Dermatitis

Dermatitis

Dermatitis is a medical term used to refer to skin inflammation which can range from being mild to being severe and can be caused by quite a lot of entities. ^[1] There are several categories including contact, nummular, atopic, seborrheic and stasis type. ^[2]

Types            

Contact dermatitis, classified as allergic or irritant type, is a skin inflammation caused by contact with a substance to which the body undergoes a subsequent reaction. Irritant type is the more frequent form which is commonly caused by industrial chemicals and cleaning products utilized in the household.  

The nummular type is typified by classic coin-shaped red plaques usually occurring on the extremities. More women are affected and one of the risk factors identified is living in dry environment.

Atopic dermatitis also called eczema usually tends to run in families and causes skin itching, swelling, scaling and at times blistering. Allergy, asthma and stress are also being linked to this class of dermatitis.

Seborrheic type is characterized by oily, yellowish, or reddish scaling. The lesions are typically found on the scalp or face. The scaling can also be seen under the breast or on the genital areas. In infants, the condition has been associated to fluctuations in maternal hormones.

Stasis dermatitis is brought about by poor circulation resulting to blood pooling and fluid accumulation consequently leading skin irritation particularly in the ankles. ^{[2] [3]}

Symptoms

Symptoms may include skin itching, swelling, blistering or scaling. Some may experience pain, stinging or burning sensation on the area. ^[5]

Diagnosis

The patient’s history may give the physician a clue to arrive at the diagnosis. A physical examination is performed which includes skin inspection. Patch testing may be performed. ^[4]

Treatment

Treatment depends on the type. When the type could not be determined, general measures can be done including maintaining skin moisture and lessening itchiness and scratching by using antihistamines. Irritating substances like harsh soaps and perfumes should be avoided. Among the drugs that are often prescribed for eczema are hydrocortisone creams and topical calcineurin inhibitors. Medicated shampoos are frequently given for cases of seborrheic dermatitis. When there is infection, antibiotics may be given. ^{[5] [6]}

References:

1. http://www.clevelandclinic.org/health/health-info/docs/0000/0066.asp
2. http://www.webmd.boots.com/skin-problems-and-treatments/guide/dermatitis
3. http://www.emedicinehealth.com/contact_dermatitis/page2_em.htm#contact_dermatitis_causes
4. http://www.mayoclinic.com/health/dermatitis-eczema/DS00339/DSECTION=tests-and-diagnosis
5. http://umm.edu/health/medical/altmed/condition/dermatitis
6. http://dermatology.about.com/cs/eczemadermatitis/a/dermatitis.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Pau D'Arco (Lapachol, Tabebuia Impetiginosa, Tabebuia Heptaphylla) [1, 10]:

Please note, this treatment has potentially serious side effects. Some of the chemicals in the plant are known to be toxic. High doses are known to cause liver and kidney. Even at low doses, chemicals in the plant may interfere with blood clotting, causing excess bleeding and anaemia. Pau D'Arco should be avoided, especially by pregnant or breastfeeding women.

Recommendation: Strongly against (There is insufficient evidence to support claims that Pau D'arco helps to treat dermatitis. This, combined with its potentially harmful side effects if taken without supervision from a doctor or pharmacist gives enough reason to avoid this treatment.)

Grade of Evidence: Very low quality of evidence

Mugwort (Artemisa Vulgaris) [1, 7, 8, 9]:

Please note, this management does NOT treat the condition itself. It has been proposed only as a weak supportive symptomatic support, and even then, has been discounted due life-threatening side effects

Recommendation: No recommendation (There is insufficient evidence to support claims that mugwart helps to treat symptoms of dermatitis. More research is needed.)

Grade of Evidence: Very low quality of evidence

Evening Primrose Oil  [1, 4, 5, 6]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation  (Available evidence does not support claims that primrose oil can help with dermatitis. Studies have shown conflicting results)

Grade of Evidence: Low quality of evidence

Chamomile (Matricaria Chamomilla) [1, 2, 3]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: Weakly against (Available evidence does not support claims that Chamomile helps treat dermatitis. In addition, allergic reactions and side effects like cramps, itching, rashes and difficulty breathing can be relatively common)

Grade of Evidence: Low quality of evidence

Black Walnut (Juglans Nigra):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Available evidence does not support claims that Black Walnut helps to treat dermatitis)

Grade of Evidence: Low quality of evidence

Arnica Root (Arnica Montana):

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (available evidence shows that Arnica is in no way helpful in the treatment of dermatitis)

Grade of Evidence: Moderate quality of evidence

Hyperbaric Oxygen Therapy (HBOT):

Recommendation: Strongly against (available evidence shows that HBOT is in no way useful in treating Staphylococcal Scalded Skin Syndrome, and can have harmful effects. NOT RECOMENDED)

Grade of Evidence: Low quality of evidence

Heat Therapy:

Recommendation: Weakly against (there is scant evidence that heat therapy may help speed healing in skin infections, however more research is needed, and there are possible harmful effects to heat therapy being used without supervision by a qualified physician)

Grade of Evidence: Low quality of evidence

Cannabis (Marijuana):

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that cannabis is able to help treat dermatitis)

Grade of Evidence: Very low quality of evidence

Flax Seed Oil [11]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that flax seed oil is able to help treat dermatitis)

Grade of Evidence: Very low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.abchomeopathy.com/r.php/Cham

3. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html

4. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/evening-primrose

5. http://nccam.nih.gov/health/eveningprimrose/

6. http://news.bbc.co.uk/2/hi/health/4395826.stm

7. Anliker MD, Borelli S, Wüthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis. 2002;46:72-74.

8. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/mugwort

9. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

10. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pau-d-arco   

11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC227015/

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