View source for Dermatitis

{{about|eczema and dermatitis in general|the most common type of eczema|Atopic dermatitis}}{{Short description|Inflammatory disease of the skin}}
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{{Use dmy dates|date=May 2024}}
{{Infobox medical condition (new)
| name = Dermatitis
| synonyms = Eczema
| image = Dermatitis2015.jpg
| caption = A moderate case of dermatitis of the hands
| field = [[Dermatology]]
| symptoms = [[Itch]]iness, [[erythema|red skin]], rash<ref name="Ned2012" />
| complications = [[Skin infection]]<ref name=NIH2013/>
| onset = 
| duration = 
| causes = [[Atopic dermatitis]], [[allergic contact dermatitis]], [[irritant contact dermatitis]], [[seborrhoeic dermatitis]], [[stasis dermatitis]]<ref name=Ned2012/><ref name=NIH2013/>
| risks = 
| diagnosis = Based on symptom<ref name=Ned2012/>
| differential = [[Scabies]], [[psoriasis]], [[dermatitis herpetiformis]], [[lichen simplex chronicus]]<ref>{{cite book| vauthors = Ferri FF |title=Ferri's Differential Diagnosis: A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders|date=2010|publisher=Elsevier/Mosby|location=Philadelphia, PA|isbn=978-0-323-07699-9|url={{Google books|pHNlxxrPHNsC|page=132|plainurl=yes}}|page=132|edition=2nd}}</ref>
| prevention = [[Essential fatty acids]]<ref name="Andrews" />
| treatment = [[Moisturizers]], [[steroid]] creams, [[antihistamine]]s<ref name=NIH2013/><ref name=Mc2012/>
| medication = 
| prognosis = 
| frequency = 245 million in 2015<ref name=GBD2015Pre/> (3.34% of world population)
| deaths = 
}}
<!-- Definition and symptoms -->

'''Dermatitis''' is a term used for different types of [[Human skin|skin]] inflammation, typically characterized by [[itch]]iness, [[erythema|redness]] and a [[rash]].<ref name=Ned2012>{{cite book| vauthors = Nedorost ST |title=Generalized Dermatitis in Clinical Practice|publisher=Springer Science & Business Media|isbn=978-1-4471-2897-7|pages=1–3, 9, 13–14|url=https://books.google.com/books?id=egXPtnc4lssC&pg=PA1|date=2012|access-date=29 July 2016| language=en|url-status=live|archive-url=https://web.archive.org/web/20160815233710/https://books.google.ca/books?id=egXPtnc4lssC&lpg=PP1&pg=PA1|archive-date=15 August 2016}}</ref> In cases of short duration, there may be small [[blister]]s, while in long-term cases the skin may become [[lichenification|thickened]].<ref name=Ned2012/> The area of skin involved can vary from small to covering the entire body.<ref name=Ned2012/><ref name="NIH2013">{{cite web |date=May 2013 |title=Handout on Health: Atopic Dermatitis (A type of eczema) |url=http://www.niams.nih.gov/health_info/Atopic_Dermatitis/default.asp |url-status=live |archive-url=https://web.archive.org/web/20150530092344/http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp |archive-date=30 May 2015 |access-date=29 July 2016 |website=NIAMS }}</ref> Dermatitis is also called '''eczema''' but the same term is often used for the most common type of skin inflammation, [[atopic dermatitis]].<ref name=":1">{{cite journal |vauthors=Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, Van Cauwenberge P, Williams HC |date=May 2004 |title=Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003 |journal=The Journal of Allergy and Clinical Immunology |volume=113 |issue=5 |pages=832–836 |doi=10.1016/j.jaci.2003.12.591 |pmid=15131563 |doi-access=free}}</ref>

<!-- Cause and diagnosis -->
The exact cause of the condition is often unclear.<ref name=NIH2013/> Cases may involve a combination of [[allergy]] and [[venous stasis|poor venous return]].<ref name=Ned2012/> The type of dermatitis is generally determined by the person's history and the location of the rash.<ref name=Ned2012/> For example, irritant dermatitis often occurs on the hands of those who frequently get them wet.<ref name=Ned2012/> Allergic contact dermatitis occurs upon exposure to an [[allergen]], causing a [[hypersensitivity]] reaction in the skin.<ref name=Ned2012/>

<!--Prevention and management -->
Prevention of atopic dermatitis is typically with [[essential fatty acid]]s,<ref name="Andrews" /> and may be treated with [[moisturizer]]s and [[steroid]] creams.<ref name=Mc2012>{{cite journal | vauthors = McAleer MA, Flohr C, Irvine AD | title = Management of difficult and severe eczema in childhood | journal = BMJ | volume = 345 | pages = e4770 | date = July 2012 | pmid = 22826585 | doi = 10.1136/bmj.e4770 | url = http://www.tara.tcd.ie/bitstream/2262/75991/1/PMID%2022826585%20Difficult%20and%20severe%20AD%20in%20childhood.pdf | hdl = 2262/75991 | s2cid = 36038433 | hdl-access = free }}</ref> The steroid creams should generally be of mid-to high strength and used for less than two weeks at a time, as side effects can occur.<ref>{{cite book| vauthors = Habif TP |title=Clinical Dermatology|date=2015|publisher=Elsevier Health Sciences |isbn=978-0-323-26607-9 |page=171 |edition=6 |url=https://books.google.com/books?id=N_D5CQAAQBAJ&pg=PA171 |access-date=5 July 2016|url-status=live|archive-url= https://web.archive.org/web/20160817173537/https://books.google.it/books?id=N_D5CQAAQBAJ&pg=PA171|archive-date=17 August 2016}}</ref> [[Antibiotic]]s may be required if there are signs of [[skin infection]].<ref name=NIH2013/> Contact dermatitis is typically treated by avoiding the allergen or irritant.<ref>{{cite journal | vauthors = Mowad CM, Anderson B, Scheinman P, Pootongkam S, Nedorost S, Brod B | title = Allergic contact dermatitis: Patient management and education | journal = Journal of the American Academy of Dermatology | volume = 74 | issue = 6 | pages = 1043–1054 | date = June 2016 | pmid = 27185422 | doi = 10.1016/j.jaad.2015.02.1144 }}</ref><ref>{{cite journal | vauthors = Lurati AR | s2cid = 40077567 | title = Occupational risk assessment and irritant contact dermatitis | journal = Workplace Health & Safety | volume = 63 | issue = 2 | pages = 81–87; quiz 88 | date = February 2015 | pmid = 25881659 | doi = 10.1177/2165079914565351 }}</ref> [[Antihistamine]]s may help with sleep and decrease nighttime scratching.<ref name=NIH2013/>

<!-- Epidemiology -->
Dermatitis was estimated to affect 245 million people globally in 2015,<ref name=GBD2015Pre>{{cite journal | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal | collaboration = GBD 2015 Disease and Injury Incidence and Prevalence Collaborators | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 }}</ref> or 3.34% of the world population. Atopic dermatitis is the most common type and generally starts in childhood.<ref name=Ned2012/><ref name=NIH2013/> In the United States, it affects about 10–30% of people.<ref name=NIH2013/> Contact dermatitis is twice as common in females as in males.<ref>{{cite book| vauthors = Adkinson NF |title=Middleton's Allergy: Principles and Practice |date=2014 |publisher=Elsevier Saunders |location=Philadelphia |isbn=978-0-323-08593-9|page=566 |edition=8 |url= https://books.google.com/books?id=vT9YAQAAQBAJ&pg=PA566 |url-status=live|archive-url=https://web.archive.org/web/20160815222715/https://books.google.ca/books?id=vT9YAQAAQBAJ&pg=PA566 |archive-date=15 August 2016}}</ref> Allergic contact dermatitis affects about 7% of people at some point in their lives.<ref>{{cite book| vauthors = Wilkinson M, Orton D |title=Rook's Textbook of Dermatology|date=2016|publisher=John Wiley & Sons| isbn=978-1-118-44117-6|edition=9|chapter-url=https://books.google.com/books?id=EyypCwAAQBAJ&pg=SA99-PA868|access-date=29 July 2016|chapter=Allergic Contact Dermatitis | veditors = Barker J, Bleiker TO, Chalmers R, Creamer D |page=128.4|url-status=live |archive-url=https://web.archive.org/web/20160815214618/https://books.google.ca/books?id=EyypCwAAQBAJ&pg=SA99-PA868 |archive-date=15 August 2016 }}</ref> Irritant contact dermatitis is common, especially among people with certain occupations; exact rates are unclear.<ref>{{cite book| vauthors = Frosch PJ |title=Textbook of Contact Dermatitis|date=2013|publisher=Springer Berlin Heidelberg|location=Berlin, Heidelberg |isbn=978-3-662-03104-9 |page=42 |edition=2nd |url= https://books.google.com/books?id=hgXtCAAAQBAJ&pg=PA42|url-status=live |archive-url=https://web.archive.org/web/20160816002717/https://books.google.ca/books?id=hgXtCAAAQBAJ&pg=PA42 |archive-date=16 August 2016 }}</ref>
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==Terminology==
{{Anchor|Terminology}}<!--Retain an anchor called "Terminology" at this discussion, because various wikilinks elsewhere (e.g., WP, WT) point to anchor "Terminology" on this page.-->The terms ''dermatitis'' and ''eczema'' are sometimes used synonymously.<ref name="Ned2012" /><ref>{{Cite web |date=2024 |title=Dermatitis and eczema |url=https://icd.who.int/browse/2024-01/mms/en#1887882424 |access-date=2024-08-12 |website=ICD-11 for Mortality and Morbidity Statistics}}</ref> However the term eczema is often used to specifically mean [[atopic dermatitis]] (also known as atopic eczema).<ref name="Clinic2011">{{cite journal |vauthors=Bershad SV |date=November 2011 |title=In the clinic. Atopic dermatitis (eczema) |journal=Annals of Internal Medicine |volume=155 |issue=9 |pages=ITC51–15; quiz ITC516 |doi=10.7326/0003-4819-155-9-201111010-01005 |pmid=22041966 |s2cid=207536375}}</ref><ref name=":1" /> Terminology might also differ according to countries. In some languages, dermatitis and eczema mean the same thing, while in other languages dermatitis implies an acute condition and eczema a chronic one.<ref name="RingPrzybilla2006">{{cite book |url=https://books.google.com/books?id=jTktMX60bPwC&pg=PA4 |title=Handbook of atopic eczema |vauthors=Ring J, Przybilla B, Ruzicka T |publisher=Birkhäuser |year=2006 |isbn=978-3-540-23133-2 |page=4 |access-date=4 May 2010}}</ref><!--To say that the terms "dermatitis" and "eczema" are widely considered trivially interchangeable ([[cognitive synonymy]]) in English is inaccurate versus real-world usage as of 2021, as confirmed by definitions in various major dictionaries, which either explicitly define eczema as hyponymous to [that is, any of various types of] or entirely ignore the question of synonymy or hyponymy versus "dermatitis"; however, it is true that when one analyzes those definitions critically with an eye toward [[operational definition]]s, one is left without clear distinction, as the aspects of inflammation, pruritus, and either exogenous or endogenous provoking agent all can apply to either term, and thus autoimmune components are not excluded from either.-->

==Signs and symptoms==
[[Image:Human hand with dermatitis.jpg|thumb|upright=1.3|Dermatitis of the hand]]
There are several types of dermatitis including [[atopic dermatitis]], [[contact dermatitis]], [[stasis dermatitis]] and [[seborrhoeic dermatitis]].<ref name="NIH2013" /> Dermatitis symptoms vary with all different forms of the condition. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, [[edema|swelling]], [[itch]]ing and skin lesions with sometimes oozing and scarring. Also, the area of the skin on which the symptoms appear tends to be different with every type of dermatitis, whether on the [[neck]], [[wrist]], [[forearm]], [[thigh]] or [[ankle]].

Although the location may vary, the primary symptom of this condition is itchy skin. More rarely, it may appear on the [[genital area]], such as the [[vulva]] or [[scrotum]].<ref>{{cite web|url=http://www.dermnetnz.org/topics/lichen-simplex|title=Neurodermatitis (lichen simplex)|publisher=DermNet New Zealand Trust|date=2017|access-date=29 January 2017|url-status=live|archive-url= https://web.archive.org/web/20170202062055/http://www.dermnetnz.org/topics/lichen-simplex|archive-date=2 February 2017}}</ref><ref>{{cite web|url=http://www.mayoclinic.com/health/neurodermatitis/ds00712/dsection=symptoms |title=Neurodermatitis|publisher=Mayo Clinic|date=2015|access-date=6 November 2010|url-status=live|archive-url=https://web.archive.org/web/20100616075418/http://www.mayoclinic.com/health/neurodermatitis/DS00712/DSECTION%3Dsymptoms| archive-date=16 June 2010}}</ref> Symptoms of this type of dermatitis may be very intense and may come and go. Irritant contact dermatitis is usually more [[pain]]ful than itchy.

Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin, on light skin. However, this redness does not appear on darker skin and dermatitis can appear darker brown or purple in color.<ref>{{Cite web |last=Hewett |first=Lauren |date=2 September 2022 |title=Eczema in skin of color: What you need to know |url=https://nationaleczema.org/blog/eczema-in-skin-of-color/ |access-date=16 November 2023 |website=National Eczema Association |language=en-US}}</ref> Typical affected skin areas include the folds of the arms, the back of the [[knee]]s, wrists, [[face]] and [[hand]]s. [[Perioral dermatitis]] refers to a red bumpy rash around the mouth.<ref>{{cite web|url=http://www.dermnetnz.org/topics/periorificial-dermatitis/|title=Periorificial dermatitis|publisher=DermNet New Zealand Trust| date=2017|access-date=29 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170202062219/http://www.dermnetnz.org/topics/periorificial-dermatitis/|archive-date=2 February 2017}}</ref>

[[Dermatitis herpetiformis]] symptoms include itching, stinging and a burning sensation. [[Papule]]s and [[Vesicle (dermatology)|vesicles]] are commonly present.<ref>{{cite web|url=http://www.dermnetnz.org/topics/dermatitis-herpetiformis|title=Dermatitis herpetiformis|publisher=DermNet New Zealand Trust|date=2017|access-date=29 January 2017|url-status=live|archive-url= https://web.archive.org/web/20170202063117/http://www.dermnetnz.org/topics/dermatitis-herpetiformis|archive-date=2 February 2017}}</ref> The small red bumps experienced in this type of dermatitis are usually about 1 cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, [[buttocks]], [[elbow]]s, knees, neck, [[shoulder]]s and [[scalp]].

The symptoms of [[seborrhoeic dermatitis]], on the other hand, tend to appear gradually, from dry or greasy scaling of the scalp ([[dandruff]]) to scaling of facial areas, sometimes with itching, but without [[hair loss]].<ref>{{cite web|url=http://www.dermnetnz.org/topics/seborrhoeic-dermatitis|title=Seborrheic dermatitis|publisher=DermNet New Zealand Trust|date=2017|access-date=29 January 2017|url-status=live|archive-url= https://web.archive.org/web/20170202062244/http://www.dermnetnz.org/topics/seborrhoeic-dermatitis|archive-date=2 February 2017}}</ref> In [[newborns]], the condition causes a thick and yellowish scalp rash, often accompanied by a [[Irritant diaper dermatitis|diaper rash]]. In severe cases, symptoms may appear along the hairline, behind the ears, on the [[eyebrow]]s, on the bridge of the [[Human nose|nose]], around the nose, on the [[chest]], and on the upper back.<ref name="merckmanuals">{{cite web|url=https://www.merckmanuals.com/home/skin-disorders/itching-and-dermatitis/seborrheic-dermatitis|publisher=Merck Manual, Consumer Version|title=Seborrheic Dermatitis}}</ref>
<gallery>
File:Eczema.png|Dermatitis
File:Eczema-arms.jpg|More severe dermatitis
File:Eczema.jpg|A patch of dermatitis that has been scratched
File:PLJohnson Complex Eczema.jpg|Complex dermatitis
</gallery>

===Complications===
People with eczema should not receive the [[Smallpox vaccine|smallpox vaccination]] due to risk of developing [[eczema vaccinatum]], a potentially severe and sometimes fatal complication.<ref>{{cite web |url= http://emergency.cdc.gov/agent/smallpox/vaccination/contraindications-clinic.asp |title=CDC Smallpox &#124; Smallpox (Vaccinia) Vaccine Contraindications (Info for Clinicians) |publisher=Emergency.cdc.gov |date=7 February 2007 |access-date=7 February 2010 |url-status=dead |archive-url=https://web.archive.org/web/20100125041841/http://emergency.cdc.gov/agent/smallpox/vaccination/contraindications-clinic.asp |archive-date=25 January 2010  }}</ref> Other major health risks for people with dermatitis are viral and bacterial infections because atopic dermatitis patients have deficiencies in their proteins and [[lipid]]s that have barrier functions along with defects in [[dendritic cell]]s and as a result are unable to keep foreign invaders out, leading to recurring infections.<ref name="Wang et al 2021">{{cite journal | vauthors = Wang V, Boguniewicz J, Boguniewicz M, Ong PY | title = The infectious complications of atopic dermatitis | journal = Annals of Allergy, Asthma & Immunology | volume = 126 | issue = 1 | pages = 3–12 | date = January 2021 | pmid = 32771354 | pmc = 7411503 | doi = 10.1016/j.anai.2020.08.002 }}</ref> If left untreated, these infections may be life-threatening, so skin barrier improvement (such as daily moisturizing to minimize [[transepidermal water loss]]) and anti-inflammatory therapy are recommended as preventative measures.<ref name="Wang et al 2021"/>

==Cause==
The cause of dermatitis is unknown but is presumed to be a combination of genetic and environmental factors.<ref name=NIH2013/>

===Environmental===
The [[hygiene hypothesis]] postulates that the cause of [[asthma]], eczema, and other allergic diseases is an unusually clean environment in childhood which leads to an insufficient [[human microbiota]]. It is supported by epidemiologic studies for asthma.<ref>{{cite journal | vauthors = Bufford JD, Gern JE | title = The hygiene hypothesis revisited | journal = Immunology and Allergy Clinics of North America | volume = 25 | issue = 2 | pages = 247–262, v–vi | date = May 2005 | pmid = 15878454 | doi = 10.1016/j.iac.2005.03.005 }}</ref> The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases the risk for asthma and allergy.<ref name="auto">{{cite web |url=https://www.lecturio.com/concepts/atopic-dermatitis-eczema/ | title= Atopic Dermatitis (Eczema)
|website=The Lecturio Medical Concept Library |access-date= 2 July 2021}}</ref> One systematic review of literature on eczema found that [[Urban area|urban]] areas have an increased prevalence of eczema compared to rural areas.<ref>{{cite journal |last1=Schram |first1=M.E. |last2=Tedja |first2=A.M. |last3=Spijker |first3=R. |last4=Bos |first4=J.D. |last5=Williams |first5=H.C. |last6=Spuls |first6=Ph.I. |title=Is there a rural/urban gradient in the prevalence of eczema? A systematic review |journal=British Journal of Dermatology |date=16 March 2010 |volume=162 |issue=5 |pages=964–973 |doi=10.1111/j.1365-2133.2010.09689.x |pmid=20331459 |s2cid=205259960 |url=https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2133.2010.09689.x |access-date=8 March 2022 |issn=0007-0963}}</ref> While it has been suggested that eczema may sometimes be an allergic reaction to the [[excrement]] from [[house dust mite]]s,<ref name="pmid2873316">{{cite journal | vauthors = Carswell F, Thompson S | title = Does natural sensitisation in eczema occur through the skin? | journal = Lancet | volume = 2 | issue = 8497 | pages = 13–15 | date = July 1986 | pmid = 2873316 | doi = 10.1016/S0140-6736(86)92560-2 | s2cid = 23111491 }}</ref> with up to 5% of people showing antibodies to the mites,<ref name="pmid17633128">{{cite journal | vauthors = Henszel Ł, Kuźna-Grygiel W | title = [House dust mites in the etiology of allergic diseases] | language = pl | journal = Annales Academiae Medicae Stetinensis | volume = 52 | issue = 2 | pages = 123–127 | year = 2006 | pmid = 17633128 }}</ref> the overall role this plays awaits further corroboration.<ref>{{eMedicine|Derm|38|Atopic Dermatitis}}</ref>

====Malnutrition====
[[Essential fatty acid deficiency]] results in a dermatitis similar to that seen in [[zinc deficiency|zinc]] or [[biotin deficiency]].<ref name="Andrews">{{cite book |url=https://books.google.com/books?id=UEaEDwAAQBAJ&pg=PA482 |page=482 |title=Andrews' Diseases of the Skin: Clinical Dermatology |isbn=978-0-323-55188-5 |last1=James |first1=William D. |last2=Elston |first2=Dirk |last3=Treat |first3=James R. |last4=Rosenbach |first4=Misha A. |last5=Neuhaus |first5=Isaac |year=2019 |publisher=Elsevier Health Sciences }}</ref>

===Genetic===
A number of genes have been associated with eczema, one of which affects production of [[filaggrin]].<ref name=Mc2012/> Genome-wide studies found three new [[copy-number variation|genetic variants]] associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.<ref>{{cite journal | vauthors = Paternoster L, Standl M, Chen CM, Ramasamy A, Bønnelykke K, Duijts L, etal | title = Meta-analysis of genome-wide association studies identifies three new risk loci for atopic dermatitis | journal = Nature Genetics | volume = 44 | issue = 2 | pages = 187–192 | date = December 2011 | pmid = 22197932 | pmc = 3272375 | doi = 10.1038/ng.1017 }}</ref>

Eczema occurs about three times more frequently in individuals with [[celiac disease]] and about two times more frequently in relatives of those with celiac disease, potentially indicating a [[Heredity|genetic]] link between the conditions.<ref>{{cite journal | vauthors = Caproni M, Bonciolini V, D'Errico A, Antiga E, Fabbri P | title = Celiac disease and dermatologic manifestations: many skin clue to unfold gluten-sensitive enteropathy | journal = Gastroenterology Research and Practice | volume = 2012 | pages = 952753 | year = 2012 | pmid = 22693492 | pmc = 3369470 | doi = 10.1155/2012/952753 | publisher = Hindawi Publishing Corporation | doi-access = free }}</ref><ref>{{cite journal | vauthors = Ciacci C, Cavallaro R, Iovino P, Sabbatini F, Palumbo A, Amoruso D, Tortora R, Mazzacca G | title = Allergy prevalence in adult celiac disease | journal = The Journal of Allergy and Clinical Immunology | volume = 113 | issue = 6 | pages = 1199–1203 | date = June 2004 | pmid = 15208605 | doi = 10.1016/j.jaci.2004.03.012 }}</ref>

==Diagnosis==
Diagnosis of eczema is based mostly on the [[Medical history|history]] and [[physical examination]].<ref name="Mc2012" /> In uncertain cases, [[skin biopsy]] may be taken for a [[histopathologic diagnosis of dermatitis]].<ref>{{cite web |title=Eczema |url=http://umm.edu/health/medical/altmed/condition/eczema |url-status=live |archive-url=https://web.archive.org/web/20160727103505/http://umm.edu/health/medical/altmed/condition/eczema |archive-date=27 July 2016 |website=University of Maryland Medical Center}}</ref> Those with eczema may be especially prone to [[misdiagnosis]] of [[food allergies]].<ref>{{cite journal |vauthors=Atkins D |date=March 2008 |title=Food allergy: diagnosis and management |journal=Primary Care |volume=35 |issue=1 |pages=119–140, vii |doi=10.1016/j.pop.2007.09.003 |pmid=18206721}}</ref>

[[Patch test]]s are used in the diagnosis of allergic contact dermatitis.<ref>{{cite book |url=https://books.google.com/books?id=sSHIlWSOiroC&q=dermatitis+%22patch+test%22&pg=PA462 |title=Contact Dermatitis |vauthors=Johansen JD, Frosch PJ, Lepoittevin JP |publisher=Springer |year=2010 |isbn=978-3-642-03827-3 |access-date=21 April 2014 |archive-url=https://web.archive.org/web/20140705040228/http://books.google.com/books?id=sSHIlWSOiroC&pg=PA462&dq=dermatitis+%22patch+test%22&hl=en&sa=X&ei=rIxUU_2FDLDMsQTi94H4BA&ved=0CE4Q6AEwAQ#v=onepage&q=dermatitis%20%22patch%20test%22&f=false |archive-date=5 July 2014 |url-status=live}}</ref><ref>{{cite book |url=https://books.google.com/books?id=dQBAzfyCeQ8C&pg=PA57 |title=Fisher's Contact Dermatitis |vauthors=Rietschel RL, Fowler JF |publisher=BC Decker Inc. |year=2008 |isbn=978-1-55009-378-0 |edition=6th |location=Hamilton, Ontario |access-date=21 April 2014}}</ref>

===Classification===
The term ''eczema'' refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard with numerous different classification systems, and many [[synonym]]s being used to describe the same condition.<ref>{{cite journal |vauthors=Johansen JD, Hald M, Andersen BL, Laurberg G, Danielsen A, Avnstorp C, Kristensen B, Kristensen O, Kaaber K, Thormann J, Menné T |year=2011 |title=Classification of hand eczema: clinical and aetiological types. Based on the guideline of the Danish Contact Dermatitis Group |url=https://pubmed.ncbi.nlm.nih.gov/21658054/ |journal=Contact Dermatitis |volume=65 |issue=1 |pages=13–21 |doi=10.1111/j.1600-0536.2011.01911.x |pmid=21658054 |s2cid=30780460 |access-date=2 July 2021 |collaboration=Danish Contact Dermatitis Group}}</ref>

A type of dermatitis may be described by location (e.g., [[hand eczema]]), by specific appearance (eczema craquele or discoid) or by possible cause ([[varicose eczema]]). Further adding to the confusion, many sources use the term ''eczema'' interchangeably for the most common type: [[atopic dermatitis]].<ref name="auto" />

The [[European Academy of Allergology and Clinical Immunology]] (EAACI) published a position paper in 2001, which simplifies the nomenclature of allergy-related diseases, including atopic and allergic contact eczemas.<ref name="pmid11551246">{{cite journal |vauthors=Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wüthrich B |date=September 2001 |title=A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force |journal=Allergy |volume=56 |issue=9 |pages=813–824 |doi=10.1034/j.1398-9995.2001.t01-1-00001.x |pmid=11551246}}</ref> Non-allergic eczemas are not affected by this proposal.

====Histopathologic classification====
{{Main|Histopathologic diagnosis of dermatitis}}

By [[histopathology]], superficial dermatitis (in the epidermis, papillary dermis, and superficial vascular plexus) can basically be classified into either of the following groups:<ref name="Alsaad2005">{{cite journal |vauthors=Alsaad KO, Ghazarian D |date=December 2005 |title=My approach to superficial inflammatory dermatoses |journal=Journal of Clinical Pathology |volume=58 |issue=12 |pages=1233–1241 |doi=10.1136/jcp.2005.027151 |pmc=1770784 |pmid=16311340}}</ref>
* Vesiculobullous lesions
* Pustular dermatosis
* Non vesiculobullous, non-pustular
:*With epidermal changes
:*Without epidermal changes. These characteristically have a superficial perivascular inflammatory infiltrate and can be classified by type of cell infiltrate:<ref name="Alsaad2005" />
::*Lymphocytic (most common)
::*Lymphoeosinophilic
::*Lymphoplasmacytic
::*Mast cell
::*Lymphohistiocytic
::*Neutrophilic

===Common types===
====Atopic====
[[Atopic dermatitis]] is an allergic disease believed to have a hereditary component and often runs in families whose members have [[asthma]]. Itchy [[rash]] is particularly noticeable on the head and scalp, neck, inside of elbows, behind knees, and buttocks. It is very common in developed countries and rising. Irritant [[contact dermatitis]] is sometimes misdiagnosed as atopic dermatitis. [[Stress (biology)|Stress]] can cause atopic dermatitis to worsen.<ref>[https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/ Atopic Dermatitis]  National Eczema Association.</ref>

====Contact====
[[Contact dermatitis]] is of two types: allergic (resulting from a delayed reaction to an [[allergen]], such as [[poison ivy]], [[nickel]], or [[Balsam of Peru]]),<ref name="dermnetnz1">{{cite web |date=28 December 2013 |title=Balsam of Peru contact allergy |url=http://dermnetnz.org/dermatitis/balsam-of-peru-allergy.html |url-status=live |archive-url=https://web.archive.org/web/20140305094411/http://dermnetnz.org/dermatitis/balsam-of-peru-allergy.html |archive-date=5 March 2014 |access-date=5 March 2014 |publisher=Dermnetnz.org}}</ref> and irritant (resulting from direct reaction to a detergent, such as [[sodium lauryl sulfate]], for example).

Some substances act both as allergen and irritants (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on [[phototoxic dermatitis]]. About three-quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable, provided the offending substance can be avoided and its traces removed from one's environment. (ICD-10 L23; L24; L56.1; L56.0)

====Seborrhoeic====
[[Seborrhoeic dermatitis]] or seborrheic dermatitis is a condition sometimes classified as a form of eczema that is closely related to [[dandruff]]. It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. In newborns, it causes a thick, yellow, crusty scalp rash called [[cradle cap]], which seems related to lack of [[biotin]] and is often curable. (ICD-10 L21; L21.0)

There is a connection between seborrheic dermatitis and ''[[Malassezia]]'' fungus, and [[antifungal]]s such as anti-dandruff shampoo can be helpful in treating it.<ref name="Bor2019" />

===Less common types===
====Dyshidrosis====
[[Dyshidrosis]] (dyshidrotic eczema, pompholyx, vesicular palmoplantar dermatitis) only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called [[Cutaneous conditions#Morphology|vesicle]]s, thickening, and cracks are accompanied by itching, which gets worse at night. A common type of hand eczema, it worsens in warm weather. (ICD-10 L30.1)

====Discoid====
[[nummular dermatitis|Discoid eczema]] (nummular eczema, exudative eczema, microbial eczema) is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. The cause is unknown, and the condition tends to come and go. (ICD-10 L30.0)

====Venous====
[[stasis dermatitis|Venous eczema]] (gravitational eczema, stasis dermatitis, varicose eczema) occurs in people with impaired circulation, [[varicose veins]], and [[edema]], and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin, and itching. The disorder predisposes to [[venous ulcer|leg ulcers]]. (ICD-10 I83.1)

====Herpetiformis====
[[Dermatitis herpetiformis]] (Duhring's disease) causes an intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to [[celiac disease]], can often be put into remission with an appropriate diet, and tends to get worse at night. (ICD-10 L13.0)

====Hyperkeratotic====
Hyperkeratotic hand dermatitis presents with hyperkeratotic, fissure-prone, erythematous areas of the middle or proximal palm, and the volar surfaces of the fingers may also be involved.<ref name="Andrews2005">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. {{ISBN|0-7216-2921-0}}.</ref>{{rp|79}}

====Neurodermatitis====
[[Neurodermatitis]] ([[lichen simplex chronicus]], localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from [[habit (psychology)|habitual]] rubbing and scratching. Usually, there is only one spot. Often curable through behaviour modification and anti-inflammatory medication. [[Prurigo nodularis]] is a related disorder showing multiple lumps. (ICD-10 L28.0; L28.1)

====Autoeczematization====
[[Autoeczematization]] (id reaction, auto sensitization) is an eczematous reaction to an infection with [[parasite]]s, [[fungi]], [[bacteria]], or [[virus]]es. It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection. (ICD-10 L30.2)

====Viral====
There are eczemas overlaid by viral infections ([[eczema herpeticum]] or [[eczema vaccinatum|vaccinatum]]), and eczemas resulting from underlying disease (e.g., [[lymphoma]]).

Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.

==Prevention==
There have been various studies on the prevention of dermatitis through diet, none of which have proven any positive effect.

Exclusive [[breastfeeding]] of infants during at least the first few months may decrease the risk.<ref name=Gre2019>{{cite journal | vauthors = Greer FR, Sicherer SH, Burks AW | title = The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods | journal = Pediatrics | volume = 143 | issue = 4 | pages = e20190281 | date = April 2019 | pmid = 30886111 | doi = 10.1542/peds.2019-0281 | doi-access = free }}</ref> There is no good evidence that a mother's diet during [[pregnancy]] or breastfeeding affects the risk,<ref name=Gre2019/> nor is there evidence that delayed introduction of certain foods is useful.<ref name=Gre2019/> There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.<ref name=Kall2010>{{cite journal | vauthors = Kalliomäki M, Antoine JM, Herz U, Rijkers GT, Wells JM, Mercenier A | title = Guidance for substantiating the evidence for beneficial effects of probiotics: prevention and management of allergic diseases by probiotics | journal = The Journal of Nutrition | volume = 140 | issue = 3 | pages = 713S–721S | date = March 2010 | pmid = 20130079 | doi = 10.3945/jn.109.113761 | doi-access = free }}</ref> There is moderate certainty evidence that the use of skin care interventions such as emollients within the first year of life of an infant's life is not effective in preventing eczema.<ref name=":0">{{Cite journal |last1=Kelleher |first1=Maeve M. |last2=Phillips |first2=Rachel |last3=Brown |first3=Sara J. |last4=Cro |first4=Suzie |last5=Cornelius |first5=Victoria |last6=Carlsen |first6=Karin C. Lødrup |last7=Skjerven |first7=Håvard O. |last8=Rehbinder |first8=Eva M. |last9=Lowe |first9=Adrian J. |last10=Dissanayake |first10=Eishika |last11=Shimojo |first11=Naoki |last12=Yonezawa |first12=Kaori |last13=Ohya |first13=Yukihiro |last14=Yamamoto-Hanada |first14=Kiwako |last15=Morita |first15=Kumiko |date=14 November 2022 |title=Skin care interventions in infants for preventing eczema and food allergy |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=11 |pages=CD013534 |doi=10.1002/14651858.CD013534.pub3 |issn=1469-493X |pmc=9661877 |pmid=36373988}}</ref> In fact, it may increase the risk of skin infection and of unwanted effects such as allergic reaction to certain moisturizers and a stinging sensation.<ref name=":0" />

===Healthy diet===
{{see also|Healthy diet}}

There has not been adequate evaluation of changing the diet to reduce eczema.<ref name="CC-Bath-Hextall">{{cite journal | vauthors = Bath-Hextall F, Delamere FM, Williams HC | title = Dietary exclusions for established atopic eczema | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD005203 | date = January 2008 | volume = 2008 | pmid = 18254073 | pmc = 6885041 | doi = 10.1002/14651858.CD005203.pub2 | url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013319/ | url-status = live | veditors = Bath-Hextall FJ | archive-url = https://web.archive.org/web/20131021223144/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013319/ | df = dmy-all  | archive-date = 21 October 2013 }}</ref><ref name="IQWiG-eliminate">{{cite web|last=Institute for Quality and Efficiency in Health Care|title=Eczema: Can eliminating particular foods help?|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005096/|work=Informed Health Online|publisher=Institute for Quality and Efficiency in Health Care|access-date=24 June 2013|url-status=live|archive-url=https://web.archive.org/web/20131021223600/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005096/|archive-date=21 October 2013}}</ref> There is some evidence that infants with an established [[egg allergy]] may have a reduction in symptoms if eggs are eliminated from their diets.<ref name="CC-Bath-Hextall" /> Benefits have not been shown for other elimination diets, though the studies are small and poorly executed.<ref name="CC-Bath-Hextall" /><ref name="IQWiG-eliminate" /> Establishing that there is a [[food allergy]] before dietary change could avoid unnecessary lifestyle changes.<ref name="CC-Bath-Hextall" />

====Fatty acids====
Oils with fatty acids that have been studied to prevent dermatitis include:<ref>{{cite journal |last1=Søyland |first1=E |last2=Funk |first2=J |last3=Rajka |first3=G |last4=Sandberg |first4=M |last5=Thune |first5=P |last6=Rustad |first6=L |last7=Helland |first7=S |last8=Middelfart |first8=K |last9=Odu |first9=S |last10=Falk |first10=ES |title=Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study. |journal=The British Journal of Dermatology |date=June 1994 |volume=130 |issue=6 |pages=757–764 |doi=10.1111/j.1365-2133.1994.tb03414.x |pmid=8011502|s2cid=25066444 }}</ref><ref>{{cite journal |last1=Callaway |first1=J |last2=Schwab |first2=U |last3=Harvima |first3=I |last4=Halonen |first4=P |last5=Mykkänen |first5=O |last6=Hyvönen |first6=P |last7=Järvinen |first7=T |title=Efficacy of dietary hempseed oil in patients with atopic dermatitis. |journal=The Journal of Dermatological Treatment |date=April 2005 |volume=16 |issue=2 |pages=87–94 |doi=10.1080/09546630510035832 |pmid=16019622|s2cid=18445488 }}</ref>
* [[Corn oil]]: [[Linoleic acid]] (LA)
* [[Fish oil]]: [[Eicosapentaenoic acid]] (EPA) and [[docosahexaenoic acid]] (DHA)
* [[Hemp seed oil]]: [[Linoleic acid]] (LA), and [[alpha-Linolenic acid]] (ALA)

In the 1950s Arild Hansen showed that infants fed [[skimmed milk]] developed essential fatty acid deficiency which was characterized by an increased food intake, poor growth, and a scaly dermatitis, and was cured by the administration of [[corn oil]].

==Management==
There is no known cure for some types of dermatitis, with treatment aiming to control symptoms by reducing inflammation and relieving itching. Contact dermatitis is treated by avoiding what is causing it.

[[Seborrheic dermatitis]] is treated with [[antifungal]]s such as anti-dandruff [[shampoo]].<ref name=Bor2019>{{cite journal | vauthors = Borda LJ, Perper M, Keri JE | title = Treatment of seborrheic dermatitis: a comprehensive review | journal = The Journal of Dermatological Treatment | volume = 30 | issue = 2 | pages = 158–169 | date = March 2019 | pmid = 29737895 | doi = 10.1080/09546634.2018.1473554 | s2cid = 13686180 }}</ref>

===Lifestyle===
Bathing once or more a day is recommended, usually for five to ten minutes in warm water.<ref name=Mc2012/><ref>{{cite web|title=Coping with atopic dermatitis|url=https://www.aad.org/public/diseases/eczema/atopic-dermatitis#tips|access-date=11 September 2017|date=2017}}</ref> [[Soap]]s should be avoided, as they tend to strip the skin of natural oils and lead to excessive dryness.<ref>{{cite journal | vauthors = Gutman AB, Kligman AM, Sciacca J, James WD | title = Soak and smear: a standard technique revisited | journal = Archives of Dermatology | volume = 141 | issue = 12 | pages = 1556–1559 | date = December 2005 | pmid = 16365257 | doi = 10.1001/archderm.141.12.1556 | doi-access = free }}</ref> The [[American Academy of Dermatology]] suggests using a controlled amount of bleach diluted in a bath to help with atopic dermatitis.<ref>{{Cite web|title=Atopic dermatitis: Bleach bath therapy|url=https://www.aad.org/public/diseases/eczema/childhood/treating/bleach-bath|website=www.aad.org|access-date=4 May 2020|archive-date=29 July 2020|archive-url=https://web.archive.org/web/20200729202648/https://www.aad.org/public/diseases/eczema/childhood/treating/bleach-bath|url-status=dead}}</ref>

People can wear clothing designed to manage the itching, scratching and peeling.<ref>{{cite journal |vauthors=Ricci G, Patrizi A, Bellini F, Medri M |title=Use of textiles in atopic dermatitis: care of atopic dermatitis <!-- |chapter=Use of Textiles in Atopic Dermatitis  -->|journal=Respiration |volume=33|pages=127–143 |year=2006 |pmid=16766885 |doi=10.1159/000093940 |series=Current Problems in Dermatology |issue=3 |hdl=11585/110806 |isbn=978-3-8055-8121-9}}</ref>

[[House dust mite]] reduction and avoidance measures have been studied in low quality trials and have not shown evidence of improving eczema.<ref>{{cite journal | vauthors = Nankervis H, Pynn EV, Boyle RJ, Rushton L, Williams HC, Hewson DM, Platts-Mills T | title = House dust mite reduction and avoidance measures for treating eczema | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD008426 | date = January 2015 | issue = 5 | pmid = 25598014 | doi = 10.1002/14651858.CD008426.pub2 | pmc = 8407038 | url = http://www.cochrane.org/CD008426/SKIN_house-dust-mite-reduction-and-avoidance-measures-treating-eczema | hdl = 10044/1/21547 | hdl-access = free }}</ref>

===Moisturizers===
Low-quality evidence indicates that moisturizing agents ([[emollients]]) may reduce eczema severity and lead to fewer flares.<ref name=van>{{cite journal | vauthors = van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BW | title = Emollients and moisturisers for eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2 | pages = CD012119 | date = February 2017 | issue = 8 | pmid = 28166390 | pmc = 6464068 | doi = 10.1002/14651858.CD012119.pub2 | url = http://www.cochrane.org/CD012119/SKIN_emollients-and-moisturisers-eczema }}</ref> In children, oil–based formulations appear to be better, and water–based formulations are not recommended.<ref name=Mc2012/> It is unclear if moisturizers that contain [[ceramide]]s are more or less effective than others.<ref name=Jung2013>{{cite journal | vauthors = Jungersted JM, Agner T | title = Eczema and ceramides: an update | journal = Contact Dermatitis | volume = 69 | issue = 2 | pages = 65–71 | date = August 2013 | pmid = 23869725 | doi = 10.1111/cod.12073 | s2cid = 9471706 | doi-access = free }}</ref> Products that contain dyes, perfumes, or peanuts should not be used.<ref name=Mc2012/> [[Occlusive dressing]]s at night may be useful.<ref name=Mc2012/>

Some [[moisturizer]]s or [[barrier cream]]s may reduce irritation in occupational irritant hand dermatitis,<ref name="Bauer_2018">{{cite journal | vauthors = Bauer A, Rönsch H, Elsner P, Dittmar D, Bennett C, Schuttelaar ML, Lukács J, John SM, Williams HC | title = Interventions for preventing occupational irritant hand dermatitis | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD004414 | date = April 2018 | issue = 4 | pmid = 29708265 | pmc = 6494486 | doi = 10.1002/14651858.CD004414.pub3 | url = http://eprints.nottingham.ac.uk/51952/1/CD004414.pdf | access-date = 26 June 2019 | archive-url = https://web.archive.org/web/20200306150356/http://eprints.nottingham.ac.uk/51952/1/CD004414.pdf | archive-date = 6 March 2020 | url-status = dead }}</ref> a skin disease that can affect people in jobs that regularly come into contact with water, [[detergent]]s, [[Chemical substance|chemicals]] or other irritants.<ref name="Bauer_2018" /> Some emollients may reduce the number of flares in people with dermatitis.<ref name=van/>

===Medications===

====Corticosteroids====
If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.<ref name=Mc2012/> [[Corticosteroids]] are effective in controlling and suppressing symptoms in most cases.<ref name="pmid11134919">{{cite journal|vauthors=Hoare C, Li Wan Po A, Williams H|year=2000|title=Systematic review of treatments for atopic eczema|url=https://doi.org/10.3310%2Fhta4370|url-status=|journal=[[Health Technology Assessment (journal)|Health Technology Assessment]]|volume=4|issue=37|pages=1–191|doi=10.3310/hta4370|pmc=4782813|pmid=11134919|access-date=18 November 2009}}{{deadlink|date=September 2023}}</ref> Once daily use is generally enough.<ref name=Mc2012/> For mild-moderate eczema a weak steroid may be used (e.g., [[hydrocortisone]]), while in more severe cases a higher-potency steroid (e.g., [[clobetasol propionate]]) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.

<!-- Adverse effects including topical steroid addiction/withdrawal-->
Long term use of topical steroids may result in [[skin atrophy]], [[stria]], and [[telangiectasia]].<ref name=Mc2012/> Their use on delicate skin (face or groin) is therefore typically with caution.<ref name=Mc2012/> They are, however, generally well tolerated.<ref>{{cite journal | vauthors = Bewley A | title = Expert consensus: time for a change in the way we advise our patients to use topical corticosteroids | journal = The British Journal of Dermatology | volume = 158 | issue = 5 | pages = 917–920 | date = May 2008 | pmid = 18294314 | doi = 10.1111/j.1365-2133.2008.08479.x | s2cid = 46445371 | doi-access = free }}</ref> [[Red burning skin]], where the skin turns red upon stopping steroid use, has been reported among adults who use topical steroids at least daily for more than a year.<ref name=Oak2016>{{cite web| vauthors = Oakley A |title=Topical corticosteroid withdrawal|url=http://www.dermnetnz.org/reactions/topical-steroid-withdrawal.html|website=DermNet NZ|publisher=DermNet New Zealand Trust|url-status=live|archive-url=https://web.archive.org/web/20160316135658/http://www.dermnetnz.org/reactions/topical-steroid-withdrawal.html|archive-date=16 March 2016}}</ref>

==== Antihistamines ====
There is little evidence supporting the use of [[antihistamine]] medications for the relief of dermatitis.<ref name="Mc2012" /><ref>{{cite journal | vauthors = Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E | title = Oral H1 antihistamines as monotherapy for eczema | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD007770 | date = February 2013 | volume = 2013 | pmid = 23450580 | pmc = 6823266 | doi = 10.1002/14651858.CD007770.pub2 | url = http://www.cochrane.org/CD007770/SKIN_effects-antihistamines-eczema }}</ref> Sedative antihistamines, such as [[diphenhydramine]], may be useful in those who are unable to sleep due to eczema.<ref name="Mc2012" /> Second generation antihistamines have minimal evidence of benefit.<ref name="Matt2019" /> Of the second generation antihistamines studied, [[fexofenadine]] is the only one to show evidence of improvement in itching with minimal side effects.<ref name="Matt2019">{{cite journal | vauthors = Matterne U, Böhmer MM, Weisshaar E, Jupiter A, Carter B, Apfelbacher CJ | title = Oral H1 antihistamines as 'add-on' therapy to topical treatment for eczema | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD012167 | date = January 2019 | issue = 1 | pmid = 30666626 | pmc = 6360926 | doi = 10.1002/14651858.CD012167.pub2 }}</ref>

====Immunosuppressants====
[[File:Protopic.JPG|thumb|Tacrolimus 0.1%]]
Topical [[immunosuppressant]]s like [[pimecrolimus]] and [[tacrolimus]] may be better in the short term and appear equal to steroids after a year of use.<ref>{{cite journal | vauthors = Shams K, Grindlay DJ, Williams HC | title = What's new in atopic eczema? An analysis of systematic reviews published in 2009-2010 | journal = Clinical and Experimental Dermatology | volume = 36 | issue = 6 | pages = 573–577; quiz 577–578 | date = August 2011 | pmid = 21718344 | doi = 10.1111/j.1365-2230.2011.04078.x | s2cid = 42321918 | doi-access = free }}</ref> Their use is reasonable in those who do not respond to or are not tolerant of steroids.<ref name="Carr2013">{{cite journal | vauthors = Carr WW | title = Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations | journal = Paediatric Drugs | volume = 15 | issue = 4 | pages = 303–310 | date = August 2013 | pmid = 23549982 | pmc = 3715696 | doi = 10.1007/s40272-013-0013-9 }}</ref><ref>{{cite web|url=http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Treatment.aspx|title=Atopic eczema - Treatment|publisher=NHS Choices, London, UK|date=12 February 2016|access-date=27 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170116200857/http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/treatment.aspx|archive-date=16 January 2017}}</ref> Treatments are typically recommended for short or fixed periods of time rather than indefinitely.<ref name=Mc2012/><ref name="fda14">{{cite web|url=https://www.fda.gov/downloads/drugs/drugsafety/ucm088587.pdf|title=Medication Guide. Elidel® (pimecrolimus) Cream, 1%|publisher=US Food and Drug Administration|date=March 2014|access-date=27 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170211080101/https://www.fda.gov/downloads/Drugs/DrugSafety/UCM088587.pdf|archive-date=11 February 2017}}</ref> Tacrolimus 0.1% has generally proved more effective than pimecrolimus, and equal in effect to mid-potency topical steroids.<ref name=Tor2013>{{cite journal | vauthors = Torley D, Futamura M, Williams HC, Thomas KS | title = What's new in atopic eczema? An analysis of systematic reviews published in 2010–11 | journal = Clinical and Experimental Dermatology | volume = 38 | issue = 5 | pages = 449–456 | date = July 2013 | pmid = 23750610 | doi = 10.1111/ced.12143 | s2cid = 24638685 }}</ref> There is no association to increased risk of cancer from topical use of pimecrolimus nor tacrolimus.<ref name=fda14/><ref>{{Cite journal |last1=Devasenapathy |first1=Niveditha |last2=Chu |first2=Alexandro |last3=Wong |first3=Melanie |last4=Srivastava |first4=Archita |last5=Ceccacci |first5=Renata |last6=Lin |first6=Clement |last7=MacDonald |first7=Margaret |last8=Wen |first8=Aaron |last9=Steen |first9=Jeremy |last10=Levine |first10=Mitchell |last11=Pyne |first11=Lonnie |last12=Schneider |first12=Lynda |last13=Chu |first13=Derek K. |last14=Asiniwasis |first14=Rachel Netahe |last15=Boguniewicz |first15=Mark|date=1 January 2023 |title=Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis |url=https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00283-8/abstract |journal=The Lancet Child & Adolescent Health |language=English |volume=7 |issue=1 |pages=13–25 |doi=10.1016/S2352-4642(22)00283-8 |issn=2352-4642 |pmid=36370744|s2cid=253470127 }}</ref>

When eczema is severe and does not respond to other forms of treatment, systemic [[immunosuppressant]]s are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are [[ciclosporin]], [[azathioprine]], and [[methotrexate]].

[[Dupilumab]] is a new{{notetag|[[Dupilumab]] received approval from the US [[Food and Drug Administration]] for moderate-to-severe atopic dermatitis in 2017<ref>{{cite web |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |title=FDA approves new eczema drug Dupixent |publisher=U.S. [[Food and Drug Administration]] (FDA) |date=10 September 2019 |access-date=29 March 2017 |archive-date=28 March 2017 |archive-url=https://web.archive.org/web/20170328204026/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |url-status=live }}</ref> and for asthma in 2018.<ref>{{cite web | title=Dupixent- dupilumab injection, solution | publisher=[[DailyMed]] | date=25 June 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780 | access-date=17 September 2020 | archive-date=24 March 2021 | archive-url=https://web.archive.org/web/20210324191531/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780 | url-status=live }}</ref>}} medication that improves eczema lesions, especially moderate to severe eczema.<ref>{{cite journal | vauthors = Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N | title = Systemic treatments for eczema: a network meta-analysis | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD013206 | date = September 2020 | issue = 9 | pmid = 32927498 | pmc = 8128359 | doi = 10.1002/14651858.cd013206.pub2 }}</ref> Dupilumab, a monoclonal antibody, suppresses inflammation by targeting the [[interleukin-4 receptor]].

====Antifungals====
[[Antifungal]]s are used in the treatment of [[seborrheic dermatitis]].<ref name=Bor2019/>

==== Others ====
In September 2021, [[ruxolitinib|ruxolitinib cream]] (Opzelura) was approved by the U.S. [[Food and Drug Administration]] (FDA) for the topical treatment of mild to moderate atopic dermatitis.<ref name="Incyte PR 20210921">{{cite web | title=Incyte Announces U.S. FDA Approval of Opzelura (ruxolitinib) Cream, a Topical JAK Inhibitor, for the Treatment of Atopic Dermatitis (AD) | publisher=Incyte | via=Business Wire | date=21 September 2021 | url=https://www.businesswire.com/news/home/20210921006072/en/ | access-date=21 September 2021}}</ref> It is a topical [[Janus kinase inhibitor]].<ref name="Incyte PR 20210921" />

===Light therapy===

====Narrowband UVB====
[[Atopic dermatitis]] (AD) may be treated with [[narrowband]] [[UVB]],<ref>{{cite journal |last1=Gambichler |first1=T |last2=Breuckmann |first2=F |last3=Boms |first3=S |last4=Altmeyer |first4=P |last5=Kreuter |first5=A |title=Narrowband UVB phototherapy in skin conditions beyond psoriasis. |journal=Journal of the American Academy of Dermatology |date=April 2005 |volume=52 |issue=4 |pages=660–670 |doi=10.1016/j.jaad.2004.08.047 |pmid=15793518}}</ref> which increases [[Calcifediol|25-hydroxyvitamin D<sub>3</sub>]] in persons in individuals with AD.<ref>{{cite journal |last1=Le |first1=P |last2=Tu |first2=J |last3=Gebauer |first3=K |last4=Brown |first4=S |title=Serum 25-hydroxyvitamin D increases with NB-UVB and UVA/UVB phototherapy in patients with psoriasis and atopic dermatitis in Western Australia. |journal=The Australasian Journal of Dermatology |date=May 2016 |volume=57 |issue=2 |pages=115–121 |doi=10.1111/ajd.12315 |pmid=25916422|s2cid=41245703 }}</ref>

[[Phototherapy|Light therapy]] using [[heliotherapy]], balneophototherapy, psoralen plus UVA (PUVA), light has tentative support but the quality of the evidence is not very good compared with narrowband UVB, and UVA1.<ref>{{cite journal | vauthors = Gambichler T | title = Management of atopic dermatitis using photo(chemo)therapy | journal = Archives of Dermatological Research | volume = 301 | issue = 3 | pages = 197–203 | date = March 2009 | pmid = 19142651 | doi = 10.1007/s00403-008-0923-5 | s2cid = 29045951 }}</ref> However, [[UVB]] is more effective than UVA1 for treatment of atopical dermatitis.<ref>{{cite journal | vauthors = Meduri NB, Vandergriff T, Rasmussen H, Jacobe H | title = Phototherapy in the management of atopic dermatitis: a systematic review | journal = Photodermatology, Photoimmunology & Photomedicine | volume = 23 | issue = 4 | pages = 106–112 | date = August 2007 | pmid = 17598862 | doi = 10.1111/j.1600-0781.2007.00291.x | s2cid = 25684608 | doi-access = free }}</ref>

Overexposure to ultraviolet light carries its own risks, particularly that of [[skin cancer]].<ref>{{cite news | vauthors=  Stöppler MC |title=Psoriasis PUVA Treatment Can Increase Melanoma Risk |url=http://www.medicinenet.com/script/main/art.asp?articlekey=548 |date=31 May 2007 |publisher=MedicineNet |access-date=17 October 2007 |url-status=live |archive-url=https://web.archive.org/web/20070929092825/http://www.medicinenet.com/script/main/art.asp?articlekey=548 |archive-date=29 September 2007  }}</ref>

===Alternative medicine===

====Topical====

[[Chiropractic]] spinal manipulation lacks evidence to support its use for dermatitis.<ref>{{cite journal | vauthors = Eldred DC, Tuchin PJ | title = Treatment of acute atopic eczema by chiropractic care. A case study | journal = Australasian Chiropractic & Osteopathy | volume = 8 | issue = 3 | pages = 96–101 | date = November 1999 | pmid = 17987197 | pmc = 2051093 }}</ref> There is little evidence supporting the use of psychological treatments.<ref>{{cite journal | vauthors = Ersser SJ, Cowdell F, Latter S, Gardiner E, Flohr C, Thompson AR, Jackson K, Farasat H, Ware F, Drury A | title = Psychological and educational interventions for atopic eczema in children | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD004054 | date = January 2014 | volume = 2014 | pmid = 24399641 | pmc = 6457897 | doi = 10.1002/14651858.CD004054.pub3 }}</ref> While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.<ref>{{cite journal | vauthors = Barnes TM, Greive KA | title = Use of bleach baths for the treatment of infected atopic eczema | journal = The Australasian Journal of Dermatology | volume = 54 | issue = 4 | pages = 251–258 | date = November 2013 | pmid = 23330843 | doi = 10.1111/ajd.12015 | s2cid = 19644659 | doi-access = free }}</ref>

====Supplements====
* [[Sulfur]]: There is currently no scientific evidence for the claim that sulfur treatment relieves eczema.<ref name=Umm2007>{{cite web |title=Sulfur |url=http://www.umm.edu/altmed/articles/000328.htm |date=1 April 2002 |publisher=University of Maryland Medical Center |access-date=15 October 2007 |url-status=live |archive-url=https://archive.today/20120805205942/http://www.umm.edu/altmed/articles/000328.htm |archive-date=5 August 2012  }}</ref>
* [[Chinese herbology]]: it is unclear whether Chinese herbs help or harm.<ref>{{cite journal | vauthors = Armstrong NC, Ernst E | title = The treatment of eczema with Chinese herbs: a systematic review of randomized clinical trials | journal = British Journal of Clinical Pharmacology | volume = 48 | issue = 2 | pages = 262–264 | date = August 1999 | pmid = 10417508 | pmc = 2014284 | doi = 10.1046/j.1365-2125.1999.00004.x }}</ref> Dietary supplements are commonly used by people with eczema.<ref name="CC-Dietary-supps">{{cite journal | vauthors = Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC | title = Dietary supplements for established atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD005205 | date = February 2012 | pmid = 22336810 | pmc = 6517242 | doi = 10.1002/14651858.CD005205.pub3 | veditors = Bath-Hextall FJ }}</ref>
* Neither [[evening primrose oil]] nor [[borage seed oil]] taken orally have been shown to be effective.<ref name=Bamford2013>{{cite journal | vauthors = Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E | title = Oral evening primrose oil and borage oil for eczema | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD004416 | date = April 2013 | pmid = 23633319 | doi = 10.1002/14651858.CD004416.pub2 | veditors = Bamford JT | pmc = 8105655 }}</ref> Both are associated with [[Gastrointestinal disease|gastrointestinal upset]].<ref name=Bamford2013/>
* [[Probiotics]] are likely to make little to no difference in symptoms.<ref>{{cite journal | vauthors = Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ, Murrell DF, Tang ML, Roberts A, Boyle RJ | title = Probiotics for treating eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD006135 | date = November 2018 | issue = 11 | pmid = 30480774 | pmc = 6517242 | doi = 10.1002/14651858.CD006135.pub3 }}</ref>

==Prognosis==
Most cases are well managed with topical treatments and ultraviolet light.<ref name=Mc2012/> About 2% of cases are not.<ref name=Mc2012/> In more than 60% of young children, the condition subsides by [[adolescence]].<ref name=Mc2012/>

==Epidemiology==
Globally dermatitis affected approximately 230&nbsp;million people as of 2010 (3.5% of the population).<ref name=LancetEpi2012>{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, etal | title = Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–2196 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 | url = http://www.documentation.ird.fr/hor/fdi:010059240 }}</ref> Dermatitis is most commonly seen in [[infancy]], with female predominance of eczema presentations occurring during the reproductive period of 15–49 years.<ref>{{cite journal | vauthors = Osman M, Hansell AL, Simpson CR, Hollowell J, Helms PJ | title = Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care | journal = Primary Care Respiratory Journal | volume = 16 | issue = 1 | pages = 28–35 | date = February 2007 | pmid = 17297524 | pmc = 6634172 | doi = 10.3132/pcrj.2007.00006 }}</ref> In the UK about 20% of children have the condition, while in the United States about 10% are affected.<ref name=Mc2012/>

Although little data on the rates of eczema over time exists prior to the 1940s, the rate of eczema has been found to have increased substantially in the latter half of the 20th century, with eczema in school-aged children being found to increase between the late 1940s and 2000.<ref>{{cite journal | vauthors = Taylor B, Wadsworth J, Wadsworth M, Peckham C | title = Changes in the reported prevalence of childhood eczema since the 1939–45 war | journal = Lancet | volume = 2 | issue = 8414 | pages = 1255–1257 | date = December 1984 | pmid = 6150286 | doi = 10.1016/S0140-6736(84)92805-8 | s2cid = 2842761 }}</ref> In the [[developed world]] there has been rise in the rate of eczema over time.  The incidence and lifetime prevalence of eczema in England has been seen to increase in recent times.<ref name=Mc2012/><ref>{{cite journal | vauthors = Simpson CR, Newton J, Hippisley-Cox J, Sheikh A | title = Trends in the epidemiology and prescribing of medication for eczema in England | journal = Journal of the Royal Society of Medicine | volume = 102 | issue = 3 | pages = 108–117 | date = March 2009 | pmid = 19297652 | pmc = 2746851 | doi = 10.1258/jrsm.2009.080211 }}</ref>

Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%.<ref name =luckhaupt1>{{cite journal | vauthors = Luckhaupt SE, Dahlhamer JM, Ward BW, Sussell AL, Sweeney MH, Sestito JP, Calvert GM | title = Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey | journal = American Journal of Industrial Medicine | volume = 56 | issue = 6 | pages = 625–634 | date = June 2013 | pmid = 22674651 | doi = 10.1002/ajim.22080 | url = https://zenodo.org/record/1229093 }}</ref>

==Etymology and history==
{{Quote box
| quote = from [[Ancient Greek]] {{lang|grc|{{Script|Greek|ἔκζεμα}}}} {{lang|grc-latn|ékzema}},<ref>{{cite web|url=https://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3D%2331961 |title=Ekzema | vauthors = Liddell HG, Scott R |work=A Greek-English Lexicon |location=Tufts University |publisher=Perseus}}</ref> <br /> from {{lang|grc|{{Script|Greek|ἐκζέ-ειν}}}} {{lang|grc-latn|ekzé-ein}}, <br /> from {{lang|grc|{{Script|Greek|ἐκ}}}} {{lang|grc-latn|ek}} 'out' + {{lang|grc|{{Script|Greek|ζέ-ειν}}}} {{lang|grc-latn|zé-ein}} 'to boil'
| source = ([[OED]])
}}

The term ''atopic dermatitis'' was coined in 1933 by Wise and Sulzberger.<ref>{{cite book|title=Textbook of Atopic Dermatitis|publisher=Taylor & Francis|isbn=978-0-203-09144-9|page=1|url=https://books.google.com/books?id=xxDHpPGHFvAC|date=1 May 2008|url-status=live|archive-url=https://web.archive.org/web/20160528010317/https://books.google.com/books?id=xxDHpPGHFvAC&printsec=frontcover|archive-date=28 May 2016}}</ref> [[Sulfur]] as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.<ref name=Umm2007/>

The word ''dermatitis'' is from the Greek {{Lang|grc|{{Script|Greek|δέρμα}}}} {{Lang|grc-latn|derma}} 'skin' and {{Lang|grc|{{Script|Greek|-ῖτις}}}} {{Lang|grc-latn|-itis}} 'inflammation' and ''eczema'' is from {{langx|el|ἔκζεμα}} {{Lang|grc-latn|ekzema}} 'eruption'.<ref>{{Cite web|title = Definition of ECZEMA|url = http://www.merriam-webster.com/dictionary/eczema|website = www.merriam-webster.com|access-date = 15 February 2016|url-status = live|archive-url = https://web.archive.org/web/20160222205710/http://www.merriam-webster.com/dictionary/eczema|archive-date = 22 February 2016|df = dmy-all}}</ref>

==Society and culture==
Some cosmetics are marketed as hypoallergenic to imply that their use is less likely to lead to an allergic reaction than other products.<ref name=FDA>{{cite web |author1=Center for Food Safety and Applied Nutrition |title="Hypoallergenic" Cosmetics |url=https://www.fda.gov/cosmetics/cosmetics-labeling-claims/hypoallergenic-cosmetics |website=FDA |language=en |date=1 September 2020}}</ref> However, the term ''hypoallergenic'' is not regulated,<ref name="pmid15115531">{{cite journal | vauthors = Murphy LA, White IR, Rastogi SC | title = Is hypoallergenic a credible term? | journal = Clinical and Experimental Dermatology | volume = 29 | issue = 3 | pages = 325–7 | date = May 2004 | pmid = 15115531 | doi = 10.1111/j.1365-2230.2004.01521.x | s2cid = 41482522 }}</ref> and no research has been done showing that products labeled ''hypoallergenic'' are less problematic than any others. In 1977, courts overruled the U.S. [[Food and Drug Administration]]'s regulation of the use of the term hypoallergenic.<ref name=FDA/> In 2019, the [[European Union]] released a document about claims made concerning cosmetics,<ref>{{cite web |title=Technical document on cosmetic claims |url=https://ec.europa.eu/docsroom/documents/24847/ |website=ec.europa.eu |publisher=European Commission |access-date=7 December 2020}}</ref> but this was issued as guidance, not a regulation.<ref>{{cite news | vauthors = Kulliney K |title=EU 'free from' cosmetics claims technical document is guidance, not regulation: Expert |url=https://www.cosmeticsdesign-europe.com/Article/2019/09/06/Cosmetics-free-from-claims-guidance-EU-explained |access-date=7 December 2020 |work=cosmeticsdesign-europe.com |date=6 September 2019}}</ref>

==Research==
[[Monoclonal antibody|Monoclonal antibodies]] are under preliminary research to determine their potential as treatments for atopic dermatitis, with only [[dupilumab]] showing evidence of efficacy, as of 2018.<ref name="Snast">{{cite journal | vauthors = Snast I, Reiter O, Hodak E, Friedland R, Mimouni D, Leshem YA | s2cid = 4220890 | title = Are Biologics Efficacious in Atopic Dermatitis? A Systematic Review and Meta-Analysis | journal = American Journal of Clinical Dermatology | volume = 19 | issue = 2 | pages = 145–165 | date = April 2018 | pmid = 29098604 | doi = 10.1007/s40257-017-0324-7 }}</ref><ref>{{cite journal | vauthors = Lauffer F, Ring J | title = Target-oriented therapy: Emerging drugs for atopic dermatitis | journal = Expert Opinion on Emerging Drugs | volume = 21 | issue = 1 | pages = 81–89 | date = 2016 | pmid = 26808004 | doi = 10.1517/14728214.2016.1146681 | s2cid = 207484890 }}</ref>

==Notes==
{{Notefoot}}

==References==
{{Reflist}}

== External links ==
{{Medical condition classification and resources
| ICD10     = {{ICD10|L|20||l|20}}-{{ICD10|L|30||l|20}}
| ICD9      = {{ICD9|692}}
| ICDO      =
| OMIM      = 603165
| MedlinePlus  = 000853
| eMedicineSubj = Derm
| eMedicineTopic = 38
| eMedicine_mult = {{eMedicine2|Ped|2567}}
| MeshID     = D004485
}}
{{Wiktionary}}
{{Commons}}
* [https://www.aad.org/public/diseases/eczema Eczema Resource Center]. American Academy of Dermatology.
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[[Category:Dermatitis| ]]
[[Category:Autoimmune diseases]]
[[Category:Eczema| ]]
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