Exfoliative Dermatitis

Exfoliative Dermatitis Treatment Options

There are several treatments available for exfoliative dermatitis. There are topical medications, there are systemic drugs, and there is laser therapy.

The following table provides some of the most common treatments:

Topical Medications Topical medications include creams, gels, ointments and other products applied directly to affected areas of skin. These medications work best when they are applied to the affected area daily.

They may be used alone or in combination with other therapies. Side effects from topical medication use include dryness, irritation, redness and peeling of skin. Some topical medications may cause allergic reactions such as hives, itching or swelling of lips or face. Other side effects may include: burning, stinging, numbness or tingling feeling in the treated area.

Topical creams and gels are typically applied to the affected skin once a day. They have been shown to provide better results than topical medications alone.

Side effects from these medications include dryness, irritation, redness and peeling of skin.

Ointments and lotions are usually applied to the affected skin twice a day (morning and evening). Creams, gels and ointments may cause less irritation than lotions.

Emollient or moisturizing products do not have any medications in them. They are used to decrease flaking of the skin and help prevent dryness.

These products come in different forms such as ointments, creams, lotions and bath additives. They need to be reapplied every two to three hours, or after bathing.

Topical corticosteroids These products may include desonide, fluocinonide, betamethasone dipropionate or triamcinolone acetonide and are available in different strengths depending on the area of skin affected. For example, for mild eczema an over-the-counter corticosteroid cream (listed above) can be used.

For moderate to severe eczema, a prescription strength medication is needed.

Corticosteroid creams, ointments and lotions are applied to the affected skin two to four times per day.

Side effects from this type of medication include thinning of skin, bruising, changes in skin color, stretch marks and acne-like lesions. These drugs should not be used on the face, underarms, or groin area and should be used for short periods of time only.

Corticosteroid sprays and inhalers are used for asthma-like symptoms.

Oral medications These drugs are taken by mouth and can be used for short periods of time.

Anti-itch or anti- inflammatory drugs such as hydroxyzine or prednisone may be used.

Oral steroids can also be used in high doses to quickly suppress the symptoms of eczema, although this is not a long-term solution. These drugs can cause side effects such as weight gain, mood swings, fatigue and osteoporosis.

Systemic medication is used when other types of treatment have not been effective.

Immunosuppressant drugs such as methotrexate, ciclosporin or azathioprine may be used. These drugs can have serious side effects and are not used very often.

Tacrolimus ointment (Protopic) is a newer drug that may be effective for severe cases of atopic eczema, but it can also increase the risk of cancer.

The side effects of these drugs can include headache, diarrhea, nausea, vomiting and abdominal pain.

Systemic corticosteroids are powerful medications that can have serious side effects. These drugs can have many adverse effects on many different parts of your body such as the liver and bone marrow.

They should not be used for extended periods of time and should only be used for the most severe cases.

Skin allergies are often confused with eczema.

Contact dermatitis is an allergic reaction that is located only on the area of skin that comes into contact with a particular substance. It is not an infection and does not involve the whole body.

Other types of dermatitis include:

Eczema is believed to be an inherited disease that may be associated with other allergic conditions such as asthma or hay fever. It is occasionally seen in people with compromised immune systems.

There is no known cure for eczema, but proper treatments can help reduce the symptoms.

It has been suggested that eczema is not a single disease, but a set of related disorders that have common features.

Atopic dermatitis is a type of eczema that occurs most often in early childhood. It is the most common type of eczema and has a strong hereditary connection, but no cure has yet been found.

The disease often starts soon after birth, but can start anytime from infancy to adulthood. Eczema can occur as a one-time problem, or it can be recurrent.

Eczema is different than typical skin conditions because it involves the immune system. Normally, the immune system will attempt to fight off harmful things that come into contact with the skin, such as viruses or bacteria.

In eczema, though, the immune system mistakes certain proteins within the skin as harmful and attacks. This leads to eczema symptoms of redness, itching and swelling.

There are many different types of eczema, including:

The disease affects people of all ages, but can be seen more commonly in infants and young children. It is also common in adults over the age of sixty.

Females are more likely to suffer from eczema than males.

Atopic dermatitis (eczema) is a long-lasting allergic skin condition that causes a persistent itchy rash. The word “atopy” refers to an inherited tendency to develop allergies.

The disease has been described since ancient times. Many famous people are believed to have had the disease, including Napoleon, Julius Caesar and Thomas Edison.

Eczema is a long-lasting (chronic) condition that is not life-threatening, but can be quite troublesome. It can cause severe itching and skin redness that can disrupt sleep and lower a person’s quality of life.

People with atopic dermatitis (eczema) may have dry, rough skin that cracks and splits open. They may develop small fluid-filled bumps called water blisters or blood vessels that are visible near the surface of the skin.

Red patches appear in some cases, similar to a rash. In the worst cases, the skin can become infected with bacteria and yeast organisms.

“Atopic” means a tendency to develop some form of allergic reaction, such as asthma or hay fever. Atopic dermatitis (eczema) is often seen in people who have allergies.

However, most people with eczema do not have other allergies.

Some experts believe that a toxic substance in the environment may trigger eczema in susceptible people, causing skin inflammation and allergic reactions. Researchers are working on ways to prevent and cure this disease.

There is no vaccine to prevent atopic dermatitis (eczema). However, if a person is allergic to something that causes eczema, then he or she can take steps to avoid these allergens.

Another treatment is called ultraviolet (UV) phototherapy. Ultraviolet light may help the skin make more of a protective substance (protein) called filaggrin.

Lack of filaggrin may cause or worsen eczema. UV phototherapy may also help prevent water loss in the skin.

A protein called filaggrin is important for keeping the outer layer of the skin (epidermis) healthy. When a person has low levels of this protein, it may cause or worsen eczema.

Researchers have found that infants who develop eczema by age two tend to have lower levels of filaggrin.

UV phototherapy involves exposing the skin to ultraviolet (UV) light. The UV light may help build up the protein filaggrin, which helps keep the skin healthy.

In UV phototherapy, a person sits in a special booth. The booth contains a special light that emits UV rays.

These UV lights may be fluorescent tubes that look similar to the lights found in offices and schools, or they may be mercury vapor bulbs.

The person sits in the booth, which contains special protective glass and is closed. The lights are turned on, and the person sits in the light for 15 to 20 minutes.

A doctor may recommend 2 or 3 sessions a week.

UV phototherapy can help improve symptoms of eczema but does not cure the disease. It helps if the person avoids sunlight exposure.

The light from UV therapy may worsen a person’s sunburn or tan.

UV therapy is not a common treatment for atopic dermatitis (eczema). It may only be used if other treatments do not work.

There is no cure for atopic dermatitis (eczema). Treatment aims to relieve symptoms such as skin redness, rashes, and itching.

The goal is to stop the dry, scaly appearance so the skin appears normal and stays flexible.

Most cases clear up by age five, but the condition may continue into adulthood. About half of adults have some degree of eczema.

The most common treatment for atopic dermatitis (eczema) in children is a type of topical corticosteroid cream, lotion, or ointment. These treatments are called topical corticosteroids.

These products are the most effective treatment for atopic dermatitis (eczema). They work by reducing swelling, redness, and irritation of the skin.

The active ingredient in most corticosteroid creams, lotions, or ointments is called betamethasone dipropionate. The most common strength of this medication used on eczema is 0.05% and is found in brand-name products such as Diprolene, Diprosone, and Luxiqa among others.

Some other types of corticosteroids are also used to treat atopic dermatitis (eczema). These include clobetasol (brand name Claversal) and fluocinonide (Lidex).

Another type of topical treatment includes tacrolimus (Protopic) 0.03% ointment, which is a type of immunosuppressant.

This means it reduces the body’s inflammatory response. However, Protopic is not a corticosteroid and it can be used in children under two years of age.

Other topical treatments include calcineurin inhibitors such as pimecrolimus (brand name:Elidel) and tacrolimus (FK506). These may be applied once or twice daily.

Whereas the corticosteroids work quickly, these take up to 3 weeks to take effect. They also tend to be less effective. While these can be used alone, they are often prescribed in combination with topical corticosteroids.

If these treatments do not provide sufficient relief of symptoms, stronger topical corticosteroids may be prescribed. A stronger type of corticosteroid called a topical calcineurin inhibitor may also be prescribed.

If the above treatments are ineffective, your doctor may prescribe a short course (2 to 3 weeks) of prescription-strength steroid pills such as prednisone.

Other medications may be applied to the skin in the form of a lotion or an ointment. These include:

Immunomodulators. These medications change the way the immune system responds to allergies.

They include pimecrolimus (Elidel) and tacrolimus (Prograf). These are topical versions of the medicines tacrolimus and pimecrolimus. They can be used to treat children aged two years and older. Pimecrolimus may work as well as tacrolimus.

Other topical medications that have been used to treat atopic dermatitis (eczema) are a medicine called diphenylcyclopropenone (DPCP) and bath oils with a high concentration of omega-3 fatty acids.

Sunscreens: Children with atopic dermatitis (eczema) should use a sunscreen with a high sun protection factor when going outside.

Other treatments for atopic dermatitis (eczema) include:

Keep the skin moist. This can be done by bathing in water that’s as warm as can be tolerated and then applying water-based moisturizers while the skin is still damp.

Oatmeal baths may also help. Do not use soap on the affected areas.

Therapeutic diets. A diet that eliminates certain foods containing additives, preservatives, or other potential allergens may help some children.

House dust mite avoidance measures. These include using allergen-proof covers on pillow and mattress, encasing the mattress in an allergen-proof cover, and keeping bedroom windows closed.

Immunotherapy (allergy shots). Your child receives injections of increasing amounts of allergens in the form of a powder.

It has been suggested that restricting your child’s diet may help the condition. This can be challenging because the foods to avoid are many and varied.

Your doctor or dietitian can help with this. Also, eating dairy products is often encouraged in children because it helps them to grow. It is important not to confuse lactose intolerance with a milk allergy. See your doctor if you are concerned about your child’s diet.

Applying ointments or creams that prevent water loss from the skin may also help. These include petrolatum and lanolin.

The emollient urea has also been used for this purpose.

Treating the condition with anti-inflammatory drugs such as the steroid group, including hydrocortisone, or other immunosuppressants like ciclosporin or azathioprine is another treatment option.

Orally taken medications for eczema include antihistamines, which help to block the release of the body’s natural chemicals that cause itching. These are sometimes used in combination with steroid tablets and other types of creams and ointments.

A type of steroid taken through the mouth (systemic) is called prednisolone. It comes as a tablet, an injection or an elixir (liquid).

In some people, the symptoms of eczema are triggered by a food allergy. Allergies to cow’s milk and other dairy produce, hen’s eggs and wheat are common.

The only way to determine if you or your child is allergic to one of these is to keep a food diary for a week, noting down everything that is eaten and any changes in the skin condition. Then the food that seems to trigger the problem can be avoided and a skin specialist can begin elimination diets.

In the longer term, it is important that the skin is kept hydrated in order to prevent the skin from cracking and damaging deeper tissues.

Applying emollients several times a day may help. These are available from a pharmacy without a prescription in a variety of forms, such as ointments, creams and lotions.

Oral steroids are increasingly being used for severe eczema. They may need to be reduced gradually once the eczema has improved to avoid side-effects of their prolonged use.

More information about steroids is given in Treatment of Inflammatory Skin Conditions .

A type of steroid that is taken by mouth (orally) may help, especially if there is a particular foodstuff that seems to trigger the eczema. Alternatively, a medicine called ciclosporin is also useful.

It is an immunosuppressant that suppresses the bodies defense system. This means that the body stops fighting the allergens, so that less scratching relieves the eczema. These drugs are generally used for people who do not respond to steroid creams or ointments.

Other options

Some people find that their eczema is triggered by night sweats, especially during times of stress or illness. A change of bedding material to something that does not ‘trap’ the sweat like cotton can help.

This includes using polyester or silk sheets and blankets. Some people also find that sleeping without bedclothes is helpful.

Severe cases of atopic eczema may need an immunosuppressant drug called ciclosporin. It is increasingly being used as an alternative to systemic steroids or even in combination with them for severe cases.

Eczema can become infected quite easily because of scratching and damage to the skin. General advice is to keep the area clean and apply a bland emollient such as aqueous cream.

If there are any signs of infection (pus, redness, warmth), then you should see a doctor who may prescribe an antibiotic such as flucloxacillin.

If you develop a rash in other areas of your body that is very itchy and has small blisters, then see a doctor immediately. This could be the sign of a rare skin condition called Sweet’s disease which can be very serious.

A few people with eczema also develop an allergic reaction to fish or shellfish (see under Food Intolerances above). Avoiding such foods may also reduce the severity of eczema.

Some people with eczema report benefit from acupuncture.

Stress can worsen any inflammatory condition, including eczema. If the emotional distress is marked then counselling or cognitive therapy may help you to gain more control over your life

Eczema is not contagious and you cannot ‘catch it’ from someone else. It is not a hereditary condition either.

It tends to run in families, but it is not caused by genes and you cannot ‘inherit’ eczema from a parent. Most children of parents with eczema will not develop it.

About 20% of children who have atopic eczema will grow out of it by the time they are 16, but this does not necessarily mean that their risk of developing hay fever or asthma is reduced.

Recent studies have found that prolonged breastfeeding (2years+) may reduce the risk of your child developing eczema by 40% during their first 6 months. But whether the benefits of breastfeeding continue after this period is less certain and not proven.

Scratching the scabs off

Scratching the scabs off not only causes intense short-term pain, but can also cause longer-term damage to your skin in other ways:

When you scratch, you tend to make the skin sore. This may result in healed skin becoming thickened and discolored with a dark blotchy appearance.

This is known as ‘lichenification’.

The more you scratch, the more you damage the skin and worsen your eczema. This is a vicious circle that can become a positive feedback cycle, making your eczema even worse.

This effect is particularly marked in atopic dermatitis, but any type of eczema can become entrenched in this way.

The more you scratch, the greater the risk of developing bacterial or fungal skin infections. These may require antibiotics or antifungal medication to cure.

The skin under your nails contains tiny blood vessels that are easily damaged by scratching. If you have a virus such as the cold or flu, the scratch can allow the virus to get into these blood vessels and infect the skin.

The skin then swells up into a small painful lump called a ‘lymph node’.

When you scratch too much, you damage the skin’s protective barrier and make it more susceptible to irritants in your surroundings. Even things such as soap and shampoo can then cause irritation as they are more readily absorbed into the skin.

When you scratch, you can injure yourself accidentally to such a degree that you may need a doctor’s help to cure the resulting infection.

Scratching makes you feel itchy so you are likely to want to scratch again, creating a vicious circle that can be very difficult to break.

How can I stop myself from scratching?

There are a number of ways in which you can try to reduce the urge to scratch:

Avoid scratching at all costs. Put your hands in gloves or mittens, tucked under your sleeves or inside your pants so you cannot get at them.

Wrapping elastic bandages around your wrists or tucking them into your clothes and undergarments will also help. Shower with gloves on and only remove them to wash specific parts of skin that are itchy.

Most people with eczema have very dry skin but scratching removes the natural oils that act as a protective barrier to help keep it moist and flexible. Keeping your skin moist not only helps protect it, it also reduces the urge to scratch.

This is particularly important at night when your skin repairs itself and grows new cells. Apply an emollient regularly, three or more times a day in severe cases.

Wash in lukewarm water only. Hot water removes natural oils from the skin and cold water can irritate already inflamed skin.

Use a mild, unperfumed soap and do not scrub too hard as this can damage the skin’s surface even more. Rinse and dry the skin gently, then apply an emollient.

Keep your nails very short to prevent scratching with your fingers. Wearing gloves at night helps too.

If you find the urge to scratch is just unbearable, distract yourself by using a deep breathing exercise, counting or some other compulsive behavior such as chewing ice, hand exercising or even biting your lip.

See your doctor if the itch is still unbearable despite following these recommendations since medication may be of benefit to you.

What can I do about dry skin?

There are several different types of lotion that can help keep your skin supple and moist. Waterproof creams such as urea are particularly effective since they stay on the skin for a long time. Vitamin A derivatives such as tazarotene may also be helpful since they encourage the growth of new skin cells. Your doctor or dermatologist can advise you about suitable creams or prescribe medication if necessary.

How can I treat the itch?

The most effective way to stop the itch is to use one of several different types of medicine:

Corticosteroid ointments: mild and medium strength corticosteroid ointments are usually applied twice daily.

Corticosteroid creams and lotions: these are less potent than ointments and can be used twice daily.

Antihistamines: these are particularly useful at night since they can make you drowsy. They work by blocking the release of histamine, a substance naturally released in the skin when it itches.

Note: Antihistamines should not be used on young children since they can cause alarming changes in the heart rhythm.

Other types of creams and ointments such as capsaicin, vitamin D or quinine are less effective.

How can I prevent scratching?

Scratching a scabies rash spreads more mites and parasite eggs to the skin from other areas making the condition worse. Scabs also trap eggs in the skin making the problem worse. Scratching also damages the skin and can lead to infection.

Here are some suggestions to avoid scratching:

Eliminate sources of irritation such as moisture, tight clothing and other itchy skin conditions (eg. eczema or dandruff).

Keep fingernails well-trimmed and wear cotton gloves at night to prevent scratching while you sleep.

Distract yourself from the urge to scratch using a deep breathing exercise, counting or some other compulsive behavior such as chewing ice, hand exercising or even biting your lip.

Seek medical attention immediately if you notice anything unusual such as pus, a black head or swelling at the site of a rash. These could be signs of infection or worst case scenario – symptoms of a disorder called systemic sclerosis.

Good luck!

Sources & references used in this article:

Exfoliative dermatitis by VN Sehgal, G Srivastava – Dermatology, 1986 – karger.com

101 cases of exfoliative dermatitis by I ABRAHAMS, JT McCARTHY… – Archives of …, 1963 – jamanetwork.com

Exfoliative dermatitis: a clinicopathologic study of 135 cases by GD Nicolis, EB Helwig – Archives of dermatology, 1973 – jamanetwork.com

Exfoliative dermatitis by G Karakayli, G Beckham, I Orengo, T Rosen – American family physician, 1999 – aafp.org

Dilantin sensitivity: report of a case of hepatitis with jaundice, pyrexia and exfoliative dermatitis by BH Chaiken, BI Goldberg, JP Segal – New England Journal of …, 1950 – Mass Medical Soc

Exfoliative dermatitis: its etiology and prognosis by HTH WILSON – AMA Archives of Dermatology and Syphilology, 1954 – jamanetwork.com

Thymoma-associated exfoliative dermatitis in cats by S Rottenberg, C Von Tscharner… – Veterinary …, 2004 – journals.sagepub.com

Erythroderma and exfoliative dermatitis by DC Wilson, JD Jester, LE King – Clinics in dermatology, 1993 – cidjournal.com