DON’T SCRATCH!
Psoriasis & Eczema – some itchy problems

Our skin is the largest organ in the body and, as we all know, if we didn’t have skin our insides would fall out.

This protective layer also works tirelessly to prevent injury and disease, make vitamin D, excrete waste, retain water and regulate our body temperature.

Skin comes in a variety of pleasing colours, and you can paint it, draw on it, shave it, cut it, stretch and bend it, expose it to all manner of irritants, potions and poisons and it will forgive you (most of the time). Not much in the body takes as much punishment as our skin, yet it is no less vital to us than our heart or liver.

Like most things in life, we probably don’t appreciate our skin until something goes wrong – and I’m not talking about wrinkles. I mean itchy, blotchy, scaly patches that make you want to scream and become one of those creatures of the night that have no reflections in mirrors.

Nobody wants to ring work and say, "I can’t come in because I’ve got big red itchy spots!" Good thing then that scientists have kindly given them serious sounding names like psoriasis vulgaris and atopic eczema.

Know your enemy.

Both psoriasis and eczema are classed as auto-immune disorders where an excessive reaction by the immune system produces inflamed, irritated and sore skin. Atopic eczema, the most common form, is closely related to our old favourites, asthma and hay-fever.

Because these conditions tend to run in families they are thought to have a genetic link. (That’s a polite way of saying it’s mum’s fault.) Both are chronic conditions and there is no known cure. Symptoms, however, can be treated and relapses lessened with a little knowledge and good management.

Atopic eczema usually presents with red, dry skin that is cracked or scaly, accompanied by moderate to severe itching. In severe cases the lesions may weep or bleed and crust over, causing much discomfort. When we can’t resist the urge to scratch, the skin can become infected, causing further problems. Eczema symptoms tend to flare and subside for no apparent reason.

The onset of eczema frequently occurs in the first year of life. All babies arrive with super-soft skin and smooth curves between cute little wrinkles and creases. They’re made that way to be irresistibly touchable. It’s no wonder new mums can be devastated by the appearance of eczema on a young baby.

Symptoms are usually mild, though some infants suffer severe itching and inflammation, usually on the face, neck and trunk, which not only affect the child’s general health, but cause ongoing stress within the family. Other auto-immune diseases such as food allergy, allergic rhinitis and asthma may also occur at a later stage. For most infants, though, the disease will resolve during childhood. A more common skin complaint in babies, seborrhoeic dermatitis, is unrelated to eczema and involves the scalp and nappy areas.

To soothe itchiness and prevent irritation of the skin try using cotton clothing and bedding to keep the skin cool and allow it to breathe. To reduce damage to the skin during sleep, cotton mittens over a child’s hands may be helpful. Use non-biological washing powder and avoid fabric softeners. Irritants such as soaps, perfumes, sand and extreme temperatures should be avoided. Be careful when choosing sun screen products and insect repellents.

It is believed that reducing the amount of house dust mites in the home may improve the condition of the skin. These little darlings prefer to live in bedding, mattresses, curtains and carpets.

Although science has found nothing to suggest any foods are the cause of an acute episode, eczema sufferers may have a predisposition to food allergies due to their auto-immune disturbance. Some sufferers have reported that certain foods can make their eczema worse.

The most common food allergies in young children are to nuts, eggs and dairy products. They will usually grow out of these allergies - dairy first, then egg and then nuts (although nut allergies can often persist into adulthood). The rash caused by a food allergy is different to that of eczema. It is seen as red wheals that develop around the mouth or on the rest of the body.

Most acute outbreaks of eczema are treated with emollients to soothe the inflammation and keep the skin hydrated. In severe cases, steroid creams or oral steroids may be prescribed for short periods, along with antihistamines to reduce the itch. Sedating antihistamines should not be used on young children as they can have life-threatening side effects.

Many people find complementary therapies helpful. Patients will often try many of the bathing and moisturising products available before finding the one that suits them.

Plaque psoriasis (psoriasis vulgaris) is the most common form of this disease. It typically appears as raised areas of inflamed skin covered with silvery white scales, or plaques. Skin affected by psoriasis grows much quicker than normal skin. Red eruptions appear on the surface of the skin and begin to itch. Patches usually appear on knees, elbows and scalp and sometimes on the trunk and legs. The disease can occur at any time of life but appears to be ‘triggered’ by a stressful event such as a nervous shock, accident or infection. Like eczema, it cannot be cured, but it is possible to control the severity of attacks.

Flexural psoriasis presents as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals, armpits and under the breasts. This condition is aggravated by friction and sweat and is vulnerable to fungal infections.

Some people with psoriasis may develop a form of arthritis known as psoriatic arthritis. It involves discomfort, throbbing or swelling in one or more joints. The joints most likely to be affected are fingers and toes, lower back, wrists, knees or ankles.

It is important to keep your skin moisturised and, like eczema, avoid soaps and other skin irritants. Use protective gloves when washing up or handling substances that might trigger an attack. Keep finger and toe nails short to avoid damage from scratching.

Your doctor may prescribe drugs such as Cyclosporin or Calcipotriol. Sometimes ultraviolet light or phototherapy is recommended along with coal tar preparations or cortisone creams. You may wish to explore an alternative treatment to complement your therapy regime. If you choose a food supplement or herbal remedy, it is important to let your doctor and your alternative therapist know what you are taking to avoid potentially adverse reactions.

It’s important to have any skin disease diagnosed accurately as there are many forms of eczema and psoriasis and treatments will differ. Not everyone responds to medications in the same way. You have a right to seek the opinion of a specialist dermatologist.

Seek out a medical practitioner with a genuine interest in your condition, who can respond to your needs and preferences and who takes their patients’ quality of life into consideration. Work at forming a good relationship with your therapist and become an active participant when choosing treatment options. Studies show that patients who are well informed about their disease and take an interested part in their treatment tend to have more positive outcomes. When you and your therapist settle on a plan, follow it through. It takes time and commitment to stick with a treatment. To give it a good go, allow 8 to 12 weeks to judge the outcome. On the other hand, if you find the cure is worse than the disease, don’t be slow to complain!

Be sure to ask questions about medications you are prescribed. How quickly will the treatment work? Are there any potential risks? What side-effects might I expect? How long will I need this treatment? What happens if I stop using it? Make a list of questions when you make the appointment. You have a right to be fully informed.

Although they are not contagious, sufferers may describe eczema or psoriasis as ‘ugly’ diseases, and may find their self-esteem is low.

Skin diseases do seem much worse because all the symptoms are on the outside where everyone can see them. When we’re on the train covered in itchy, hot blotches it’s easy to be reminded of former days when lepers were not welcome on public transport. I really feel sorry for lepers now.

Eczema and psoriasis are chronic conditions, and every outbreak can be traumatic. We live in a world where physical perfection is a paramount concern. Billions of dollars are involved in industries dedicated to making us all believe we can be beautiful.

We have the right to be angry or depressed that we have this disease. We have a right to ask for support and encouragement from family and friends. We have the right to expect sympathy and courteous treatment from the medical profession. We have a right to deal with our disease in our own way, on our own terms.

Dealing with a chronic disease is tough. Being stared at is tough. Being avoided is tough. But hey, we are tough!

Repeat after me: I am a person of great worth who happens to have a diagnosed medical condition.