Hints & Info

  We all have dry skin from time to time. This is completely normal, as our skin has to cope with a lot of influences during the day. Usually the skin recovers quickly, so we don’t pay much attention to smaller irritations. But sometimes the skin problems occur so often or continue for such a long time that we feel disturbed and constrained by them. Such skin problems, often simply described as “dry skin”, can lead to the so-called dermatitis.

Skin that appears dry is just one symptom of dermatitis, however. Dermatitis is an inflammation of the upper skin layers and can produce itching, small blisters, fine fissures and skin swelling. These symptoms can, of course, be very troublesome and disturbing, and skin problems of that type can have a serious impact on your career choice and your personal contacts.

More Info here: Definition and Consequences.

A number of people have inherited the predisposition to develop dermatitis from their parents, but they don’t occur to the same extent in all affected people. Dermatitis can also result from various internal and external causes, for example substances one has contact with, or an allergy.

More Info here: Origination and Myths.

For this reason, it is a good idea to become active before your skin problems become serious. The more you know about the causes of and remedies for dermatitis, the better you can do something to take care of your skin. Important activities are to avoid irritating substances and allergic triggers, to apply optimal skin care and skin protection measures and to receive specific medical treatment.

More Info here: Protection and Treatment

Nobody has to endure dematitis passively. There is a lot you can do to avoid this skin condition or at least ease it remarkably.

Definition

Many of you will have heard or read the term “dermatitis/eczema” in magazines, television or internet. But most people are not sure what this word exactly means.

Dermatitis is very often related to itching and dry skin, but can show a range of other symptoms as well.

 

    Dermatitis is an inflammation of the upper skin layers. The inflammation leads to the appearance of small blisters, which are itching and are visible as small red dots. If these blisters become or are scratched open, a clear fluid – lymph - is discharged. After that, the skin dries out and scales off.  

If you examine your hands thoroughly, you may find some areas with the described skin condition. These “mini dermatitis” are usually not very troublesome, but they may start to trouble you when larger skin regions are affected.

Here you find a few images of forms of dermatitis for illustration:

The hands are frequently affected, as they are exposed to a high number of different strains. This is not astonishing if you imagine what your hands touch during the day! In the morning, you wash your hands and use water, detergent and a towel. Then you prepare and eat your breakfast, touching plates, cutlery, bread, cheese, milk, cereals etc. If you go to school by bicycle, you get in contact with your keys, the metal of your bicycle, the leather or plastic of your school bag; and at school you’ll touch paper, pencils, books etc.

Dermatitis can occur at any age. In babies, it tends to appear in the face, in working people on the hands, and in older people the skin of the body is often generally dry and shows some changes in skin condition.

Consequences

Dermatitis can be experienced as more or less troublesome. That depends on the seriousness of the medical condition. If you just have a slight itching at the earlobe combined with a light reddening, you will probably not pay much attention. If you have serious skin lesions with oozing wounds, strong itching and swellings, this will be quite different.

The afflictions can be rather constrictive. Reddening and itching can persist for a long time. The longer the problems persist and the stronger the sensations are, the more you will feel restrained in your normal life.

Dermatitis can appear on all parts of the body and will cause uncomfortable sensations. On body parts visible to our environment (hands, face) or used in our everyday life (hands), the impairment will feel especially strong. Above all, our hands are very important tools to get in contact with the rest of the world.

For illustration here are images of dermatitis on different parts of the body:

Hand dermatitis is particularly unpleasant. In addition, we cannot really hide our hands under our clothing. This would look quite unusual. Therefore, our skin lesions are visible to everyone. More information...

Hand dermatitis

If the skin of the hands is swollen, irritated or thickened and cracky, the skin nerves located under these skin parts cannot take in the signals of touch or only in a changed form. You may have a sensation of having a layer of dry soil to be glued to your hands. As this dry layer is not elastic, you will not be able to move your fingers well, neither can you really feel anything if you touch objects.

When a person has stronger skin problems, he or she avoids direct skin contact to other people. If you touch someone (e. g. when shaking hands), the dry hand feels like a grater. That is the reason why skin contact to friends and other contacts are often avoided without any other necessity.

 

 

Origination

Human skin is very robust, but also very sensitive. It reacts to external factors like heat, cold, dirt, and to internal factors, like stress, food and illnesses.

Everybody may react differently to these trigger factors, and a part of this reaction is inherited from one’s parents. If the barrier function of the skin is impaired, dermatitis can develop, depending on the personal and genetic disposition. Dermatitis can also be related to allergies.

The following factors contribute to the development of dermatitis:

Internal (endogenous) triggers
The way our skin feels, healthy or ill, depends among other things onto processes, that happen inside our body. Those processes also influence the development of dermatitis.

The development of dermatitis may for example be influenced by genetic factors; it can befamiliy-related. Furtheron dermatitis may also be affected due to our wellbeeing (e.g. fear, stress) or an illness like a flu.

For more information about the internal triggers that may cause dermatitis just see the following Abschnitt.

Genetic factors. More...

The genetic predisposition to react to the various dermatitis triggers plays an important role.

If someone has a genetic (inherited) disposition to show dermatitis, this is called “atopy”. Dermatitis that develops in this situation is called "eczema" or “atopic eczema.

Many people have this disposition unknowingly. Besides the increased probability for eczema, it also increases the probability to develop so-called atopic diseases, e. g. hay fever. The inflammations can also change location and move from the skin to the respiratory tract (asthma) or other mucous membranes (running nose, irritated and streaming eyes).

Eczema

Eczema (or atopic eczema) is a specific congenital form of dermatitis which reacts to specific triggers that do not play an important role in other forms of dermatitis.

(Atopic) Eczema is related to strong itching and usually comes in bouts. The nerves have an important part in eczema. Firstly, the itching is reported to the brain by the nerves, as is the case with pain. Secondly, eczema has also a lot to do with our mind. In eczema, all body regions and all ages can be affected. The inflammatory reactions are usually not based on an allergy but result from different causes. From its appearance, it is very difficult to distinguish between eczema and other forms of dermatitis (e. g. allergic contact dermatitis or irritant contact eczema).

Mood. More...
The skin is subject to constant changes. Many body functions have a remarkable impact on the skin condition and on this replacement scheme.

Among these body functions are for example the menstrual cycle in girls and women, the hormonal metabolism in general, developments like ageing, which is related to the loss of elasticity of the skin, and individual events like infections and stress. All these factors trigger the discharge of substances within the body, their transport to the skin by the blood circulation and the skin’s reaction to this.

These inner factors can be especially important for the course of eczema. More...

Eczema and the mind

The main triggers in eczema are of endogenous (internal) character. Among them, the mind is the most important factor, that means our mental wellbeing. Mind and eczema can influence each other in a “vicious cycle”.

Effects of the mind on eczema

Every kind of mental stress can have an impairing influence on the skin. Mourning a break-up, homesickness, exam nerves, a job interview, conflicts with friends – all this can suddenly cause itching. This reaction can be explained as follows: our nervous system influences the immune system, which causes an intensified inflammatory reaction.

Effects of eczema on the mind

Just as our mind has an impact on eczema, eczema also has an impact on our mind. During an acute episode, the skin discharges inflammatory substances (“mediators”) that travel through the blood system into the central nervous system (brain, spinal cord). During an episode people suffering from eczema may therefore be particularly sensitive, irritable and restless.

The inner restlessness that may accompany strong itching may lead to lack of sleep. This increases irritability and the capability to deal with stress goes down: small events can lead to tensions and aggravate the condition. The lack of sleep can lead to reduced concentration at school and work and reduce performance, which causes additional potential for conflict.

Changes in visible parts of the body, especially in the face, can have negative consequences: the reaction of the people around you (curiosity, astonishment, sympathy etc.) can lead to social withdrawal. Looking into the mirror can become a nuisance. Patients can be seen as principally introverted, withdrawn or little outgoing, while this behaviour has nothing to do with their general personality but is simply caused by their health condition. Eczema can literally “work on your nerves".

 
 External (exogenous) triggers

The condition of our skin is also influenced by external triggers which are also able to evocate dermatitis. Those triggers include beside climatic conditions (heat, Cold, dry and humid air) mainly different substances which may get in contact with our skin.  

Concerning substances that provocate dermatitis one makes a difference between (strongly) irritation substances and allergens which cause allergies.

For more information about external triggers causing dermatitis read the following paragraphs.  
Skin irritation substances. More...
The external world challenges our skin permanently as well.

Long-term cycles like the seasons of the year or short-term factors like the contact with irritating or drying substances (intensive contact with water, chemical substances like solvents, permanent wave) can change the skin condition remarkably and trigger dermatitis. In this case, the genetic factor is not predominant. A dermatitis that is caused strongly by irritation and abrasion or wearing is called irritant contact dermatitis.

Irritant contact dermatitis (subtoxic cumulative dermatitis)

Irritant contact dermatitis is neither triggered by an allergy nor does genetic disposition play an important role.

The term “wearing dermatitis” explains a bit better what the cause of this skin condition is. Contact dermatitis develops when the skin is irritated by an aggressive substance. With a certain dosage and exposure time, any person would develop contact dermatitis. “Subtoxic” means that the substance is not strongly irritating for the skin (= “toxic”) but only “slightly irritating”. “Cumulative” expresses that the frequent (=cumulative) contact with a substance causes the skin condition.

The most frequent trigger substances for subtoxic cumulative contact dermatitis are water, soap, shampoo, cleaning substances, acids, bases and solvents. A mechanic skin irritation like rubbing can aggravate a skin lesion additionally. Affected by this type of dermatitis are especially persons that have to deal regularly with skin irritating substances, e. g. in the household, in the medical field by regular hand washing, and hairdressers.

As it is often not easy to classify dermatitis according to its appearance, it may become necessary to do some allergy testing. In addition, the skin irritability can be tested by bringing a slightly irritating substance onto the skin and observing the reactions.

Therapy includes the reduction or avoidance of contact with the irritating substances, careful skin care and, if necessary, the use of protective gloves in certain activities.

Allergies. More...

Allergies

Allergies form a very specific form of influence on the skin condition. The number of allergies has strongly increased in the past decades.

Allergies are skin reactions to natural substances (polls, cat hair, latex) or artificial substances (hair dyes, soap). As soon as the immune system has become contact with the substance classified as alien, e. g. when inserting an earring into the earlobe, a chain reaction is unleashed: as defence against the intruder, the skin area swells and reddens.

Specific allergies are not inherited, but what you may inherit is the increased risk to acquire allergies in the course of your life. But the way your body reacts (which chain reaction it produces) is genetically determined. Allergies are a reaction that the body “learns” in the course of life. They can also change the location of reaction.

There is also one form of dermatitis which is basically caused by an allergic reaction: so-called allergic contact dermatitis .

   

Medical scientists differentiate between an immediate reaction type and a late reaction type. The names indicate that, in the case of an immediate reaction type, the reactions occur immediately after contact with the allergen (e. g. hay fever), while in the late reaction type they occur some time after the contact (hours to days).

Allergic immediate response (type I allergy)

The allergic immediate response (type I allergy) is the prototype of an allergic reaction.

It appears seconds to minutes after contact with the allergen. The triggers are mostly natural substances. Typical examples for this allergy type are hay fever (running nose), allergic asthma (dyspnoea, coughing) and the anaphylactic shock following insect bites (anaphylactic reactions).

The most frequent trigger substances in the immediate allergic reaction type are grass and birch pollen, house dust mites, mould and cat's hair.

Type I reactions can be determined by a prick test, laboratory tests and a thorough evaluation of the patient history. In a prick test, the suspected trigger substance is placed onto the skin and the skin is slightly pricked. The response is controlled after 20 minutes.

Allergic late response type (type IV allergy)

The allergic late response type (type IV allergy) is the cause of contact allergies of the skin.

This type is a reaction to substances that get in contact with the skin directly (e. g. nickel in jewelry; cosmetics), by the air (perfume, fragrances, solvents), or by oral intake through the blood system (medication). In type IV allergies, the reactions appear only after hours to days.

Type IV reactions are determined by a so-called “patch test”. The suspected trigger substances are placed in very low concentrations on the back of the patient under a plaster. After 2 to 3 days the doctor controls if dermatitis has developed.

Allergic contact dermatitis

The allergic contact dermatitis is usually the result of a type IV allergy (allergy of the late reaction type).

The immuno-competent cells must have had contact with the triggering substance at least once. When an allergy develops (this is called “sensitization”), specific immuno-competent cells “save” the “data” of this substance and define it as dangerous for the body.

As soon as the body, after this sensitization, gets exposed to this substance again, the substance is identified on the base of the “saved data” and the defence reaction is initiated.

The consequence is allergic contact dermatitis with reddening, blisters and itch. Such an allergy usually develops in the course of years. In exceptional cases, a sensitization can also emerge within 7 to 10 days. Important to know: the “data storage” will never be emptied again in life; an allergy will persist for the rest of your life.

These are the most frequent trigger substances for allergic contact dermatitis: metals (especially nickel, very often contained in costume jewellery, metal buttons, belt-buckles, belt-eyes etc., then cobalt and potassium-dichromate), additives used in rubber production, cosmetics (fragrances, additives), medicines, disinfectants, e. g. formaldehyde, epoxy resin (e. g. used in the plastics and electrical industry).

With the start of a vocational career, occupation related substances start to play an important role. In children and adolescents, an increasing number of allergies to henna tattoos can be found nowadays. The trigger substance is not the henna itself but p-Phenylenediamine (PPD), a chemical colouring substance that is often added to the henna to increase colour intensity and stability.
 

 

Myths

The less we know about diseases and health problems, the more insecure we feel in dealing with them. In addition, there are a lot of myths about dermatitis which we should know to find our way when looking for information and help:

Dermatitis is not infectious. It cannot be transmitted from an affected body area (e. g. the hands) to a healthy body area (e. g. the face) by touching. And you can’t get it by handshaking with someone who has hand dermatitis. If you have dermatitis, you don’t have to fear that you might transmit it to other people; dermatitis does not work this way.

Even less is poor skin hygiene the reason for dermatitis. On the contrary – too intensive or wrong skin care can even cause it. If your skin gets in contact with water too intensively, the skin dries out, even when you add oily bathing or showering substances.

Dermatitis is not necessarily a chronic skin condition that you can’t get rid off any more. You may keep the disposition for dry skin for the rest of your life, but dermatitis disappears again very often or occurs in some situations and/or in specific body areas only.

Food is seldom playing an important role in the development of dermatitis in adolescents and adults. Some people react allergic to certain foods, and they will have to avoid these triggers in the future. If an “allergy vaccination” (desensitization) can be undertaken, the allergic reactions will diminish or completely disappear in the course of treatment.

Protection and treatment

Dermatitis tends to take a very varying development and rarely persists without phases of healing in between: that means, dermatitis occurs in bouts or episodes.

There are a number of possibilities to prevent the occurrence of dermatitis or to keep the inflammations as mild as possible. This is something everybody can do.

The measures must be chosen according to the causes and triggers of the skin condition on one side and according to the occurring skin problems on the other side.
Everyone who has dermatitis or wants to protect his or her skin against developing dermatitis can take several measures, and often it is a good idea to combine them.

Please find some hints below:

Avoid possible or already known trigger factors. More...
It is very important to avoid strong trigger factors. In most cases, it is easy to detect which influences dry out the skin..

The most frequent cause is water (washing, showering). That doesn’t mean, of course, that you shouldn’t wash any more. But it might be recommendable to reduce the frequency of water exposure and to use mild detergents. The water contact should also be as short as possible. For that reason, showering is encouraged more than bathing. The detergents should be chosen according to your skin type and condition. Please use only detergents that have about the same pH-value as the human skin (5.5 on the pH scale). They are called pH neutral detergents. This will avoid damage to the protective skin layer.

If you know your allergic triggers, please avoid them (e. g. costume jewellery). For many triggers this is possible, but for others you may need professional support (physician, nutritionist) to be successful.

Apply adequate skin cleaning and skin care. More...
If you already have dermatitis or want to avoid getting it: adequate skin cleaning and skin care are important measures to keep your skin healthy and to alleviate the consequences of skin problems.

Intensive water exposure makes the skin dry and can lead to dermatitis. Therefore it is recommended to avoid intensive water exposure (e. g. bathing for longer than 15 minutes). Shorter water exposure is to be preferred (e. g. showering).

Additives with a slight conditioning and moisturizing effect lessen the drying-up of the skin produced by water contact. It is a good idea to use conditioning products with as few ingredients as possible, to reduce the possibility to become allergic to or irritated by one of them.

The best choice in skin cleansing products are mild synthetic detergents. Their pH value should be around 5.5, corresponding to the pH value of the human skin, to avoid damage of the protective skin barrier.

It is important to use skin cleaning and care products you feel comfortable with: you should find them relaxing to your skin and notice a reduction of your itching or skin dryness.

And they should be adequate to your skin type and condition, especially regarding their fat content: in summer and with warm weather, highly greasy products are usually experienced as uncomfortable, the skin feels clammy and “closed” then. In winter, when the heating dries up the air anyway, greasy ointments can be much more welcome.
Take care of your dermatitis. More...
Has dermatitis occurred anyway, there are various substances available to soothe the skin.

Beside the pharmaceutical agent, the lipid content of the cream or ointment is important. Oozing dermatitis prefer a treatment with a more fluid cream (lotion): it will cool the skin, take away the itch and stop the development of blisters and the discharge of lymph. In dry dermatitis, however, a fat cream (ointment) will make the skin more elastic again. The helpful pharmaceutical substances can be added to any kind of lotion or ointment. In this, it is important to observe not only short-term, but also long-term effects. Cold water may be nicely cooling and take away the itching for the moment, but in the long run it will dry out the skin even more: the afflictions are reduced for a short while and come back more strongly later.

Ask for professional help. More...
Dermatitis is a skin disease. Light dermatitis often heals without additional measures. But dermatitis that lasts for a longer time or appears frequently should receive professional treatment.

The physician will try to find out together with you, like a detective, the causes of your skin problems. As soon as there are some “suspects”, more detailed examinations and testings can be carried out. If you find the triggers of the dermatitis, you can take measures to deal with the skin problems in everyday life. Sometimes it is not possible or also not enough to avoid the triggers completely; in that situation there are a number of other measures that can be taken to bring the dermatitis to a quick healing. These measures will be adapted to your skin condition and your personal situation.

To be avoided: scratching! More...
It is very important to prevent drying-up of the skin. When your skin itches, please don’t scratch! The itching may cease for the moment when you scratch, but the scratching usually leads to lesions and wounds that will aggravate the situation.

Better beat or press lightly onto the skin with the palm of your hand. Wet packs should only be applied on skin that you have lotioned before, to avoid the skin to dry up. Heat often worsens the itch.

Be patient. More...
Be patient

Dermatitis can be rather annoying, as it often appears without warning and without a visible reason. The skin problems come quickly and take a long time to leave. This may be a hard strain on one’s patience. It is very important to keep to your treatment routine patiently. This will help you to be successful in getting rid of them again.

Don’t give up, but become an expert. More...
In the course of life, dermatitis appears in many people. There is no reason to bury one’s head in the sand.

There are a lot of things one can do to avoid dermatitis, and even when it occurs, you can learn to deal with the situation by applying adequate treatment and skin care measures. Many people with dermatitis become “experts” about their skin condition and know when to take which measures. And there is a lot of information to be found if one knows where to look for it.