Dermatitis Causes and Treatment
Dermatitis means inflammation of the skin, so for a doctor to say that a patient has dermatitis is a rather meaningless statement, because almost any rash is dermatitis. What is important is the type of dermatitis that is present, so after stating that a rash is dermatitis, the doctor must determine the cause of that dermatitis before any reasonable treatment program can be instituted. This is often very difficult, for although the skin is the most visible of our organs, its diseases are very diverse and often difficult to diagnose accurately. For this reason, the specialty of dermatology has developed and grown rapidly over the past decade, to the point that there is now a significant shortage of dermatologists in Australia.
In some mild, early stages of a disease, a general practitioner may try simple anti-inflammatory creams to settle down an undiagnosed dermatitis, but if the problem persists or recurs, further investigation is essential.
Contact dermatitis is one of the most common forms of dermatitis. The skin is red, itchy, swollen, burning and may be blistered in an area that has come into contact with a substance to which the patient has reacted. After a few days, the area may become crusted, weeping and infected with bacteria. Contact dermatitis is most common on exposed parts of the body, but may occur on other areas if, for example, underclothes are washed in a detergent to which the patient reacts. Soaps, detergents, chemicals, solvents, cosmetics, perfume, jewelery, metals, rubber and plants are the most common substances causing contact dermatitis. Sometimes the creams used by doctors to treat other rashes can cause this type of dermatitis. Substances that a person has used or touched regularly for many years without any adverse effect may suddenly sensitize them, and cause a reaction. This is particularly common in the workplace (e.g. solvents, dyes, rubber, inks) and with cosmetics.
Investigations to test a person's reaction to suspect agents may be undertaken, but these tests, in which a patch of skin is exposed to a substance to test its response, are often inconclusive. The best treatment is prevention, and if the substance causing the dermatitis can be identified and avoided, the problem is solved. Gloves can be used to avoid detergents, soap substitutes used for washing, and changes in occupation to avoid solvents. Unfortunately, all to often the offending substance is widespread and cannot be reasonably avoided. In these situations, it may be possible to desensitize an individual to a particular allergen, but in most cases the dermatitis must be treated when it occurs.
The mainstays of treatment are steroid creams, lotions and ointments. These are available in many different forms and strengths. Placing an occlusive dressing over the dermatitis and cream increases the effectiveness of the treatment but must only be done for short periods of time. In severe cases, steroids may need to be given in tablet form, or even by injection. If the dermatitis has been secondarily infected by bacteria, antibiotics may also be required. Provided the causative agent is not touched again, the dermatitis should settle with treatment, and not recur.
With exfoliative dermatitis, there is widespread scaling, peeling and redness of the skin. It is often associated with drugs or foods, and removal of the offending substance causes the rash to subside. Commonly used medications that may cause this rash are gold injections (used for rheumatoid arthritis), sulphonamide antibiotics, some diabetes tablets and some anti-inflammatory arthritis tablets. Exposure to heavy metals (such as lead in battery factories) may also be responsible.
Dermatitis artefacta is the term used to describe a rash that is deliberately self-inflicted to attract attention or obtain special treatment. The rash can be extraordinarily varied in its form, and quite bizarre in its presentation. It usually does not respond to treatment, and occurs on unusual parts of the body. Patients who produce these rashes may be disturbed psychiatrically, prisoners, deprived of affection or attention, senile or confused. They may use heat, sharp instruments, sandpaper, chemicals or their fingernails to create the rash. Women are five times more likely to have the condition than men. Once created, the rash may become infected or gangrenous, and thus disguise its origins.
Treatment involves psychiatric counselling and medication, and dressings that cannot be easily removed by the patient. Plaster casts may occasionally be necessary to stop a patient constantly picking at an ulcer that will not otherwise heal.
Dermatitis herpetiformis occurs on the elbows, knees and backside. It consists of small, intensely itchy, fluid-filled blisters on red, inflamed skin. It often appears scratched and bleeding because of the almost irresistible itching.
There are several different causes for this relatively uncommon type of dermatitis. In some cases it is caused by a substance called gluten in the diet. This is found in many cereals, and the dermatitis can be cured by avoiding them. The other types are more resistant to treatment, and may require very potent tablets for their control.
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