Dermatitis: a flaky, itchy and persistent problem

dermatitis photo

Dermatitis is a broad term for an inflammation of the skin that usually involves an itchy rash. It is not contagious, but comes in many forms and can be due to many causes. The most common types of dermatitis are atopic dermatitis (also known as eczema), contact dermatitis, and seborrheic dermatitis.

Let’s look at each condition in depth.

Eczema (Atopic dermatitis)

The causes of eczema are still unknown, but researchers have discovered that there is a genetic component. A person who has eczema typically has family members who have specific medical conditions – eczema, asthma, or hay fever – and that person is also more likely to develop asthma and hay fever themselves.

There are certain risk factors to developing eczema:

  • Age: eczema usually begins in infancy;
  • Allergies and asthma: as mentioned above, those with a personal or family history of hay fever, asthma, or eczema are at a higher risk of developing eczema; and
  • Occupation: working as a healthcare provider is linked to hand eczema.

Eczema symptoms differ depending on the age of the patient. Infants usually have these symptoms:

  • A suddenly-appearing rash, that’s dry, scaly, and itchy;
  • The rash forms on the scalp and face, and can ooze and weep fluid; and
  • The child rubbing against things to scratch the itch and having difficulty sleeping.

Children between two years and puberty experience these symptoms:

  • Rash in the creases of the elbows or knees (also, the neck, wrists, ankles, and/or crease of the buttocks and legs);
  • Itchy, scaly patches where the rash was; and
  • Thickened skin developing over time where the rash was.

Adults rarely get eczema, but about half of those who had childhood eczema continue to experience a milder form as an adult. Their symptoms are usually different:

  • Rash in the creases of the elbows or knees, or nape of neck;
  • Very dry skin, including a non-stop itch; and
  • Scaly skin (more so than in infants or children).

Is it possible to prevent your child from developing eczema? Breastfed children until age four months may have a lower risk of developing eczema. Even if your child can’t be breastfed, using partially hydrolyzed formula (formula that contains cow milk protein) may also provide protection.

However, if your child does develop eczema, there are many treatment options. Maintaining daily skin care at home may decrease the need for over-the-counter (OTC) or prescription medications. It involves avoiding scratching by:

  • Keeping skin moist;
  • Taking antihistamines if needed for severe itching;
  • Keeping fingernails short;
  • Avoiding food or other irritant triggers that make symptoms worse; and
  • Bathing appropriately.

If medications are needed, they may include:

  • Oral antihistamines: Allegra, Claritin, Zyrtec;
  • Topical steroid creams or ointments: Hydrocortisone, Triamcinolone, etc.;
  • Topical Immunomodulators: Elidel, Protopic;
  • OTC Coal tar products: Neutrogena T/Gel, etc.;
  • OTC Anthralin products: Zithranol, etc.;
  • OTC barrier creams with ceramides: CeraVe, etc.; and
  • Other treatment:
    • Antibiotics for infected skin;
    • Drugs to suppress your immune system;
    • Phototherapy; and
    • A short burst of systemic steroids.

Contact dermatitis

Contact dermatitis occurs when a substance either irritates the skin or causes an allergic reaction. If it damages the outer layers of the skin, then it’s known as an irritant contact dermatitis. Common substances are hair dyes, paints, foods, oils, solvents, and metalworking fluids.

In an allergic contact dermatitis, a person may sometimes touch the item for years before the allergy develops. Typical substances are poison ivy, fragrances, latex, nickel, and nail cosmetics. Sometimes a trigger (like sweat or ultraviolet rays) is needed for the reaction to happen.

Working in a job where you come into contact with certain metals, cleaning supplies, or solvents increases your risk of developing contact dermatitis.

The symptoms of irritant contact dermatitis differ depending on whether it’s a mild or strong irritant.

If you come into contact with a mild irritant, you will gradually experience:

  • Dry, chapped skin;
  • Patches of itchy, red, swollen, and scaly skin with repeated exposure;
  • Cracked, scaly, and excessively dry skin if exposure continues; and
  • Blisters and sores that may develop and erupt.

Upon contact or within hours of a strong irritant, your skin may:

  • Burn, sting, and/or itch;
  • Become red and swollen; and
  • Develop fluid-filled blisters.

Allergic contact dermatitis symptoms rarely develop upon contact and may take hours to appear. If it’s your initial contact, it may even take weeks for you to notice these symptoms:

  • Intense, itchy skin;
  • Rash;
  • Excessively dry skin;
  • Burning;
  • Stinging;
  • Hives;
  • Fluid-filled blisters; and
  • Oozing blisters.

If, however, you develop the below, rapidly-occurring symptoms of a severe allergic reaction (also known as anaphylaxis), you need to seek immediate medical attention:

  • Difficulty breathing from your throat swelling closed;
  • Swollen face and/or eyes; and
  • Confusion.

Treatment for contact dermatitis generally depends on the cause of the problem. Washing the affected area with water to remove the irritant can be helpful, as is avoiding further exposure. You can use moisturizers or emollients to keep the skin moist and help it repair itself. Wet dressings and anti-itch lotions can be used for other symptoms.

Medications prescribed may include:

Seborrheic dermatitis

Researchers still do not know the exact cause of seborrheic dermatitis, but do know that it is complex. They have learned that it’s not due to poor personal hygiene, is not an allergy, and doesn’t harm the body.

There are however several risk factors for developing it. They include:

  • Stress or fatigue;
  • Weather extremes;
  • Oily skin or skin problems (i.e. acne);
  • Infrequent shampoos or skin cleaning;
  • Using alcohol-containing lotions;
  • Obesity;
  • Neurologic conditions (i.e. Parkinson disease, head injury, stroke); and
  • HIV.

The symptoms of seborrheic dermatitis differ from adults and adolescents to infants. In adults and adolescents, it presents as

  • Scaly patches that look greasy or moist, with reddish skin underneath;
  • Yellowish to white colored scales that can flake off; and
  • Itchy or burning skin, especially on the scalp and ear canal.

In infants, the condition is also known as cradle cap and symptoms include:

  • Yellow to brownish colored, greasy scale on the scalp;
  • Scale is thick and can cover the entire scalp; and
  • Over time, the scale becomes flaky and rubs off easily.

While it is impossible to prevent seborrheic dermatitis, controlling any risk factors you may have and maintaining a careful skin care regimen is key to decreasing the severity of your disease.

Choosing the right treatment approach is also a necessary component. You can use OTC dandruff and medicated shampoos for flakes and dryness. Make sure to choose a product that specifically treats seborrheic dermatitis and contains an active ingredient such as

If you need a stronger product, your healthcare provider may prescribe a medicated shampoo or lotion, or a prescription cream:

About the Author

Julie Kaplan, Pharm. D.
Julie Kaplan is a licensed pharmacist in Virginia and the District of Columbia. She received a Bachelor’s of Arts in English from The College of William and Mary and a Doctor of Pharmacy from Virginia Commonwealth University. She has experience in patient communication from working as a retail pharmacist.