If your doctor has diagnosed you with generalized dermatitis or generalized eczema, and suspects that allergic contact dermatitis may be playing a role, then the information below will provide more guidance on what substances to avoid and how to avoid them.
What is generalized dermatitis and why does it happen?
Generalized dermatitis refers to inflammation of the skin that is “generalized” on the body, meaning that it affects many different parts of the body. It can occur due to different causes. In some cases, the inflammation of the skin is due to a condition known as eczema, in which the skin becomes very sensitive, easily irritated, and is prone to dryness. This becomes more common as people age, but it can occur in anyone at any age, even if they have no history of sensitive skin. Other people may develop dermatitis for other reasons.
It’s very important for people with dermatitis to protect their skin. Certain habits (such as long, hot showers) can irritate or damage the skin. Certain substances can irritate the skin also. More recommendations to help protect your skin are found below.
In some cases, generalized dermatitis is due to other causes apart from eczema. Your dermatologist may recommend a skin biopsy to search for these other causes. They may also recommend that you see your primary care doctor for a physical exam and routine blood work, which may include tests for liver, kidney, and thyroid function.
How do I protect and strengthen my skin?
Our skin comes into frequent contact with many substances and chemicals that can cause irritation of the skin. This includes the obvious and the not-so-obvious. Harsh soaps can be irritating to the skin. Long, hot showers or baths can dry out the skin and lead to damage to the skin barrier. Certain laundry detergent or additives can also be irritating. Tight clothing can be irritating. Even sweat in prolonged contact with the skin can lead to irritation. This is why the proper skin care is so important.
1. When bathing, use lukewarm water only. Avoid extremes of hot or cold water.
2. Use a very mild soap. Avoid soaps with fragrances and harsh/ potentially allergy-causing chemicals. Some recommendations are below. In general, soap does not need to be applied to all body surfaces; you may just apply to face, groin and underarms.
3. Limit bathing time to under 15 minutes.
4. Immediately after bathing, pat with a towel, and while skin is still damp apply a moisturizer to the skin. Ointments are the most moisturizing, but may be greasy. Creams are very good moisturizers. Lotions are the least moisturizing. When applied after bathing, these all help to “lock in moisture.” These should also be applied as needed during the day.
5. If prescribed topical steroid ointments for dermatitis, remember that the medication should always be applied first, followed by the moisturizer. As the dermatitis begins to improve, the medication may be tapered off, but the regular use of moisturizers should continue.
6/Avoid the use of anything that might irritate or inflame sensitive skin. This includes cleansers with scrubs, bubble bath, washcloths, brushes, loofahs, or perfumed products.
7. Use fragrance-free and dye-free laundry detergents. If necessary, consider double-rinsing clothing. Examples include All Free and Clear, Tide Free, and Cheer Free.
8. Wear the right clothing. Rough, tight, wool, or new clothing may be irritating.
9. Heating in the house contributes to dry skin. A humidifier is helpful.
Is my dermatitis due to an allergic reaction? Why is it so hard to diagnose?
There are different types of allergic reactions. Allergic contact dermatitis (ACD) is one type that may result in generalized dermatitis. In this type of allergy, a substance contacts the skin, and later results in a rash. The rash from poison ivy is one example. The rash classically occurs 2-3 days later, but it may happen just a few hours later, or one week later. This delay is what makes ACD so hard to figure out.
Once the rash occurs, it may last for weeks, and sometimes up to 8 weeks. People may stop using the triggering product for 1-2 weeks, but that’s usually not long enough to see results.
What are some of the most common substances that trigger ACD? How can I avoid them?
1. Fragrance additives and certain preservatives in skin care products are common triggers of allergy. These may be found in products such as liquid soaps, bar soaps, lotions and creams. The products listed below will avoid some of the most common triggers.
2. Note that even some products that are labeled as “hypoallergenic” or “for sensitive skin” will contain some of the ingredients that are common causes of ACD. Even products labeled as “baby products” may trigger reactions, since baby products frequently contain fragrance additives. Both synthetic and natural fragrance additives are common triggers of allergic reactions.
3. Some people react to over-the-counter antibiotic ointments. Many people apply Neosporin or Polysporin when they develop cracks in their skin. The antibiotics in these, neomycin and bacitracin, are actually one of the most frequent causes of ACD. For cuts in the skin, it is better to apply pure Vaseline petroleum jelly to the cut. If the skin is actually infected, your doctor can prescribe an antibiotic.
4. Some people will react to other over-the-counter medications. We have seen allergic reactions to Benadryl cream, benzocaine [in Lanacaine, Solarcaine and others], and Sarna lotion [due to the added fragrance]. Because of this potential for allergic reactions, it’s important to use only those products recommended by your physician.
5. Certain “natural” eczema treatments may trigger reactions. We have seen allergic reactions to “natural” eczema treatments such as certain essential oils and tea tree oil. Other treatments, such as witch hazel, rubbing alcohol, or apple cider vinegar, should NOT be applied directly to inflamed skin, as they cause irritation.
6. Do NOT use any type of cleansing wipes, as many of these contain major allergens.
7. Chemicals in clothing may also trigger a rash. Some clothing dyes may trigger rashes, especially dark clothing dyes found in synthetic materials (such as work-out clothing). Formaldehyde finishes may also trigger a rash. These tend to be used more in wrinkle-free or permanent press clothing. To protect against these chemicals, you may need to use white or light-colored work-out clothing, or wear white cotton undershirts underneath dress clothing. Several companies sell chemical-free clothing that is free of dyes and added chemicals, such as cottonique.com. Note that many 100% cotton items do contain added chemicals, so words such as “100% cotton” or “organic cotton” will not necessarily avoid these chemicals. Sometimes people will switch to looser clothing or wear skirts or shorts, which helps limit close contact with clothing. Note that most blue jeans actually use different types of dyes, and are usually OK.
What are examples of products that contain less of the substances that commonly trigger ACD?
The products below do not contain some of the common (and less common) triggers of ACD. They do not contain any synthetic fragrance additives, natural or botanical fragrance additives, formaldehyde, methylchloroisothiazolinone, propylene glycol or lanolin. Some are available at major retailers, and others must be ordered via phone or website.
Note that every product must contain some additives, and some people are allergic to less common triggers. Therefore, if these recommendations do not help, you may require further testing. It can take up to 8 weeks of allergen avoidance for your skin to recover.
Your physician will prescribe a medicated ointment to use during this time to help with the inflammation.
Liquid cleansers: Cerave hydrating cleanser [does not foam], Free and Clear liquid cleanser [does foam; available at 1-800-325-8232]
Bar soaps: Aveeno fragrance-free bar soap, Cerave hydrating cleanser bar soap, Neutrogena fragrance-free bar soap
Cleansers to remove grease: Albolene moisturizing cleanser [This product is often used to remove eye make-up and as a cleanser for very sensitive skin. It may also help to remove grease]
For bedtime: Pure Vaseline petroleum jelly [purchase the version without added fragrance or flavoring]
Other moisturizers [from most greasy to less greasy]: Theraplex Healing Emollient [theraplex.com], Neutrogena Norwegian Formula Hand Cream, Aveeno Eczema Therapy cream, Cerave cream
Laundry detergent: All Free and Clear, Cheer Free, or Tide Free
Hair care: Free and Clear shampoo [1-800-325-8232] and DHS Conditioning Rinse
What should I do if these recommendations do not help?
Remember, it can take up to 8 weeks of following these recommendations to see if they will help. If these recommendations do not work, then you may need patch testing to pinpoint exactly which allergens, if any, are playing a role in this dermatitis.
You may also need other types of testing. Other causes and other types of allergies may also cause generalized dermatitis.
1. A skin biopsy may be necessary to rule out other conditions.
2. Rarely, allergy to a medication [taken by mouth] may result in generalized dermatitis. Some examples of triggers are dyes that are found in pills or tablets [such as red dyes], statin medications [used for cholesterol], or calcium channel blockers such as diltiazem [used to treat high blood pressure]. There is no test for this kind of allergy. The only test possible is to stop the possible triggering medication for 8 weeks and see if the rash improves. This should only be done with your doctor’s approval.
3. For rashes on the face, a different type of allergy may be playing a role. Some people react to certain pollens, molds, cat dander, dog dander, dust mites, or other types of airborne substances, with a rash [in addition to the typical sneezing or hayfever symptoms].
4. Some cases of generalized dermatitis are diagnosed as eczema. The skin may become very inflamed, but no single cause is identified. Treatment for dermatitis usually includes topical medications [which have the least potential for side effects]. Since some cases of generalized eczema are more severe, topical medications may not be strong enough. In these cases, your dermatologist will discuss other options, such as light therapy or systemic therapies [such as pills by mouth].