Winter is here and the air is getting dryer. Many skin conditions are exacerbated in the winter months due to dry air both outdoors and indoors. Dermatitis is a condition of skin inflammation that occurs from many causes.

Atopic Dermatitis

The skin generally is red, dry, and inflamed. There is often scaling or vesicles. This type of dermatitis is immune based and usually associated with other atopic conditions like seasonal allergies and asthma. Keeping skin moisturized during the dry months helps prevent outbreaks but this is a chronic condition that relapses.

Contact Dermatitis

There are generally 2 types of contact dermatitis, irritant and allergic. One is more delayed than the other though both can lead to a burning sensation, blister formation, redness, and swelling. Irritant dermatitis is a direct result of exposure to a toxic substance which is treated with removal of the substance and moisturization. Allergen dermatitis requires identification and elimination of exposure as well as treatment with topical steroids (creams and ointments) or oral steroids in severe cases.

Poison ivy, oak, sumac

Dermatitis from this exposure is quite prevalent in New England. Though exposure is more common in the summer when the leaves are in bloom, the oils that cause the rash are present in the roots of the plants as well. Prevention of exposure can be difficult in the winter as it is harder to identify the plant. Wearing protective clothing when potentially around the plant can be an effective way of preventing exposure. If exposed, immediate washing of skin is imperative. Treatment is directed at managing the severe itching with topical steroids. For more severe cases, especially exposures to face and genitals, oral steroids are often required. Once exposed to the oils, the rash generally develops within 48 hours and new lesions can present and persist for 10-15 days.

Dyshidrotic

Frequent hand washing or excessive sweating can lead to this type of dermatitis. Typical features include small crops of blisters measuring 1-2 mm in diameter. These eruptions usually occur on the palms of the hands or soles of the feet with occasional appearances over the lateral aspects of fingers. Again avoidance of the activity or barrier protection can be helpful. Treatment requires topical steroids and possibly oral steroids or even oral immunomodulators. If these treatments fail there are other options like phototherapy and nickel-directed therapy.

Seborrheic

Different parts of the body are prone to more complex rashes. Common places include the scalp, behind the ears, in between the eyebrows, around the facial folds above the lips, and over the anterior chest. These are areas that are particularly prone to seborrhea or red, scaly, and somewhat greasy rashes. Dandruff in the scalp is a milder version of this rash. Treatment for the scalp should start with the very moisturizing shampoos available over the counter; however, occasionally antifungal medication ?and steroids are also necessary.

Lichen simplex chronicus

This condition is a complication of any dermatitis. It occurs when chronic scratching and rubbing changes the nature of the skin to become thickened, dry, and leathery. It can often appear darker than the surrounding skin. This is much more difficult to treat given its chronic nature. The scratch cycle must be broken so the skin can heal.

Overall maintaining moisture in the skin can promote healthy skin. The most effective way to achieve this is to use emollients after showering. If your home environment is particularly dry due to heating elements, humidification of the environment may be helpful. If a rash develops that does not seem to improve with these measures medical evaluation may be necessary.