Dermatitis refers to inflammation of the skin and is often used anonymously with the term eczema.

There is an erythematous pink discolouration of the skin, (the lesions have crusted) little red dots and some dry scaling. The skin lesions are very itchy and scratching is usual. If the skin is torn bacteria can get in and cause an infection on top of the lesion.

Dermatitis can be caused by a chemical, to which the patient is allergic, such as nickel, in jean studs or a belt. There are many chemicals to which the patient can be allergic, even the topical medication given by the Doctor. Usually this allergic type of dermatitis comes up where the actual allergen touches the skin. Special tests can be done in an attempt to find out what the allergen is.

Far more common is the inherited form of dermatitis, called endogenous eczema. This is divided into atopic dermatitis or atopic 'eczema' and a group of eczemas that do not fit the atopic variety. These latter would be labelled 'non-atopic' endogenous eczema.

Atopic dermatitis is usually associated with a dry skin, comes on in childhood, often before the age of one. The eczema seems to have a certain distribution characteristic for the condition. These are lesions in the flexures of the elbows, wrists and knees. The condition can be extremely irritating for the patient and, again, with excoriation secondary infection of the skin may occur.

Because of the dry skin that accompanies it, moisturisers are essential in the management of the patients with atopic dermatitis. Various topical steroids can also be essential, such as hydrocortisone based products for children and adults who have lesions on the head and neck, but stronger topical steroids, such as Betnovate, Synalar or Locoid can be used in resistant cases. Usually good moisturisers and low power topical steroids used judiciously are important treatments for young children and young people. However, in the case of chronic scratching then the stronger steroids are used. Lately we have non-steroidal medications, such as Protopic or Elidel and these have a role, but care must be taken when they are used to ensure the skin has no infection on it as it may encourage the infection to spread.

There are other forms of eczematous dermatitis that do not fit in with the dry skin inherited variety. These include seborrhoeic dermatitis in which the eczema involves the sides of the nose and the eyebrow zones, nummular eczema in which the patches of eczema are on the calves and elsewhere on the body, and asteototic eczema whereby these nummular patches are seen in dry skin in the elderly. At the other end of the age scale the newborn baby can have infantile eczema, in which the skin is not dry, but smooth and pink, between the lesions. The lesions themselves are round patches usually on the limbs and trunk near to the joints, but not involving them. The scalp can be scaly, (cradle cap). These children tend to grow out of their eczema before the age of one. Canesten-HC and Fucidin H are two creams very commonly used to treat these conditions in babies and children. Prognosis is good for this type of eczema, whereas the atopic type of eczema in children, starting after the age of one can go on for about five years, especially if the case is associated with having a very dry skin and the parents are not using the treatment advice adequately to control the itching in the child.

Click here for more information on Dermatology consultants at London Bridge Hospital