Eczema and dermatitis in Puerto Rico: symptoms, treatment and video visits

Types of dermatitis and their symptoms

Atopic dermatitis (eczema): long-lasting, comes and goes in flares, and is most common in children. It usually starts with itching, which is why it is called "the itch that rashes".

Contact dermatitis: appears where the skin touched a substance. The most common kind is irritant (soaps, detergents, cleaning products, frequent hand washing). The allergic kind usually appears 24 to 48 hours after contact with something you are allergic to.

The most common symptoms of dermatitis are:

• Itching, sometimes intense
• Dry, red or inflamed skin
• Rough, scaly or thickened patches
• Bumps or blisters that ooze and crust
• Burning or pain in irritated skin
• Cracks in the skin of the hands

Causes and triggers

In eczema, the skin doesn’t hold in water or keep out irritants well. It runs in families and often comes with asthma or allergies, but foods don’t cause it and it is not contagious. It is made worse by dry skin, heat and sweat, temperature changes, stress, colds, wool, and fragrances or dyes in soaps and lotions.

In allergic contact dermatitis, the usual culprits are nickel in jewelry and buckles, fragrances, latex, hair dyes, some preservatives in creams and skin medicines, and certain plants.

Dermatitis in Puerto Rico: heat, sweat and sun

Heat and sweat are known eczema triggers, so in Puerto Rico’s climate it helps to wear soft cotton, shower after heavy sweating and moisturize straight away.

Some reactions only appear when the skin is also exposed to sunlight. Products that can cause them include oil from lime peel, some sunscreens, some shaving lotions and some perfumes. If you got a rash on sun-exposed skin after squeezing limes or trying a new product on vacation, tell the doctor.

What happens in the video visit

In an online doctor visit, the doctor asks when the rash started, where it began, whether it itches or hurts, what products, plants or metals you touched, and what you have used on it. In good natural light, she will ask you to show the affected skin on camera.

She then tells you whether it is likely eczema or contact dermatitis, how to care for it, and whether you need a dermatologist. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances. If the rash doesn’t look like dermatitis, see skin rash; for a painful band-shaped rash on one side of the body, see shingles.

Eczema and dermatitis treatment and skin care

Daily skin care cuts down flares and the need for medicine:

• Take short baths or showers in lukewarm, not hot, water and use a gentle cleanser instead of harsh soap.
• Pat the skin dry and apply a thick, fragrance-free moisturizing cream or ointment all over while the skin is still damp, at least once or twice a day, even when there is no rash.
• Keep nails short to limit scratching.
• For contact dermatitis, wash the area well with water to remove the substance, and avoid it from then on.
• For flares, the doctor may prescribe a steroid cream or ointment, used for short periods and only as directed.
• Antihistamines taken by mouth can help with itching.

Eczema in children

Up to 1 in 4 children have eczema, according to the American Academy of Pediatrics (AAP). In babies it usually starts on the face and scalp; in school-age children it shows up in the elbow creases, behind the knees, on the neck and around the eyes. It is not contagious, and for some children it starts to fade by about age 4.

The AAP recommends a 5- to 10-minute lukewarm bath or shower daily or every other day, without bubble bath; patting dry, applying any prescribed medicine to the rash first and then moisturizer all over; dressing in cotton; and using fragrance-free detergent. Talk to a doctor before cutting foods from your child’s diet.

Get checked if you see yellow or honey-colored crusts, weeping skin, blisters, pus bumps, or a rash that isn’t improving with the usual treatment. Get care the same day if the eczema is getting worse fast and is painful, with clustered blisters like early cold sores, round punched-out sores, or fever and lethargy: NICE guidance says suspected eczema herpeticum is treated immediately and referred the same day. The doctor sees children from 6 months with a parent or guardian on camera, and she is not a pediatrician; see video visits for children and rashes in children.

When to see a dermatologist

See a dermatologist, or get an in-person exam, if:

• The dermatitis isn’t getting better with home care, or gets worse despite treatment.
• You have signs of infection: pain, warmth, spreading redness, pus or fever.
• The diagnosis is unclear.
• Eczema on the face isn’t responding to treatment.
• A contact allergy needs confirming with patch testing, which is done in person over several visits.
• Itching keeps you from sleeping or affects work or school.

Frequently asked questions

Can eczema be treated by telehealth?

Often, yes. The doctor looks at your skin on camera, asks about symptoms and possible triggers, and gives you a care plan and, if appropriate, a prescription. If you need a biopsy, patch testing or a close-up exam, she will send you in person.

Is eczema contagious?

No. Eczema doesn’t spread from person to person. But skin with eczema gets infected more easily, and some of those infections may need treatment.

How long does contact dermatitis last?

Most cases clear in 2 or 3 weeks once you avoid what caused it. It can come back if the cause isn’t found.

Related pages

• Online doctor visit
• Skin rash
• Rashes in children
• Allergies (allergic rhinitis)
• Shingles
• Online doctor for kids
• Sick on vacation in Puerto Rico
• Emergencies