Eczema, Psoriasis & Dermatitis

Introduction
Atopic dermatitis may begin in the first few months of life, with red, weeping, crusted lesions on the face, scalp, nappy area, and extremities. In older children or adults, it may be more localised and chronic. The course is unpredictable. Although the dermatitis often improves by age 3 or 4 yr. exacerbations are common during childhood, adolescence, or adulthood.
Itching is a constant feature; consequent scratching and rubbing lead to an itch-scratch rash-itch cycle. In older children and adults, atopic dermatitis typically appears as erythema and lichenification (skin thickening and scaling) in the elbow crease, and behind the knees and on the eyelids, neck, and wrists. The dermatitis may become generalised. Secondary bacterial infections and regional gland inflammation are common. Frequent use of drugs, whether proprietary or prescribed, exposes the atopic patient to many topical (applied externally) allergens, and contact dermatitis may aggravate and complicate the atopic dermatitis, as may the generally dry skin that is common in these patients. Intolerance to primary irritants is common, and emotional stress, environmental temperature or humidity changes, bacterial skin infections, and wool garments commonly cause exacerbations.

Complications
Patients with long-standing atopic dermatitis may develop cataracts while in their 20s or 30s. Herpes simplex may induce a sometimes-grave febrile illness (eczema herpeticum) in atopic patients. Therefore, the patient with atopic dermatitis should avoid exposure to patients with clinically active herpes simplex.

Diagnosis
Diagnosis is entirely clinical: It is based on the distribution of lesions, their duration, and often a family history of atopic disorders. Because atopic dermatitis is often hard to differentiate from seborrheic dermatitis in infancy or from primary irritant dermatitis at any age, the physician should see the patient several times before making a definitive diagnosis. The physician must be careful not to attribute all subsequent skin problems to an atopic cause.

Etiology
The cause is unknown. Although the relationship to the dermatitis is not clear, these patients have high levels of cyclic AMP phosphodiesterase in their white blood cells. Frequently, numerous inhalants and foods produce wheal-and-flare reactions on scratch or intradermal tests, but these reactions are usually non-specific. Recent studies suggest that certain foods induce erythema (red rashes) and itching in young individuals. Patients with atopic dermatitis usually have high scrum levels of lgE antibodies and peripheral eosinophilia (Increased levels of some specific white blood cells) but the significance of these findings is unknown. Several studies have reported a defect of immune regulation that may be associated with increased lgE antibody responses.


Eczema- General Measures of Treatment
1. Offending agents and complex topical drugs should be avoided if possible. When the causative agent is unknown, inert "barrier" products, like zinc oxide, may protect the skin and have a calming effect.
2. Corticosteroid creams or ointments applied three times daily are very effective drugs. Emollients applied between corticosteroid applications help to hydrate the skin, which is very important. Prolonged, widespread use of corticosteroid creams or ointments should be avoided especially in infants, as adrenal suppression (reversible), and skin thinning and striae may ensue. The damaging effects of topical steroids can be reduced by alternating their continuous use with effective emollients for a week or more. By using this pattern the damaging effects of steroids can be reduced.
3. Oral corticosteroids should be considered only as a last resort. Stunting of growth, osteoporosis, and the other side effects of prolonged systemic corticosteroids are serious hazards when atopic patients take the drug for extended periods, and rebound exacerbations on stopping therapy are frequent.
4. Maintaining the hydration of the skin is vitally important, if the skin is dry emollients should be used liberally. Paraffin based products help to protect the skin against moisture loss, and to maintain the hydration.
5. Bathing should be minimised if the effect seems deleterious; use of soap on the area of dermatitis should be avoided, since soap and water may be drying and irritating. Oils help to lubricate the skin, and emollient products should be applied within 3 min after a bath, before the skin is dried, to enhance their emollient effects.
6. For children, an antihistamine may be a useful sedative at bedtime when itching is worst.
7. Fingernails should be kept short to minimise scratches and secondary infections.
8. It is important to minimise the risk of infections; for secondary infections, which cannot be stopped by other means, an antibiotic may be required. It should be noted that the use of corticosteroids reduces the bodies natural ability to fight infections.
9. If the dermatitis resists home treatment, hospitalisation, with its closer psychological and dermatological attention and the change in environment, is sometimes required, this has great cost implications, and is the last resort.

Wet Wrapping
We have found that in severe cases of eczema and psoriasis, where the skin has broken down to some degree, and there is bleeding that the most effective way to improve the condition quickly is to use a wet wrap. 

Wet wrapping is the application of an appropriate cream onto the affected area, or over the whole body if needed, and then covering up the cream with first a wet bandage and then over this wet bandage a dry bandage. This second bandage is primarily to protect clothing and bedding from the wet bandage.

The overall effect of wet wrapping it to improve the penetration of the cream into the skin, and to provide an environment conducive to rapid healing of the skin. Steroid creams should generally not be used with wet wrapping, as this process will markedly increase the side effects and long term skin damage that steroid creams can cause.

Wraysbury Skin Salve with tea tree oil is very safe when used with wet wrapping. Aloe Vera calms and soothes the skin and tea tree oil not only calms the skin, but also has potent antibacterial, antifungal and antiviral actions, reducing the tendency for the skin to further break down. Moisturising oils penetrate the skin better and so improve the vital moisture balance, which is so important in managing eczema and psoriasis.

For further information on wet wrapping or suitable bandages and creams you can contact the pharmacy directly by email or phone.

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