Dermatitis

The skin works as a barrier between the body and the environment. This barrier is made of the cells of the horny layer and of the lipids between them, which hold water in the skin and keep out irritants, allergens and microbes. In dermatitis the barrier is defective: the skin loses water, becomes dry and permeable to external factors, and the immune system within the skin responds with inflammation. The result is the characteristic vicious circle — dry skin causes itching, scratching damages the barrier further, and the inflammation intensifies.

Who is affected. Dermatitis occurs at any age. Atopic dermatitis most often begins in the first years of life and may improve at puberty, but it can persist or return in adulthood. Contact dermatitis is common in adults, especially in occupations involving exposure to water, detergents, metals, cement, paints or cosmetics. Seborrheic dermatitis affects infants in their first months and then adults, more often men.

The main forms.

• Atopic dermatitis (atopic eczema). It has a genetic background and is often associated with asthma, allergic rhinitis or food allergies in the family. It shows as red, dry, intensely itchy patches, located on the cheeks and scalp in infants and later in the creases of the elbows and knees, on the neck and at the wrists. It runs in flares, with quieter periods in between. Prolonged scratching leads to thickening of the skin, known as lichenification.
• Irritant contact dermatitis. This is caused by the direct action of a substance that damages the skin barrier — detergents, solvents, excessive water, disinfectants. It does not involve an allergic reaction and can occur in anyone if the exposure is intense or repeated enough.
• Allergic contact dermatitis. This is a delayed immune reaction to a substance to which the patient has previously become sensitised: nickel, chromium, fragrances, preservatives, rubber, dyes, certain plants. The lesions appear 24 to 72 hours after contact, often with an outline that reproduces the shape of the object or of the area touched.
• Seborrheic dermatitis. It affects areas rich in sebaceous glands: the scalp, eyebrows, nasolabial folds, ears and the mid-chest. It shows as redness covered by greasy, yellowish scales. It is linked to sebum secretion and to commensal yeasts of the Malassezia genus, normally present on the skin.
• Nummular dermatitis presents as round, coin-shaped patches, often on the limbs, on a background of dry skin. Stasis dermatitis appears on the lower legs in people with chronic venous insufficiency, through swelling and pooling of blood.

Causes and risk factors:

• Genetic predisposition and defects of the skin barrier.
• Repeated contact with irritants or with contact allergens.
• Dry, cold weather, air conditioning and overheated homes.
• Excessive washing, very hot water and alkaline soaps.
• Stress and disturbed sleep.
• Superimposed skin infections, especially with staphylococcus.

What makes dermatitis worse:

• Scratching and rubbing the affected area.
• Wool or synthetic clothing worn directly against the skin.
• Heavy sweating and tight clothes.
• Sudden changes of temperature.
• Continuous use of products containing fragrance, alcohol or irritant preservatives.

Dermatitis is not contagious. Its course is usually chronic and marked by flares, and identifying each person’s own triggers — occupational, dietary, environmental — is part of the assessment of every case.

In our practice, dermatitis is addressed through the Kozak Method — internal and external treatment, individually tailored, following a consultation. Results differ from patient to patient.