Dr Preeya Alexander’s Fast Five: Dermatitis/Eczema
Dermatitis/atopic dermatitis/eczema (all the same condition) is the red itchy rash people develop due to the immune system being heightened. Dermatitis typically occurs in the elbow and knee creases. In children it also commonly involves the face. However, dermatitis can occur anywhere really!
You are at increased risk of dermatitis if you have a family history of allergic conditions or a personal history. We call it “atopy” in the medical world – the triad of hay fever, asthma and dermatitis are known as atopic conditions. When you come in with a red itchy rash –taking a good family history can be key to diagnosis!
Management of dermatitis varies according to the patient and severity of the disease. But these are the simple skin care rules all patients with dermatitis should follow:
DON’T use soap to bathe – this is something a lot of my patients aren’t aware of! Soap is drying to the skin and dry skin is more likely to suffer from an eczema flare. Soap free washes are crucial and there are many suitable ones available. For kids – bubble bath is a no no; it’s very drying for the skin!
DO moisturise skin religiously and regularly. The KEY to dermatitis management is giving the skin moisturise. I explain to patients that moisturising makes “on edge” dermatitis skin a bit calmer. And on that note – pick the right moisturiser. You ideally want to use high oil, low water moisturisers – some Sorbolene creams for instance are high in water and can actually make dry skin and hence, dermatitis worse. There are lots of suitable brands in pharmacies. For kids with moderate or severe dermatitis I suggest parents apply moisturiser at every nappy change to get the skin under control.
DO NOT vigorously rub the skin after bathing – rather pat dry to avoid aggravating the skin further
DO NOT scratch – easy to say, hard to do! The more you scratch – the higher the risk of permanent scarring and infection.
Steroid creams are commonly used to treat dermatitis flares – we make choices (ointment versus cream, strength of steroid, duration of therapy) based on the severity of the flare and the location (some areas are more sensitive than others). The topical steroid (meaning it is applied to the skin as opposed to taken orally) tells the skin to calm down, chill out, relax a little. Once the redness and itchiness have settled we try and wean the topical steroid and maintain the skin with regular moisturising and the other measures above (like avoiding soap and rubbing the skin for instance). Some patients require regular topical steroids to keep the skin under control. It’s worth chatting to your GP, eczema nurse or dermatologist for your own plan for your eczema. For patients with severe dermatitis there are other immune therapies available; we involve a dermatologist for these.