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DEFINING
PROBLEMS AND FINDING SOLUTIONS:
The
International Eczema-Psorasis Foundation is an organization whose
mission is to gather in one place, available information found on
the web, in books and articles concerning the often confusing
terms dermatitis, eczema, and psoriasis. Our goal is to assist
others in learning about these chronic conditions. The information
provided by this site should not be considered medical advice, nor
is it intended to replace consultation with a 'qualified
physician'. The various dermatitis conditions and treatments may
vary substantially from one patient to another, and treatment must
be tailored for each individual case.
Sometimes
we view the world from the standpoint of how others view us. Our
skin is often perceived as the window to who we are. It is only
human to judge others by their appearance; therefore we are often
identified by our skin condition or imperfections, or even the
color of our skin.
The largest human organ isn't the liver, the kidneys or the lungs;
it's the skin. Our skin is our front line protection against the
outside world. The skin guards our internal organs against
sunburn, dirt, bacteria, and other dangers.
As our body's largest organ, the skin is also the first to react
to change. A number of factors can affect the skin.
There are
hundreds of different skin conditions. Dermatitis, melanoma and
other types of skin cancer, acne, rosacea, eczema, and psoriasis
are just a few of the many types of skin problems. Skin problems
may be caused by food allergies, sunburn, hormones, pregnancy,
genetics or a host of other causes. They are rarely life
threatening. Even skin cancers (including melanoma) often respond
well to treatment if detected early enough.
Skin
problems cause many people emotional pain and suffering. Some skin
conditions are severe enough that patients can suffer depression.
In many cases, healing the emotional scars related to a skin
condition can take even longer than treating the physical problem.
The cause
of skin conditions range from sunburn and drug reactions to
genetics and pregnancy. Many of the causes can be avoided with a
little prevention, while others are more random in occurrence.
Below are the most common causes of skin conditions. Any of these
conditions can occur alone or in a combination of two or more
which can sometimes make the diagnosis difficult.
Skin
Infections - Skin infections have a viral, bacterial or
fungal basis. Rashes caused by athlete's foot, impetigo, and
chicken pox all fall into this category. Bacterial and fungal skin
infections are usually successfully treated with antibiotics and
other medications. Viral skin infections must be combated by the
body's own immune system, although the symptoms associated with
the infection can be treated. Skin conditions caused by infections
may appear as rashes or other types of lesions such as pustules.
Sun
Exposure, Sunburn and Heat Rash - Sunlight contains
harmful ultraviolet rays that can damage the skin. Sunburn
increases your chance of developing a skin condition, as does
tanning and lengthy unprotected exposure to the sun. Skin cancer
is the best known condition caused by sunburn and tanning.
Premature aging of the skin also occurs with prolonged exposure to
the sun.
Certain drug
reactions increase the skin's sensitivity to sunlight,
thereby increasing the chance of sunburn or heat rash. A skin
condition called hyperpigmentation, where areas of skin become
darker than the surrounding area, can be caused by unprotected
exposure to sunlight. As hyperpigmentation may also be caused by
drug reactions; excessive sun exposure while taking certain
medications is ill advised.
In hot,
humid weather, prickly heat rash can develop. Staying
cool and dry, wearing light, cool clothing and drying thoroughly
after bathing are the best defenses against the irritating prickly
heat of the heat rash pustules.
Pregnancy
- Certain skin conditions occur more often during
pregnancy. Almost 90% of pregnant women have temporary
hyperpigmentation called Melasoma, or the "mask of
pregnancy" where naturally darker areas of pigmentation (such
as freckles, scars, moles, and nipples) appear darker than usual.
The condition slowly disappears after childbirth.
Natural
Irritants and Allergies - Many temporary skin problems
are caused by natural sources. Insect bites inflame and irritate
the skin. Poison ivy and other irritating plants cause skin
rashes, pustules and itching. Parasites such as lice and mites can
cause extreme itching and discomfort.
A food
allergy can cause skin rashes, hives and even facial
swelling. While the symptoms of a food allergy are often dramatic,
tracking down the food that causes the allergic reaction can
sometimes take time. If you suspect you have a food allergy,
consult your doctor: allergy testing may be in order.
Diaper
rash is caused by exposure to urine and feces,
allergies to disposable diapers, soaps and detergents, or by
diapers that are worn too tightly. While most cases of diaper rash
are mild and resolve in a day or two, more severe cases form
painful pustules that cover the baby's bottom, and may even result
in a yeast infection. All cases of diaper rash should be monitored
for potential secondary infection by bacteria or yeast.
Drug
Reactions - Adverse drug reactions can cause rashes,
hives, and swelling. As mentioned above, some medications increase
the skin's sensitivity to the sun. Notify your doctor of any skin
problem that develops after you start a new medication.
Genetics
- People whose parents suffer from skin-affecting
allergies may themselves be at increased risk of developing
allergies. Acne has a hereditary pattern, as do some other common
skin conditions. In the field of new drug development, a skin rash
is considered to be a relatively "minor" side effect.
Even medicines that successfully treat problems for most people
frequently list the side effect of causing or worsening skin
problems for an unfortunate few. After all, who's to say whether
their product caused a new rash, or was just ineffective in
treating an existing one? Supplements include vitamins, minerals,
herbs, botanicals, and amino acids. The FDA requires that they
include the words, "dietary supplement" on the label. By
law, supplement manufacturers may not make health claims linked to
a specific disease, in most cases. But many supplements do mention
specific diseases (including eczema) in their ads, which is a
legal gray area. Some supplements probably are effective, but
don't yet have formal scientific studies to demonstrate this.
Others may be a waste of your money or may worsen your condition.
Don't
jump to the conclusion that an "all-natural" regimen is
best for your skin. Products derived from animal or plant sources
may have irritating or allergenic effects for some people, as with
any other substance. While it is true that some persons with
eczema have good success in using plant- or animal-based products,
others may do better using synthetic formulations.
Over-the-counter
medications are available without a prescription
because they contain relatively low concentrations of active
ingredients. They are "not designed to treat the causes"
of a skin condition, but to give some relief of
"symptoms". Many good moisturizers are available as
over-the-counter products. They are important in terms of
prevention and maintenance to reduce eczema's impact. Regular use
of these products may reduce the frequency of flare-ups.
Prescription
medicines, by contrast, are usually much more powerful
in treating the underlying cause of a condition. They are closely
regulated in the U.S. by the Food and Drug Administration (FDA),
and are approved for use in treating a specific disease only after
they have demonstrated effectiveness and safety. No prescription
drug is free of side effects, and FDA approval is sometimes given
to drugs that must be used with caution to avoid the negative
effects which could result in something worse than the disease
itself. Consequently, these drugs must be administered under the
watchful eye of a licensed practitioner - a doctor or, in some
states, a nurse practitioner.
People
with chronic eczema will occasionally find themselves in a
situation where they will require something stronger than an
over-the-counter product to bring a flare-up under control. This
usually means topical or oral corticosteroids. Except for the very
mildest preparations, these are only available by prescription.
Specific
strategies to employ:
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Do
your homework- ask questions before you begin the new
treatment
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Use
your support networks. Ask your friends with eczema if they
have experience with the therapy.
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Look
carefully at the product's ingredient list, printed on the
package. There should also be a Product Insert (PI) sheet for
all FDA-approved prescription drugs. If you do not get one,
ask your pharmacist, prescribing physician, or check the
Physician's Desk Reference (PDR), available in most public
libraries. Most PI's are also available over the Internet.
A good
pharmacy is an important source of health information. When
filling your prescription, the pharmacist will double-check to see
that the drug is the right one, and should offer instructions on
how to use the medication properly. If the ingredients of a
product you are considering aren't fully disclosed on the label,
beware. If all ingredients are stated, you can usually track down
why they are included, and what they do. Drugs and pharmaceutical
products must designate the name of the "active
ingredient"-the therapeutic agent. The rest of the
ingredients are usually "helpers" to make the product
easier to use or to extend its shelf life. In the case of creams
or lotions, there will be emulsifiers, preservatives, perfumes, or
dyes. Unfortunately, any of these non-active ingredients can cause
irritation or allergic reactions for sensitive or allergic skin.
Ointments (also called "greases") don't need these, as a
rule, because most active drugs against eczema mix well with
ointments. After a little experience, you will become expert at
reading labels.
Pick a
specific day to start the therapy. Try to pick a time that will
minimize the possibility that other things happening in your life
may cause misleading results. If you're a woman, don't start the
therapy while you are menstruating, as hormonal changes may affect
your eczema. Avoid consuming alcohol or engaging in activities
which may cause dehydration. Be aware that other drugs
(prescription or not) can mask a therapeutic effect of the new
regimen, or could possible have an adverse effect when combined
with a new therapy.
If you
hope to replace an existing therapy with a new one you've never
tried, start the new one on a part of your body that is relatively
free of eczema, to eliminate the possibility that something in it
may cause allergic contact eczema, thus making your problems
worse. Or better still, mark a small area where you will try the
new agent and then only apply it there, using your regular regimen
everywhere else. Once you've tried this for a day or two, try the
new therapy on one side of your body and the old one on the other.
Be
patient! Results may not be immediate. The healing process takes
several days.
Remember
that treating skin disease is a mixture of both science and art,
and fine-tuning may improve the outcome, even with relatively
small changes. It's best to make these in close partnership with
your trusted provider. A small proportion of persons with eczema
will learn that their disease is primarily based on an allergic
reaction to something. Indeed, the hope of every person with
eczema is for a real cure, but at this writing there isn't one in
sight. The clinical management of this disease remains quite
complex, with much trial and error required. It's always a good
idea to look into any rumored new therapy, whether you actually
try it or not. And if you do try it, don't be too put off by
apparent failures, or too ecstatic at what appear to be promising
results. Although your disease is stubborn, it is also manageable.
This information sets forth current opinions from recognized
authorities, but it does not dictate an exclusive treatment
course. Persons with questions about a medical condition should
consult a physician who is knowledgeable about that condition.
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