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Atopic Dermatitis and Contact Dermatitis: Learning the Difference Between Two Common Forms of Eczema

Dry, red skin. Itchiness that won’t stop. Rashes, possibly with blisters.

Different kinds of skin flare-ups can look alike, even when they result from very different conditions. Understanding the underlying causes of the conditions is the only way to treat them effectively – and to prevent or reduce recurrences in the future.

Two forms of eczema that are commonly confused with each other are atopic dermatitis and contact dermatitis. Even as the symptoms of these two conditions can look similar, they have different causes. One is a chronic and genetic condition that can create lifelong flare-ups; the other is the result of exposure to a particular substance. Hence, the treatment strategies for both differ, too.

Working with a dermatologist to get a definite diagnosis will be your first step to gaining relief from either of these uncomfortable conditions. If you live in the Charlotte area, the providers at Carolina Asthma & Allergy Center can help you learn more about dermatitis – and how we can help you find relief, no matter which kind you may have.

Dermatitis and Eczema

Eczema encompasses seven types of skin conditions, and it’s a common ailment: it affects more than 31 million Americans. The types of dermatitis are atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis and stasis dermatitis.

While each type of eczema has its own characteristics, they have much in common as well. No form of eczema is not contagious, for one. Also, eczema has no cure. It can be managed, however, with treatments. To find the most effective treatment, it’s important to learn which type of eczema a patient has.

What are Similarities and Differences Between Atopic Dermatitis and Contact Dermatitis?

The primary difference between atopic dermatitis and contact dermatitis is the cause of each condition. Atopic dermatitis is a chronic condition that may be passed from parents to children. It may also result from changes in the immune system. Some children will grow out of atopic dermatitis, while others will experience flare-ups throughout their lives. Like all forms of eczema, atopic dermatitis cannot be cured, but it can be managed.

In contrast, contact dermatitis is not a chronic or genetic condition. It’s a reaction that occurs when the skin comes in contact with certain substances. This can be irritant contact dermatitis, that occurs after the skin comes in contact with a toxic substance, like a chemical or detergent. Or this can be an allergic contact dermatitis, which occurs after the skin contacts something that it’s developed an allergy to, such as poison ivy or nickel. An allergy can develop after a single exposure or even after many years of exposure. Contact dermatitis can be treated to relieve symptoms. Although it can’t be cured, it may be prevented: by identifying the cause of the reaction, avoiding exposure to that substance can prevent recurrence.

The symptoms can be similar. Both progress through the three stages of eczema: acute phase (red, itchy rash), the sub-acute phase (rough and dry with small bumps), and the chronic stage (a thickening of the skin).

Because of these similarities, they may be hard to distinguish initially. In addition, it is also possible to have both atopic and contact dermatitis.

What is Atopic Dermatitis?

Atopic dermatitis is one of the most common skin problems today. A form of eczema – a condition which causes skin to become red, swollen and painful – this disorder causes chronic itching eruptions, or breakouts.

Atopic dermatitis is most frequently experienced in children younger than five, and it usually begins during infancy or early childhood. Although there is no cure, about 50% of children outgrow the disorder and treatment plans are available that make the ailment manageable while symptoms persist.

What is Contact Dermatitis?

Contact dermatitis is also a common skin problem and another form of eczema. This occurs when the skin comes into contact with a substance that triggers a reaction. Common causes of contact dermatitis include metals (often nickel), plants (for example, poison ivy and poison oak), cosmetics, detergents, cleaners and soaps. Irritant contact dermatitis results from exposure to a toxic substance, such as a chemical or cleaner. Allergic contact dermatitis is the result of an allergy, such as one to poison ivy or cosmetics. About 80 percent of contact dermatitis cases are irritant contact dermatitis.

People who come into regular contact with these materials, such as maintenance workers or those who work with chemicals, are most likely to develop irritant contact dermatitis. For allergic contact dermatitis, the allergic reaction can occur after a single exposure to the substance; other times, allergic contact dermatitis forms after continual and repeated exposures.

What are Symptoms of Atopic Dermatitis?

Symptoms include dry, red patches on the skin that may crust, scale or ooze. These rashes generally appear on the face, torso, and outside of the arms and legs. The itchiness often worsens at night.

Atopic dermatitis can develop in children as young as one or two years old. When the child reaches two to four years of age, the rash may affect the elbow and knee creases, neck, wrists, ankles and feet. Clusters of red or flesh-colored bumps or scaly patches will appear in these areas. Skin may also become drier, thicker and more noticeably creased. When the patient reaches adolescence, the rash may become more predominant on the sides of the neck, hands, feet and face. Accentuated creasing of the skin is also more common at this stage.

Bacterial infections frequently occur with this disorder during all of its stages. These infections produce redness and itching and may cause crusting, oozing and ulcers to develop on the skin.

What are Symptoms of Contact Dermatitis?

There are two forms of contact dermatitis, each with different symptoms. Allergic contact dermatitis – which occurs when the skin has an allergic reaction to another substance – the skin will redden, burn and may appear leathery. The skin will also be dry and flaky, and the itchiness can be intense. Oozing blisters may form. There may be swelling in the face, eyes, and groin.

Much more common is irritant contact dermatitis, which occurs when the skin comes in contact with a toxic substance. It’s symptoms include dry skin that forms blisters. But the dryness can also make the skin feel stiff or even crack. In addition, open sores may form.

How is Atopic Dermatitis Diagnosed?

Atopic dermatitis can be diagnosed by a thorough examination by a medical professional and by taking a medical history. Some cases may need additional testing. While it is frequently found in children, atopic dermatitis can occur at any age.

How is Contact Dermatitis Diagnosed?

Contact dermatitis is diagnosed by its appearance and by taking a careful medical history. Offending agents can sometimes be identified based on the timing of onset of the rash. Other times the causes are more elusive. An allergist can conduct patch testing, in which suspected offending agents are taped to the skin for 24 hours and then removed. The test area is observed for the next several days, looking for skin reactions.

How is Atopic Dermatitis Treated?

The main goal of treatment is to eliminate the itching which provokes the other symptoms and causes the most discomfort. (Itching makes the sufferer scratch the irritated skin, causing outbreaks to occur and bacterial infections to develop.)

Itching is minimized by keeping the skin moist. This can be accomplished by applying emollients, or moisturizers, both after bathing and one to two other times during the day. Tepid – not hot – water is recommended for bathing. Hot water may create drier skin and with it, induce more itching. Those with atopic dermatitis should take showers less frequently, since showers wash oils off the skin. This promotes dryness and therefore aggravates the itching and other problems seen in such patients.

Soft cotton fabrics are advised for clothing. Wools, polyesters and other scratchy materials should be avoided. Mild soaps and detergents should be used for washing and fabric softeners should be avoided, as they can be irritating to the skin.

Medications for atopic dermatitis include topical steroids, such as over-the-counter hydrocortisone. While antihistamines won’t eliminate the rash, they may relieve the itching that makes this condition so challenging. Some people, over the age of two, who have atopic dermatitis find topical calcineurin inhibitors helpful as well.

An allergist can help a patient develop a systematic treatment program to keep skin moist and alleviate itching. So, even though there is no cure for atopic dermatitis, there’s no reason why a patient should suffer from its symptoms.

How is Contact Dermatitis Treated?

Treatment for contact dermatitis is similar to that of atopic dermatitis. The main goal of treatment is to reduce itching and inflammation and to prevent recurrences. To prevent recurrence, it’s vital to identify the substance that triggers the reaction and to avoid it as much as possible in the future.

Symptoms can be relieved by keeping the skin well moisturized. This can be accomplished by applying emollients, or moisturizers, after bathing and one to two other times during the day. Tepid rather than hot water is recommended for bathing, as hot water may induce itching. People dealing with contact dermatitis should reduce their number of showers, since they wash the oils off the skin. Excessive showering can promote dryness and therefore aggravates the itching and other problems seen in such patients.

Soft cotton fabrics are advised for clothing. Wools, polyesters and other scratchy materials should be avoided. Mild soaps and detergents should be used for washing and fabric softeners should be avoided as they can be irritating to the skin.

Medications for contact dermatitis include topical steroids, such as over-the-counter hydrocortisone. For more advanced cases, a prescription topical or oral steroid may be necessary. While antihistamines won’t eliminate the rash, they may relieve the itching that makes this condition so challenging.

An allergist can help a patient develop a systematic treatment program to keep skin moist and alleviate itching.

Living with Eczema and Dermatitis: Answers to Essential Questions

With eczema being as common as it is, those who suffer from it often have questions about how it may impact their lives. Here, we answer some of the most frequent questions we hear about living with eczema and dermatitis.

Is There a Link Between Eczema and Asthma?

Yes. Both eczema and asthma, which are both inflammatory conditions. While not everyone with asthma has eczema, the opposite tends to be true: most children who have eczema will go on to develop asthma, too. Although no one knows for sure why these conditions are related, they’re likely both tied to environmental allergens.

What is the First Sign of Dermatitis?

The first sign of dermatitis, a form of eczema, is often the presence of red, dry, swollen skin or a rash. How – and when – the skin irritation forms depends upon the type of dermatitis. Atopic dermatitis usually begins in young children, and it has no specific trigger. Flare-ups occur from time to time and may continue into adulthood. Contact dermatitis, however, happens to people of all ages and is triggered by a particular substance. For irritant contact dermatitis, the triggering substance is often a toxic one, such as a chemical or disinfectant. For allergic contact dermatitis, the triggering occurs with an allergic response, such as to poison ivy, perfumes, dyes or metals.

Does Dermatitis Go Away?

Sometimes. As like all forms of eczema, there is no cure for dermatitis. That does not mean, however, that people with dermatitis have to deal with the condition forever. About half of children will atopic dermatitis will grow out of the condition entirely. For others, effective treatments can manage the condition, and – in the case of contact dermatitis – identifying the trigger can reduce the change of future recurrences. With a variety of treatments for each type of dermatitis, there is no reason to suffer the effects of this condition. If you live in Charlotte and have dermatitis, call Carolina Asthma & Allergy to learn how we can help you relieve these symptoms.

 

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