Eczema

The term eczema derived from the Greek word for boiling which reflects that the skin can become so acutely inflamed that fluid weeps out or vesicles appear. It accounts to a large proportion of skin diseases. It is estimated that 10% of the people have some form of eczema at one time and up to 40% of the population will have an episode of eczema during their lifetime.

The common eczema is called Atopic Eczema. It is common in childhood. The exact cause is not well understood. Infections seem to be a triggering factor. Strong detergents, chemicals, even woolen clothing can exacerbate eczema. Teething is another factor in children. Severe anxiety and stress appears to exacerbate. Cat and dog fur certainly makes eczema worse. Food allergies may play a role. Dairy products may play a role in some infants.

The commonest presentation is of itchy red scaly patches especially in front of elbows, ankles, behind the knee and around the neck.In infants it often starts in the face. Very severe lesions may weep or be moist and can show as watery bubbles. Repeated scratching will thicken the skin. It may present as elevated patches or follicles.

Involvement of the nails may produce pitting abd ridging of the nails. The palms may show prominent skin creases. The broken skin often gets infected with bacteria. They appear as crusted lesions. Eye can get affected and present as a red eye and irritation. Retarded growth may be seen in children with the chronic disease.

The majority of children with early onset eczema will spontaneously improve and clear before the teeanage years. A few will get a recurrence as adults. However, if the onset is late in childhood or in adulthood the diseases follows a more chronic remitting/relapsing course.

Management includes avoiding of known irritants especially soaps or fury animals, wearing cotton clothes, and not getting too hot. Manipulating the diet (Example avoiding dairy products) is rarely beneficial except in a few children especially under 12 months of age. Any change in diet should be made under supervision especially with growing children who may need supplements like calcium. Local applications are sufficient to control eczema in most people. Medical guidance about detailed management should be carefully followed.

Psoriasis

It is a common disorder affecting 2% of the population. It is characterized by well demarcated red scaly plaques. The skin thickens about ten times the normal rate. It affects both males and females equally. Infections with streptococcal bacteria, drugs, example lithium, ultraviolet light, alcohol abuse, and possibly stress may be trigger factors to cause psoriasis.

The commonest variety is characterized by pinkish red scaly plaques with silver scales seen especially on the knees and elbows lower back, ears and the scalp. In older age the plaques are common in the groin, natal deft, under the breasts. A common variety seen in children is 'rain drop like psoriasis'. They are small oval or circular lesions appearing over the trunk. Nails can get affected in 50% of individuals where there will be pitting or separation of the nail plate or yelliwish brown pigmentation. 5 to 10 % individuals develop arthritis.

Urticaria/Angiooedima (hives, nettle rash)

This is a common skin condition characterized by development of itchy weals or swellings in the skin due to leaky skin blood vessels. These swellings are due to the action of chemical mediators including histamine which makes the skin blood vessels to leak fluid out into the skin. These conditions are viral or parasitic infections, drug reactions (Example Penicillins, NSAIDS), food allergy, example strawberries, food colourings, sea food, insect bites.

Urticaria produces skin swellings or weals developing over a few minutes. They can occur anywhere in the skin and last between minutes or hours before resolving spontaneously. They are extremely itchy and show no surface changes or scaling. They are normally red in colour but when very acutely swollen may be flesh coloured. It is treated with oral non sedating anti histamines.

Angio oedima affects the tissue deeper to the skin especially around the eyes, lips, and the hands but is rarely itchy this can be very alarming to the affected person. It can be dangerous if the mucus areas such as the mouth, breathing passage are involved but fortunately is very rare. This needs urgent treatment with adrenalin injection.

Acne Vulgaris (pimples)

It is a very common facial rash occuring in over 85% adolescents and infrequently continuing into early mid adult life. Occasionally it can cause psychological disturbance and depression, even suicide. The cause is multifactorial but follicular proliferation, blockage of sebaceous units with surrounding inflammation, increased sebum production are critical factors as is infection with a bacteria.

Acne presents in areas rich in sebaceous glands such as face, back and front of central chest. The three cardinal features are:
1. Open comedones (black heads)or closed comedones (whiteheads).
2.Inflammatory small swellings (papules).
3. Pustules small pus containing swellings.

The skin may be very greasy. Rupture of inflamed lesions lead to deep seated inflammation of the skin and cystic lesions which are more likely to cause facial scarring. A premenstrual exacerbation of acne is sometimes noticed. There is a tendency for spontaneous improvement over a number of years but can persist unabated into adult life.

Treatment is aimed at reduction of the production of sebum, decreasing infection, normalizing the inner thickening of the ducts, and decreasing inflammation. Regular washing with acne soap is helpful. Normal soaps are best avoided. Picking should be discouraged. There are local applications available. Low dose antibiotic for 3 to 4 months is often given. Retinoid drugs are available.

Blushing

Blushing is characterized by facial flushing in response to emotional stimuli and would be regarded as normal physiological response. In some individuals it is very frequent and can be a debilitating disorder interfering with work and social interaction. The cause may be psychological. Non emotional causes of flushing should be excluded example Post menopausal, drugs, alcohol, and diet. Treatment include cognitive behavioral theraphy, cosmetic camauflagand some drugs.

Rashes in new born babies

Strawberry naevus. Affects 1% of babies. Present at or shortly after birth, present as a single red lumpy nodule that grows rapidly for the first few months. Multiple number may be present. They will spontaneously resolve with good cosmesis but may take up to 7 years for complete resolution. Reassurance of parents is needed.

Milia

'Milk Spots'. Are small tiny cysts of pinhead size commonly found on the face of babies. They resolve spontaneously.

Mongolian Blue Spot

This appears in infants as deep blue-grey bruise like areas usually over lower back. It is very common in oriental children. It usually disappears by 7 years.

Nappy Rash

This is an infant eczema caused by occlusion of faecis and urine against the skin. It is almost universal in babies. The folds are spared. This is related to the ammonia in the urine. The last wash of the napkins with a tablespoon of vinegar added to the water is helpful to neutralize the ammonia.