Dermatitis, sometimes referred to as eczema, is an inflammation of the skin
that occurs in acute, subacute, and chronic stages. The cardinal feature is
itching. There are numerous types of dermatitis, ranging from mild to chronic
and affecting approximately 10% of children and from 7% to 24% of
Dermatitis is caused by allergic contact (e.g., poison ivy), irritant contact
(e.g., factors promoting water loss such as low humidity, organic solvents, or
alkaline soaps), chemicals (e.g., nickel, cobalt, or detergent), or allergies
(especially those associated with dairy products). Acute dermatitis may progress
to subacute dermatitis, and chronic dermatitis either results from subacute
dermatitis or appears as lichen simplex chronicus. Atopic dermatitis and
dermatitis herpetiformis do not have clear etiology, but both have genetic
links. Atopic dermatitis is associated with asthma and allergic
- Genetic risk factors (for atopic dermatitis and dermatitis
- Occupation (e.g., cleaners, hair dressers, jobs requiring repeated
- Allergic or irritant contact
- Gender (female, for contact dermatitis)
- Skin infections
|Signs and Symptoms|
- Mild to intense pruritus, pain, stinging, or burning
- Vesicles, blisters, scales, fissuring, thickened and lichenified
- Mildly to intensely red
- Fungal infection
- Skin eruption from reaction to drugs, including botanicals
- Human immunodeficiency virus–associated
- Cutaneous T-cell lymphoma
- Mycosis fungoides
- Exfoliative erythroderma
The skin appears red and inflamed with serum-filled vesicles, lesions, or
blisters. Excoriation causes accumulation of serum, crust, and/or purulent
material. There is thickened and lichenified skin with chronic
- Patch testing can determine the type of allergic dermatitis,
especially for environmental allegens.
- Biopsy can rule out spongiosis and lymphoma.
- Cultures reveal bacterial infections (e.g., Staphylococcus
- Blood testing may reveal elevated serum immunoglobulin E levels,
which are seen in about 80% of cases of atopic dermatitis, especially those
involving food allergens.
When the protective properties of the stratum corneum epidermidis are
diminished, the skin decompensates and becomes eczematous. Epidermis becomes
- Rash is recognized as eczematous and not psoriasiform or
- Determine allergic, irritant, or endogenous source.
- The diagnosis for atopic dermatitis, in addition to itchy skin,
includes flexural dermatitis, history of hay fever or asthma, and rash before
the age of 2.
In addition to avoiding the triggering agent (if applicable), treatment may
include one or more of the following.
- Control of symptoms
- Control of external stresses that may exacerbate the
- Drugs (corticosteroids, nonsteroidal immunomodulators,
antihistamines, and antibiotics)
- Ultraviolet light, including photochemotherapy that combines psoralen
and UVA light (PUVA)
Compresses are a good choice for controlling symptoms. Cool wet compresses
cause vasoconstriction and decrease serum production, reducing inflammation and
itching. The patient should replace the soaked cloth after 30 minutes. Burrow's
solution (Domeboro) added to the compress reduces bacterial growth. Doak Tar and
Complex 15 lotions or colloidal oatmeal (Aveeno) baths help to decrease
Corticosteroids: Systemic corticosteroids reduce inflammation (e.g.,
prednisone 20 to 30 mg bid for 7 to 30 days, tapered gradually, depending on
severity), side effects, and rebound effects. Topical corticosteroids cannot
penetrate vesicles but decrease pruritus, preventing further complications
(e.g., 1% to 2.5% hydrocortisone, twice daily on affected areas, decreasing the
strength as the conditions improves). Side effects with more potent brands
include atrophy, telangiectasia, striae, and adrenal axis suppression.
Nonsteroidal immunomodulators (e.g., tacrolimus [FK-506], phosphodiesterase
inhibitors) are newer topical ointments.
Antihistamines: Antihistamines relieve itching but do not change the course
of the disease (e.g., diphenhydramine [Benadryl], every 4 hours, as needed;
hydroxyzine [Atarax], every four hours, as needed or 10 to 100 mg three hours
before sleep for soporific effect). Newer, less sedating antihistamines include
cetirizine (Zyrtec) and loratadine (Claritin).
Antibiotics: Systemic antibiotics (e.g., erythromycin, 250 mg qid for 7 to 10
days), treat secondary infections, which usually involve staphylococcus (in 90%
of patients). Infections of the hand frequently occur with atopic dermatitis.
Topical antibiotics are less effective than systemic
|Complementary and Alternative
Discerning and eliminating exposure to the causative factor is of primary
importance in treating dermatitis. Following nutritional guidelines and using
herbal support as needed may be effective in reducing inflammation,
hypersensitivity reactions, and relieving dermatitis.
Hypersensitivity reactions may be associated with stress and anxiety.
Mind-body techniques such as meditation, tai chi, yoga, and stress management
may help reduce reactivity.
Note: Lower doses are for children.
- Eliminate or reduce exposure to all known environmental or food
allergens. The most common allergenic foods are dairy, soy, citrus, peanuts,
wheat (may be intolerant to all gluten-containing grains), fish, eggs, corn, and
- Reduce pro-inflammatory foods in the diet including saturated fats
(meats, especially poultry, and dairy), refined foods, and sugar.
- Increase intake of fresh vegetables, whole grains, and essential
fatty acids (cold-water fish, nuts, and seeds).
- Flaxseed, borage, or evening primrose oil (1,000 to 1,500 mg one to
two times/day) are anti-inflammatory. Children should be supplemented with cod
liver oil (1 tsp./day). Excessive omega-6 oils may increase inflammation. In
this case, omega-3 (fish oils) are more effective.
- Beta-carotene (25,000 to 100,000 IU/day), zinc (10 to 30 mg/day), and
vitamin E (200 to 800 IU/day) support immune function and dermal
- Vitamin C (1,000 mg bid to qid) inhibits histamine release. Vitamin C
from rose hips or palmitate are citrus-free and hypoallergenic.
- Selenium (100 to 200 mcg/day) helps to regulate fatty acid metabolism
and is a cofactor in liver detoxification.
- Bromelain (100 to 250 mg bid to qid) is a proteolytic enzyme that
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
Flavonoids, a constituent found in dark berries and some plants, have
anti-inflammatory properties, strengthen connective tissue, and help reduce
hypersensitivity reactions. The following are flavonoids that may be taken in
dried extract form as noted.
- Catechin (25 to 150 mg bid to tid), quercetin (50 to 250 mg bid to
tid), hesperidin (50 to 250 mg bid to tid), and rutin (50 to 250 mg bid to
- Rose hips (Rosa canina) are also high in flavonoids and may be
used as a tea. Drink 3 to 4 cups/day.
Herbs that support dermal healing and lymphatic drainage are useful for
relieving dermatitis. Use the following herbs in combination as a tincture (15
to 30 drops tid) or tea (2 to 4 cups/day). Peppermint (Mentha piperita),
red clover (Trifolium pratense), cleavers (Gallium aparine),
yarrow (Achillea millefolium), and prickly ash bark (Xanthoxylum
Sarsaparilla (Smilax species) helps heal hot, red, inflamed skin, and
gotu kola (Centella asiatica) is good for dry, scaly, crusty skin. Use 3
ml sarsaparilla and 2 ml gotu kola tincture daily, or 3 cups tea per day.
Oregon grape (Mahonia aquafolium) or red alder bark (Alnus rubra)
can be taken as tincture (20 to 30 drops tid) to help liver eliminate
Topical applications of creams and salves containing one or more of the
following herbs may help relieve itching, burning, and promote healing.
Chickweed (Stellaria media), marigold (Calendula officinalis),
comfrey (Symphytum officinale), and chamomile (Matricaria
A tea made from peppermint leaf (Mentha piperita) may be cooled and
applied via spray bottle to relieve itching and burning. An external ointment
containing menthol can also be applied.
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Apis mellifica for hot, swollen vesicles that are relieved with
- Rhus toxicodendron for intense itching and burning relieved
with hot applications
- Urtica urens for burning, stinging
Acupuncture may help restore normal immune function and reduce the
Therapeutic massage may help reduce stress which exacerbates
Dermatitis worsens with pruritus and excoriation. Monitoring control of
symptoms aids resolution.
Avoiding the irritating agent can prevent recurrence. Controlling symptoms
can prevent scratching, thus avoiding further
Uncontrolled pruritus and excoriations cause infection and scarring.
Psychological problems (e.g., anxiety, anger, self-esteem) may occur. Ocular
complications that may occur with atopic dermatitis include
With causes of irritation removed, excoriation controlled, and no secondary
infection, inflammation can be resolved without scarring. The disease can
progress to being self-perpetuating and chronic. Atopic dermatitis cannot be
cured, but symptoms and appearance can be controlled. Compliance with treatment
ensures a more successful prognosis.
Types of pregnancy-induced dermatitis include pemphigoid gestationis,
polymorphic eruption of pregnancy, prurigo of pregnancy, and pruritic
folliculitis of pregnancy. Symptoms usually clear postpartum. Pemphigoidal
gestation is associated with a risk of premature births and low birth weight;
however, there is no correlation to spontaneous abortion or fetal mortality.
High-risk drugs during pregnancy and lactation include isotretinoin,
antineoplastic agents (e.g., methotrexate), antipruritic medications (e.g.,
doxepin), antibiotics (e.g., tetracycline, ciprofloxacin), and nonsteroidal
anti-inflammatory drugs. Analgesics and topical corticosteroids (except
povidone-iodine and podophyllin) are lower risk drugs during pregnancy, and
penicillins are comparatively safe antibiotics. Maternal antigen avoidance diets
do not reduce the risk of giving birth to an infant with atopic dermatitis and
may adversely affect fetal birth weight.
High doses of vitamin A are contraindicated during pregnancy. Nutritional
support, rose hips tea, and topical herbal applications are safe, supportive
treatment of dermatitis in pregnancy.
Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace
Habif TP. Clinical Dermatology. 3rd ed. St. Louis, Mo: Mosby-Year
Middleton E, ed. Allergy: Principles and Practice. 5th ed. St. Louis,
Mo: Mosby-Year Book; 1998.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:29, 326, 394.
Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB
Saunders Co; 1998.
Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango,
Colo: Kivaki Press; 1994:36.
Schulpis KH, Nyalala JO, Papakonstantinou ED, et al. Biotin recycling
impairment in phenylketonuric children with seborrheic dermatitis. Int J
Stewart JCM, et al. Treatment of severe and moderately severe atopic
dermatitis with evening primrose oil (Epogam): a multi-center study. J Nutr
Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
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instructions for individual patients. The publisher does not accept any
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