Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Patients often come into my office frustrated, because they have changed their expensive soaps, detergents, fabric softener, shampoo, makeup, etc., yet their skin rash has not gone away. Their first question is, "Is this a rash, or eczema (dermatitis)?"
There are many types of
eczema. Atopic dermatitis, seborrheic dermatitis, contact dermatitis, allergic contact eczema, etc. The signs and symptoms of eczema vary depending on the type of eczema. The skin can be red, itchy, appear as scaly patches on the body, or patches of skin may be crusted, scaling, and very itchy.
So, can expensive soaps, detergents, make-up, fabric softeners, and fragrant soaps "cause" a rash, eczema, or aggravate an existing skin condition?
Atopic dermatitis is a very common, often chronic (long-lasting) skin disease
that affects a large percentage of the world's population. It is also called
eczema, dermatitis, or atopy. Most commonly, it may be thought of as a type of
skin allergy or sensitivity. The atopic dermatitis triad includes asthma,
allergies (hay fever), and eczema. There is a known hereditary component of the
disease, and it is seen more in some families. The hallmarks of the disease
include skin rashes and itching.
The word "dermatitis" means inflammation of the skin. "Atopic" refers to
diseases that are hereditary, tend to run in families, and often occur together.
In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing
redness, swelling, cracking, weeping, crusting, and scaling. Dry skin is a very
common complaint and an underlying cause of some of the typical rash symptoms.
Although atopic dermatitis can occur in any age, most often it affects
infants and young children. In some instances, it may persist into adulthood or
actually first show up later in life. A large number of patients tend to have a
long-term course with various ups and downs. In most cases, there are periods of
time when the disease is worse, called exacerbations or flares, which are
followed by periods when the skin improves or clears up entirely, called
remissions. Many children with atopic dermatitis enter into a permanent
remission of the disease when they get older, although their skin may remain
somewhat dry and easily irritated.
Multiple factors can trigger or worsen atopic dermatitis, including dry skin,
seasonal allergies, exposure to harsh soaps and detergents, new skin products or
creams, and cold weather. Environmental factors can activate symptoms of atopic
dermatitis at any time in the lives of individuals who have inherited the atopic
disease trait.
What is the difference between atopic dermatitis and eczema?
Eczema is used as a general
term for many types of skin inflammation (dermatitis) and allergic-type skin
rashes. There are different types of eczema, like allergic, contact, irritant,
and nummular eczema. Several other forms have very similar symptoms. The diverse
types of eczema are listed and briefly described below. Atopic dermatitis is
typically a more specific set of three associated conditions occurring in the
same person including eczema, allergies, and asthma. Not every component has to
be present at the same time, but usually these patients are prone to all of
these three related conditions.
Types of eczema
Contact eczema: a localized reaction that includes redness, itching, and burning where the
skin has come into contact with an allergen (an allergy-causing substance) or with an irritant
such as an irritating acid, a cleaning agent, or other chemical
Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact
with a substance that the immune system recognizes as foreign,
such as poison ivy or certain preservatives in creams and lotions like Neosporin or Bacitracin
Seborrheic eczema (also called seborrheic dermatitis or seborrhea): is a very common form of mild skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, ears, and occasionally other parts of the body. Often this is also called dandruff in adults or "cradle cap" in infants.
Nummular eczema: coin-shaped (round), isolated patches of irritated skin -- most commonly on the arms, back,
buttocks, and lower legs -- that may be crusted, scaling, and extremely itchy
Neurodermatitis: a very particular type of dermatitis where the person frequently picks at their skin, causing rashes. The underling cause may be a sensitivity or irritation which sets off a cascade of repeated itching and scratching cycles.
It may be seen as scratch marks and pick marks on the skin. Sometimes scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite)
may become intensely irritated when scratched.
Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems and congestion of the leg veins.
It may have a darker pigmentation, light-brown, or purplish-red discoloration from the congestion and back up of the blood in the leg veins.
It's sometimes seen more in legs with varicose veins.
Picture of stasis eczema on the leg
Dyshidrotic eczema: irritation of the skin on the palms of hands (mostly) and less commonly soles of the feet characterized by clear, very deep-seated blisters that itch and burn.
It's sometimes described as a "tapioca pudding"-like rash on the palms.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Swimmer's ear (external otitis) is an infection of the skin that covers the outer ear canal. Causes of swimmer's ear include excessive water exposure that leads to trapped bacteria in the ear canal. Symptoms include a feeling of fullness in the ear, itching, and ear pain. Chronic swimmer's ear may be caused by eczema, seborrhea, fungus, chronic irritation, and other conditions. Common treatment includes antibiotic ear drops.
What are noninfectious, common rashes localized to a
particular anatomical area?
Common, noninfectious rashes are listed below. Since these conditions are not caused by infectious organisms, it is reasonable to attempt to treat them with
over-the-counter 1% hydrocortisone cream for a week or so prior to seeking medical attention.
Seborrheic dermatitis: Seborrheic dermatitis is the single most common rash affecting adults. It produces a red, scaling eruption that characteristically affects the scalp, forehead, brows, cheeks, and external ears.
Atopic dermatitis: Atopic dermatitis, often called eczema, is a common disorder of childhood which produces red, itchy, weeping rashes on the inner aspects of the elbows and in back of the knees as well as the cheeks, neck, wrists, and ankles. It is commonly found in patients who also have asthma and hay fever.