Causes Of Dermatitis

A number of health conditions, allergies, genetic factors, physical and mental stress, and irritants can cause dermatitis.
Contact dermatitis results from direct contact with one of many irritants or allergens. Common irritants include laundry soap, skin soaps or detergents, and cleaning products. Possible allergens include rubber, metals such as nickel, jewelry, perfume, cosmetics, weeds such as poison ivy, and neomycin, a common ingredient in topical antibiotic creams. It takes a greater amount of an irritant over a longer time to cause dermatitis than it takes for an allergen. If you're sensitized to an allergen, just brief exposure to a small amount of it can cause dermatitis.
Neurodermatitis typically develops in areas where something, such as a tight garment, rubs or scratches your skin. This irritation may lead you to rub or scratch your skin repeatedly in that area. Common locations include ankles, wrist, outer forearm or arm, and the back of your neck.
Seborrheic dermatitis causes a red rash with a yellowish and somewhat "oily" scale. It's common in people with oily skin or hair, and it may come and go depending on the season of the year. It may occur during times of physical stress, travel or in people who have neurological conditions, such as Parkinson's disease. In infants, this disorder is known as cradle cap.
Stasis dermatitis can occur when fluid accumulates in the tissues just beneath your skin, and typically involves the lower leg. The extra fluid interferes with your blood's ability to nourish your skin and places extra pressure against the skin from underneath. Varicose veins and other chronic conditions that slow the return of venous blood in your legs often cause this fluid buildup.
Atopic dermatitis often occurs with allergies and frequently runs in families in which other family members have asthma or hay fever. It usually begins in infancy and may vary in severity during childhood and adolescence. It tends to become less of a problem in adulthood, unless you're exposed to allergens or irritants in the workplace. The exact cause of this disorder is unknown, but is likely due to a combination of dry, irritable skin together with a malfunction in the body's immune system. Stress can exacerbate atopic dermatitis, but it doesn't cause it.
Perioral dermatitis may be a form of the skin disorder rosacea, adult acne or seborrheic dermatitis, involving the skin around the mouth or nose. The exact cause is unknown, but makeup, moisturizers, topical corticosteroids or some dental products containing fluoride may play a role.
Parkinson's disease
Varicose veins
Asthma
Hay fever
Rosacea
Acne

American Academy of Dermatology Disagrees With Action Taken By FDA

The American Academy of Dermatology (Academy) has issued a statement in response to the U.S. Food and Drug Administration's (FDA) announcement that a black box warning will be added to the labeling and a medication guide will be distributed for the topical calcineurin inhibitors (TCIs), pimecrolimus and tacrolimus.
These topical medications effectively reduce the inflammation and other symptoms associated with the skin disease eczema.
"The American Academy of Dermatology disagrees with this action taken by the FDA. We believe that the data does not prove that the proper topical use of pimecrolimus and tacrolimus is dangerous," said dermatologist Clay J. Cockerell, M.D., president of the American Academy of Dermatology. "Because these medications are applied to the skin, virtually none of it gets inside the body. It's not the same as taking a pill. These are valuable medications, and if used properly, they allow millions of our patients with eczema to live normal lives."
This past summer, the Academy held a conference to discuss the scientific, regulatory, clinical, and public concerns raised by this potential FDA action. The dermatologists, patients, pharmacists and immunologists participating in the conference reviewed the current literature and safety data for these medications. It was determined that the addition of a black box warning and medication guide was unwarranted and could limit access to TCIs, or limit treatment options if qualified patients decide not to use these medications based on fear of a malignancy risk.
"The health, safety and welfare of our patients being treated with these topical medications are of paramount importance to dermatologists," said Dr. Cockerell. "We are concerned that this warning will confuse and unnecessarily worry our patients. We urge patients to get the facts on how to appropriately manage their eczema from their dermatologist."

Eczema Treatment's Receive Black Box Warnings

The labels on two prescription creams to treat eczema will have to bear "black box" warnings of possible cancer risks. The Food and Drug Administration's action Thursday follows an agency advisory committee recommendation last February that Elidel cream and Protopic ointment carry the label warnings.
The new labeling also will clarify that the two drugs are recommended for use only after other prescription topical medicines have been tried by patients, the FDA said. The agency is also issuing a guide updating patients of its concerns.
A black box warning is the most serious type of warning in prescription drug labeling. The warning will be located lower on the labels of the two drugs than is typical, although a statement higher on the labels will refer to the risk.
"This is something that is a possible risk, is a long-term possibility and is something that still needs to be researched," FDA spokeswoman Susan Cruzan said.
As of October, the FDA has received reports of 78 cases of cancers, including skin and lymphoma, in patients treated with the two drugs, said Dr. Stanka Kukich, the acting director of the FDA's dermatologic and dental drug products division.
Novartis Pharmaceuticals, which makes Elidel, said in a statement Thursday that it remained confident in the safety and efficacy of Elidel.
"While Novartis believes this action is not substantiated by scientific or clinical evidence, Novartis has agreed to make the requested changes," the company said.
Astellas Pharma Inc., formed through the merger of Protopic maker Fujisawa Healthcare Inc. and Yamanouchi Pharmaceutical Co., said in a statement that its drug "is safe and effective when used in a manner consistent with its label."
"It addresses a theoretical risk — a potential risk, not a demonstrated link," Dr. Joyce Rico, vice president for medical sciences research and development at Astellas, said of the warning.
While the two manufacturers dispute whether there is a cancer link, the FDA felt it had to convey notice of the cancer reports to doctors and patients, said Dr. Julie G. Beitz, an acting director of one of the FDA's drug evaluation offices.
Along with the small number of cancers reported in both children and adults treated with the drugs, animal tests have shown an increase in cancer associated with the drugs, the FDA said last year.
No causal link between use of the drugs and cancer has been established, Beitz said.
The long-term safety of the drugs has not been established, according to the FDA. While both companies are studying that issue, the results may not be known for years, the FDA said.
Elidel and Protopic are applied to the skin to control eczema by suppressing the immune system.
The companies estimate that roughly 10 million people combined have used the two drugs.

Defining Urticarial Dermatitis

Urticarial dermatitis may represent a useful term for a subset of a reaction pattern designated most commonly as dermal hypersensitivity by pathologists. The term is not commonly used, and requires definition to determine whether it is clinically relevant.

To define urticarial dermatitis and distinguish it from other urticarial reaction patterns and to review the frequency with which dermatologists can recognize clinical settings that match the biopsy findings of urticarial dermatitis.

Retrospective analysis of clinical and/or histological diagnosis of urticarial dermatitis, applying strict histological criteria in a center using urticarial dermatitis as a diagnostic term in 190 archived reports.

Tertiary referral dermatopathology service reporting for dermatological practices in Sydney, Australia.

The correlation between clinical and histological diagnoses of urticarial dermatitis and alternate diagnoses was analyzed. The frequency of positive immunofluorescence findings for bullous pemphigoid was determined in a subset of patients with urticarial dermatitis in whom this test was ordered to exclude prodromal bullous pemphigoid.

Urticarial dermatitis was the histological diagnosis in at least 1 biopsy result in 148 patients, and matched the provisional clinical diagnosis in 49 (33.1%) patients. Urticarial dermatitis was the only diagnosis provided in 21 patients. The main alternate clinical diagnoses provided were early bullous pemphigoid or dermatitis herpetiformis (47 patients [31.8%]), dermatitis (39 patients [26.4%]), drug reaction (35 patients [23.6%]), urticarial vasculitis (24 patients [16.2%]), and urticaria (12 patients [8.1%]). In 91 patients with a clinical diagnosis of urticarial dermatitis, the histological diagnosis in at least 1 biopsy result was matched in 49 patients (53.8%); other histological diagnoses included dermatitis (21 patients [23.1%]), papular urticaria (12 patients [13.2%]), drug reaction (6 patients [6.6%]), and urticaria (3 patients [3.3%]). Review of 38 direct immunofluorescent results for prodromal bullous pemphigoid and a biopsy finding of urticarial dermatitis revealed only 3 positive results (7.9%).

Urticarial dermatitis seems to be a useful histological and clinical term for a subset of the dermal hypersensitivity reaction pattern. Although the clinical presentation is not restricted to a specific entity, eczema and drug reactions seem to be the most frequent clinical associations; and in a subset of patients, urticarial dermatitis remains as a recognizable reaction pattern. Urticarial dermatitis without eosinophilic spongiosis is not a reliable indicator for bullous pemphigoid, because the findings of immunofluorescence are often negative.

PMID: 16415383 [PubMed - in process]

Kiwi Can Relieve Dry Flaky Skin

Kiwi's complexion-soothing powers come from its high Vitamin C content: One kiwi contains 75 mg. or 95% of the recommended daily intake of vitamin C.
Vitamin C helps produce collagen, a protein in the skin's connective tissue that provides structural support, strength and resilience, explains S. Manjula Jegasothy, M.D., medical director of Miami Skin Institute.
To reap the full beauty beneficts of kiwi, he recommends consuming two kiwi fruits per day.

Contact Dermatitis And Thimerosal

Contact dermatitis is an inflammatory response of the skin to an antigen or irritant. Common allergens associated with contact dermatitis include, poison ivy, poison oak, poison sumac, nickel or other metals, antibiotics, topical anesthetics, detergents, cosmetics, perfumes, and other chemical substances.

Thimerosal is a preservative that is used in vaccines, topical medications, oils, and cosmetics.

According to various medical journals, such as the Archives of Dermatology and American Journal of Contact Dermatitis, thimerosal is considered one of the most common allergens in North America and worldwide. Recent studies have suggested that these reactions to thimerosal are of no consequence. A study in the medical journal Contact Dermatitis, examined 508 adult patients who were suspected to have an allergic contact dermatitis using a patch test.

Dermatologists apply patch tests in patients with dermatitis, to find out whether their skin condition may be caused or aggravated by a contact allergy. Although former studies had shown a low percentage of relevant allergies to thimerosal of 8 to 16 percent, “our study population shows a relatively low (3.7%) percentage of positive reactions to thimerosal but a much higher [percentage of] relevant ones.

A high proportion of thimerosal positive reactions (approximately 73%) was found to be clinically relevant.” This means that of the small percentage of reactions to thimerosal, approximately 3 out 4 of those were considered to be important by the study authors.

The face was found to be the most common location for contact dermatitis among the thimerosal sensitive group, followed by the palms, and eyelids. The authors conclude that, “although previous reports found thimerosal highly irrelevant, our daily experience being supported by the above data indicates that positive reactions to thimerosal could be relevant for many patients.”

SOURCE: Contact Dermatitis, December 2005

Soothing And Protecting The Skin

Native Americans used to extract the oil from jojoba beans as a treatment for cuts, sores and bruises, as well as sunburn. It has been applied to both face and scalp to help prevent evaporation and provide lubrication for dry, flaky skin. It absorbs easily, is non-greasy, and is very pleasant and soothing no matter what your skin type. Many women claim that jojoba oil also has a minimizing effect on pores!
Jojoba oil, like other natural oils, is considered a "natural moisturizing factor". Just like the lipids that are naturally found in your skin, it helps fight surface roughness, flaking, and fine lines. But it isn't reserved just for those who have dry skin. People with acne-prone skin, who suffer more than others from clogged pores and blackhead formation, tend to avoid oil-based products like the plague. They assume that all oil-based products will make their acne worse.
Not so! Due to the unique molecular structure of jojoba oil, not only will it mix readily with the skin's natural oils, but studies have shown that it can even inhibit the growth of certain types of bacteria associated with acne.
Jojoba oil is also soothing for skin conditions like rosacea and sebborheic dermatitis, and will not cause flare-ups. By helping to reinforce the structure of the skin's outer layer (the epidermis), jojoba oil -along with the natural oils produced by the skin- is extremely helpful in the healing process. Natural oils help prevent individual cells from losing moisture, and aid in keeping the skin smooth and supple.