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Eczema, Dermatitis (Peri) and Psoriasis

Dermal Aesthetics

A quick explanation of the difference in these conditions are: Eczema begins with water loss and an impaired immune system, Psoriasis is over production of cells and Dermatitis is inflammation and contact with irritants. Now let’s delve further:

Eczema is a skin disorder characterised by patches of dry, red, scaled and itchy skin. Scratching leads to the formation of thick plaques on the skin and can result in skin infections. It usually begins in infancy as babies have immature gut systems, and it is often associated with allergies and asthma (known as the atopic triad pyramid). It can also occur later in life when the skins barrier becomes impaired with harsh detergents, inflammation of disorder of the immune system. New research has found that a gene called FLG which is responsible for the production of a protein filaggrin, may be defective in eczema sufferers. Filaggrin breaks down into a natural moisturising factor and a deficiency in this can lead to an impaired skin barrier. The skin barrier is a double layer of lipids that surround each skin cell and prevent the evaporation of water loss. It also protects from external irritants. Detergents, friction, heat, stress, diet, medication and the wrong skincare can all damage or affect the ability of the barrier to protect the skin.
Psoriasis an autoimmune disease that is often hereditary which an unknown cause. It presents with red scaly patches (plaques), silver white scales which shed and flake, dry and cracked skin, itchy and sore. The shiny silvery appearance is due to loose cohesive keratin. Suffers have a higher level of inflammatory mediators. It is found to have links with Diabetes, Celiac Rheumatoid Arthritis and Chrohn’s disease. This is because psoriasis sufferers have 100 times the likelihood of developing secondary autoimmune diseases. Some recent discussion has encouraged psoriasis sufferers to be on gluten free diets but there is little solid evidence at this stage.
It can also affect fingernails with small pits like pinheads. The nails look orange/yellow and can crumble off nail bed due to overgrowth of yeast and bacteria. It can occur in scalp and look like dandruff and can also cause balding. The cells in a psoriasis sufferer are regenerating at a fast rate of 2-4 days unlike 28 days for regular skin turnover. In addition to the fast turnover there is also an abnormality in over proliferation of inflammatory cells. Either abnormality can trigger the other, leading to a vicious cycle of keratinocyte proliferation and inflammatory reaction.
Treatment is usually with medicated cream and medicines that work inside the body. Skin must be kept moisturised to soften plaques and relieve itching. Vitamin D has shown to be effective by inhibiting interleukin and T cell function and reduces epidermal activity. A Vitamin D cream called calcipotriol slows down the cell production and can see improvements after 6 weeks. Cortisone etc can relieve inflammation but comes with it’s own problems. Vitamin A: is a supreme regulator so can assist in slowing down proliferation for Psoriasis. Creams containing Beta Glucan which is known to stimulate the langerham cells whilst also suppressing the inflammatory cytokines, may also help. Salicylic acid will remove dead skin but cannot be used if allergic to aspirin. Stress, smoking , over weight, alcohol and sunburn can all trigger. Pregnancy improves it for some time but then it returns. Deficiencies in magnesium and zinc can create imbalance in fatty acids that lead to inflammatory responses.
Dermatitis is usually an acute reaction that can last days to years. It presents with itching, red hot skin, dry and scaly, papules and blisters and weeping skin. It may have painful cracks and appear rough and leathery. Contact dermatitis is allergic reaction and irritant dermatitis may be caused by soaps or gloves etc. To treat: moisturize dry skin, relieve itch and stop inflammation, do use anything fragranced. Corticosteroids can also relieve inflammation, however must be used with caution as can cause rebound and sometimes have been the cause of the rash in the first place (eg when using for eczema). Anti histamines and tar may also be useful. Do not use very hot water and avoid getting too hot. Keep areas cool. Animal fur can also irritate. Coffee could also aggravate. There is a close connection for food allergy sufferers and dermatitis.
Perioral dermatitis
Is a form of dermatitis that usually presents around the mouth but can sometimes be around eyes, chest and genitals. It appears as non itchy papules, diffused redness and scaling around mouth and more severe cases can have a burning sensation, become angry, swollen, scabby and infected. Cause of PD remains unknown, however treatment has commonly been topical corticosteroids. As mentioned above caution should be taken with corticosteroids and overuse can worsen condition and cause a rebound when cream is stopped. It is unknown why steroid cream worsens condition but thought perhaps due to action in pilosebaceous unit and subsequent change in microflora. It can often be confused with eczema and then topical steroids make it worse.
Possible triggers may be: Bacteria and change of micro flora, candida, dermatox mite, Dysfunctional barrier or immune system. Overuse of corticosteroids, makeup, fluoride toothpaste, hormonal changes, UV, stress, nasal sprays, chewing gum, sunscreen.
• Change of diet may help: avoid spicy foods, salt, acids, caffeine, sugar, alcohol.
• Ingredients : avoiding SLS (in shampoos and skincare), parabens and glycols as they are thought to aggravate, exfoliating regularly.
• Boosting ZINC can speed up recovery process.
• Remove anything new you have added to routine. Only use gentle products.
• Non steroid creams: Probiotic creams such as Amperna and Beta Glucan creams such as Ganodex may help and will avoid the risks associated with steroid creams.
Additional tips for all
• Remove anything that suds or bubbles as these can remove valuable lipids
• Avoid scrubs and facial brushes that cause friction on the skin
• Avoid hot water, saunas, spas that cause internal heat
• Salt rooms have been found to be beneficial
• If crusting or pus occurs on skin use an anti bacterial cream
• Use anti itch medications: Anti-histamines such as Benadryl, Claratyne or Zyrtec can help decrease itchiness and reduce chance of infection
• Avoid fragrance and scratchy fabrics such as wool
• Eat food or take supplements with anti inflammatory properties that can help decrease inflammation. Wild salmon, flax seed, evening primrose, argan and safflower are all good sources of omega 3 fatty acid which are known anti-inflammatories.
• Zinc is also great for healing skin as it strengthens immune system.
• Use a humidifier if you live in a dry climate
• Reduce stress (exercise, relax) as stress has been shown to damage the skins barrier
• Led and Low level laser have been shown to help.
• Beta Glucan: is an important ingredient that assists all three conditions. It works with the cells immune system and keeps the inflammatory process under control. It can suppress the inflammatory cytokines when calming is needed, and stimulate the langerham and macrophage cells when action is needed. Langerhams migrate in and out of epidermis and eat invaders as well as stimulate fibroblast manufacture. UV and trauma compromise these cells, which is when we need them the most. Even when we don’t think we have inflammation, we do. The ageing process itself is inflammatory. B Glucans is known to be antioxidant, liver protecting, anti tumor, anti bacterial, anti viral, wound healing and immunity enhancing. 80% of our immune system resides in the intestinal tract so taking B. Glucans internally can also fast tract the inflammation control.
• Barrier creams: Look for protective barrier creams that can help with water loss. Ingredients such as shea butter, argan, jojoba, safflower and Hylauronic with repair moisture barrier and decrease irritation.
Sources: APJ, immune intelligence seminar, APAN – how psoriasis is impacted by various diets, Perioral Dermatitis: A Review of the Condition with Special Attention to Treatment Options, Therdpong Tempark & Tor A. Shwayder

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