Q: Some time ago you answered a man who thought he had eczema and he was having a difficult time controlling the breakouts. I had a similar problem and went to several dermatologists. They all said the same thing – keep moisturizing. I finally went to a physician who identified my problem as psoriasis. I now use Halopetasol Propionate to control the cracking and it has been working so far. I hope this reduces my outbreaks.
A: It’s easy to confuse eczema with psoriasis but they are two entirely different conditions since in their early stages, they look quite similar. Eczema (atopic dermatitis) is defined as a condition that makes skin red and itchy. It commonly begins in childhood but can affect anyone of any age. It is generally long-lasting, has stages when it exacerbates and periods when it subsides. Signs and symptoms may include the severe itch mentioned herein that increases at night, cracked/dry/scaling skin, red to brownish gray patches that frequently appear on the hands/wrists/neck/eyelids/feet/ankles and the insides of the bend of the elbows, and more.
The precise cause of eczema is unknown, yet several articles have discussed the possible role of staph playing a role. What is known is that healthy skin retains moisture, protects us from bacteria, allergens and irritants. Many individuals with eczema have a staph infection on their skin that multiplies rapidly when the skin barrier is damaged and fluid is present on the skin. What is also known is that eczema is related to allergies; thus, eliminating environmental factors may be helpful. Factors that increase a person’s risk of developing eczema include being African-American, having a diagnosis of ADHD, a family history of the disorder, and more.
On to psoriasis, a condition that causes skin cells to build up quickly on the skin’s surface. These extra cells form scales that are silver in color, itch, and are dry red patches that cause pain. Joints may be stiff and finger and toenails may become pitted, ridged and thickened. Psoriasis is chronic and, as with eczema, there are instances when the condition will flare up and instances when symptoms will diminish. Treatment is geared toward taking steps to slow the over-production of skin cells with over-the-counter cortisone creams and controlled exposure to natural sunlight.
While the cause of psoriasis to develop isn’t fully understood, it is believed related to a dysfunction of an immune system issue. One type of white blood cell is referred to as a T lymphocyte or T cell. In a healthy individual, T cells migrate through the body in an effort to fight viruses and bacteria; however, the individual with psoriasis has T cells that inadvertently attack healthy skin cells. Further, overactive T cells cause dilation of blood vessels in the skin around the areas of plaque and an increase in other white blood cells that enter the outer layer of skin. Both changes cause an increased production of healthy skin cells, more T cells and other white blood cells, creating an ongoing cycle of new skin cells that move to the skin in days rather than in weeks. When dead skin and white blood cells are unable to slough off in a timely manner, thick and scaly patches build up on the surface of the skin and continue unless treatment is provided. There are a number of factors that trigger psoriasis. They include stress, viral and/or bacterial infections, a family history of the disorder, specific medications, the habits of smoking and drinking to excess and more.
Treatment options may include topical corticosteroids, doses of ultraviolet light, synthetic forms of vitamin D that slow the growth of skin cell production, topical retinoids such as those used to treat acne, coal tar, OTC or prescription salicylic acid, Cyclosporin, moisturizers, and a great deal more.
