Dermatitis

Dermatitis is a common condition that causes inflammation, redness, and itching of the skin, affecting millions of people worldwide and ranging from mild discomfort to significant disruption of daily life.

Table of contents

• What is dermatitis?
• Types of dermatitis
• Symptoms
• Causes and risk factors
• Diagnosis
• Treatment
• Living with dermatitis

What is dermatitis?

Dermatitis is a general term used to describe various types of skin inflammation and irritation. In the word “dermatitis,” “derm” means “skin” and “itis” means “inflammation.” The word as a whole means “inflammation of the skin.”^[1][2]

This condition causes swelling and irritation of the skin and has many causes and forms. It often involves itchy, dry skin or a rash. In some cases, it might cause the skin to blister, ooze, crust, or flake.^[1] The rashes can range from mild to severe and cause a variety of problems, depending on their cause.^[2]

Dermatitis is not contagious, meaning you cannot catch it from someone else. It does not mean that your skin is unclean or infected.^[1][2] While dermatitis causes no serious harm to your body, it can be very uncomfortable and affect your quality of life.^[1]

Anyone can get dermatitis, whether young or old. Some types of dermatitis are very common while others are less common. For example, atopic dermatitis (also known as eczema) affects 2% to 3% of adults and 25% of children. Contact dermatitis happens at some point to 15% to 20% of people.^[2]

Types of dermatitis

There are many different types of dermatitis. Each type tends to occur on a different part of the body and has different characteristics.^[2][3]

Atopic dermatitis, also known as eczema, usually develops in childhood but can occur at any age. It causes itchy, red rashes that can show up anywhere on your skin. In teens and adults, it’s typically found on the hands, inner elbows, neck, knees, ankles, feet, and around the eyes.^[2][3] This condition often runs in families and is frequently linked to allergies, asthma, and stress.^[3]

Contact dermatitis is caused when an allergen or irritant touches your skin. There are two main types: allergic contact dermatitis, which is an allergic reaction to something that touches your skin (such as poison ivy, metals like nickel, fragrances, or hair dyes), and irritant contact dermatitis, which is caused by harsh substances like detergents or cleaning products coming into direct contact with your skin.^[3][4] Contact dermatitis affects about 15% of the global population and over 14 million Americans each year.^[4]

Seborrheic dermatitis, called cradle cap in infants, consists of greasy, yellowish, or reddish scaling on the scalp, face, or other areas. In adults, it is commonly known as dandruff when it appears on the scalp. On the face, it typically appears in or near the eyebrows, hairline, or along the sides of the nose.^[3]

Stasis dermatitis is caused by poor circulation in the legs. You might get it if you have varicose veins, congestive heart failure, or another condition that causes chronic leg swelling. When the veins in your lower legs fail to return blood to your heart effectively, blood can pool and push into the skin tissue, causing irritation.^[3][6]

Nummular dermatitis consists of distinct coin-shaped red patches that usually show up on your legs, hands, arms, and body. It is more likely to occur in people assigned male at birth and aged 55-65 years. Living in a dry climate or taking frequent, very hot showers can trigger this type.^[3]

Symptoms

The symptoms of dermatitis can vary depending on the type, but there are common signs that many people experience.^[1][2]

The most common early symptoms include itchiness and redness, which are often the first signs of dermatitis.^[2] Other symptoms may include:^[1][3]

• Dry, cracked, scaly skin, more typical on white skin
• Rash on swollen skin that varies in color depending on skin color
• Blisters, perhaps with oozing and crusting
• Thickened skin
• Small, raised bumps, more typical on brown or black skin
• Dandruff-like scaling

In lighter skin, the rash may look pink or red. In darker skin, the rash may be hard to see or it may look dark brown, gray, or purple. Or there may be patches of lighter skin.^[7]

Dermatitis starts with very itchy, dry skin. The skin becomes irritated from scratching. Little blisters may appear and ooze fluid or crust over. A recurring rash can become scaly, tough, and thick from constant scratching.^[7] The itching can be painful and often intensifies at night, causing difficulty sleeping.^[7]

Causes and risk factors

Dermatitis is caused by a complex interaction of factors. The cause isn’t always clear, but it involves problems with the skin’s ability to hold in moisture and protect against irritants.^[7]

Atopic dermatitis is caused by a person’s inability to repair damage to the skin barrier (the protective outer layer of skin). This is due to changes in a gene called filaggrin, which is important for forming and maintaining the skin barrier. When the skin barrier is disrupted, moisture leaves the skin and allergens or irritants from the environment can enter, activating the immune system and producing inflammation that makes the skin red and itchy.^[7]

Contact dermatitis arises from an allergic immune reaction or direct chemical injury to the skin when it comes into contact with allergens or irritating substances. The immune system is activated whether the ingredient causes an allergy or damages the skin barrier.^[4] You can develop contact dermatitis even from things you’ve been in contact with for years. It can develop slowly and is not always an immediate reaction after exposure.^[4]

Several risk factors increase the likelihood of developing dermatitis:^[2][7]

• A family history of dermatitis, hay fever, or asthma
• Being female (for atopic dermatitis)
• Working around chemicals, such as in a factory, restaurant, or garden (for contact dermatitis)
• Having celiac disease (increases risk for certain types)

Things that can trigger a flare-up of dermatitis include:^[7][3]

• Allergens such as dust mites, pollen, molds, or animal dander
• Harsh soaps or detergents
• Rubbing the skin and wearing wool
• Workplace irritants such as fumes and chemicals
• Weather changes, especially dry and cold conditions
• Temperature changes, such as suddenly higher temperatures that bring on sweating
• Stress, which may lead to more itching and scratching
• Washing without moisturizing afterward

Diagnosis

To diagnose dermatitis, your doctor will likely examine your skin and talk with you about your symptoms and medical history. You may be asked about your family health history as well.^[7][8]

Your doctor can usually tell if you have dermatitis by doing a physical examination and asking questions about your health. During the examination, the doctor will check for redness, swelling, and signs of infection.^[6]

In some cases, additional tests may be needed:^[8]

• Skin biopsy: You may need to have a small piece of skin removed for study in a laboratory, which helps rule out other conditions
• Patch testing: Your doctor may suggest a patch test to identify what is causing your symptoms. In this test, small amounts of potential allergens are put on sticky patches, which are then placed on your skin for 2 to 3 days. Your healthcare provider then checks for skin reactions under the patches and determines whether further testing is needed
• Allergy testing: Sometimes allergy testing is recommended to identify specific triggers

If your dermatitis is extensive, severe, or difficult to manage, you may be referred to a dermatologist (a doctor who specializes in skin conditions) for further evaluation and treatment.^[6]

Treatment

The treatment for dermatitis varies depending on the cause and your symptoms. While there is no cure, treatment methods and medications can manage your symptoms effectively.^[2]

Moisturizers and emollients are the foundation of dermatitis treatment. Moisturizing regularly helps control the symptoms by improving the condition of the skin and helping it retain moisture.^[1][10] All patients should use moisturizers as the primary therapy for both flare-ups and maintenance. Liberal use of emollients is essential.^[10]

Using soap substitutes and bath oils is recommended long-term. All patients should be instructed to avoid regular soaps and instead use soap-free cleansers.^[10] Once-daily bathing with lukewarm water that is limited to 5 to 10 minutes is recommended. After bathing, gently pat (never rub) your skin dry and immediately apply a moisturizing cream or ointment to help seal in moisture.^[8]

Topical corticosteroids (steroid creams or ointments applied directly to the skin) are the main drug treatment and first-line treatment for dermatitis flare-ups.^[8][10] Different strengths of topical corticosteroids can be prescribed depending on the severity of your dermatitis and where the affected skin is. When used as instructed by a doctor, corticosteroids are a safe and effective treatment.^[11] Apply the treatment as directed (often twice a day) before you moisturize.^[8]

Topical calcineurin inhibitors are medicines that affect the immune system. Examples include tacrolimus and pimecrolimus cream. These can be considered for sensitive sites such as the face where potent topical corticosteroids are potentially harmful. They may be used as first-line treatment for moderate to severe dermatitis in combination with topical steroids.^[10][12]

Other treatment options include:^[8][10]

• Phototherapy (light therapy): Exposing the rash to controlled amounts of natural or artificial light. This may be considered by a specialist for adults if there is inadequate response to other treatments
• Wet dressings: A medical treatment for severe atopic dermatitis that involves applying a corticosteroid ointment, wrapping it with wet bandages, and topping that with a layer of dry bandages
• Oral medications: For more severe disease, prescription-strength pills or injected medicines may be needed, such as oral corticosteroids or injectable medications like dupilumab

For contact dermatitis specifically, one of the most important steps is identifying and avoiding the allergens or irritants that affect you. If you can successfully avoid or reduce your exposure to the cause, you should not experience any symptoms.^[11]

Living with dermatitis

Living with dermatitis requires ongoing management and self-care practices. While lifestyle changes won’t eliminate the condition, they can help reduce flares and improve your quality of life.^[15]

Daily management strategies include:^[19]

• Take a bath or shower once a day (or even twice a day if needed) using eczema-friendly products. Bathing helps replenish moisture lost through the skin barrier
• Moisturize at least twice a day, ideally anytime your skin feels dry
• Get plenty of sleep, as poor sleep has a direct negative effect on the skin barrier
• Prioritize mental health and seek support when needed
• Find ways to relax and de-stress through meditation, yoga, journaling, or other practices

Avoiding triggers is crucial for managing dermatitis. It is usually possible to identify factors that trigger a flare. Some triggers can be avoided:^[10][15]

• Heat: Most patients report that their skin flares in response to heat. Avoid hot baths or showers, heavy bedding, and warm clothing. Use cool compresses when your skin is hot or itchy
• Irritants: Avoid soaps, detergents, rough fabrics, clothing seams and labels, and harsh products
• Allergens: Use fragrance-free products. Do not use products containing essential oils or food ingredients, as these have a high risk for causing sensitization

Clothing choices can also help protect your skin. Soft, non-irritating clothing that covers the arms and legs can help protect the skin from irritation.^[14] Wear gloves outside during cold winter months, and wear rubber gloves if you wash dishes by hand to protect your skin from hot water.^[22]

Mental and emotional health is an important aspect of living with dermatitis. The condition can affect your quality of life, sleep, and mood. Stress and dermatitis impact mental health and are known to contribute to flares.^[15][19] Consider:^[15]

• Therapy with a mental health professional who can help you understand what’s happening in your brain and body and teach coping skills
• Support groups where you can connect with others who have dermatitis
• Mindfulness practices, which studies have shown can help reduce symptom severity and improve quality of life

When to see a doctor:^[1]

• If you’re so uncomfortable that the condition is affecting sleep and daily activities
• If your skin is painful
• If you have a skin infection — look for new streaks, pus, or yellow crusts
• If you have symptoms even after trying self-care steps
• Seek immediate medical attention if you have a fever and the rash looks infected