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Skin Conditions

Monday, 17 May 2010

Approximately three in 10 people who visit their GP with a skin problem are diagnosed with atopic eczema. Ireland's leading dermatologist is here to give us her tips if you suffer from common skin conditions eczema and psoriasis.

It's summer, where heat and allergens can cause discomfort for people who have eczema.
One in ten sufferers with eczema are children, so some parents watching may be worried about their child if they have a rash and how to deal with it.

Dr. Rosemary Coleman - Consultant Dermatologist, Blackrock Clinic


"Eczema is a chronic skin condition that causes the skin to become itchy, reddened, dry and cracked.

Atopic eczema is the most common form of eczema, and mainly affects children. The exact cause of atopic eczema is unknown, but it often occurs in people who are prone to allergies.
Approximately three in 10 people who visit their GP with a skin problem are diagnosed with atopic eczema.

About eight in 10 atopic eczema cases occur before a child reaches five years of age. Many children develop it before their first birthday.

How will atopic eczema affect me or my child?

Atopic eczema can vary in severity. Some people are only mildly affected and have small areas of dry skin, which are occasionally itchy. Others may experience more severe symptoms, such as cracked, sore and bleeding skin.

For most children with atopic eczema, it clears up or significantly improves as they get older. In approximately 53% of young children with atopic eczema, it clears up by the time they reach 11, and in 65% of cases it clears up by the age of 16.

People with severe eczema often find that it has a significant impact on their daily lives. However, there are many different treatments that can help control symptoms and manage the eczema.
The symptoms of atopic eczema may always be present, but during a flare-up they will worsen and you or your child may need more intense treatment.

Atopic eczema can cause your skin to become:
. dry
. itchy
. red
. broken
. thickened
. cracked

During a flare-up, your skin may be:
. extremely itchy, red, hot, dry and scaly
. wet, weeping and swollen
. infected with bacteria (usually staphylococcus).

People with mild atopic eczema will normally only experience small areas of dry skin, which are occasionally itchy. However, in more severe cases, atopic eczema can cause widespread dry skin, constant itching and oozing fluid.

Scratching can disrupt your sleep and make your skin bleed. It can also make an itch worse and an itch-scratch cycle may develop, with regular scratching. In children, this can lead to sleepless nights and difficulty concentrating at school.


Atopic eczema is an inherited condition, which means that you are born with it. It may be made worse by 'external' factors, such as pet fur and pollen, or 'internal' factors, such as stress and hormone levels.

Genetic factors
Research suggests that atopic eczema is primarily caused by a genetic problem.

Environmental factors
There are a number of environmental factors that can make atopic eczema worse.

Allergens are substances that can cause the body to react abnormally. This is known as an allergic reaction. Some of the most common allergens that can worsen atopic eczema include:
. house dust-mites
. pet fur
. pollen

Atopic eczema can also sometimes be aggravated by food allergens. Foods that typically cause allergic reactions include:
. cow's milk
. eggs
. nuts
. soya
. wheat

Approximately 10% of children with atopic eczema are affected by the food allergens listed above. It is relatively rare for food allergens to trigger atopic eczema in adults.

Hormonal changes
Approximately 30% of women experience a flare-up of their eczema in the days before their period. Pregnancy can also have an adverse affect on those who have atopic eczema, with up to 50% of pregnant women finding that their eczema symptoms worsen during pregnancy.

Some people with eczema feel that their symptoms are worse when they are stressed. Others find that it is their symptoms that cause them to feel stressed.

Exercise (sweating)

Treating eczema
Although there is no simple cure for atopic eczema, the symptoms during an eczema flare can usually be eased using a variety of treatments. Children with atopic eczema normally find that their symptoms naturally improve with time.

There are a number of self-care treatments that you can use at home to help manage your or your child's eczema symptoms.

Eczema Skin Care & Tips

. Limit your contact with things that can irritate your skin.
Some things that may irritate your skin include household cleansers, detergents, aftershave lotions, soap, petrol or diesel, turpentine & other solvents.
. Wear gloves to protect the skin on your hands.
Wear vinyl or plastic gloves for work that requires you to have your hands in water. Also, wear cotton gloves under plastic gloves to soak up sweat from your hands. Take occasional breaks and remove your gloves to prevent a buildup of sweat inside your gloves.
. Wear clothes made of cotton or a cotton blend.
Wool & some synthetic fabrics can irritate your skin. Most people with sensitive skin feel better in clothes made of cotton or a cotton blend.
. Avoid scratching or rubbing the itchy area.
Try not to scratch or irritate the affected area on your skin even if it itches. Scratching can break the skin. Bacteria can enter these breaks and cause infection. Moisturizing your skin will help prevent itchiness.
. Avoid getting too hot and sweaty.
Too much heat & sweat can make your skin more irritated and itchy. Try to avoid activities that make you hot and sweaty.
. Continue skin care even after your skin has healed.
The area where you had the eczema may easily get irritated again, so it needs special care.
Although house dust mites have been shown to trigger eczema flares, it is not recommended that you try to eradicate dust mites from your home. The process is very time consuming and difficult to carry out effectively. Studies have also shown that dust mite avoidance techniques are rarely effective.

If you or your child have atopic eczema, you should not make any significant dietary changes without first consulting your GP. Some foods, such as milk, eggs and nuts, have been shown to trigger eczema symptoms. If you are breastfeeding a baby who has atopic eczema, you should also seek medical advice before making any changes to your regular diet.

Emollients are substances that help to soften and smooth your skin in order to keep it supple and moist. They are one of the most important forms of treatment for atopic eczema.
As atopic eczema can cause your skin to become dry and cracked, it is important to keep it moisturised to prevent it from becoming further irritated.

Examble Products
If you have recently been diagnosed with atopic eczema, and you or your child is receiving treatment for the first time, a number of different emollients may have to be tried before a suitable one is found.
Most people will need to be prescribed a number of different emollients for long-term use.
There are a number of different emollients that are designed for use on different skin types. For example, for very dry skin, ointments are often prescribed, and for skin that is less dry, creams and lotions are usually recommended.
If you have been using a particular emollient for some time, it may eventually become less effective, or it may start to irritate your skin. If this is the case, you should speak to your GP.

How should I use them?
Emollients should be applied by smoothing them into the skin in the same direction that the hair grows. You should avoid rubbing emollients in, because doing so can irritate the skin.
After washing, make sure that you gently dry the skin. Apply the emollient as soon as the skin is dry. Do not share emollients with other people.
Creams and lotions tend to be more suitable for red, inflamed areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.

When should I use them?
Emollients should be used frequently, even when the skin appears to be clear. This should help to reduce the number of eczema flares that you or your child has. If the skin is very dry, emollients should be applied every two to three hours.
During a flare-up, you should apply emollients very frequently and in generous amounts.

Emollient treatments should be used instead of soap. This is because most normal soaps irritate atopic eczema. You can also get emollient bath and shower additives.

Topical corticosteroids

If your or your child's skin is red and inflamed from an atopic eczema flare, your GP may prescribe a topical corticosteroid (one that is applied directly to your skin) to help ease your symptoms. Corticosteroids work by quickly reducing inflammation.
You may be concerned about using medication that contains steroids. However when used correctly, corticosteroids are a safe and effective treatment for eczema.

If your atopic eczema is moderate to severe, you may need to apply topical corticosteroids in between flare-ups, as well as during them.
If you need to use corticosteroids frequently, you should visit your GP regularly so they can check that the treatment is working effectively.

How should I use them?
When using corticosteroids, you should apply the treatment sparingly to the affected areas (see box). Always follow the directions on the patient information leaflet that comes with the corticosteroid, which will provide details about how much you should apply.
During an atopic eczema flare, you should not apply the corticosteroid more than twice a day. Most people will only have to apply it once a day. You should continue to apply the treatment for 48 hours after the flare-up has cleared up.

If you or your child are using corticosteroids on a long-term basis, you may be able to apply them less frequently. Your GP will advise you about how often you should be applying them.
Speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved.

Alitretinoin (sold under the brand name Toctino) is a medication for severe, chronic hand eczema that has failed to respond to other treatments, such as topical corticosteroids. Treatment with alitretinoin must be supervised by a dermatologist (a specialist in treating skin conditions). Alitretinoin is a type of medication called retinoids. Retinoids help reduce the levels of irritation and itchiness associated with eczema.
Alitretinoin should never be taken during pregnancy because it can cause severe birth defects. You should also avoid taking alitretinoin when breastfeeding because the medication can enter your breast milk and harm your baby.
Due to the risk of birth defects, the use of alitretinoin is not recommended for women of child-bearing age.

Antihistamines are a type of medicine that work by stopping the effects of a substance in the blood, known as histamine. Your body often releases histamine when it comes into contact with an allergen. It can cause a wide range of symptoms, including sneezing, watery eyes and itching.

Your GP may refer you if you fail to respond to prescribed treatment, or if they are uncertain about what is causing your eczema.
Some of the treatments a dermatologist may be able to offer you include phototherapy, where your eczema is exposed to ultraviolet (UV) light, bandaging (where treatments such as medicated dressings or wet wraps are applied to your skin) and topical calcineurin inhibitors (a type of medicine that helps to reduce inflammation).
However, these types of treatments are not be suitable for everyone, and can only be carried out by experienced skin-care specialists.

What are bleach baths?
"Some experts suggest using a dilute solution of bleach to kill the bacteria. The hope is that taking a bleach bath will reduce the number of bacteria and improve the symptoms of eczema - particularly the itching.
Because exposing a child or an adult with eczema to a bath of chlorine bleach isn't the healthiest option, bleach baths should be taken no more than twice a week for ten minutes at a time. The bleach should always be diluted to a half a cup per forty gallons of bath water. Bleach baths should only be used in the most severe cases of eczema where the itching isn't relieved by other measures. Chlorine can exacerbate asthma symptoms in some children, so use them only under medical supervision.
Dilute bleach baths may improve the symptoms of eczema, but should only be used in the most severe cases where the itching and other symptoms of eczema fail to respond to other treatments."

It usually begins between the ages of 11 and 45. Psoriasis runs in families and one-third of people with psoriasis have a close relative with it. Psoriasis is not infectious.

What is it?
Psoriasis causes flaky, red patches on the skin. They can look shiny and cause itching or burning. They can be anywhere, but are more common on elbows, knees and the lower back.

What causes it?
The exact cause of psoriasis is unknown, but it is known that your immune system plays a part.

If you have psoriasis, T cells (which exist in the blood and are part of your body's defence system) start to attack healthy skin cells by mistake. This triggers the immune system to produce new skin cells and also more T cells.

The cycle of skin cell production becomes faster and faster. Skin cells are created and then die in the space of five to six days, rather than the normal 28 days. The dead skin cells build up on the surface of your skin in thick, scaly patches.

Psoriasis runs in families. One in three people with psoriasis has a close relative with the condition. The exact role that genetics plays in causing psoriasis is unclear. Research studies have shown that many different genes are linked to the development of psoriasis. It's likely that different combinations of genes may make people more vulnerable to the condition. However, having these genes doesn't necessarily mean that you'll develop it.

Psoriasis triggers
. An injury to your skin such as a cut, scrape, insect bite or sunburn (this is known as the Koebner response).
. Alcohol.
. Smoking.
. Stress.
. Certain medicines such as lithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen, ACE inhibitors (used to treat high blood pressure) and beta blockers (used to treat congestive heart failure).
. Throat infections. In some people, usually children and young adults, a form of psoriasis called guttate psoriasis (which causes smaller pink patches, often without a lot of scaling) develops after a streptococcal throat infection. However, most people who have streptococcal throat infections do not develop psoriasis.
. Other immune disorders. Diseases of the immune system, such as the HIV infection, can cause psoriasis to flare up or to appear for the first time
Most people's psoriasis goes through cycles, causing problems for a few weeks or months then easing or stopping.
There are several different types of psoriasis, although sometimes two different types can occur together. One type may change to another type or may become more severe.
Common types of psoriasis are:
. Plaque psoriasis. Around 80% of people with psoriasis have plaque psoriasis.
Its symptoms are dry, red skin lesions, known as plaques, that are covered in silver scales. They normally appear on your elbows, knees, scalp and lower back but can appear anywhere on your body. The plaques can be itchy, sore or both. In severe cases, the skin around your joints may crack and bleed.
. Guttate psoriasis. This normally occurs following a streptococcal throat infection and is more common among children and teenagers. It causes small (less than 1cm or 1/3 inch) water drop-shaped sores on your chest, arms, legs and scalp. There is a good chance that guttate psoriasis will disappear completely, but some people go on to develop plaque psoriasis.
. Scalp psoriasis. This can occur on localised parts of your scalp or on the whole scalp. It causes red patches of skin covered in thick silvery-white scales. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases, it can cause hair loss, although this is usually reversible.
. Nail psoriasis. This affects your nails, causing them to develop tiny dents or pits, become discoloured and grow abnormally. Often nails can become loose and separate from your nail bed. In severe cases, your nails may crumble.
. Inverse (flexural) psoriasis. This affects areas of the skin that are in folds or creases, such as the armpits, groin and the skin between the buttocks and under the breasts. It can cause large, smooth red patches in some or all of these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather.
ALSO:- People with psoriasis have a slightly higher risk of developing diabetes and cardiovascular disease, although it is not known why. Regular exercise and a healthy diet are recommended for everyone, not just people with psoriasis, because they can help prevent many conditions, including heart disease and many forms of cancer. Eating a healthy, balanced diet and exercising regularly can also relieve stress, which may have an effect on your psoriasis.

What's the treatment?
Treatments to reduce the patches depend on their severity. They include:
. creams containing vitamin D or vitamin A
. steroid creams
. tar preparations
. exposing the skin to ultraviolet (UV) light
. medication taken by mouth or injection

Do I need to see a doctor?
Most people are treated by their GP, but some are referred to a dermatologist (skin specialist).

With regards to how the summer affects eczema and psoriasis, the sun improves the vast majority of psoriasis sufferers but a minority will have photosensitive psoriasis and notice a deterioration, particularly on their face. With eczema, its 50:50. Approx half get better with 'sun, sea and sand' and half get worse with the heat causing itch and sweat."

Over the counter treatments consist entirely of 'skin care' using
1. Soap substitutes such as Elave wash, Aveeno, aqueous cream
2. Shower gel substitutes such as Elave wash, Aveeno shower gel
3. Bath oils such as Aveeno, diprobath, emulsiderm, oilatum, balneum
4. Daily moisturisers such as Diprobase, Aveeno, Elave, Eucerin.
5. Scalp treatments such as Cocois Ointment (to lift the scale in psoriasis) and T-gel or capasal shampoo.
6. Anti-histamines play no role in psoriasis and a very small role in eczema.
Betnovate - Eczema or Psoriasis
Coal Tar Products - Psoriasis
vitamin D products (dovonex, dovobet) - Psoriasis
There are no non-prescription medications apart from these types of skin care products that can improve psoriasis. There is a single weak OTC steroid called hydrocortisone but I would not promote this for the treatment and maintenance of eczema as it can do harm if not used under supervision in the quantities needed.
Alitretinoin for hand eczema is not available in Ireland.

All products shown today are from:
McCabes Pharmacy
Dundrum Town Centre
Level 3 Unit 17
01 298 6709