"The number of people with psoriasis in Ireland could fill Croke Park," says Skincare Expert, Selene Daly.

After obtaining her Dermatology Nursing Diploma from the University of Wales and subsequently her Skin Surgery Skills course from the University of Hertfordshire, the Sligo-based woman worked her way to becoming a Dermatology Clinical Nurse Specialist.

The mother of two has a keen interest in Childhood Eczema and Skin Cancer Prevention and has previously worked to raise awareness at both regional and national levels.

We spoke to Selene about the facts versus myths of Eczema treatment for children, the developments, links to nut allergies and asthma and prevention. Listen to the interview on The LifeStyle Show above.

Generation SunSmart
Generation SunSmart

What exactly are eczema and psoriasis?
Psoriasis is a common inflammatory skin disease affecting 2% of the population. In real terms, the number of people with psoriasis in Ireland could fill Croke Park with a queue forming the length of Jones road.

It occurs equally in men and women, can appear at any age, and tends to come and go unpredictably. It is not infectious; therefore you cannot catch psoriasis from someone else. It does not scar the skin although sometimes it can cause a temporary increase or reduction in skin pigmentation.

Although psoriasis is a long-term condition there are many effective treatments available to keep it under good control. Psoriasis can affect the nails and the joints as well as the skin. About half of people with psoriasis have psoriasis affecting the nails.

For people with moderate to severe psoriasis about one in three will develop psoriatic arthritis at some time. Psoriatic arthritis produces swelling and stiffness in the joints or stiffness in the lower back and should be managed by a rheumatologist who works closely with your dermatologist and/or your GP. 

Psoriasis, particularly moderate to severe psoriasis, is associated with an increased risk of anxiety and depression. Moderate to severe psoriasis increases the risk of heart disease and stroke and treatment of psoriasis may reduce this risk. Psoriasis can also be associated with an increased risk of harmful use of alcohol and with diabetes and obesity.

Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age but the onset is often in childhood. 1 in every 5 children in Ireland are affected by eczema at some stage. It may also start later in life in people who did not have atopic eczema as a child. 

The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever and food allergy. These conditions are all linked by an increased activity of the allergy side of the body’s immune system.

‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.

What are the symptoms of psoriasis/eczema?
Psoriasis may not have any associated symptoms but it can be itchy and painful. Certain sites such as the scalp, lower legs and groin can be particularly itchy. If psoriasis affects the hands and feet, painful fissures or cracks can develop and these can affect the use of the hands and walking. Severe psoriasis on the body can also develop fissures which are painful and can bleed. 

Psoriasis can affect the nails and lifting of the nail plate from the nail bed can be painful. Psoriatic arthritis produces pain, swelling and stiffness in one or more joints, particularly in the morning. 

Atopic eczema can affect any part of the skin, including the face, but the areas that are most commonly affected are the creases in the joints at the elbows and knees, as well as the wrists and neck (called a flexural pattern). Other common appearances of atopic eczema include coin-sized areas of inflammation on the body and numerous small bumps that coincide with the hair follicles. 

Affected skin is usually red and dry, and scratch marks are common. When eczema is very active, it may become moist and weep fluid (during a ‘flare-up’) and small water blisters may develop especially on the hands and feet. In areas that are repeatedly scratched, the skin may thicken (a process known as lichenification), and this may cause the skin to itch more. Sometimes affected areas of the skin may become darker or lighter in colour than the surrounding, unaffected skin.

Selene Daly and her daughter Grace.
Selene Daly and her daughter Grace.

Are certain ages affected more than others?
Atopic eczema tends to occur in infancy and patients can sometimes ‘grow out of it’. However, it may reoccur in late teens or early 20’s. Psoriasis may occur in children but more commonly presents in teenagers and is chronic.

What causes these conditions?
Psoriasis is a genetic, inherited condition but a complex one.  Not everyone with a genetic predisposition will automatically inherit the skin condition.

Atopic eczema is a complex condition and a number of factors appear important for its development including patient susceptibility and environmental factors. Patients typically have alterations in their skin barrier, and overly reactive inflammatory and allergy responses.

Environmental factors include contact with soaps, detergents and any other chemicals applied to the skin, exposure to allergens, and infection with certain bacteria and viruses. A tendency to atopic conditions often runs in families.

An alteration in a gene that is important in maintaining a healthy skin barrier has been closely linked to the development of eczema. This makes the skin of patients with eczema much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation. Atopic eczema cannot be caught from somebody else.

What about home remedies?
In short, we do not recommend home remedies to treat any skin condition.  A traditional treatment for eczema was to add oatmeal to bathwater, however, it is no longer recommended as the coating on the oat may scratch the skin's surface adding to inflammation.

Remedies, potions, and lotions that you can purchase online or in shops may contain substances that irritate skin conditions. Over the years we have become aware of some ‘natural’ remedies containing strong steroids.

Topical treatments need to be manufactured in clean environments like factories which are subject to inspection. Uncontrolled environments may be contaminated with bacteria causing secondary skin infections. Dermatologists prefer that patients go to their G.P./Consultant for assessment and prescription of approved safe effective topical and oral treatments for their skin condition.

Selene Daly
Selene Daly

When is it time to go to the doctor?
You should attend your G.P. at the first sign of any new skin rash.  A correct diagnosis is vital in order to treat skin effectively and safely.

If your skin condition is not improving your G.P. can refer you to a hospital-based consultant dermatologist for review.

Do people end up being hospitalised for these conditions?
There is a serious form of psoriasis known as erythrodermic pustular psoriasis where the entire body becomes red, irritated and inflamed with small sterile pustules scattered across the skin's surface.

This requires hospitalisation for intense topical treatments and monitoring. Children can be frequently admitted to hospital with exacerbations of their eczema either caused by bacterial infection or viral infection (known as eczema herpeticum).

What are the most common prescription medications?
For psoriasis, all patients will be prescribed total emollient therapy (soap substitutes and moisturisers) in combination with topical steroids and something called vitamin D analogues such as Dovonex.

Psoriasis patients can also be prescribed something called phototherapy which is an artificial form of sunlight carried out in Dermatology departments 3 times per week for 6-8 weeks. There are also tablets and injection medications available to treat psoriasis and which are only available from hospital-based consultant dermatologists.

The mainstay treatment for eczema patients are total emollient therapies with topical steroids and sometimes occlusion dressings. Research is ongoing at the moment looking at medications to treat patients with chronic eczema.

Does the sun help these conditions?
Dermatologists prescribe an artificial form of sunlight to treat psoriasis. This a controlled measured form of UVA or UVB that is safe to use.

UV light suppresses the immune system of the skin and temporarily relieves psoriasis. However, if we expose our skin to too much UVL it can cause skin cancer.  

Are there any myths associated with both diseases?
There are 2 common myths around psoriasis and eczema. Firstly these skin conditions are not contagious and secondly, we have no quick fix cure for these skin diseases.

They are chronic in nature and most of the effective treatments involve rubbing in topical therapies for elongated periods of time. It’s important to link in with your health care professional and to seek advice form good online sources such as www.irishskin.ie and www.bad.co.uk.