Let’s Talk: Skin Conditions

Posted on May 2 2018 - 9:00am by Samantha Clark
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When we consider that 60% of the population will suffer from some form of skin condition in their lifetime it’s a pretty important topic to consider; especially when it can be hard to distinguish one disease from another and whether it is a long term issue or additional treatment is required.

With skin diseases being so common, it can be all too easy for us to be blasé when we see a rash or patch of seemingly dry skin. Yet, even if it is a disease that may not seem problematic, without appropriate treatment, it certainly could be.

To help better understand some of the most common skin conditions, we talk to the British Association of Dermatologists to find out more

Eczema

There are varying forms of eczema, the most common being Atopic Eczema. It is a very common skin condition due to skin inflammation. It can start at any age but is quite common in childhood with 1 in every 5 children affected by eczema at some stage.

The term ‘atopic’ is used to describe a group of conditions, which include asthma, hay-fever and food allergy. In fact, approximately one third of children diagnosed with AE will also develop asthma and/or hay fever. These conditions are all linked by an increased activity of the allergy side of the body’s immune system. ‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.

It is a complex condition and a number of factors are important for its development including patient susceptibility (e.g. genetics) and environmental factors (such as soaps, detergents and other chemicals in contact with the skin as well as infections from certain bacteria and viruses).  It is not contagious.

It can affect any part of the body including the face, though creases in the joints around the elbows, knees, neck and wrists are commonly affected. The most common symptom is itching which, when scratched, causes many of the changes in the skin.

Treatment usually involves topical treatment but more severe cases will involve oral medication too. Most topical treatment is the form of a moisturiser targeted at dry skin. It is also recommended to substitute products for those who experience flare-ups because of particular products. If you’re aware of products that cause a flare-up in your eczema, it’s best to stop using this product immediately and seek an alternative.

For more information, read the BAD leaflet.

Psoriasis

Psoriasis is a common inflammatory skin disease that affects 2% of the population. It can affect any gender, at any age and tends to come and go unpredictably. It is not infectious and does not scar the skin; however, it can sometimes cause a temporary increase or reduction in skin pigmentation. Although it is a long term condition, there are effective treatments available to keep it under good control.

It is a condition that can affect nails and joints as well as skin; half of those with psoriasis will have it affecting their nails as well.  1 in 3 with moderate to severe psoriasis will develop psoriatic arthritis at some point; this is a condition that produces swelling and stiffness in the joints and/or lower back. This can be managed by a rheumatologist alongside your GP. It is also associated with an increased risk of anxiety and depression and it increases the risk of heart disease and stroke.

Both inherited and environmental factors play a role in the development of psoriasis. Some people are more likely than other to develop it particularly if someone in their family has it.

Skin affected by psoriasis can be painful and itchy and pink or red with silvery-white scales. The outer layer of skin contains cells which are continuously being replaced. This process normally takes between three and four weeks; in psoriasis, the rate of turnover is dramatically increased so that cells are formed and shed in as little as three or four days.

Treatment will vary depending on personal circumstances; usually it can be controlled with topical treatments but it is best to visit your GP for diagnosis and tailored treatment. Find out more by reading the BAD leaflet on psoriasis.

Herpes Simplex known as Cold Sores

There are two types of herpes virus; herpes simplex type 1 which usually infects the mouth or eye area and herpes simplex type 2 which infects the genital area. Herpes infection is caught from another person through contact with the mouth, eye or genital secretions or through direct contact with an active lesion.  After the virus infects the person, whether it shows on the skin or not, it goes to the local sensory nerves and lies dormant until reactivated. Reactivation can occur after a few weeks or even years, when the virus travels to the skin supplied by the nerve and appears as a blister or rash.

A first infection can make a person feel very unwell with a temperature, swollen lymph glands and soreness and blisters in the mouth, on the lips or elsewhere on the skin.  When it becomes active again, the first symptom is a burning or stinging pain at the affected site, followed by pink bumps and small blisters. The blisters quickly dry and crust over, and the areas usually heal within a few days. Repeated attacks usually occur at a similar site.

Symptoms clear in 7-10 days, with or without treatment, though the virus will remain in a dormant state in the body. In a majority of patients, recurrent symptoms are mild and infrequent, or do not happen at all. For a minority, troublesome recurrences can usually be prevented by using oral anti-viral drugs or adopting lifestyle changes.

Factors that may increase the risk of virus reactivation are:

  • Other infections such as colds or flu
  • Getting tired and run down
  • Sunlight on the affected area

Read the dedicated leaflet for further information on herpes simplex type one and two.

Urticaria/ Hives

Is a common skin condition that affects 20% (one in five) people at some point in their lives. Urticaria consists of pink or white, round or ring-shaped raised areas of the skin resembling nettle rash. It is caused by the release of histamine from cells in the skin which are usually itchy, sometimes painful and can appear anywhere on the skin. These usually disappear on their own within 24 hours without a trace.

The most common form of hives is called spontaneous urticarial. In this type, no cause is usually identified, though sometimes an infection such as a cold or physical contact with an allergen such as an animal, specific food or medicine can be a trigger. Often this is accompanied with deeper skin swelling known as angioedema. Angioedema may affect the tongue or throat, rarely, causing difficulty with breathing or swelling. This can be alarming but is rarely life-threatening.

Treatment can suppress the symptoms of the condition rather than cure it. Acute forms lasts up to six weeks; in half of people affected by chronic ordinary urticarial, the rash lasts for 6-12 months and then gradually disappears. Antihistamine tablets block the effect of histamine, and reduce itching and the rash in most people, but it may not relieve urticaria completely.

If possible, do not take the medicines codeine, or aspirin, ibuprofen and naproxen. It is important to avoid anything that may worsen the symptoms such as heat, tight clothing and alcohol.

Seek medical advice urgently if you are having problems with breathing or swallowing.

If the problem is persistent or you are having difficulties finding the right medication, talk to a pharmacist or medical practitioner for advice. You can find out more about urticaria and angioedema through the BAD.

Impetigo

Impetigo is usually caused due to bacteria called staphylococcus aureus which affects the surface of the skin. These germs pass from person to person by skin-to-skin contact, or less often, by bedding, clothing and towels. It can spread rapidly through families and school classes. It is the most common skin infection seen in young children, but may be seen in people of any age.

The bacteria that cause impetigo can invade normal skin, but more often take advantage of skin that is already damaged by cuts or grazes, insect bites, head lice, scabies, cold sores or eczema. People with diabetes or low immunity are more susceptible to getting impetigo. It is more common in warm, humid weather.

Impetigo can make the skin red, sore and itchy. There may be swollen glands though it is unusual to have a fever or feel very unwell. It starts as a rash of small, pus-filled blisters. These tend to break easily and leave around oozing patches covered with yellow or brownish crusts. These patches are small at first but slowly get bigger. Bacteria are easily spread, and new lesions can develop at other sites away from the original infection.

It clears in a few days with treatment and 2-3 weeks without treatment. It may not clear if there is an underlying skin problem such as scabies or head lice; these additional skin problems will also need treatment.

The first step is to remove the crusts gently and regularly with antibacterial liquid soap. Apply antibiotic cream or ointment onto the patches and the skin around them, two or three times a day for 7-10 days or until they clear up.

For further information regarding treatment and how to control the spread, read the dedicated leaflet.

Warts & Verrucas

Warts are localised thickenings of the skin. Plantar warts, also known as verruca’s, occur on the soles of the feet.

They are caused by infection in the outer layer of skin with a virus called the human papilloma virus (HPV). There are many different strains of this virus, and plantar warts are usually due to just a few of these strains. These are caught by contact with infected skin scales- for example from the floors of public locker rooms, shower cubicles and the areas around swimming pools. The virus is not highly contagious and it is unclear why some people develop plantar warts while others do not. The virus enters the skin through tiny breaks in the skin surface. Moistness and maceration of the skin on the feet probably makes infection with the virus easier.

They do not cause symptoms but can be uncomfortable, particularly if they are present on a weight-bearing area. A person may have one or many and can also have warts elsewhere on the body. Close inspection with a magnifying glass may reveal small black dots.

Most verrucas will clear with time and can be left untreated if not causing problems without leaving a blemish or scar.  Some warts can be very stubborn; treatment does not always work and may be time-consuming. Treatment options include salicylic acid- which works by removing the outer, dead layers of the skin and triggering the immune system into clearing the virus; cryotherapy- a process of freezing the warts with liquid nitrogen, it is painful and may cause blisters and burns, several treatments may be required.

Other treatment options as well as self-care advice to help reduce the chance of spreading can be found on this informative leaflet.

When it comes to identifying skin conditions in children, Dr Sweta Rai of the British Association of Dermatologists adds

“There are some common skin rashes present in children which should be taken seriously by parents and identified as a medical emergency.

Eczema which is a common childhood skin condition can get infected with the cold sore virus i.e. herpes simplex. If you or a family member have had a cold sore it is a good idea to restrain contact with a child with active eczema. If your child develops pus filled and eroded area of skin which are weeping and painful particularly on the face, near the eyes or generalised over the skin you should see a doctor to exclude eczema herpeticum. If not diagnosed on time this skin infection can cause damage to sight, particularly if it is near the eyes.

If your child looks unwell with purple rash which, when you press your fingers over the purple, the colour does not go pale pink then you must see a doctor urgently as this could be a sign of meningococcal septicaemia. This is a dermatological condition called purpura fulminans.  Other rashes which may appear purple on a child’s skin and do not become pale pink on pressure can be a sign of inflammation of the blood vessels called a cutaneous vasculitis. This can be as a result of an underlying infection. “

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