Tag Archives: Atopic dermatitis

Cradle Cap

Alternative Names:  Seborrheic eczema; Cradle cap,infantile or neonatal seborrhoeic dermatitis,
crusta lactea, milk crust, honeycomb disease.

Definition:
Cradle cap  is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies. It is usually not itchy, and does not bother the baby. Cradle cap most commonly begins sometime in the first 3 months. Similar symptoms in older children are more likely to be dandruff than cradle cap. The rash is often prominent around the ear, the eyebrows or the eyelids. It may appear in other locations as well, where it is called seborrhoeic dermatitis rather than cradle cap. Some countries use the term pityriasis capitis for cradle cap. It is extremely common, with about half of all babies affected. Most of them have a mild version of the disorder. Severe cradle cap is rare.
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It’s not due to poor hygiene and isn’t contagious or an allergy. Cradle cap tends to run in families, so there may be a genetic predisposition.

Cradle cap usually resolves on its own within a few months. Self-care measures, such as washing your baby’s scalp daily with a mild shampoo, can help loosen and remove the cradle cap scales. If cradle cap persists or seems severe, your doctor may suggest a medicated shampoo, lotion or other treatment.

Symptoms:-
Common signs of cradle cap include:
*Skin lesions
*Plaques over large area
*Greasy, oily areas of skin
*Skin scales — white and flaking, or yellowish, oily, and adherent — “dandruff”
*Itching — may become more itchy if infected
*Mild redness
*Hair loss
*Patchy scaling or thick crusts on the scalp
*Greasy skin covered with flaky white or yellow scales
*Skin flakes or dandruff
*Possibly mild redness

Similar scales may also be present on the ears, eyelids, nose and groin.

Cradle cap is most common in newborns. It isn’t contagious and probably won’t bother your baby. In most cases, the condition isn’t itchy for infants.

Causes:
Cradle cap is not caused by a bacterial infection, allergy, nor from poor hygiene. Doctors are not in agreement as to the causes, but the two most common hypotheses include fungal infection and overactive sebaceous glands.

In many cases, what is commonly called cradle cap is actually a fungal infection. This infection may be related to antibiotics given to the mother just before the infant’s birth, or the infection could be related to antibiotics routinely given to infants during the first week of life. Antibiotics kill both harmful bacteria as well as the helpful bacteria that prevent the growth of yeast, which is why people who are prone to fungal infections will often discover a fungal infection after taking a round of antibiotics. In infants, the fungus is mostly likely to appear on the scalp (cradle cap), diaper area (fungal diaper rash, jock itch), ear (fungal ear infection, or an ear infection that does not respond to antibiotics),or in the mouth (thrush).

Another common cause of cradle cap appears to be a common manifestation of biotin insufficiency. This may be due, in part, to the influence of biotin on fatty acid biosynthesis. Possibly it has to do with overactive sebaceous glands in the skin of newborn babies, due to the mother’s hormones still in the baby’s circulation. The glands release a greasy substance that makes old skin cells attach to the scalp instead of falling off as they dry. There may be a relationship with skin yeasts (Pityrosporum ovale, newly renamed Malassezia furfur). Seborrheic dermatitis is the adult version of cradle cap

SOME SIGNS OF WARNING:-
If the condition thickens, turns red and irritated, starts spreading, appears on other body parts, or if the baby develops thrush (fungal mouth infection), fungal ear infection (an ear infection that does not respond to antibiotics) or a persistent diaper rash, medical intervention is recommended.

Severe cases of cradle cap, especially with cracked or bleeding skin, can provide a place for bacteria to grow. If the cradle cap is caused by a fungal infection which has worsened significantly over days or weeks to allow bacterial growth (impetigo, most commonly), a combination treatment of antibiotics and antifungals may be necessary. Since it is difficult for a layperson to distinguish the difference between sebaceous gland cradle cap, fungal cradle cap, or either of these combined with a bacterial infection, medical advice should be sought if the condition appears to worsen.

Cradle cap is occasionally linked to immune disorders. If the baby is not thriving and has other problems (e.g. diarrhoea), a doctor should be consulted.

Possible Complications:
•Psychological distress, low self esteem, embarrassment
•Secondary bacterial or fungal infections

Treatment:
Treatment other than gentle washing is not necessary in most mild cases (flaking, with or without small patches of yellow crusting), as the problem often resolves itself whether the cause is sebaceous-gland-related or fungal, but since many patients (and/or parents) are concerned about cosmetic issues, the following options are often considered:

-For all ages: Home remedies include the application of various oils, lotions, or petroleum jelly. There is little adequate or controlled research to support or negate the usefulness of most common home remedies at any age, but there is anecdotal evidence to support either position. When cradle cap is related to fungal infection, treatment for other fungal infections can also work. Tinea capitis is one example of a fungal cause. Doctors may prescribe a seven-day daily application of clotrim (commonly prescribed for jock itch or athlete’s foot) or miconazol nitrate (commonly prescribed for vaginal yeast infections).

-For infants: in cases that are related to fungal infection, doctors may recommend once-daily application of clotrim (1%) or miconozal nitrate (2%) for seven to fourteen days.

-Application of  lavender oil may be helpful for fungal infection.

-For toddlers: doctors may recommend a treatment with a mild dandruff shampoo such as Selsun Blue or Neutrogena T-gel, even though the treatment may cause initial additional scalp irritation. A doctor may instead prescribe an antifungal soap such as ketoconazole (2%) shampoo, which can work in a single treatment and shows significantly less irritation than over-the-counter shampoos such as selenium sulfide shampoos, but no adequate and controlled study has been conducted for pediatric use as of 2010.

-For adults: Seborrheic dermatitis (the adult version of cradle cap) usually requires the use of an antifungal shampoo, possibly along with the nightly application of an antifungal cream or an anti-itch cream/gel like Scalpicin. Some doctors also recommend the supplementation of a B-vitamin complex to improve fatty acid metabolism..

Scalp, behind ears, eyebrows:
The common home remedy of applying oil (vegetable, particularly olive oil, or mineral oil) liberally to the scalp and letting it soak in overnight or for lesser periods of time seems to conflict with the fact that Malassezia yeasts thrive in oily environments preferring saturated fats, although anecdotal reports suggest it may be effective. This may be because olive oil is primarily unsaturated fat and does not promote fungal growth. If the cradle cap is not severe, you may try to comb it out gently after bathing. The softened scales can then be brushed away with a soft brush, comb or cloth, but if not done very gently, this can worsen the condition and bring about temporary hair loss. There has been no studies done on these recommendations. Applying petroleum jelly (e.g., Vaseline) liberally overnight is another popular treatment. The softened scales either fall off during the night, or can be brushed off in the morning. Making a paste from sodium bicarbonate (baking soda) and leaving it on the affected area for 10 minutes can also help lift the scales.

There is broad disagreement regarding the role of shampoos. Some sources warn against frequent shampooing, others recommend it. Mild baby shampoo is often recommended, while never specifying what “mild” actually means. Baby shampoos often contain detergent surfactants, perfumes, quaternium-15 and other eczemagenic irritants. Again, no studies have been performed on non-prescription shampoos.

Keratolytic (dandruff) shampoos (e.g. with sulfur, selenium, zinc pyrithione, or salicylic acid) are generally not recommended as they sting eyes and may worsen the dermatitis. In stubborn cases some doctors do recommend them while others warn against the use of medicated shampoos in newborns due to systemic absorption. Dandruff shampoos often contain sodium dodecyl sulfate, a noted skin irritant.

Steroid and tar preparations have also been used but have significant drawbacks. Immunomodulators (tacrolimus/Protopic, pimecrolimus/Elidel) have not been approved for babies under two years.

Ketoconazole shampoos and creams are taking first place in medical treatment of moderate to serious cradle cap. Research so far indicates that this anti-fungal medication is not absorbed into the bloodstream. Ketoconazole shampoo is currently made with a number of problematic irritants and allergens.

A Swedish study   found good results from massaging the scalp with small amounts of borage oil twice a day.

Other home remedies recommended in various alternative sources and parent forums are herbal washes (e.g. burdock or chamomile), aloe gel, and tea tree oil (Melaleuca oil) shampoo. Tea tree oil and aloe can be sensitizers; any worsening should be an occasion to discontinue the remedy in question. Both remedies have been tested in medical trials and found useful.

Eyelids:…….click & see
Typical medical advice is to use diluted baby shampoo on a cotton swab to cleanse the eyelid. There is no agreement on the dilution, which ranges from a few drops to a half cup warm water, to a 50/50 mix. No studies have been performed on the efficacy or safety of this treatment. (Please note the problems with baby shampoo noted above.) In adults, a study comparing soap and baby shampoo to commercial eyelid scrubs found that patients strongly preferred not to put soap or shampoo on their eyelids. Baking soda has also been recommended (a teaspoonful in a cup of boiled water) and is well accepted by adults. Boiled warm water wash may help.


Prognosis:
As the baby matures this conditions will be cleared.However, studies have shown that the condition occasionally persists into the toddler years, and less commonly into later childhood. It tends to recur in adolescence and persists into adulthood. In an Australian study, about 15 percent of previously diagnosed children still had eczema 10 years later. Sometimes, cradle cap turns into atopic dermatitis. Rarely, it turns out to be misdiagnosed psoriasis.

Prevention:
Shampooing your baby’s hair every few days can help prevent cradle cap. Stick with a mild baby shampoo unless your baby’s doctor recommends something stronger.

The severity of cardle cap can be lessened by controlling the risk factors and by paying careful attention to skin care.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/cradlecap2.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000963.htm
http://www.mayoclinic.com/health/cradle-cap/DS01074
http://en.wikipedia.org/wiki/Cradle_cap
http://www.livestrong.com/article/294548-itchy-scalp-behind-my-ears/
http://www.dermis.net/dermisroot/en/39521/image.htm

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Dyshidrosis

Definition:
Dyshidrosis, also termed Dyshidrotic Eczema, Pompholyx and Dyshidrotic Dermatitis, is a skin condition that is characterized by small blisters on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic, clear vesicles; later, scaling, fissures and lichenification occur. Recurrence is common and for many can be chronic. Incidence/Prevalence is said to be 20/100,000 in the USA, however, many cases of eczema are diagnosed as garden-variety atopic eczema without further investigation, so it is possible this figure is misleading.
It is a non-contagious skin problem that is thought to be perhaps a reaction to some environmental irritant; it may also be an autoimmune disease. It is common, slightly more women get it than men, and has been one of the earliest known skin problems. It is rare in children under 10.

This condition is not contagious to others, but due to its unsightly nature can cause significant distress in regards to social interactions with others.

The name comes from the word “dyshidrotic,” meaning “bad sweating,” which was once believed to be the cause. Sometimes called pompholyx (Greek for “bubble”) which is generally reserved for the cases with blisters; in some countries, pompholyx refers to hand dyshidrosis.

……You may click to see the picture.

Symptoms:
Small blisters with the following characteristics:

*Blisters are very small (1 mm or less in diameter). They appear on the tips and sides of the fingers, toes, palms, and soles.

*Blisters are opaque and deep-seated; they are either flush with the skin or slightly elevated and do not break easily.
*Eventually, small blisters come together and form large blisters.

*Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact with soap, water, or irritating substances.

*Scratching blisters breaks them, releasing the fluid inside, causing the skin to crust and eventually crack. This cracking is painful as well as unsightly and often takes weeks, or even months to heal. The skin is dry and scaly during this period.

*Fluid from the blisters is serum that accumulates between the irritated skin cells. It is not sweat as was previously thought.

*In some cases, as the blistering takes place in the palms or finger. Lymph node swelling may accompany the outbreak. This is characterised by tingling feeling in the forearm and bumps present in the arm pits.

*Nails on affected fingers, or toes, may take on a pitted appearance.

Causes:
Causes of dyshidrosis are unknown. However, a number of triggers to the condition exist:

*Dyshidrosis has been historically linked to excessive sweating during periods of anxiety, stress, and frustration, however, many cases present that have no history of excessive sweating, and the hypothesis of dyshidrosis as a sweating disorder is largely rejected. Some patients reject this link to stress, though as a trigger of vesicular eruption it cannot be overlooked, as with other types of eczema.

*Vesicular eruption of the hands may also be caused by a local infection, with fungal infections being the most common. Sunlight is thought to bring on attacks, some patients link outbreaks to prolonged exposure to strong sunlight from late spring through to early autumn. Others have also noted outbreaks occurring in conjunction with exposure to chlorinated pool water or highly treated city tap waters.

*Soaps, detergents, fragrances and contact with fruit juices or fresh meat also can trigger outbreaks of dyshidrosis, as with other types of eczema.

*Systemic nickel allergies may be related such as foods high nickel content – cocoa, chocolate, whole grains, & nuts.

*Keeping skin damp will trigger or worsen an outbreak. For this reason, people with dyshidrosis should wear gloves, socks, and shoes made of materials which “breathe well”, such as cotton or silk. Certain fabrics may greatly irritate the condition, including wool, nylon and many synthetic fabrics.

*Inherited, not contagious. Often, patients will present with other types of dermatitis, such as seborrheic dermatitis or atopic eczema. For this reason, among others, dyshidrosis is often dismissed as atopic eczema or contact dermatitis.

*Can be the secondary effect of problems in the gut. Some sufferers claim diet can ease symptoms (relieving internal condition of IBS or intestinal yeast infection). Also Inflammatory bowel diseases of Ulcerative colitis and Crohn’s disease.

*Bandages, plasters or other types of skin-tapes may be irritating to dyshidrosis and should be avoided. As the skin needs to breathe, anything that encourages maceration of the palms should be avoided. If the ‘wounds’ are raw enough to warrant covering, pure cotton gloves or gauze should be used. Liquid Band-Aid brand bandage may be tolerated and helpful, refer to the Treatment section, below.

*Latex and vinyl gloves may increase irritation.

*Multiple Chemical Sensitivity

*Allergic reaction to Potassium Dichromate (leather preservative)

*Dyshidrosis can sometimes even be caused by dust mite allergies, with sufferers having to wash and change bedding weekly, sometimes even every 2 days or even every day, to combat symptoms.

*Balsam of Peru is a common irritant among sufferers of hand eczema, more commonly, people with dyshidrotic eczema.

Treatment:
There are many treatments available for dyshidrosis, however, few of them have been developed or tested specifically on the condition.

*Topical steroids – while useful, can be dangerous long-term due to the skin-thinning side-effects, which are particularly troublesome in the context of hand dyshidrosis, due to the amount of toxins and bacteria the hands typically come in contact with.

*Nutritional deficiencies may be related, so addressing diet and vitamin intake is helpful

*Hydrogen Peroxide – posited as a key alleviating treatment (not a cure) on a popular website, it is used in dilutions between 3% and 27% strength, but side-effects of its use include burning and itching, and there is argument as to whether it only attacks the ‘sick cells’.

*Potassium permanganate dilute solution soaks – also popular, and used to ‘dry out’ the vesicles, but can also be very painful and cause significant burning.

*Domeboro (OTC) helps alleviate itching in the short term.

*Emollients during the drying/scaling phase of the condition, to prevent cracking and itching. While petroleum jelly may work well as a barrier cream, it does not absorb into the skin and or allow it to breathe, so may actually be less helpful.

*Salt soaks

*White vinegar soaks

*Avoidance of known triggers – dyshidrosis sufferers may need to abstain from washing their own hair or bodies, or wearing gloves when they do so, however waterproof gloves are often potential irritants.

*Zinc oxide ointment

*Nickel-free diets

*When in the scaling phase of the condition, the scales may cause deep cracks and fissures in the skin. Filing (as with an emery board) may help to minimize this.

*Stress management counseling

*Light treatment: UVA-1, PUVA, Grenz rays, Low Level Light Therapy using a Red + NIR (LED) combination

*Ciclosporin a strong immunosuppressant drug used to combat dyshidrosis caused by ulcerative colitis

*Efalizumab (Raptiva) a medication used to treat psoriasis

*Tacrolimus and Pimecrolimus, potent immunomodulators often used to prevent organ rejection in topical, ointment form, may be used in severe cases.

*Unbleached cotton gloves may be used to cover the hands to prevent scratching and vulnerability of the skin to bacteria

*Plantain (Plantago major) infused in olive or other oil can be soothing.

*Band-Aid brand liquid bandage regularly applied during the (often painful) peeling stage allows the skin to breathe while protecting it from further irritation. Some suffers have found that with regular application the skin will close and reform within 1 to 2 days. Protection is sufficient that the user can (gently) wash their hands with no irritation, however additional application after each hand wash is suggested. It does not cure the condition and only aids healing during the peeling stage. Other spray-on or brush-on liquid bandaids can contain irritating ingredients and have not been found to be helpful, some will aggravate the condition significantly.

*Avoid metal computer keyboards and track pads which contain nickel.

Many sufferers of dyshidrosis will find that treatments that were previously suitable for them no longer work or have induced sensitive reactions, which is common in most types of eczema.

*It may be prudent to wear light cotton gloves while reading newspapers, books and magazines. The inks and paper may irritate the condition.
*Avoid Purell and other hand sanitizing products which contain alcohol. These may aggravate the condition.

*Wash affected hands and feet with cool water and apply a moisturizer as soon as possible.

*On the other hand, hot water usually kills the itch.

*Avoid moisturizers that contain water (cremes and lotions). Stick with ointments.

*Valium in small doses during flare ups
Click to learn more about Dyshidrosis and it’s proper treatment

ABC Homeopathy Forum for Dyshidrosis

Allergy testing:
Allergy testing is a contested subject among eczema communities. Some dermatologists posit that if a sufferer is allergic to a substance, then a general allergy test on the forearm will suffice, yet others believe that in conditions like dyshidrosis, the suspect substances need to be applied to the affected area to induce a reaction. -Often seen in people who are already suseptible to allergies and/or asthma.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://en.wikipedia.org/wiki/Dyshidrosis
http://www.geocities.com/vyera/dyshidrosis/main.html