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The term dermatitis, also known as eczema, is used to describe an array of skin conditions caused by inflammation of the skin. The symptoms are often itchy and dry skin or a rash; however, there may also be blisters, oozing sores, crusts, or flaking patches on the affected area. Three forms of this condition include: 

  • Atopic dermatitis
  • Seborrheic dermatitis 
  • Contact dermatitis 

Atopic Dermatitis

Atopic Dermatitis, commonly known as “eczema” or “atopic eczema”, is a common cutaneous condition that can affect anyone at any age; however, it often appears in early childhood. Statistics show approximately one-fifth of children experience eczema in their lifetime. The affliction may cause extremely itchy rashes, which may come and go throughout the time affected. 

It is a complex disorder influenced by both individual susceptibility and environmental elements. People who suffer from eczema tend to have weakened skin barriers, which can lead to amplified inflammatory and allergy reactions. 

Eczema can appear on any body part, but severe forms usually confine around the joints (elbows, knees, wrists), neck and facial areas. The affected area appears red and dry with scratch marks that may lead to bleeding. 

When atopic eczema is active, the skin may become moist and weepy, with water blisters developing over the area. Constant scratching of affected parts can cause skin thickening, which further generates more itching. When the condition is calm, these areas usually have a different shade than unaffected regions—either darker or lighter.

Seborrhoeic dermatitis 

Seborrhoeic dermatitis is surprisingly common, with an estimated 4% of the population affected by it. Its milder form, dandruff, can even be found in almost half of all adults. It usually begins after puberty and is more frequent in males than females. Babies may also experience a temporal form of seborrhoeic dermatitis on their scalp (or cradle cap) and diaper area, which usually resolves after several months. 

It is believed that the overgrowth of yeast known as Malassezia or an inappropriate reaction by the immune system to this fungus can trigger seborrhoeic dermatitis. However, these are not similar to thrush-causing yeasts nor those found in foodstuffs. Seborrheic Eczema can be triggered by extreme fatigue or stress sometimes; it tends to manifest more in cold weather rather than warm climates and has nothing to do with eating habits either.

Contact Dermatitis 

Contact dermatitis (contact eczema) is skin inflammation caused by direct or indirect contact with something in the environment. Contact dermatitis commonly occurs on the hands and arms. Once in contact with a potential irritant or allergen, the skin may become red, bumpy, scaly, blistering or oozing. The neck and face are other common areas for this type of reaction to happen.

Two main types of contact dermatitis are:

1. Irritant contact dermatitis is caused by direct exposure to harsh substances, such as laundry detergents, solvents and hot water. These elements strip away the skin’s natural oils, normally creating a protective barrier from irritants—repeated, or long-term contact with these materials results in eczema flare-ups.

Patients can develop this condition from regularly handling irritating materials or too much frequent handwashing. It is common among people whose hands are often in contact with water – nurses, hairdressers, bartenders, cooks, and cleaners – causing hand dermatitis. Those with a history of skin conditions, such as eczema in childhood, are especially vulnerable to developing this type of dermatitis.

2. Allergic contact dermatitis arises when a person develops an immune response to specific substances that make physical contact with the skin. Commonly, these materials include hair dye, nail cosmetics, fragrances, nickel-made objects or jewellery pieces such as rings, bracelets and earrings, rubber items or compounds contained in some beauty products. It is unclear why certain persons react hypersensitively to allergens while others don’t show any symptoms at all after being exposed.

Frequently Asked Questions

Various environmental elements can trigger atopic eczema, such as soaps and detergents, high temperatures, dust mites, wool garments and animals. Furthermore, if one has a cold or other illness, their flare-ups may worsen; the same applies when infected with bacteria or viruses. Therefore it is essential to take extra precautions while managing this condition. 

  • Dry skin: can disrupt the skin barrier, which generally helps to keep moisture in and irritants out. When the skin becomes too dry, the barrier may weaken, allowing irritants and allergens to penetrate the skin more easily. This can trigger an immune response in the skin, leading to inflammation and itching.
  • Stress: When the body experiences stress, it releases hormones such as cortisol and adrenaline that can affect the immune system and the skin. Additionally, stress can disrupt sleep, which can also exacerbate atopic eczema. Lack of sleep can lead to increased levels of the stress hormone cortisol, which can further aggravate the condition.
  • Teething in babies: The exact mechanism by which teething triggers eczema is not fully understood, but it may be related to changes in the immune system or increased inflammation. Teething can cause increased drooling and chin rash, exacerbating existing eczema or triggering a flare-up. The moisture from drooling can irritate the skin and lead to itching and inflammation. Teething can also be a stressful time for babies, which can further worsen eczema symptoms. 
  • Food allergens: When a person with atopic eczema comes into contact with a food allergen, it can cause an immune response in the skin, leading to inflammation and itching. In some cases, food allergens can trigger immediate skin reactions, such as hives or swelling. However, in other cases, the skin reaction may be delayed, making it more difficult to identify the trigger. Delayed reactions can occur up to 24-48 hours after consuming a food allergen. Common food allergens that trigger atopic eczema include cow’s milk, eggs, peanuts, soy, wheat, fish, and shellfish. In some cases, food additives such as preservatives or food colouring can also trigger eczema.

Areas affected by this condition appear red and are covered with scaly skin flakes. It usually targets one or two body zones, but it can happen anywhere in the body. The  region’s most commonly afflicted are:

  • On the scalp: Seborrhoeic dermatitis can range from mild, flaky skin (dandruff) to an intensely scaly and inflamed rash that may weep.
  • On the face: Seborrhoeic dermatitis regularly affects the inner eyebrows, around the nose and cheeks, as well as causing redness, swelling and flakiness in the eyelids. 
  • In and around the ears: People can suffer from inflammation inside their ear canals, cups of the ears and behind them. This type of inflammation may lead to bacterial infections that result in oozing, crusting and blockage in the ear canal.
  • On the front of the chest and between the shoulder blades: it shows up as well-defined, round, pink-red patches with mild scaling.
  • In the skin folds: Moist areas like the skin beneath breasts, groin folds, underarms, and abdominal creases are especially vulnerable to this condition. It renders these body parts a shiny pink with surface cracks as its primary symptom.

To effectively treat contact dermatitis, it is essential to identify the root cause and completely remove any irritants or allergens coming into contact with your skin. However, this can be challenging; thus, protective measures like wearing gloves, using emollient creams regularly for better skin barrier protection, and avoiding soaps/detergents should be taken into consideration. 

Topical steroid creams of the proper strength should be applied as directed for the mainstay treatment of contact dermatitis. Moreover, emollients should be applied multiple times daily – heavier ones at night and lighter or gel-based ones during the day. By adhering to this regimen, you can quickly achieve a successful recovery from contact dermatitis. Using steroid creams and moisturizers for several months is crucial to ensure the most effective results. 

For those with extreme cases of contact dermatitis, additional treatments may be necessary; these could include oral steroid tablets, antibiotics or even immunosuppressants in rare circumstances.

Dr Miller is here to help

dr natalie miller

Dr. Natalia Miller

In order to provide you with the highest quality of care, Dr Miller will comprehensively evaluate your skin condition and type of eczema by taking a thorough medical history and performing a physical examination. She may also recommend additional testing to help diagnose your dermatitis, such as a skin patch test to identify allergens that may be triggering your symptoms. She may take a sample (swab) if an infection is suspected. 

Once a diagnosis has been made, she will review treatment options with you and recommend a treatment plan tailored to your needs. This may include topical or oral medications, moisturisers, and lifestyle changes such as avoiding irritants that can trigger symptoms. She will also typically provide guidance on how to properly care for your skin to prevent further flare-ups. 

Finally, she may schedule follow-up appointments to monitor your progress and make adjustments to your treatment plan as needed. It is important to follow the recommendations closely and communicate any changes in symptoms or concerns during the course of your treatment.