Atopic Dermatitis usually occurs in individuals who have a personal or family history of Atopy or Atopic Diseases, such as hay fever, asthma, eczema, hives, bee sting allergy, latex sensitivity, food allergy, multiple medication allergy, etc. In infancy, atopic dermatitis may be precipitated by food allergy and can affect generalized areas of the face, torso, and extremities. Later in childhood the eczema may be localized to the face or flexor creases of the arms and legs. Some patients “outgrow” their eczema while in others it is a lifelong, incurable, but usually controllable condition.
Contact Dermatitis usually results from a chemical irritant, eg. excess exposure to soap and water, or a substance which produces a true allergic reaction, such as the nickel in earnings or fragrances. Poison ivy grows along many Montana rivers and is a common cause of severe allergic contact dermatitis in the summer. Occasionally patch testing is performed to identify the source of allergic contact dermatitis.
Dyshidrotic Eczema often presents as intensely itchy blisters between the fingers or toes. In many patients stress is a precipitation factor.
Neurodermatitis is caused by an itch-scratch-cycle involving localized areas of the skin, such as the nape of the neck, arms, or legs.
Nummular Dermatitis literally means “coin-like” patches of rash in a generalized distribution. Although dry skin is a common cause, occasionally “internal diseases” can be associated with this type of eczema.
Seborrheic Dermatitis is an itchy condition characterized by redness and scaling of the scalp, ear canals, central face skin, eye lashes, or chest. It probably represents a “sensitivity” to a normal yeast found on all human’s skin. It is made worse by stress or neurological conditions, such as Parkinson’s disease or stroke. Seborrhea is a chronic and incurable condition but it can be controlled with medicated shampoos, cortisone salves, or anti-fungal medications.
Stasis Dermatitis occurs from poor circulation in the lower extremities. Red or brown scaly and itchy areas develop on the shins and ankles. In people with varicose veins, chronic leg ulcers can develop.
Generally speaking, the various types of eczema can be controlled with topical cortisone creams plus emollients. Rarely expensive immunomodulators such as Protopic or Elidel are needed to control difficult cases of eczema.
Psoriasis causes red, scaly patches on the scalp, torso, and extremities in approximately 3% of the population. 30% of patients with psoriasis have a positive family history and 10-20% have co-existent psoriatic arthritis. Psoriasis is caused by a defect in the immune system which allows tumor necrosis factor to cause excessive skin turn over. Localized psoriasis is easily controlled with topical cortisone ointments, tar ointments, topical vitamin D-3, or UV light treatments. Widespread psoriasis is best controlled with systemic medication such as methotrexate or injections of “biologicals” such as Enbrel.
Urticaria or Hives
20% of the population develops urticaria (itchy welts or hives) or angioedema (itchy red swelling of the face, hands, or feet) at some point in live. Red itchy welts affect widespread areas of the body and usually fade after a few hours, but appear in new areas in cyclic patterns. This is an “internal allergy” caused by a circulating complex molecule, e.b. penicillin, peanut protein, or a viral particle, which causes the blood vessels in the skin to dilate and leak serum into the skin or deeper tissues. Most cases of acute urticaria are caused by a new food, medication, or a viral infection, This type of hives clears within 4-6 weeks. Chronic urticaria by definition lasts more than 8 weeks and rarely my last for years. Most cases of chronic urticaria have no specific cause despite any amount of laboratory testing. In some patients stress is the cause of this type of hives. Other patients have physical urticaria such as dermatographism (hives produced by skin stroking or writing). Other people have physical urticaria produced by vibration, pressure, exertion, or exposure to cold. Topical medications have no effect on hives. Oral antihistamines, cortisone, and other medications are needed to “break the cycle” of hives.
This is an autoimmune disease caused by defective regulation of the immune system allowing self – or auto – antibodies to attack normal tissues such as the skin, joints, or internal organs. Discoid lupus is the most common category of lupus seen in dermatology. Red, scaly, burning or scaring lesions develop on the scalp, face, or arms as a result of sun exposure. Topical cortisone creams and an antimalarial drug, Plaquenil, provide effective control. Systemic lupus is less common, more serious, and can affect internal organs such as the brain, heart or joints.
Rosacea occurs in adults and starts as “easy blushing” or persistent facial redness. As the disease progresses, pimples develop over the nose and central face. In severe, untreated, cases disfiguring nasal enlargement, the so-called W.C. Field’s nose or rhinophyma, can develop. Trigger factors for rosacea include alcohol, hot beverages, spicy foods, and sun light.
Acne usually starts in the early teens with plugged pores on the central face. As the condition progresses pimples and larger cystic nodules can develop over the face, back and chest. Mild acne can be controlled with topical products. More advanced, potentially scarring acne requires treatment with oral antibiotics, hormone manipulation in women, and in extreme cases oral Accutane.