatitis that is common in childhood and tends to run in families.
- Contact Dermatitis – A short-term (acute) dermatitis that is triggered by exposure of the skin to certain substances.
- Seborrheic Dermatitis – A common dermatitis that primarily affects the scalp and face.
Other less common forms of dermatitis include:
- Discoid (or nummular) dermatitis: which may be due to particularly dry skin or caused by a skin injury.
- Infectious dermatitis – triggered by a bacterial or fungal infection
- Varicose (or gravitational) dermatitis – which develops on the lower legs of older people due to increased pressure in the leg veins.
Dry skin (xerosis) is a common skin problem (especially in older people) caused by lack of moisture in the skin, it can be associated with various forms of dermatitis.
Dermatitis differs from psoriasis, which is a chronic inflammatory skin disease caused by a problem with the immune system that causes excessive production of skin cells.
Although there are several types of dermatitis, as it is used to describe many types of skin rashes, but the two most common forms are: atopic dermatitis and contact dermatitis.
- Atopic dermatitis is inherited and usually occurs first when children are babies.
- Contact dermatitis occurs when the skin comes into contact with something that causes an allergic reaction (allergic contact dermatitis) or injures the skin (irritant contact dermatitis).
The exact cause of dermatitis is not known, but certain health conditions, genetics, allergies, and irritants can cause different types of dermatitis.
Several factors can increase the risk of developing dermatitis:
- Age: Although dermatitis can occur at any age, eczema usually develops during childhood.
- Allergies and Asthma: People who have a personal or family history of eczema, allergies, hay fever, or asthma are more likely to develop dermatitis.
- Occupation – Jobs where the skin is exposed to certain metals, solvents, or cleaning products increase the risk of developing contact dermatitis.
- Certain Health Conditions – People with congestive heart failure, Parkinson’s disease, and HIV / AIDS may be at increased risk of developing seborrheic dermatitis.
- Psychological stress or anxiety: can aggravate existing dermatitis, probably by affecting the functioning of the body’s immune system.
Treatment for dermatitis
Treatment for dermatitis will depend on the causes. In addition to personal care, dermatitis treatments include the following:
- Application of anti-inflammatory creams such as corticosteroids. Application of creams that modify the function of the immune system (calcineurin inhibitors).
- Phototherapy, exposing the affected areas to controlled amounts of natural or artificial light.
- Antibiotics if there is a bacterial skin infection.
- Antihistamine tablets, which can help reduce itching.
One of the most commonly prescribed medications for all types of eczema is topical corticosteroids, which can relieve redness and reduce inflammation and itching so that the skin can begin to heal.
Steroids are natural substances that our bodies produce to regulate growth and immune function.
Corticosteroids have been used for more than 50 years in topical (applied to the skin) medications to treat many types of inflammatory skin conditions, including dermatitis.
There are several different types of topical steroids and a few different vehicles (ointments, creams, lotions, sprays) in which they are contained.
Topical steroids are classified by strength, ranging from “super potent” (Class 1) to “less potent” (Class 7):
- Class 1: super potent -0.05% clobetasol propionate (Clobex, Olux, Temovate E). 0.05% halobetasol propionate (Ultra Cream Cream). -Fluocinonide 0.1% (Vanos).
- Class 2: potent -0.05% diflorasone diacetate (ApexiCon E). 0.05% halobetasol propionate (Elocon). Fluocinonide 0.01% (Halog). -0.25% deoxymethasone (Topicort).
- Class 3: upper average strength -Fluocinonide 0.05% (Lidex-E) -0.05% deoxymethasone (Topicort LP).
- Class 4: medium strength -0.1% clocortolone pivalate (Cloderm). 0.1% mometasone furoate (Elocon). 0.1% Triamcinolone Acetonide (Aristocort A, Kenalog OIntment). 0.1% Betamethasone Valerate (Valisone Ointment). 0.025% fluocinolone acetonide (Synalar). -0.05% deoxymethasone (Topicort).
- Class 5: low medium resistance -0.05% fluticasone propionate (Cutivate). 0.1% Prednicarvate (Dermatop). 0.1% hydrocortisone probutate (Pandel Cream). 0.1% Triamcinolone Acetonide (Aristocort A, Kenalog). -0.025% fluocinolone acetonide (Synalar).
- Class 6: mild – 0.05% Alclomethasone Dipropionate (Aclovate Cream). 0.05% desonide (Green Foam, Desonate). 0.025% Triamcinolone Acetonide (Aristocort, Kenalog). 0.01% Hydrocortisone Butyrate (Locoid). 0.01% fluocinolone acetonide (Derma-Smoothe).
- Class 7: less potent -2% / 2.5% hydrocortisone (Nutracort, Synacort). -0.5 – 1% hydrocortisone (Cortaid and many other over-the-counter products).
- The steroid should only be applied to the skin areas affected by dermatitis as prescribed by the doctor.
- Steroids are most effective when applied within three minutes of bathing.
- The steroid should only be used as prescribed by the doctor, as more often it increases the risk of side effects.
- For many topical steroids, one application per day is sufficient.
- A steroid should not be used as a moisturizer.
- After applying the steroid, follow with a moisturizer on top.
- The use of large amounts of steroids for long periods of time should be avoided.
- Certain areas or skin types (face, genitals, raw or thin skin, and areas that rub against each other, such as under the breasts, or between the buttocks or thighs) absorb more drugs and care should be taken when applying steroids to these areas.
- Applying a bandage to the area of skin that you are treating with the steroid will increase the potency and absorption of the drug into the skin.
- Only topical steroid dressings should be used, as directed by the physician.
- Once the inflammation is under control, reduce or stop using the steroid.
- If you are using high potency steroids and / or have been using steroids for a while, your doctor should be consulted to avoid the risk of a flare after stopping the medication.
Risks of topical steroids
There are side effects with the use of topical steroids.
Steroid medications are safest when used as prescribed – in the right amount, for the proper amount of time. Common side effects of steroids include:
- Thinning of the skin (atrophy).
- Thickening of the skin (lichenification).
- Stretch marks.
- Darkening of the skin
Some of these, such as stretch marks, generally only appear in limited areas of the body (on the upper thighs, under the arms, and in the creases of the elbows and knees) and are rarely permanent with proper use of the medication.
However, frequent use of steroid medications on certain parts of the body, such as the face and around the mouth, can cause more serious side effects, especially when used for long periods of time.
Less common, but more serious side effects of steroids include:
- Glaucoma (damage to the optic nerve of the eye).
- Cataracts (clouding of the lens of the eye).
- Small pink bumps on the skin.
- Red, pus-filled hair follicles (folliculitis).
- Adrenal suppression.
- Topical steroid addiction / withdrawal.
- Calcineurin inhibitor creams.
Although topical corticosteroids are considered to be the first-line agents, they can be associated with cutaneous and systemic adverse effects.
Two new classes of topical nonsteroidal therapies have been introduced, such as topical calcineurin inhibitors and phosphodiesterase 4 (PDE4) inhibitors, providing a safe treatment alternative.
Topical calcineurin inhibitors are non-steroidal medications that are applied to the parts of the skin affected by eczema.
Once absorbed into the skin, topical calcineurin inhibitors work by preventing a part of the immune system from activating, preventing it from causing certain symptoms of dermatitis, such as redness and itching.
Topical calcineurin inhibitors can be applied to all affected areas of the skin, including the eyelids, and can be used for extended periods of time to control symptoms and reduce flare-ups.
Topical calcineurin inhibitors do not cause certain side effects associated with overuse of steroids, such as thinning of the skin or stretch marks, spider veins, or skin discoloration.
Common side effects of topical calcineurin inhibitors include a mild burning or stinging sensation when the drug is first applied to the skin.
As with any new medicine, it is important to discuss the benefits and risks of using a topical calcineurin inhibitor to control your eczema with your doctor.
- Topical calcineurin inhibitors should be used only on areas of the body where the skin is affected by eczema.
- Topical calcineurin inhibitors should not be used in children under two years of age.
- Topical calcineurin inhibitors should not be used at the same time as phototherapy treatments.
- Skin should be covered and protected when exposed to direct sunlight while using topical calcineurin inhibitors.
There are two topical calcineurin inhibitors available by prescription:
- Elidel. Topical PDE4 inhibitor.
Topical calcineurin inhibitors have been shown to be effective both in achieving clearance of the lesion and in reducing relapse when used long-term and proactively.
Similarly, in clinical trials, the PDE4 inhibitor has shown success in clearing the lesion and managing symptoms.
This medicine blocks or “inhibits” an enzyme called phosphodiesterase 4 or PDE4 so that it does not allow too much inflammation in the body.
PDE4 is produced by cells of the immune system and helps the body function in part by controlling cytokines.
Cytokines are parts of proteins also produced by cells that contribute to inflammation.
When cytokines are mistakenly activated in the body, the resulting inflammation can contribute to the development of certain diseases, including atopic dermatitis.
Currently, there is a topical PDE4 inhibitor for atopic dermatitis: Eucrisa (crisaborol) is available for people with mild to moderate atopic dermatitis from the age of 2 years.
In clinical trials, Eucrisa (crisaborol) was shown to reduce the symptoms of atopic dermatitis, such as itching, redness, lichenification (thickened skin), rash, and raw lesions with scratches.
Generally, fair or almost fair skin is achieved after 28 days of use.
Reported side effects include irritation of the skin where the ointment is applied and hypersensitivity to Eucrisa’s active ingredient, crisaborole.
The medicine comes as a 2% topical ointment and is applied to the skin twice a day.