Acne, Eczema & Psoriasis

Acne

Acne is a common skin disorder that is caused by hormone action on the sebaceous glands (oil secreting glands) of the skin. Hormones act on the skin's oil glands and hair follicles leading to clogged pores and lesions which we commonly call pimples. These usually form on your face, neck, back, chest, and shoulders. Even though acne does not lead to a serious health problem, it can lead to emotional disturbances such as low self esteem. When it is severe, it can even leave behind permanent scars.

The sebaceous glands secrete an oily substance called sebum that is normally carried out to the skin surface through the tiny opening of the hair follicle, called a pore. The hair, sebum, and dead skin cells in the follicle may form a plug that prevents sebum from reaching the skin surface. The bacteria Propionibacterium acnes (P. acnes) found normally on your skin start to grow in these follicles and cause inflammation. When this plug breaks down, it causes pimples.

There are many types of pimples. The most common types include:

• Whiteheads - These pimples form under the surface of the skin and appear as a small white bump on the skin
• Blackheads - These pimples form on the skin surface and are black in colour
• Papules - These are small pink bumps that can be painful when you touch them
• Pustules - These pimples appear red at their base and are filled with pus
• Nodules - These are large, painful, solid pimples
• Cysts - These are deep, painful, pus-filled pimples and can cause scars

Causes

Acne is common in teenagers because of excessive hormone production of androgens during puberty. These hormones make the oil glands produce more sebum and also clog the pores of your skin. It can also occur as a result of hormonal changes during pregnancy or when birth control pills are started or stopped. In addition heredity may also play a role, where it runs in families. The use of certain drugs containing lithium and oily creams can also contribute to acne. In women, acne frequently worsens at the time of menstruation.

Treatment

Acne is often treated by medicines that may be applied to the skin or taken by mouth. There are several over-the -counter medicines used, the most common being Benzoyl peroxide.

These medicines are available in many forms like gels, lotions, creams, or soaps. Prescription medicines such as antibiotics or Roaccutane (vitamin A derivative) are recommended if the problem persists.

Skin Care Tips

Practising some skin care tips may prevent acne from developing or becoming worse.

• Cleanse your skin gently with a mild cleanser twice a day. Avoid using strong soaps or rough scrubs as overstimulation can make the problem worse
• Do not try to squeeze the lesions as this can lead to permanent scarring
• Use cosmetics sparingly, and make sure to use products labelled "oil-free" and "non-comedogenic" which means it won’t block your pores and aggravate the condition
• Protect your skin from tanning by wearing a sunscreen daily

Eczema

Eczema is a general term used to describe a group of skin diseases in which skin becomes swollen, irritated, and itchy as in a rash. Eczema affects both adults and children, but is most common in babies.

The most common type of eczema is called atopic dermatitis. Eczema is not contagious. You are more prone to have eczema if your parents or family has a history of eczema and allergic conditions like asthma and hay fever.

Eczema can be aggravated by certain substances such as soaps, detergents, cosmetics, jewellery, or sweat. Humidity and psychological stress may also worsen eczema.

Eczema causes dry, scaly, red skin that itches or burns. It occurs on the face, neck, and the insides of the elbows, knees, and ankles. In babies, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.

Treatment of eczema aims at keeping the skin moist by applying creams or ointments. Corticosteroid creams are applied to decrease the inflammation.

In some cases, a short course of oral corticosteroids (prednisolone) is given to control an outbreak of eczema. Ultraviolet light therapy is another treatment option for eczema. Topical Tacrolimus may be used in severe cases of facial eczema.

Eczema cannot be cured completely, but you can follow these measures in order to relieve your symptoms and lessen the flare-ups. Such measures include:

• Avoiding taking long, hot baths. Try to limit bathing to 1-2 minutes with warm water and a soap substitute
• Apply a good moisturizer every day  right after bathing
• Avoid contact with soaps, perfumes, detergents, or jewellery which irritates your skin
• Wear loose-fitting cotton clothes
• Keep your fingernails short to prevent scratching
• Exercise and meditation can help those for whom stress triggers an outbreak
• Avoid physical activities that promote excess sweating if this triggers an outbreak
• Practise good skin hygiene habits
• The goal is to learn what works for your skin and manage your skin accordingly

Psoriasis

Psoriasis is an inflammatory skin condition characterised by red, dry, and thick plaques on the skin. Psoriatic lesions develop on the skin because of faster proliferation of skin cells which is caused by abnormal functioning of the lymphocytes present in the blood. Psoriasis is a non-communicable disease and is considered as mild or severe depending upon the spread of disease and the time for its recovery.

Psoriasis is a chronic skin condition. However patients may have a relapse period where the symptoms recur & worsen after a period of improvement. Often the symptoms are worse in winter.

Psoriasis is global condition affecting people of all age groups with higher incidence in younger adults. There is often a family history. Certain factors can trigger its appearance including stress, injury to the skin, infections and the use of certain medications.

Symptoms

The symptoms of psoriasis depend on the type of psoriasis. The most common symptom is the development of scaly, red patches which are usually asymptomatic but can occasionally be itchy, on the elbows and knees but other parts of the body can also be affected. Other symptoms such as genital lesions in males, pain in joints, deformities & discolouration of nails and severe dandruff on the scalp are seen.

Based on the characteristics of plaques and the body part affected, psoriasis is categorised into five types, namely:

• Erythrodermic psoriasis – Spreads all over the body with characteristic red skin and shed the scales in sheets
• Guttate psoriasis – Small pink spots develops on the trunk and limbs
• Inverse psoriasis – Smooth, shiny bright-red lesions develop in the regions of skin folds such as armpits, groin, under breasts and around groins
• Plaque psoriasis – Most common form of psoriasis and is characterised by red raised plaques with silvery white scales that develop on elbows, knees, scalp and lower back
• Pustular psoriasis – Psoriasis subtype with blisters of non-infectious pus surrounded by inflamed skin

Diagnosis

The diagnosis of psoriasis involves the physical examination of the patient's skin and sometimes skin biopsy can also be done for confirmation.

If the patient is experiencing any joint pain, then X-rays may also be ordered.

Treatment

Several options are available for treatment of psoriasis and the choice depends on the type of psoriasis, area affected, disease severity and other factors. The treatment approaches include topical treatment, systemic treatment and phototherapy.

With topical treatment different medicated creams or lotions are applied directly to the skin or scalp.

Phototherapy is exposure of affected skin to ultraviolet radiations. The type of treatment now used is NBUVB (narrow band UVB)

With systemic treatment, medications that suppress the auto-immune activity are recommended. The medicines include immunosuppressant and newer classes of agents called biologic drugs.

In addition to the treatments mentioned above, your dermatologist may prescribe antibiotics to treat the associated infections, recommend other techniques such as stress relieving techniques, oatmeal bath and exposure to sun to improve the condition.