Psoriasis & Eczema

Psoriasis and Eczema are common conditions affecting approximately 1-4% of adults. Due to their chronic and relapsing nature, these conditions present a global public health concern.

Although these dermatological conditions can be reasonably well controlled with cortical steroids there is no known cure and these can only provide so much relief. This means research into psoriasis and eczema treatments are constantly on-going to try and find a treatment with better symptom relief.

Psoriasis has a multi-factorial pattern of inheritance with about 30% of patients having a family history of psoriasis. The severity of psoriasis varies greatly. In some people it is mild with a few small patches that develop and are barely noticeable. In others, there are many patches of varying size. In many people the severity is somewhere between these two extremes. People with psoriasis have a faster turnover of skin cells. It is not clear why this occurs. There are also some changes in the blood vessels that supply the skin in people with psoriasis. Small blood vessels can widen (dilate) and increase in number. This is why the skin underneath a patch of psoriasis is usually red.

People with psoriasis are more likely to have or develop some other problems like:-

Joint problems: Around 1 or 2 in 10 people with chronic plaque psoriasis also develop inflammation and pains in some joints (arthritis). This is called psoriatic arthritis.

Cardiovascular disease: People with psoriasis are more likely to have some of the risk factors for developing cardiovascular disease (heart disease and stroke).

Obesity: Psoriasis also seems to be more common in obese people. However, just because you have psoriasis does not mean that you will definitely develop these.

Some people with psoriasis may feel embarrassed about their skin problem and develop a negative body image. They may avoid certain activities such as swimming because of fear of uncovering their skin and of other people seeing it. Personal relationships may be affected. Others may develop anxiety and depression. Management of psoriasis may involve drugs, light therapy, stress reduction, climatotherapy and various adjuncts such as sunshine, moisturizers, and salicylic acid.

Eczema is sometimes called dermatitis which means inflammation of the skin. There are different types of eczema. The most common type is atopic eczema. In this type of eczema there is a typical pattern of skin inflammation which causes the symptoms and tends to flare up from time to time. It usually starts in early childhood. The severity can range from mild to severe. About 2 in 3 children with atopic eczema grow out of it by their mid-teens.

The symptoms include:

– The skin usually feels dry.

– Some areas of the skin become red and inflamed. The most common areas affected are next to skin creases, such as the front of the elbows and wrists, backs of knees and around the neck. However, any areas of skin may be affected. The face is commonly affected in babies with atopic eczema.

– Inflamed skin is itchy. If you scratch a lot it may cause patches of skin to become thickened.

– Sometimes the inflamed areas of skin become blistered and weepy.

– Sometimes inflamed areas of skin become infected.

The cause is not known. The oily (lipid) barrier of the skin tends to be reduced in people with atopic eczema. This leads to an increase in water loss and a tendency towards dry skin. Also, some cells of the immune system release chemicals under the skin surface, which can cause some inflammation. But it is not known why these things occur.

Other factors which may play a part include:

– Genetics

– Changes in climate.

– Pollution.

– Allergies to house dust mite or pollens.

– Diet.

– Infections.

– Other early-life factors.

There is no cure but treatment can usually control or ease symptoms. The usual treatment consists of three parts:

– Avoiding irritants to the skin and other causes (triggers) wherever possible.

– Moisturisers (emollients) – used every day to help prevent inflammation developing.

– Steroid creams and ointments (topical steroids) – mainly used when inflammation flares up.

Other treatment include:

Tacrolimus ointment and pimecrolimus cream are treatments introduced in 2002. They work by suppressing some cells involved in causing inflammation (they are called topical immunomodulators); they are not steroids. They seem to work well to reduce the skin inflammation of atopic eczema.

Steroid tablets are sometimes prescribed for a short time if the eczema becomes severe and topical treatments are not helping much.

Tar shampoos are useful to lift scale from affected scalps.

Antihistamine tablets are sometimes tried to help ease itch.