Dermatitis Types and Treatment Options

Dermatitis is a group of skin problems related to genes, environment, and allergies. In medical terms, “dermatitis” describes inflammation of the skin. The disease tends to come and go, causing flare-ups or “flares” (periods of active symptoms) and remission (periods of low or absent symptoms).

While eczema and dermatitis are often used interchangeably, dermatitis is a broader term that includes eczema and other types of rashes. Dermatitis can be typed by cause, appearance, or site. Most types of dermatitis involve symptoms that include dry skin, itching, rashes, and inflamed skin. Pain can occur as the problem worsens.

Types and Symptoms

There are several types of dermatitis. The main types include the following.

Atopic Dermatitis

Atopic dermatitis, often referred to as atopic eczema, is a chronic (long-lasting) condition that usually begins in childhood, though it can occur at any age. It is the most common form of dermatitis. It is commonly associated with other allergic disorders, like asthma or hay fever.

Symptoms of atopic dermatitis include:

• Itching, which can become severe
• Red or discolored dry patches of skin
• Rashes that may ooze, bleed, or weep clear liquid when scratched
• Hardening and thickening of your skin
• In infants, a red or discolored rash on the face, scalp, and areas around where your joints bend
• In childhood, a red or discolored, thickened rash on the neck, ankles, elbows, knees, and in the areas where your joints bend
• In teens and adults, a red-to-dark brown scaly rash on the hands, neck, the skin around your eyes, in the bend of elbows and knees, and on ankles and feet

Contact Dermatitis

Contact dermatitis occurs when skin becomes irritated or inflamed after contact with an allergen (a normally harmless substance that triggers an allergic reaction) or irritants such as cosmetics, perfume, poison ivy, or a cleaning product.

Symptoms of contact dermatitis include:

• Itchy skin that can be intense
• Rash with discolored, swollen, and hot skin
• Excessive dry skin that may crack
• Tender, burning, or stinging skin
• Urticaria (hives)
• Fluid-filled blisters
• Oozing blisters that leave scales and crusts

Diaper Dermatitis

Diaper dermatitis, or diaper rash, is a common skin disorder in infants. It occurs in the area covered by an infant’s diaper. Factors such as infections, allergies, or wearing a wet or soiled diaper for too long can contribute to diaper dermatitis.

Symptoms of diaper dermatitis affect the areas covered by a diaper. They can include:

• Mild rashes with areas of pink or discolored dry skin
• Areas of redness or discoloration, blisters, pimples, bumps, ulcers, or sores
• Severe rashes with areas of red or discolored skin that may be raw or bleed
• Red or discolored or scaly spots on the infant’s buttocks, genitals, or thighs
• Skin that feels warm to the touch
• Crying, fussiness, and poor sleep as a result of the discomfort and pain

Dyshidrotic Dermatitis

Dyshidrotic dermatitis is a type of eczema that occurs on your hands, feet, or both, though it is often limited to the hands. While its cause is unknown, it is thought to occur most often in people with some type of hypersensitivity.

Dyshidrotic dermatitis can occur as a single flare and then vanish forever. However, most people have flares that come and go, with new blisters appearing at intervals ranging from once a month to once a year.

Symptoms of dyshidrotic dermatitis include:

• Tiny, itchy, fluid-filled blisters on the sides of your fingers, palms, or feet that last about three to four weeks
• Dry, scaly skin that remains after the blisters clear
• Dark spots that linger after the blisters clear, especially on dark skin
• Skin infection as a result of intense scratching
• Pits, ridges, thickening, and other changes to your nails

Neurodermatitis

Neurodermatitis, also known as lichen simplex chronicus, is a type of dermatitis that begins with an itchy patch that spreads to a rash as a result of itching. It tends to start during periods of stress, anxiety, or worry and continue long after these feelings fade.

Symptoms of neurodermatitis include:

• An intensely itchy patch of skin that commonly develops on the back of your neck, arms, eyelids, scalp, anus, or genitals
• Pain at the site of the rash
• Raised rough patch that appears red in light skin tones or violet in dark skin tones
• Open sores that bleed at the site of the rash
• Infection as a result of the intense scratching
• Skin thickening and leathery appearance at the site of the rash
• Scarring at the site of the rash

Nummular Dermatitis

Nummular dermatitis, also known as discoid eczema or nummular eczema, involves scattered, circular patches that are often itchy and may ooze. The word “nummular” originates from the Latin word for “coin,” since the spots can appear coin-shaped on your skin.

While its triggers are unclear, nummular dermatitis can occur as a result of very dry or sensitive skin and trauma to your skin from irritations such as scrapes, chemical burns, or other types of dermatitis.

Nummular dermatitis can occur with other types of dermatitis or as an isolated condition. Symptoms of nummular dermatitis include:

• Coin-shaped lesions on your legs, arms, hands, and/or torso
• Lesions that ooze liquid and crust over
• Intense itching and burning at the site of the lesions
• Skin that appears red, pinkish, or brown, scaly, and inflamed around the lesions

Perioral Dermatitis

Perioral dermatitis, or peri-orificial dermatitis, is an itchy rash that typically occurs around your mouth or other areas of your face. It can be mistaken for acne or rosacea.

Though its cause is unknown, perioral dermatitis may occur as an irritation caused by a skincare product, topical steroids, fluorinated toothpaste, or an allergy to something touching your skin in the affected area.

Symptoms of perioral dermatitis include:

• Burning feeling around your mouth, especially between your nose and mouth
• Bumps around your mouth that may be filled with pus or fluid
• A rash or bumps that also appear around your eyes, nose, and/or forehead

Seborrheic Dermatitis

Seborrheic dermatitis is an inflammatory condition that causes dry, flaky skin patches. These usually occur in oil-prone areas of your body except the palms and soles.

Mild seborrheic dermatitis on your scalp is often referred to as dandruff. In infants, it is known as cradle cap. The condition usually appears during infancy, adolescence, or in people age 30 or later.

Symptoms of seborrheic dermatitis include:

• Dry, flaky skin, often on your scalp, face, or chest
• Rash with dry skin and/or greasy scales on your scalp
• On darker skin, a rash on your face that appears darker than your natural skin tone or as light spots
• On lighter skin, a red rash
• Mild to intense itching accompanied by burning at the site of the rash
• Blepharitis (rash on your eyelids)
• Rash with inflammation around or inside your ears
• Maceration (a rash in your armpits, beneath your breasts, and other skin folds that causes pain, tenderness, and itchiness when this skin remains damp and starts to break down)

Stasis Dermatitis

Stasis dermatitis, also called gravitational dermatitis, venous eczema, or varicose eczema, occurs when there is poor blood flow through your veins.

It is caused by chronic venous insufficiency, a condition in which you have poor blood return within your veins. The problem occurs when valves in the blood vessels in your lower legs weaken and can’t push blood toward your heart. The problem causes stasis (pooling of blood in your legs). When the excess fluid leaks out of your blood vessels, it causes swelling.

Symptoms of stasis dermatitis include:

• Itchy, discolored, and dry skin, especially over varicose veins
• Feelings of irritation and soreness on the skin
• Feelings of achiness or heaviness in one or both legs when standing or walking
• Swelling, often on the inside of your ankle, at the end of the day
• Swelling in your legs that resolves during sleep then recurs when you stand up
• Painful leg wounds, sores, and hardened skin when the condition remains untreated

Causes and Triggers

While no one knows the cause of dermatitis, it is regarded as the effects of an interaction between environmental triggers, genetics, and an overactive immune system. These effects can make your skin dry, resulting in skin inflammation and damage. Causes and triggers vary by individual and include the following.

Genetics

Atopic dermatitis, the most common type, tends to run in families. Having a close family member with the condition increases your chances of having it.

Some people affected by dermatitis have a mutation in the gene that produces filaggrin, a protein that maintains a protective barrier on the epidermis (the outermost skin layer). Low levels of filaggrin can weaken your skin’s barrier, leaving it brittle and scaly, making it vulnerable to bacteria, viruses, and allergens that trigger itchy skin and other dermatitis symptoms.

Environmental Factors

Eczema can be triggered by certain materials and products in your environment. These factors are usually involved in contact dermatitis, which commonly occurs after your skin comes in contact with certain dyes, chemicals, or cleaning products that irritate your immune system.

Excess heat can trigger a flare-up when sweat collects in the folds of the skin, irritating it. Very cold temperatures can dry skin and trigger dermatitis symptoms such as brittle and flaky skin.

Allergies and Other Immune System Reactions

While allergies and dermatitis are unique conditions, they can be related. Contact dermatitis can occur as the result of an allergy to an allergen. Common allergens include fragrances, skincare products, and preservatives. Food allergies can also trigger dermatitis symptoms.

While dermatitis is not an autoimmune disease (in which the immune system attacks the body), it can result from the actions of your immune system triggered by allergens or irritants. This can result in inflamed skin and dermatitis.

Stress

Higher stress or anxiety levels can trigger an increase in cortisol (a hormone), which increases skin oil production and can trigger a dermatitis flare-up. Stress and anxiety can also suppress the body’s immune system, increasing the risk of dermatitis.

Self-Care for Irritating Symptoms

Self-care involves using non-prescription treatments with or without supervision from your healthcare provider. Depending on the extent of your condition, you may be able to use one or more of the following to reduce irritating symptoms, such as itching and inflammation.

Avoid scratching the itchy or inflamed area:

• Keep your fingernails cut short to avoid damaging the skin or spreading dirt and germs into the affected skin if you scratch.
• Consider wearing light gloves at nighttime if you scratch while you sleep.

Apply lotions and moisturizers as needed to provide relief. Look for products with the following ingredients:

Bathe less often with shorter, cooler baths or showers:

• Use gentle skincare cleansers only on your underarms, face, genital areas, hands, feet, or areas with visible dirt.
• Do not scrub or dry your skin vigorously.
• Apply a lubricating cream or lotion while your skin is damp to trap the moisture.

Take an oral antihistamine to relieve itching. Some antihistamines may have a sedative effect to help you sleep through the itching. Over-the-counter (OTC) antihistamines used for dermatitis include:

Take one of the following types of OTC pain relievers to treat burning, pain, and inflammation:

Apply a topical OTC low-potency hydrocortisone cream, lotion, or gel to relieve itching and rashes temporarily. Do not use these products longer than advised on the label or by your healthcare provider.

Avoid ingredients known to trigger inflammation and flares. These substances should be avoided alone or as an ingredient in skincare products, soaps, and shampoos. They include:

Steroid Cream Comparison

Steroid creams, also called topical steroids or topical corticosteroids, are applied directly to your skin to relieve inflammation and irritation. Steroid creams are grouped into seven classes based on their concentration and performance.

Class I steroids, which are the strongest steroid creams, require a prescription. Class VII steroids, such as hydrocortisone, are the least potent and available OTC. They can be used as treatments in self-care when applied according to the package instructions.

The choice of formulation affects the way the steroid cream is absorbed. Formulations include:

• Creams consist of a mixture of water, oils, and a preservative. They are the most commonly prescribed formulations. They can be applied without a greasy feel. Creams are typically advised for wet and hairy areas and body folds.
• Ointments contain oils and little to no water but usually don’t contain a preservative. They are typically advised for dry, scaly skin or areas with thick skin, such as the palms of hands and the soles of feet.
• Gels are made with water and propylene glycol, a synthetic alcohol.
• Solutions, foams, and lotions contain water, oil, and chemicals and are typically used on your scalp.
• Powders are used to protect skin against chafing, easily cover large areas, and absorb excess moisture.

Prescribed Treatment and Length of Use

There are several commonly prescribed treatments for dermatitis. However, they should be used as directed for the prescribed length of time to avoid adverse effects. Your healthcare provider will determine the treatment and duration based on your condition. Prescribed treatments and common durations include:

Topical corticosteroids:

• Super-high-potency topical corticosteroids: 2 to 3 weeks
• High- or mid-potency topical corticosteroids: Up to 12 weeks
• Low-potency OTC hydrocortisone: Usually 7 days, though no maximum use recommendation

Other medications:

• Topical Janus kinase (JAK) inhibitor: Maximum of 16 weeks
• Topical calcineurin inhibitors: Up to 6 weeks
• Topical phosphodiesterase 4 (PDE4) inhibitors: 14 to 28 days
• Biologic injectables: No set time frame
• Oral JAK inhibitors: Maximum of 16 weeks
• Prescription phototherapy: 2 to 3 times a week for 12 to 16 weeks

When to Consult a Provider

While many types of dermatitis can be managed at home without medical treatment, you should consult a healthcare provider if you have any type of dermatitis with the following characteristics:

• A rash that persists after a week of home treatment
• Severe pain at the site of the rash
• Blisters, especially around your eyes, mouth, or genitals
• Signs of infection, such as yellow or green fluid, warmth, and/or red (or darker than the surrounding skin) streaks in the rash area
• Fever with a rash
• Persistent itching that interferes with sleep and/or your normal activities

Managing dermatitis often involves working with an interdisciplinary care team to identify and treat different aspects of your condition. Depending on your needs, your dermatitis care team may include:

• Primary care provider (PCP): Your general physician, nurse practitioner, or physician’s assistant can treat your condition or refer you to specialized providers for specialized care.
• Allergist/immunologist: This physician can diagnose, treat, and manage allergies and identify dermatitis triggers.
• Dermatologist: This specialist treats skin abnormalities, such as dermatitis, and how it affects your skin.
• Mental health provider: This healthcare professional can help you manage feelings of stress, depression, and other emotional aspects of living with a chronic disease like dermatitis.
• Dietitian/nutritionist: These healthcare professionals can help you determine what to eat to avoid triggers while maintaining proper nutrition.

Is Dermatitis Chronic?

Dermatitis is considered a chronic or long-term condition for most people. It typically ebbs and flows in a cycle of flares and remission. However, certain types of dermatitis can be limited. These include:

• Atopic dermatitis: Atopic dermatitis usually occurs during infancy and childhood. For many children, the disorder goes away before their teenage years. However, it can be a chronic condition that lasts through the teenage and adult years.
• Contact dermatitis: This type of dermatitis can be limited to an acute problem if you can identify and limit your exposure to the irritating substance. However, continued exposure to the irritating substance or allergen can lead to contact dermatitis becoming a chronic condition.
• Perioral dermatitis: While bumps may return after several months of treatment, they do not return in most cases. However, they may recur if you use skin creams that contain steroids.

How to Stay Ahead of Flares

While it may be impossible to prevent all dermatitis symptoms, the following strategies may help you stay ahead of flares and relieve the discomfort they cause:

• Learn what causes your dermatitis and work to avoid those triggers. Triggers differ by individual. They can involve a range of substances, including soaps, cleaning chemicals, foods, and cosmetics. Internal and external factors such as extreme temperatures, hormonal changes, and stress can also act as triggers.
• Establish skincare routines to avoid dry skin. To help prevent the loss of skin moisture, limit your baths and showers to under 10 minutes and choose warm over hot water. Apply a fragrance-free moisturizer immediately after bathing when your skin is still damp to lock in the moisture. Use a thick moisturizing cream or ointment instead of a lotion for the best results.
• Choose fragrance-free skincare products for your face and body. Fragrance-free products don’t contain substances added for scent. Avoid products labeled as “unscented.” While an unscented product won’t have a noticeable scent, it may contain ingredients used to cover up the odors of other fragrances, which can trigger a flare if your skin is sensitive to certain scents.
• Test new skincare products in a small area. Before introducing any product into your daily skincare routine, test it in a small area to check for a reaction. To do this, apply a quarter-sized amount to the inside of your arm every day for 7 to 10 days. If no reaction occurs after that time, the product should be safe to use.
• Make conscious clothing choices. Wear loose-fitting 100% cotton clothing that doesn’t rub or allow sweat to collect in the folds of your skin. Avoid wearing tight clothing or itchy materials such as wool.
• Modify clothing to prevent it from rubbing against your skin. You can make clothing more comfortable by removing irritating tags and washing new clothes before wearing them. Cover irritating clothing seams with a smooth material such as silk to avoid abrasive irritation.
• Protect your skin from extreme hot and cold temperatures. High temperatures can cause you to overheat and sweat, while cold temperatures can dry your skin. Both sweat and dry skin are common triggers of dermatitis flare-ups.

Summary

Dermatitis refers to a group of skin ailments that cause inflammation. While triggers vary by person, most people experience periods of disease flares and remission. Symptoms can involve extremely dry skin, inflammation, scaling, and discomfort.

While most types of dermatitis are chronic, some types can resolve. Finding your triggers and limiting your exposure to them can help you reduce your risk of flares.

Self-care can be useful for treating most cases of dermatitis. However, if symptoms persist or show signs of infection, contact a healthcare provider.