Eczema, dermatitis and how to treat dry, flaky and itchy skin

Dermatitis often runs in families and is one of the most common complaints GPs and dermatologists see in patients, especially in young children.

One in four children develop the condition before the age of two. Fortunately, a large proportion of children who suffer from dermatitis will outgrow this condition.

Dermatitis is a catch-all term for inflammation of the skin and although there are different causes of dermatitis, the effect is usually the same: red, swollen, dry, flaky, and very itchy skin, which occasionally forms blisters.

Dermatitis is also highly prone to developing infections.

While it's not contagious, dermatitis is often chronic and recurring.

Given that it can be very painful and uncomfortable, it can also have a huge physical and emotional impact on sufferers and their families. Here you can read about:

• What eczema is
• How to manage eczema
• How to treat eczema
• What contact dermatitis is
• Symptoms of contact dermatitis
• How to treat contact dermatitis
• Other types of dermatitis

Eczema (atopic dermatitis)

Eczema (atopic dermatitis) is the most common form of dermatitis in children.

In fact, 90 per cent of people with eczema experience their first symptoms in the first year of life.

Eczema causes an itchy pinkish-red, scaly rash, which can develop on the face, scalp, body and arms and legs.

The rash can get lumpy, weepy and crusty; and is prone to infection.

It is more common in children who have a strong family history of "atopic tendencies", which includes conditions such as asthma, hay fever and eczema, or in children who already have some of these conditions.

While the exact cause of eczema is not known, there are certain recognised triggers — including dry weather, stress, infection and contact irritants such as soaps and detergents.

Dry skin is often the first symptom of eczema, and sometimes it flares up for no apparent reason.

Fortunately, as children get older, eczema often improves, with some children growing out of the condition altogether.

In general, eczema cannot be cured, but it can be managed.

How do you manage eczema?

The following tips can help you to manage the symptoms of eczema:

• Avoid excessive hot water when bathing or showering;
• Avoid dry conditions (air conditioners and heaters);
• Use a soap-free cleanser or bath oil;
• Apply a thick moisturiser (preferably immediately after a bath to retain moisture in the skin);
• Wear soft clothes made of natural fibres that allow the skin to breathe;
• Avoid known triggers and irritants;
• Don't scratch the skin as this can lead to infection or scarring (this is much easier said than done).
  

Treatment for eczema

In most cases a doctor or dermatologist will prescribe a corticosteroid cream or ointment to relieve symptoms.

These usually work well when used appropriately. Other treatments include:

• Non-steroidal creams, such as topical calcineurin inhibitors (including pimecrolimus or tacrolimus).
• Antihistamines — these are helpful for some people, but in general they do not relieve symptoms.
• Phototherapy — dermatologists use this treatment sometimes if symptoms are widespread or severe.
• Stronger medications such as steroids (prednisolone) or immunosuppressants (such as cyclosporine or azathioprine) are used in a small percentage of patients.
• Antibiotics (topical or oral) may be prescribed if the skin becomes infected.
• Anti-viral treatments are sometimes prescribed if the eczema is complicated by a viral infection, such as herpes.

Contact dermatitis

Contact dermatitis is inflammation of the skin due to contact with a particular substance, either an irritating chemical or an allergen (an allergen is something that causes an allergic reaction).

Generally, most contact dermatitis is of the irritant type (75 per cent) versus the allergic type (25 per cent).

Irritant contact dermatitis is caused by the chemical effect of strong alkali or acidic substances touching the skin.

This often develops over time and with continued exposure and it is commonly seen in certain occupations, such as hairdressers, cleaners, healthcare workers, builders, chefs and mechanics.

Water itself is a common known irritant as it weakens the skin's barrier function.

Everyone can develop irritant contact dermatitis with enough exposure to strong irritants.

Hand dermatitis is commonly caused by contact irritation.

Allergic contact dermatitis is less common and is the result of an allergic reaction in the skin to a certain substance.

Allergies can occur at any time after the initial exposure and in some cases, an allergy can occur after years of exposure to a substance.

Allergic contact dermatitis is an individual response to the allergen and will not occur in everyone who has been exposed.

Symptoms of contact dermatitis

The skin can become red, swollen and dotted with small, clear, fluid-filled blisters. These break down and weep fluid.

The skin is often extremely itchy. It can also lead to thickening of the layers of the skin, often with scaling, fissuring and cracking.

Usually a doctor can recognise contact dermatitis just by looking at it. But sometimes it's hard to tell what has caused the reaction because the rash often doesn't appear until hours or days after exposure.

When trying to identify the cause, the location of the affected skin offers a clue, because the irritant usually only affects those parts of skin it has contacted directly.

So if the rash is on the wrist, for example, it may be from the metal on the underside of a wristwatch.

A 'streaking' appearance may indicate the person has brushed past a plant to which they're allergic.

To test for allergic dermatitis, a doctor might recommend patch testing. This involves placing small amounts of substances that are commonly known to trigger allergic dermatitis onto patches placed on the skin to see if they trigger a reaction.

How to treat contact dermatitis

Whether it's the irritant or allergic type, most cases of contact dermatitis will gradually fade and disappear once exposure stops, though this can take quite a few weeks to months.

The most important thing is to protect the skin from further exposure to a known irritant or allergen.

Specific treatment for the contact dermatitis is similar to that used for atopic eczema, such as topical steroids and emollients.

Other types of dermatitis

Seborrheic dermatitis is a red, itchy, scaly rash on the scalp, face and other areas of the body like the eyebrows, beard, under the breasts, and in the folds of skin in the genital area (all areas where there are high numbers of oil glands in the skin).

Dandruff on the scalp is a mild form of seborrheic dermatitis. When it occurs in infants it's known as 'cradle cap'.

Seborrheic dermatitis is thought to be triggered by a build up of yeast in the skin that breaks down the oil and inflames the skin. It tends to recur, flaring up with stress and with other illnesses.

It can be treated with anti-yeast shampoos or lotions containing selenium, zinc or tar products. In severe cases, steroid creams and ointments are used to reduce the inflammation.

Venous dermatitis: A blue/brown discoloration of the skin caused by poor circulation of the veins, usually because of varicose veins in the legs.

It's most common in the lower legs and ankles, and is also known as stasis dermatitis or varicose eczema.

At first, the skin becomes itchy, reddened and mildly scaly. Over several months, the skin turns dark brown (caused by staining from blood that's seeped out of veins) and hardens.

The skin may break down and form a painful sore (ulcer), typically near the ankle. It improves with exercise, weight loss and the wearing of compression stockings.

Nummular dermatitis: Also known as discoid eczema, this condition usually affects older people.

Well-defined, small round or oval red patches with tiny blisters, scabs, and scales can affect any part of the body, especially the lower leg. It's usually intensely itchy.

The cause isn't known. It tends to be chronic and recurring and resistant to treatment.

Dyshidrotic eczema: Also known as pompholyx, it's another form of dermatitis that commonly occurs on the hands and feet.

It is characterised by tiny and intensely itchy blisters which can then cause peeling and cracks in the skin. Infection is a common complication.

It usually appears suddenly, especially after dramatic changes in the weather (from cold to hot) or with stress. It tends to recur.

Soaking the affected hands and feet in weak potassium permanganate (Condy's crystals) and strong topical steroids can help this condition.

This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.

This story, which was reviewed by dermatologist Dr Eleni Yiasemides and originally published by ABC Health and Wellbeing, was updated in 2019.