The terms dermatitis and eczema are used for a variety of inflammatory allergens, and other factors. Characteristically, the skin changes consist of reddening’s swelling, moist “weeping,” and mild to severe itching. Later stages exhibit scaling with crust formation and eventual scarring. Several types are described below.

Contact Dermatitis

Skin changes in this category of inflammation start in areas of contact with the irritating or allergy-producing agent. The reaction is usually localized, and limited to the area of exposure. There are two main types. Primary or toxic dermatitis may occur in any individual without prior exposure.

The allergic type occurs only in sensitized individuals. Some of these will be considered in the next chapter. Substances that contact the skin and produce this rash are found in clothing, soaps or detergents, cosmetics, industrial chemicals, or the outdoor environment.

An example of the latter is the distressing rash produced by poison ivy, poison oak, and poison sumac. The causative agent is a plant resin, called urushiol. Certain exotic hardwoods resins, and the sap from the mango tree can produce a similar rash.

Formalin and certain flame-retardant chemicals may be impregnated in garments and cause the same rash described above. Occupational dermatitis may be due to cement (chromics) in bricklayers, to wheat in bakers, to adhesive tape, anesthetics, sunscreen lotion, and many other substances.

Most important, first eliminate the offender as soon as it can be identified. Then apply soothing lotions to relieve the itching and prevent further spread. Needless to say, it is imperative to avoid scratching these lesions or otherwise irritating them during the healing phase.

Seborrheic Dermatitis

Areas of the body richly supplied with sebaceous glands may develop this skin condition. Scaly, somewhat greasy material is produced, which can vary from the dandruff of scalp involvement to the cradle cap seen on babies. Redness around the face is common, with specific involvement of the eyebrows, scalp, and other areas rich in oil glands.

Dietary changes to reduce the fat intake in conjunction with adequate sun exposure, frequent shampooing, reduction of stress factors, and improvement of skin hygiene are all important in relieving these conditions.

Atopic Dermatitis

Called at times infantile eczema, this condition typically begins early in life. Usually there is a strong family history of various allergic conditions. Dryness, cracking, and scaling produces the characteristic lichen-like (lichenification) appearance that is the hallmark of atopic eczema.

The disease reaches its maximum severity during the second and third decades of life, then gradually subsides. Each episode starts with violent attacks of itching, probably related to excessive dryness of the skin. These attacks frequently occur at night, and provoke furious scratching, which often leads to infection.

Treatment is difficult in this chronic condition. It is important to avoid measures that produce excessive drying of the skin, such as harsh soaps, frequent washing, or scratching involved lesions. Special nondrying soaps, such as Neutrogena, or Cetaphil lotion can be soothing.

Reduction of all known stress factors careful examination of the diet, and general habits of temperance are important to control this troublesome condition. The itching can often be relieved temporarily with the use of a moist oatmeal paste applied to the skin. Aveeno baths are also beneficial in this regard. The challenge of eczema is well worth further study for physicians or families interested in granting relief for these highly visible problems.

Psoriasis

Psoriasis is a common, chronic and recurrent disease of the skin. It affects people of both sexes and is most frequently seen from youth to middle age. Typical lesions appear commonly on the elbows and knees, as well as the scalp and the lower part of the back. These patches may be thick and tough.

In early stages they are red with a dry, silvery scale. Coin-shaped lesions are common. Scrapings of the scales resemble scrapings of a candle. In acute stages of psoriasis the characteristic lesions may develop in areas irritated by scratching or from contact with other nonspecific irritants.

The nails may be involved and are usually pitted. Occasionally, psoriatic arthritis is seen in conjunction with this rash. Tension and stress in the home, tobacco usage, and a diet high in fat, greasy foods and particularly meat will aggravate the condition. Sedentary indoor workers may carry these lesions for years.

Sunlight, especially the natural ultraviolet rays, has been very helpful in treating psoriasis. Most lesions gradually clear where exposed to the sun. Even severe scalp involvement may respond if the hair is cut short. Although steroids, such as Cortisone, are often used in treatment of psoriasis, the side effects are such that I advise real caution.

A mixture of lanolin, zinc oxide paste, and Burroughs’ solution (see Appendix) helps soothe the irritated, inflamed areas. Toxic mineral elements, such as mercury and arsenic or the use of coal tar are all quite irritating and should usually be avoided. With a combination of hygienic remedies, careful diet, and a liberal use of sunlight, this difficult condition can be improved and in many cases arrested.