Dermatitis is a skin disorder that is characterized by itchiness and inflammation of the skin. The most common types of dermatitis that affect adolescents include atopic dermatitis, seborrheic dermatitis and contact dermatitis. Poison ivy, oak and sumac are forms of contact dermatitis and are discussed in another chapter.
Atopic dermatitis is a recurrent and chronic skin condition. Although up to twenty percent of children may have atopic dermatitis in the first two years of life, less adolescents are afflicted with this condition. There is a substantial amount of evidence to hypothesize that atopic dermatitis has an allergic cause. Many children with this type of dermatitis have asthma, runny nose due to allergy or a positive family history of allergy.
Seborrheic dermatitis is an inflammation of the skin in areas where the oil producing sebaceous glands are numerous. This is usually the scalp, face, behind the ears, around the breastbone, underneath the breasts, in the armpits and in the groin. It is not clear why adolescents develop seborrheic dermatitis, but there is some evidence that the inflammatory reaction is dependent upon a yeast that is a normal inhabitant of human skin.
Contact dermatitis occurs in two forms. The irritant form is more common and results from an exposure to a substance that is toxic to the skin and initiates the inflammatory reaction. This could be a chemical or even a cream, cosmetic or lotion. The other form is allergic in origin. This may refer to the poison ivy, oak or sumac. Beside these common plants, in teens, allergic contact dermatitis may be due to nickel jewelry, preservatives and topical antibiotics. In allergic contact dermatitis, the body initiates an immune response to the allergen. Inflammation and itchiness are symptoms of the immune response.
Who is likely to develop dermatitis?
Dermatitis could occur in any adolescent. A previous history of allergy or asthma may predispose a teen to atopic dermatitis or allergic contact dermatitis. Many teens may be susceptible to irritant contact dermatitis. For example, teens may develop irritation if handling fiberglass insulation without protective gloves. Some teens may develop skin irritation after using chemicals and detergents when employed as hairdressers or custodial workers. And some teens have an allergy to nickel, which may be found in some jewelry. Acids, alkalis and solvents may also produce irritation.
What are the symptoms of dermatitis?
Atopic dermatitis is characterized by skin that is itchy, dry, mildly red and has fine scales or flakiness. The skin may become raw or thickened from recurrent atopic dermatitis. Most often the rash is found on the arms and legs and the itching could be intense. Some teens with atopic dermatitis may develop itching from a light touch or a scratchy fabric such as wool. Symptoms from atopic dermatitis are usually worse in the winter when the indoor air is dry.
The symptoms of seborrheic dermatitis may range from mild to severe. The skin is dry and flaking and dandruff may appear on the scalp. The skin on the middle of the forehead and on either side of the nose may be red and flaky. Skin in other parts of the body including the armpits, under the breasts and in the groin may also be red.
Contact dermatitis is characterized by itchiness, swelling, redness of the skin and blisters. These blisters may open and ooze, then crust and have scale. The skin inflammation occurs where the irritating or allergy producing substance has touched the skin.
How is dermatitis evaluated?
Atopic dermatitis needs to be differentiated from other causes of dermatitis. Important factors are the appearance and distribution of the rash, itchiness, a family or personal history of allergic issues and the chronic relapsing course of this skin disorder. Other clues include a history of the rash either behind the knees or in the antecubital areas—the crease in front of the elbow where blood samples are often taken.
A clinician who is evaluating an adolescent for seborrheic dermatitis will look for dandruff. There also may be redness and scale around the eyelids, ear canals, between the eyes and behind the ears. There also may be redness and greasy scale in the sideburns, beard and mustache areas. A clinician can usually diagnosis seborrheic dermatitis by the appearance and distribution of the rash.
Contact dermatitis is evaluated by a careful history from the teen and the distribution of the rash. The distribution and configuration of the rash are excellent clues to the diagnosis of the offending agent. For example, rash around the wrist, or neck may be consistent from nickel found in jewelry. A rash around the eyes may result from cosmetics, cleansers or a moisturizer. A rash at the top of both feet may suggest a contact dermatitis due to a chemical in the shoe fabric or leather.
How is dermatitis treated?
Teens with atopic dermatitis need to be educated about the illness. It is important to avoid irritants or allergens that may cause the skin to worsen including wool or synthetic fabrics. A non-detergent soap may reduce flares and a mild laundry detergent may help the itch. It is very important to keep the skin well hydrated. It is usually recommended to use a moisturizer after the bath or shower. Frequent bathing without the use of a moisturizer may worsen the atopic dermatitis. Inflammation is reduced using a topical steroid cream prescribed by a clinician. Some teens have so much itch that they must be prescribed medication such as hydroxyzine or diphenhydramine hydrochloride. Unfortunately, these antihistamines may cause drowsiness that could affect the adolescent’s alertness and academic work. Non-sedating prescription antihistamines are also available.
The treatment for seborrheic dermatitis depends on the location and severity of the rash. Teens who have scalp involvement including dandruff may use antiseborrheic shampoos containing zinc pyrithione or selenium sulfide. Sometimes a steroid lotion is needed on the scalp. For rash on the face, a low potency steroid cream and a topic anti-yeast agent may be ordered.
Topical steroid preparations and avoidance of the offending substance are the mainstays for the treatment of contact dermatitis. A mid or high potency steroid cream is usually needed to treat the rash. Usually the inflammation can be controlled within seven to fourteen days. If an extensive amount of skin is involved, then oral steroids may be prescribed. For the teen with significant itchiness, an oral anti-itch preparation may be recommended.
Calcineurin inhibitors are a new class of topical medications that do not contain steroids and are effective for the treatment of atopic dermatitis. Tacrolimus and pimecrolimus are examples of this drug class.
How is dermatitis prevented?
Since many teens inherit the tendency for atopic dermatitis, there is no way to prevent the disease. However, flare-ups may be prevented by adequate moisturization of the skin. Some clinicians feel that minimizing stressful situations may help to prevent flares.
There is no known prevention for seborrheic dermatitis. Aggressive treatment of the rash is usually effective in treating the symptoms.
Avoiding the substance that causes the irritation or allergic reaction can prevent contact dermatitis. This may require detective work or even patch testing. In patch testing, the clinician will place a minimal amount of the chemical against the teen’s skin to see if an allergic reaction is initiated. It may be helpful for the adolescent to use hypoallergenic cosmetics and jewelry and avoid fragrances. If using solvents and chemicals, wear heavy gloves. Teens who wash dishes should wear rubber gloves. Regular use of moisturizing cream on the hands may prevent detergent induced hand dermatitis.
Related topics:
Allergies, anti-inflammatory drugs, chronic illness, hair dye, poison ivy, oak and sumac, skin care, yeast infections
