ECZEMA & PSORIASIS
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By RAJGOPAL NIDAMBOOR

Eczema, or dermatitis, is an inflammatory skin disease that affects millions of people worldwide.

Psoriasis, or scaly patches syndrome, is a chronic progressive inflammatory disorder of the skin. Its cause is unclear. Some researchers implicate our genetic root, or predisposition for it.

This essay presents a holistic overview -- as to what you can do to manage and/or best prevent the two ailments.

There are two key categories of eczema. 1. contact eczema, or exogenous eczema, and 2. atopic eczema, or endogenous eczema. The former occurs when substances, or chemicals, cause annoyance to the skin, and, thereafter, lead to an allergic reaction. The latter, on the other hand, occurs when there is a genetic, or inherited, predisposition to eczema.

Atopy is the medical term that describes a family predisposition to a variety of allergic conditions, which also includes asthma and hay fever [allergic rhinitis].

While the areas of the body that are affected differ depending on the type of eczema, the common symptoms of the disorder are itchiness of the skin and dryness. However, in some cases, the skin maybe scaly. It can also crack, become red or inflamed, and susceptible to infection. Besides, when bacteria living on the surface of the skin “break in,” it can lead to what is called “wet” eczema -- or, weeping of fluid -- which may also include crusts and scabs.

In most cases, it is difficult to pin down the exact cause of eczema. Experts suggest that it is often an outcome of a number of different factors working together. It may often run in families, although the disorder does not spread from one person to another. Yet another possible cause of eczema maybe exposure to chemicals, detergents, soap, or shampoo -- ingredients which can irritate the skin. Besides, what we may presuppose as non-irritants are not entirely “passive.” In cases where the skin tends to become sensitised -- or, allergic -- they may generate the typical eczematous reaction.

Signs & Symptoms

Atopic eczema, which is the most common form of eczema, usually affects the face, trunk, the back of the knee, and the front of the elbow. It usually starts in childhood, affecting almost 20 per cent of children. While most children outgrow the condition, the disorder has a tendency to persist in 2-3 per cent of adults.

There are other forms of eczema too. One of the more common forms is allergic contact eczema [contact dermatitis] which develops when the body’s immune system reacts against a substance that makes contact with the skin. The rash usually starts at the site of “communication” with the substance; it may later spread to other areas. For example, some forms of jewellery may cause eczema of the ear lobes, wrists, and nape of the neck. Sometimes, substances like rubber, or perfume, may also trigger the allergic response.

Prevention & Medication

It’s wise to avoid the irritant that maybe the cause of your eczema -- if you recognise it. Example: some types of soap, washing powder, and shampoo, as well as chemicals you may work with, or exposed to, are also a likely cause. Avoid their use -- if you can.

There are several over-the-counter [OTC] products for eczema available without prescription, viz., emollients, creams, lotions, ointments etc., that ease, soften and “water” the skin. They may all be applied directly to the skin. The best time to apply them is soon after bath, when the skin is still slightly moist. You may also use oils or washes when you have a shower, or add them to your bath water.

When emollients don’t correct the condition, your physician may prescribe a steroid cream, or ointment. Steroids soothe flare-ups and suppress the body’s inflammatory response. Only thing is steroids should be applied sparingly -- and, they should be used in their mild forms. You need to, for instance, apply very mild steroidal preparations to the face, because potent steroidal creams often cause thinning of the skin. Long-term use of such creams will make your face more delicate. This can lead to blemishes, wrinkles, or noticeable small blood vessels.

It is also a common practice for physicians to prescribe anti-histamine tablets, or medicines, to reduce itching in eczema. Anti-histamine medicines are often sedating -- however, newer versions are not. They maybe used for long-term treatment with relative safety.

If a bacterial infection is suspected, your physician may prescribe antibiotics. Occasionally, a steroid medication in the form of tablets maybe recommended in severe eczema.

While hospital admission is a rare possibility in eczema, it maybe required in extremely severe cases. In such instances, hospital admittance ensures that the affected skin is wrapped in bandages soaked with dilute potassium permanganate solution.

Diet

Some people often report that certain foods “activate” eczema. The fact is -- food allergies are quite uncommon. However, excluding foods may not help patients -- especially those that don’t have an allergy to food. It may cause more harm than good, because exclusion diets could lead to a deficiency of essential nutrients -- especially, protein and calcium. Dietetic [re]orientation should only be considered under the supervision of a medical/health professional, or nutritionist/dietician.

Alternative Treatment

It is reported that complementary treatment, such as evening primrose oil, is helpful in eczema. Other treatments that have been found useful are herbal creams, ayurveda, and homoeopathy. It is also said that Chinese herbal medicines could be more than useful; however, studies report that there is a risk of side-effects with their use. To name one danger: liver damage. It is best to speak to a health/herbal professional and your physician who’s open to the idea of giving the nod to complementary therapy, alongside conventional treatment.

Scaly Social Hitch

What is quite apparent is the presentation of psoriasis per se -- red patches, or plaques, on the skin, which are often covered by silvery scales.

Psoriasis is not infectious; it is also not brutal enough to affect general health, contrary to popular opinion. The problem is more than a cosmetic anomaly; it is also a social glitch.

Experts say that psoriasis often tends to run in families. They also note that if both parents are affected, their offspring has a 60 per cent chance of developing the condition.

Psoriasis affects approximately two per cent of the population; as a matter of fact, people with very mild symptoms may not even be aware of its presence. However, the disorder affects people of every age -- although, experts reckon, that it has a tendency to affect youngsters around age 20 and/or people in their fifth or sixth decade of life.

Causes

Psoriasis is a product of environmental stressors, or triggers -- stressors fuel the condition in predisposed people. “Stressors” include throat infections, skin distress such as cuts, bruises or burns, some medications, stressful situations or psychological trauma, smoking and high alcohol intake. Also, psoriasis is more likely in people with a family history of the condition, as already suggested; but, it does not, in any way, spare others.

Signs & Symptoms

Psoriasis is multi-faceted. What is, however, common to many forms is the outward manifestation -- psoriasis often produces thickening and reddening of patches of skin. These patches typically occur on the elbows, knees, scalp and lower back. They may have a thick silvery-white scale of dead skin on the surface, which is often itchy. Most people afflicted by the disorder retain it for life. In a majority of cases, psoriasis often fades and reappears, with no evident reason. While the severity of each eruption may vary, the disorder maybe the cause of generalised illness, if it envelops the whole body. In some patients, the disorder may also be associated with arthritis -- this can either be mild or severe.

Diagnosis

Your physician usually diagnoses psoriasis from the symptoms and on the basis of a physical examination. In some cases, if one is not sure, a tiny skin sample maybe taken for tests in a laboratory to help confirm the diagnosis.

Self-Care & Treatment

Some simple self-help plans are often useful. It is beneficial if you do not scratch or pick at the skin: if you do, it may bleed, become infected, and may expand in that area with a vengeance. You would also need to do away with soaps that give you a dry feeling -- it is always better to wash with an aqueous cream or emollient. After washing, allow the skin to dry. It is also best not to irritate the skin by rubbing vigorously. It is said that sunlight is good medicine for some patients -- but, it isn’t good in patients who experience pain during exposure. Cotton clothing is ideal attire; it is best to avoid synthetic clothes.

While creams and ointments are usually the first resort, followed by pills and treatment with ultraviolet light, steroids -- what with their side-effects profile -- are the most widely acclaimed therapy of choice. Another favoured form of treatment is Psoralen and ultraviolet-A light treatment [PUVA]. This involves combining the medicine [Psoralen] which sensitises the skin to sunlight, along with a controlled dose of ultraviolet light. This can reduce symptoms in moderate psoriasis. Some therapists also prefer vitamin A derivatives in the form of ointments/creams or tablets for better results.

Alternative Therapy

The use of complementary therapy has most often been a case of desperate measure, not necessarily curative in application, according to critics. However, ayurveda, homoeopathy, and relaxation methods such as meditation, yoga and Alexander Technique, have been reported to be beneficial, because they reduce stress -- stress is a confirmed “outcome” of eczema and psoriasis.

Speak to your physician and/or an alternative practitioner -- to get a good picture of what can work for you, and with better results.