Psoriasis On Skin

Psoriasis is a common, long-term, slow progressing skin condition that affects up to one and a half million people in the UK. Psoriasis makes the skin of a person inflamed (becoming red, swollen and painful) and can make it look like fish scales (scaling). Psoriasis can affect any part of the body.
There are a number of different types of psoriasis and they are explained in the section ‘Will I have any tests or investigations?’.

What Causes Psoriasis?

The cause of psoriasis is unknown. But certain types of the condition might be inherited: about three in ten people with psoriasis have a relative who also has the condition. However, a definite genetic link has yet to be proved.
It is thought that the underlying problem is that new skin cells are produced too quickly and rise to the surface before the old skin cells have had time to die off and be scrubbed away. The result of this overproduction of skin cells is red and raised patches on the skin.
The overproduction of skin cells may be due to a problem with the immune system. In psoriasis sufferers, their bodies’ immune systems may cause too many white blood cells (known as T cells) to be produced in the skin. These T cells cause the skin to become inflamed by releasing chemicals that cause the body to react as if it was being attacked by an infection – this is known as the inflammatory cycle. This inflammatory cycle causes the excess production of skin cells and this produces psoriasis.

Symptoms Of Psoriasis And Signs

On the skin, psoriasis appears as patches of thick, red skin that have a silvery scaly appearance. These skin patches are known as plaques. The plaques usually appear on the elbows, knees, scalp (skin under the hair of the head) and on the lower back. However, plaques can appear on any part of the body. Plaques may itch intensely, or ‘burn’ and the skin may crack around the joints (such as the elbow or knuckles).

No matter which type of psoriasis a person has, they will find that their nails become thickened, crumbly and pitted.

Psoriasis tends to appear and disappear and there may be wide differences in its severity on the same person over time. Most sufferers only have a few isolated patches but, in its worst form, the psoriasis may affect the whole body and 6 people with psoriasis in every 100 develop a form of arthritis in the joints. This rare form of arthritis usually occurs at the tips of the fingers, in the toes and in the lower back of those who develop it. And, just like the skin plaques, this form of arthritis can disappear completely.

Will I Have Any Tests Or Investigations?

Most forms of psoriasis can be diagnosed by a doctor carrying out an examination and asking the sufferer a number of questions (known as ftaking the history’). But diagnosing psoriasis can sometimes be tricky as psoriasis can look like other skin conditions so, if there is any doubt in the doctor’s mind, a small sample of skin is taken and sent to a specialist for confirmation.

The most common type of psoriasis – plaques of reddened skin with a silvery covering – is called plaque psoriasis, but other forms include:
 
¤ Guttate psoriasis. This form of psoriasis often appears several days after infection by a virus or a certain type of bacteria known as streptococcus. It looks like drop-like patches on the torso, scalp or limbs and is often milder than plaque psoriasis.

¤ Pustular psoriasis. With this form of psoriasis, painful bumps of pus (known as pustules) or blisters appear on the palms of the hand or soles of the feet. These pustules and blisters then turn brown and scaly. It is common in middle age and more painful than plaque psoriasis although not usually more severe.

¤ Flexural psoriasis. The skin is red but not scaly. Flexural psoriasis appear in the armpits, groin or under the breasts, and is often as severe as plaque psoriasis.

¤ Erythrodermic psoriasis. A rare condition where much of the body’s skin has become red and scaly. The body’s ability to control its temperature and fluid balance have been badly affected. People with this erythrodermic psoriasis often need to be treated in hospital.

What Psoriasis Treatments Might I Need?

Doctors normally follow the ’1-2-3′ treatment system for psoriasis.

Step 1. Using treatments that are applied directly to the skin in the affected area. Such localised treatment of a condition is known as topical treatment. Topical treatments for psoriasis include skin softeners (known as emollients), coal tar and salicylic acid preparations, steroids applied to the skin (if used carefully), Vitamin D ointments and dithranol – a synthetic chemical used effectively in plaque psoriasis. Your doctor will probably try a number of different treatments as not every treatment works for every patient, so that he or she can find the one that suits you best.

Step 2. Treating the condition with light (known as phototherapy). The majority of sufferers benefit from sunlight, and this type of treatment developed from this observation. It is called PUVA treatment, where the patient takes a drug called psoralens before being exposed to ultraviolet A light in a solarium ‘box’ for half an hour two to three times a week. This is effective, especially in the more severe types of psoriasis.

Step 3. Treating with oral tablets. The usual one given is called methotrexate, which works by slowing down the excessive production of the skin cells and so reducing the psoriasis. This can be dramatically effective, but these drugs are generally avoided unless all else has failed and your psoriasis is severe, because of the potential side-effects of the drugs such as severe nausea, vomiting and toxic effects on red and white blood cells. Any treatment with such drugs requires regular blood tests to monitor the body’s reaction to it.

What Course Will The Illness Follow?

Psoriasis follows a fluctuating pattern, so many people will need little or no treatment for a while and then more active therapy as the condition becomes worse, before the condition gets better again and so on. Each person’s psoriasis is different and will respond differently to different types of treatment, so often trials of treatment are needed. At least one third of people with psoriasis will find that their problem disappears for long periods of time or, for some people, for ever. However, a permanent cure for all people has not been found yet.

Can I Do Anything To Help Myself?

Definitely. There are at least three easy steps you can take.

Stress. Stress makes psoriasis worse, so one of the most beneficial things you can do is to try to develop a positive attitude to the condition.

Diet. Although no specific diet has been shown to be of benefit, if you find your psoriasis seems to be worse after eating certain foods, avoid them and see what happens.

Sunlight. Moderate sunlight helps many people, although a small number find that their psoriasis worsens after exposure to the sun.

Tell Your Doctor

1. Does anyone else in the family have this problem?
2. Have you noticed any problems with your joints?
3. Is it worse when you are stressed?
4. Does your skin seem to be flaking off more than usual?
5. Are the patches very itchy?

Ask Your Doctor

1. Is it infectious?
2. Can it be linked to my hormones?
3. Can my children inherit it?
4. Should I shower or bathe, or does it make no difference?
5. Are there any alternative treatments which may help my skin?

by Dr Roger Henderson, MB BS Lond., LMSSA Lond.

This free Medical Advice Online is published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Boy Using Asthma Inhaler

Asthma is a condition that affects your airways – the small tubes that carry air in and out of the lungs. People with asthma have airways that are almost always red and sensitive (inflamed).

When a person has asthma their airways react to a trigger by becoming narrower, as the muscle surrounding the airway tightens and inflammation inside the airway leads to swelling and a build up of mucus. This causes a cough, wheezing or breathlessness. It is difficult to predict who is going to develop asthma. Like eczema and hayfever, it often runs in families and may be inherited. It can develop at any age. About one in seven children and one in 25 adults in the UK have asthma.

What Causes Asthma

A trigger is anything that irritates your airways and causes the symptoms of asthma to develop. Triggers vary from person to person. Most people will have several. Triggers include the following:

• Colds and viruses
• Exercise
• Pollen
• Mould
• Pet hairs
• Dust
• Tobacco smoke
• Certain types of medication
• Weather changes
• Certain foods may also cause problems

It is important to try and identify possible triggers: talk to your doctor or nurse about avoiding them.

Asthma Treatment

Asthma Inhaler

Most asthma medication is delivered using an inhaler. This makes sure that very small amounts of medication are delivered directly into the lungs. There are a variety of inhalers available. It is important that you use an inhaler that you are comfortable with and that is available with the appropriate medication. Your doctor or nurse will help you decide which is the most appropriate inhaler and should show you how to use it correctly.

There are three types of medication to treat asthma – relievers, preventers and protectors.

Asthma Relievers

Reliever inhalers are usually blue. They act by opening up the airways by causing the muscles to relax and so allowing you to breathe more easily. You should only use the reliever when the symptoms of asthma appear or, if recommended, before exercise. They do not reduce the inflammation in the airways.

If you need to use your reliever three times a week or more this may suggest that there is inflammation in your airways and so you need preventer treatment.

Preventers
Preventer inhalers are usually brown or orange They work by reducing the swelling and inflammation in the airways and can take between 10 and 14 days to build up the preventive effect. You need to use them every day, even when you are well.

Most preventers are steroids, but because they are inhaled only low doses need to be used. (It is important to understand that these steroids are NOT the same as anabolic steroids used by athletes to improve their performance.)

Protectors
Protectors are long-acting medicines which reduce asthma symptoms and work by keeping the airways open and relaxed. This makes it easier for air to get in and out of the lungs, and so helps to ease asthma symptoms. They are available as inhalers or tablets.

A protector would usually be taken with a preventer. Like preventers, it is important that you take protectors every day.

Managing Your Asthma

Asthma symptoms can happen at any time. It is important to understand what to do if you feel your asthma is getting worse.

Your nurse or doctor may provide a peak flow meter to help you manage your asthma. A peak flow meter measures the performance of your lungs. The meter has a marker which slides up and down as you blow into it. The marker stops at a point where you blow hardest. Each time you use the meter (usually morning and evening) you mark the result on a chart. It gives you a very clear idea of how you are controlling your asthma.

Your doctor or nurse may discuss a management plan with you. This enables you to take control of your asthma. The management plan has a step-wise approach. Each step shows what treatment is needed to control your asthma. If the treatment on one step is not controlling your asthma your doctor may recommend increasing your medication. If your asthma is well controlled your doctor may well consider reducing your medication.

Your Lifestyle

Asthma should not get in the way of you leading a full and active life. Always carry your reliever medication with you. It is important to know what might trigger your asthma so you can avoid triggers. Also, take your preventer medication regularly so that your asthma does not deteriorate.

What to do during an asthma attack
• Take your reliever medication immediately
• Try and stay calm
• The attack should pass off and you can continue with normal activities
If the reliever has no effect after 5-10 minutes do the following:
• Call your doctor or an ambulance
• Continue to take reliever medication every few minutes until help arrives.

By Dr Peter Stott.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Eczema

Eczema is a chronic skin condition, which affects about 1 person in 12 at some time in their lives. It is given the scientific name atopic dermatitis, and is often seen in patients who have asthma or hay fever as well. It usually appears initially in childhood, often improving with age although adults can develop it for the first time occasionally. The majority of people who get it come from families with a history of atopy i.e. a history of asthma, eczema or hay fever.

It is a disease characterised by flare-ups and remissions and cannot be caught from other people.

What Causes Eczema?

Eczema often proves to be something of a puzzle since there is often no obvious cause for it. Some eczema is due to allergies but may just as readily be triggered by stress or emotional upsets. Sufferers are especially prone to irritation from chemicals, so care is needed with the choice of job in an adult with eczema.

What Are The Signs And Symptoms Of Eczema?

The typical appearance is of an inflamed area of skin, which becomes dry and then cracked. There may be small blisters at this time but the main symptom is of intense itching – a fretful scratching child is commonly seen as a result. This itching sets up what is known as the ‘itch-scratch’ cycle where scratching makes the itching worse and aggravates the skin inflammation. This can lead to wet, bleeding patches on the skin as well as infection due to the skin being broken. In chronic eczema, scratching may thicken the skin – this is known as lichenification. Atopic eczema usually affects the face, neck, inside of the elbows and back of the knees, where the skin folds or clothes rub and it is usually the scratching of the skin itself rather than the patch of eczema which causes symptoms.

Will I Have Any Tests Or Investigations?

Most eczema is diagnosed simply from the appearance of the skin alone. In adults, where there may be a question as to whether any work chemicals or other irritants are causing the skin irritation, patch testing is sometimes used. This is where small patches of different possible allergens (anything which may cause a skin reaction such as pollen, nickel or dyes) are stuck on the skin for 48 hours, then removed. Any positive reactions are noted, along with what has caused them, and there is a further examination at 96 hours to detect any further reaction.

What Treatment Might I Need?

The main aim of all treatment is to stop the itch-scratch cycle. Each treatment is tailored to the individual concerned, but there are several general principles;
¤ Small children and babies can wear cotton mittens to prevent them causing more damage to the skin by scratching.
¤ Cotton underclothes and socks should be worn, and wool should be avoided since sharp fibres irritate the skin.
¤ Avoid frequent hot baths or showers. In place of soap, aqueous cream or emulsifying (softening) ointment should be used.
¤ When bathing, bath oils will prevent the skin from drying out.
¤ Steroid-based creams may be used to relieve the itching, such as 1% hydrocortisone. This may be used in addition to antibiotics if the skin is infected, and for more severe eczema, the strength of the steroid cream can be increased. Such strong creams should only be used for limited periods however, since prolonged use of these – for weeks or months on end – can cause the skin to thin and age prematurely.
¤ Creams containing coal-tar extracts are well known and often effective, but smell rather strongly of tar and so are often passed over in favour of other creams.
¤ Antihistamine tablets can help reduce severe itching, and in young children can be used to have a sedative effect to help the child sleep.

What Course Will The Illness Follow?

Most cases of atopic eczema in children clears as childhood progresses, and is absent in adulthood. It is not dangerous in any way, but follows a pattern of flares and remissions, often with superficial infection of the skin caused by scratching triggering attacks. By the age of seven, 50% of children with eczema have grown out of it, and less than 10% still have eczema by the age of thirteen.

Can I Do Anything To Help Myself?

If the eczema can be linked to allergy, then this should be avoided. With babies who suffer from eczema, changing their milk from cow’s to breast milk (or goat’s milk or soya milk if the mother cannot breastfeed or the baby is being weaned) reduces the possibility of allergic eczema. Avoid certain plants such as primulas, ivy or chrysanthemums which can trigger skin reactions. It is always very important to avoid anyone suffering from cold sores since the herpes virus which causes these easily infects patches of eczematous skin. As a general rule, avoid as much stress as possible although this is sometimes very difficult to achieve.

Tell Your Doctor

1. Does it itch?
2. Do you have to scratch it, however hard you try not to?
3. Is it usually on specific parts of the body, such as behind the knees?
4. Do any foods or anything else seem to make it worse?
5. Do you suffer from asthma or hay fever?

Ask Your Doctor

1. Will I have this condition for life?
2. Will I have to change my job?
3. Should I change my diet?
4. How much steroid cream should I be using?
5. Will alternative treatments (such as Chinese herbal treatment) be of any use?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

If you suffer from an allergy, you are definitely not alone. In fact, the number of people suffering from allergies such as hayfever, asthma, eczema and food allergies is increasing.

Your immune system protects you against infections by producing antibodies to kill harmful organisms. When you have an allergy, your immune system overreacts to substances that are not harmful to other people. True allergies are reactions to substances called allergens.

Common allergens are pollen, mould, house dust mites, animal hairs, feathers, nickel, rubber and certain foods. Reducing your exposure to allergens can be an effective way of preventing an allergic reaction; however, this is not always possible. There are many treatments available to help reduce the symptoms of allergies, although at the moment there are no cures.

What Are The Most Common Allergens?

The house dust mite, which feeds on flakes of human skin, is one of the most common allergens, and causes symptoms all year round. Every household has house dust mites, no matter how clean and hygienic it is, but house dust mites are only a problem if you are allergic to them. Pollen, mould and animal hairs are other common allergens. You can even become allergic to a substance you have used or eaten for years.

All of these allergens are mostly breathed in. They cause sneezing, running or blocked noses, watery eyes and wheezing in up to 40 per cent of the population. Food allergies are most commonly caused by eggs, cow’s milk, nuts, fish and shellfish (such as prawns).

Food allergies may cause eczema to develop in babies, but older children and young adults often develop a rash (hives). Hives affect one in five people during their lifetime.

Why Are Allergies Increasing?

There have been a number of possible reasons put forward for the rise in allergies. It could be due to an increase in house dust mites because of the way we build and furnish homes. Most homes now have wall-to-wall carpets, and ventilation is reduced to keep warmth in winter and coolness in summer. This results in an even temperature and high humidity – ideal conditions for house dust mites.

Air pollution may be playing a role in increasing asthma, and processed foods containing artificial colour and preservatives could be responsible for an increase in food allergies. Changes in children’s diets mean they are being exposed to a much wider variety of foods earlier on in life than in the past, possibly stimulating their immune system.

How Do You Find Out What Causes Your Allergies?

Keep a record of when and where your symptoms appear. For example:
• Do you sneeze or wheeze when you clean the house or empty the vacuum cleaner bag?
• Do your symptoms occur when you are in a room with a cat (even if you don’t handle the cat)?
• Do your symptoms occur throughout the year, or only in certain seasons, such as spring and early summer?
• Do your symptoms occur at particular times in the day, for example in the morning and evening?

Noticing your own pattern of symptoms is the most useful way of identifying the cause of your allergies. Allergy testing is not routinely done as the results can be confusing, but in certain cases blood tests and skin pricks can be helpful. A positive reaction identifies an allergen but does not necessarily mean that it is responsible for your symptoms at that time.

Using blood test and skin pricks to test for food allergies is difficult and cutting certain foods from your diet and then reintroducing them is the best way to identify the allergen causing the problem. This needs to be done carefully and under the supervision of a dietitian, particularly for children, who may otherwise lose out on essential nutrients.

Allergies Treatment

First you have to work with your GP to identify the allergens responsible for your symptoms and then try to avoid them. You can do this by doing the following:
• Remove carpets and soft furnishings to reduce house dust mites
• Keep your house well ventilated and free from damp
• Buy special mattresses and pillow coverings that are resistant to house dust mites
• Don’t buy pets (such as cats, mice or guinea pigs) if family members are allergic to animal hairs
• Place soft toys and teddy bears in the freezer every 6 months to kill the house dust mites
• Mow your lawn regularly to prevent the grass from flowering
• Avoid visiting rural areas during high pollen seasons
• Don’t allow people to smoke cigarettes in the house.
• Breastfeeding your baby for as long as possible (preferably 4 to 6 months) can help your child build up an immunity to allergens. Try to avoid exposing your baby to pets and dust during this time.
• Avoid sheepskin underlays as they encourage house dust mites.

It is also important to improve your general health. These measures include having a good diet, getting plenty of exercise, getting enough sleep and not smoking.

Antihistamines

If you have an allergy, you may need to take antihistamines. Rashes are also often well controlled by the newer non-drowsy antihistamines. Antihistamines prevent symptoms (like itching, sneezing, watery eyes, runny noses and rashes) that are caused by the body releasing a substance called histamine during an allergic reaction. The newer antihistamines have very few side-effects. Your doctor will help you find one that does not make you drowsy.

If your symptoms cannot be controlled by avoiding allergens or taking antihistamines, your GP may prescribe a steroid nasal spray. These sprays are anti-inflammatory drugs that will help the symptoms of allergies. Because they are applied to the lining of the nose and lungs, the newer steroid drug is hardly absorbed into the blood stream, so the risk of side-effects is reduced. Many different home remedies have been used for treating allergies, but there is no evidence that they are effective.

What is anaphylaxis?

Anaphylaxis or anaphylactic shock is a sudden, severe reaction to a substance, but it is very rare. The reaction rarely occurs in response to allergens in the air (like pollen) but may be in response to a food, bee sting or a drug. The severe reaction causes swelling of the face and throat, difficulty in breathing and a drop in blood pressure.

You should call for an ambulance unless your GP’s surgery or casualty department is very close. After your first attack you will probably be given an adrenaline injection to carry with you in case it occurs again.

Edited by Dr Carol Blow, MB BS, MRCP, MRCGP, DRCOG.

Free medical advice online published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.