What is it, Psoriasis or Eczema?

What is it, Psoriasis or Eczema?

Psoriasis is a chronic autoimmune condition that accelerates the growth of skin cells, which causes rash like symptoms such as dry or itchy skin.  Bumps and lesions may also be present anywhere on the body and it may be misdiagnosed as dermatitis or eczema.  

Conditions relating to the skin such as dry skin, dandruff, rashes, eczema and fungal infections may look like psoriasis.  They may not be psoriasis, so it is important to identify the condition correctly and then get the treatment that addresses the problem.

Psoriasis Condition 'Look-a-likes' 

Psoriasis is one of the most common autoimmune diseases in the world and several millions of people in the U.S. are affected.  Many people who suffer from it do not know what it is?

Psoriasis is a chronic autoimmune condition that accelerates the growth of skin cells, which causes rash like symptoms such as dry or itchy skin.  Bumps and lesions may also be present anywhere on the body and it may be misdiagnosed as dermatitis or eczema.

How does psoriasis appear on your body and how do you make the distinction between other skin conditions.  
There are several types of psoriasis that exhibit different characteristics:

Psoriasis vulgaris (plaque psoriasis).  The most common form of the disease that accounts for, on average, nearly 85% of cases.  It causes regular, distinct, inflamed, bright red, raised blotches, or plaques that are covered with silvery platelets.  These platelets can appear on any part of the body but typically they will present themselves on elbows, knees, shins, lower back and the belly button.

Guttate psoriasis is a type of psoriasis that shows up on your skin as red, scaly, small, teardrop-shaped spots.  It usually occurs in young children or in early adult years.  It accounts for about 10% of the population who suffer from psoriasis.

Inverse psoriasis. This is a type of psoriasis that typically appears in the armpits, groin, under the breasts, and in skin folds around the genitals and buttocks.  Inverse psoriasis is so named because it's most common in areas usually spared by the more common plaque-like psoriasis.  The affected patches are usually very red but lack scales.  It is particularly subject to irritation from rubbing and sweating because of its location in skin folds and tender areas.  It usually lacks the scale associated with plaque psoriasis due to the moist environment.

Pustular psoriasis.  In pustular psoriasis, small white or yellow blisters or pustules appear on the top of very red skin. The pus is composed of white blood cells.  On darker skin, instead of red patches, the patches are darker in colour.  The exact cause of pustular psoriasis is not known, but in some cases it is believed to be due to gene mutations.  It is thought to be hereditary and it tends to run in families.

Factors that can trigger pustular psoriasis include:  Internal medications, Irritating topical agents, Overexposure to ultraviolet light, Pregnancy, Systemic steroids, Infections, Emotional stress, sudden withdrawal of systemic medications or potent topical steroids, Skin injuries.

Erythrodermic psoriasis.  This version of Erythrodermic psoriasis is a very rare type of psoriasis.  It only affects about three of people with psoriasis, but it can be very serious.  It typically occurs in people with unstable plaque psoriasis.  It can cause your skin to lose its ability to control your body temperature and protect against infections.  Losing the ability to perform these vital functions can be life-threatening.  The main symptom of Erythrodermic psoriasis is a deep red rash that forms all over the body.  Other symptoms include: shedding of the skin in sheets instead of smaller scales, burned looking skin, increased heart rate, severe pain and itching, fluctuating body temperature, especially on hot and cold days.  Not only Erythrodermic psoriasis affect the skin, it can disrupt your whole body chemistry.  It can lead to wild temperature swings in your body.  This may cause fluid retention which causes swelling — especially in the ankles. In severe cases, people can get pneumonia or have heart failure, requiring hospitalization. 

Various skin conditions might give the impression of psoriasis, but there are differences, from the shape of the borders of the affected areas to the colour and thickness of the platelets.  Here are some similar-looking skin conditions:

Eczema. Also known as atopic dermatitis is more common than psoriasis.  It appears frequently on the back of the knee or in front of the elbow, which is a more limited area than the common forms of psoriasis.  What activates the rash also helps differentiate atopic dermatitis from psoriasis.  Eczema can be brought on by irritants such as dust, foods, or pollen.  In addition, the skin lesions of eczema can get infected with bacteria. 

Seborrheic dermatitis (seborrhoea) also known as seborrheic eczema, is a chronic, relapsing and usually mild dermatitis.  In infants seborrheic dermatitis is called cradle cap.  Dandruff is a type of seborrheic dermatitis where inflammation is not present.  Seborrheic dermatitis is a skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin.

Dandruff. Seborrhoea on the scalp, known as ‘dandruff’, produces fine, greasy scales and usually is distributed generally over the head.

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Psoriasis - A chronic rash that is more than skin-deep!

Psoriasis - A chronic rash that is more than skin-deep!

Psoriasis patients need to go for screening as they have twice the risk of metabolic syndrome.  "Don't go near him!"  That is what patients with psoriasis, a chronic condition which manifests as thick, red, scaly patches on the skin, often hear in public spaces.

One of my patients said that everyone got out of the condominium pool the minute they saw him entering it.  He now swims only late at night, when there is no one around.

It is disheartening to see people with non-infectious skin diseases, such as psoriasis, shunned and discriminated against in public.  Psoriasis can affect any part of the body, including the scalp and genital regions.  Up to half of psoriasis patients may have nail changes and one-third of them may have painful, swollen joints.

Psoriasis affects about 100 million people worldwide, according to the World Health Organization.

The condition is non-contagious.  But due to poor public awareness and the unsightly appearance of the rash, people with psoriasis are often stigmatized.

In a survey conducted by the Psoriasis Association of Singapore in 2015, about half of the respondents said they would not eat food prepared by people with psoriasis, share a workplace or residence with them, or allow their children to play with them.

I have encountered many patients who have difficulty getting jobs.  There is a high chance that they would be rejected when any prospective employer learns about their psoriasis condition.

Mr. L, a 52-year-old driver, came to see me recently as his psoriasis had deteriorated in the past few months - the rash was covering more than 20 per cent of his body surface area.  He has had psoriasis for the past 10 years and was previously treated with topical creams and lotions prescribed by his family doctor.  However, he did not follow up on the treatment.  He had also not gone for health screening for several years, as he felt well and did not have symptoms such as joint pain.

A heavy smoker who had been puffing about 20 cigarettes a day since his teenage years, he rarely exercised. He also drank alcohol occasionally.  As I was preparing to start him on an oral medication to treat his psoriasis, I did some checks.  I discovered that he had diabetes mellitus, as well as hyperlipidaemia and hypertension.  He was dismayed when I informed him about this.

In recent years, research has greatly advanced our understanding of psoriasis.  We now know that psoriasis is not just a skin disease per se, but one that is associated with nearly twice the risk of metabolic syndrome (a group of cardiovascular risk factors, including hypertension, insulin-resistant diabetes and abdominal obesity), ischemic heart disease and stroke.  The greater the severity of psoriasis, the higher the risk.  Other conditions that share a link with psoriasis include non-alcoholic fatty liver disease, inflammatory bowel disease and depression.

It is very important for people who have psoriasis to undergo annual health screening and to lead a healthy lifestyle.

At the National Skin Centre, we routinely screen psoriasis patients for metabolic syndrome once a year.  As for Mr L, I encouraged him to exercise regularly, control his diet and quit or, at least, cut down on smoking and alcohol.  He agreed to see his family doctor for treatment and follow-up on his metabolic syndrome.

A SILVER LINING

Although psoriasis is a chronic skin disease with no permanent cure, there are numerous treatment options that offer patients a reasonably good chance of suppressing the disease and leading a normal life.

Topical creams and lotions are used for patients with very mild psoriasis. For those with moderate to severe psoriasis, treatment methods include ultraviolet light phototherapy and oral medication.

The medication contains ingredients that aim to suppress skin inflammation and normalize the growth rate of superficial skin cells, which are both markedly increased in psoriasis.

As these medications carry a potential risk of side effects, such as decreased production of blood cells, kidney problems or liver damage, patients need to go for regular blood tests to check for these effects.  Newer treatments, such as biologic agents that work by blocking specific immune pathways that drive psoriasis, have been proven to be generally effective and safe for most people.

There is, however, a slightly higher risk of infections.  These biologic agents are administered via injections, ranging from once every two weeks to once every three months.

For the patient to continue experiencing its benefits, the treatment needs to be continued long term.

Psoriasis is a serious disease that goes beyond being skin-deep.

Early diagnosis and appropriate treatment tailored to each patient will ultimately make a positive difference to his/her lifespan and quality of life.

Source of information: Dr. Eugene Tan Sern Ting is a consultant dermatologist at the National Skin Centre, National Healthcare Group, Singapore.

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Fungus in the toenails

Fungus in the toenails

It's not only unsightly but potentially detrimental to our health - fungus in the nail!

Millions of people are infected by this virulent fungus.  Currently there are three methods of treatment: 

1. Topical application of tinctures, this is not only expensive but can take months to see a result and if the infection has reached the cuticle it may not be not effective.
2. Prescribed anti-fungal medication: a course of medication takes months and the side effect is liver damage
3. Surgical removal of the infected nail - success short term but the fungus can return when the nail grows back.

There is, however, a natural option. A remedy, that is effective, inexpensive and painless you can do it while watching TV.  Soak the infected finger/s or toes in a solution made of 50% apple cider vinegar and 50% Listerine (antiseptic).  Soak for at least 30 min every day for at least a week.  Between each soak file both the top and end part of the nail.  You will notice the difference after the first soak.  

Repeat this process, changing the solution every couple of uses.  This method will kill the fungus even if the cuticle is infected, it just takes time! 

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Do Creams Work?

Do Creams Work?

There are lots of claims made about different creams.  The cosmetic industry is full of promises that in many cases are not delivered.  We all dream of the magic potion that will somehow make us more attractive and more youthful than we are. 

Most creams will help make the skin appear more supple and healthy however there are no regulations to ensure cosmetic creams are safe and healthy.  The responsibility for this rests on the manufacturer.  Equally the responsibility for making realistic claims about products also rests with the manufacturer.

So how do creams work?  Let’s talk about the face, a cream should contain ingredients that are beneficial to skin health and in applying it, the cream is absorbed into our skin making the skin more supple, healthy and hopefully resilient.  Many creams reduce the signs of aging by slightly plumping the skin. Good skin care is very important.

Sadly many Australians have dry, damaged and aged skin, the results of time spent in our harsh conditions or perhaps too much sun bathing when we were young.  It is not really possible to reverse this damage but good skin care can help transform dry and damaged skin into the best condition that can be achieved.

We all feel just a little bit immortal when we are young, getting old, damaging our skin or having skin problems as we get older is not really considered when we are young.  Yet this is the most important time to start good skin care and the use of a good moisturising cream.

Good skin care early in our life and a good daily routine with a moisturizing cream, will result in us looking years younger as time goes by, in looking healthier and in feeling more self-confident.  It can be very confusing when reading the ingredients of creams, many scientific terms are used, sometimes these relate to natural ingredients but sometimes they are describing chemicals and synthetic ingredients.

To be sure that the cream you use is safe and healthy, research your ingredients.  Our experience has shown that natural is best.

The fountain of youth can best be described as good skin care.

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Vitamin B3 (Niacin) and Skin Cancer

Vitamin B3 (Niacin) and Skin Cancer

Researchers from the University of Sydney, have found that vitamin B3 has a range of anti-cancer effects.  Vitamin B3 can be rubbed onto the skin or taken as a vitamin supplement.  There is hope that it may also help to prevent melanoma cancers. 

Vitamin B3 is non-toxic and inexpensive to purchase.  The research of Professor Diona Damian and Professor Gary Halliday from the University of Sydney, have found that vitamin B3 has a range of anti-cancer effects. Vitamin B3 can be rubbed onto the skin or taken as a vitamin supplement.

In pilot studies it was established that Vitamin B3 helped to reduce existing precancerous lesions and reduced the number of new non-melanoma skin cancers.  There is hope that it may also help to prevent melanoma cancers.

As Australia is a country with a very high incidence of skin cancer, the discovery of the benefits of Vitamin B3 is an extraordinary step forward in the reduction and hopefully prevention of skin cancers.

Read more at: Research Study at the University of Sydney – Skin Cancer

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Dermatitis

Dermatitis

Dermatitis is a relatively common condition that can make you feel uncomfortable and self-conscious.

It is a term that describes inflammation of the skin and covers a range of conditions that have many causes and many forms.  

Dermatitis typically presents itself as an itchy rash on red or swollen skin.  Examples of dermatitis include atopic dermatitis (eczema), dandruff and rashes caused by contact with any of a number of substances, such as chlorinated water, harsh soaps or frequent hand washing due to occupation e.g. nurses and hair dressers often have issues with dermatitis on their hands.  

Jewellery with nickel in it can also cause irritation, there are many possible causes and sometimes sadly it is just genetic.

Seborrheic dermatitis is a common skin condition that mainly affects the scalp.  It causes scaly patches, red skin and dandruff.  It can also affect oily areas of the body and face.  In infants this is known as cradle cap.

While it is always sensible to seek medical advice, there are also many alternative therapies, which have helped some people manage their dermatitis.

These include:

·    Dietary supplements, such as vitamin D and probiotics, for atopic dermatitis

·    Rice bran broth (applied to the skin) for atopic dermatitis

·    Tea tree oil, either alone or added to your shampoo, for seborrheic dermatitis

·    Fish oil supplements for seborrheic dermatitis

·    Aloe Vera for seborrheic dermatitis

An essential for any dermatitis sufferer is to find a very gentle soap that firstly, does not aggravate their condition, and secondly ideally will help bring the skin into normal balance. 

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Body Moisturisers

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