Eczema & Psoriasis: Two pesky skin conditions

The fairly common skin conditions called "eczema" and "psoriasis" can really test their victims.

This page will provide you with important information about them.

The term eczema is often used inappropriately to describe almost any kind of skin rash accompanied by dryness, itching, redness, and bleeding. The photo above shows a classic example of the condition.

Eczema is a form of dermatitis, which is basically an inflammation of the skin. Many types of eczema exist. These include xerotic eczema, contact dermatitis, seborrhoeic dermatitis and atopic eczema.

There are other, less common types, such as discoid, venous, and Duhring's disease, but we will not deal with these here.

However, if you are interested to learn more about them - especially about Duhring's disease which is related to celiac disease, simply use the Contact Me form and I will provide you with additional information.

Eczema may be caused by a variety of things. Lifestyle and dietary habits, a predisposition to allergies, including the side effects of certain medications, and - you guessed it - stress! It is also believed to be a hereditary affliction.

Atopic dermatitis is the most common by far. The body areas most often affected include the face, wrists, elbows, and knees.

For many people, atopic dermatitis becomes chronic. Infants are more likely to develop it. However, they usually outgrow it by the age of two. If the condition continues past this age, chances are it'll become chronic.

The skin condition called psoriasis (see photo) causes skin cells to grow too rapidly. Instead of weeks, the new cells move to the surface in a matter of days. This process results in thick patches of skin which are usually silvery, white, or red. It is not contagious, but it may have a genetic component.

Psoriasis is a skin condition that may be caused by an overactive immune system which causes the inflammation. Flare-ups are common and include: changes in the weather (cold and dry), certain medications (especially those for the treatment of depression and hypertension), infection, and - you guessed it again - stress!

Psoriasis can turn nasty. Because of it, some people will experience swollen, painful joints ("psoriatic arthritis"). It can also affect the toenails and fingernails. (See picture below). Even without treatment, symptoms eventually subside until the next flare-up.

There are many forms of this condition. Plaque psoriasis is the most common, affecting up to 90% of the people suffering from the condition.

Other types include postular, flexural, psoriatic, and erythrodermic psoriasis. Again, we will not cover these varieties, but if you require more information, use the Contact Me form, and I will promptly provide you with additional information.

Science has yet to come up with a cure. Nevertheless, we do have effective weapons to manage - not cure - this skin disorder which can cause considerable physical and psychological stress, especially among young adults.

FDA has warned medical practitioners about the increased risk of skin cancer and non-Hodgkin's lymphoma in patients who use Protopic and Elidel.

These are prescription topical creams, which should NEVER be used in children under the age of 2 years.

The creams will carry the FDA black box warning sign on the package (the black box is used for the most serious health hazards).

Elidel and Protopic should only be used for short-term treatments of eczema, and only when all other treatment options have been exhausted.

Patients with weakened immune systems should NOT use these drugs.

On the topic of skin conditions, let me add just a little something about diaper rash, generally caused by the contact of soiled diapers against the baby's skin.

When my daughter was little (still in diapers, that is!) she did develop diaper rash. Here are a few things which I found effective:

(1) A sitz bath, four times a day (the last one just before going to bed at night). Length: approximately 10 minutes. Use 3 tablespoons of baking soda dissolved in warm water. Pat, not rub skin dry. Leave baby's bottom uncovered for at least 30 minutes, allowing the room air to dry it "naturally".

(2) Do you have some Maalox or Mylanta on hand? Use it on the irritated baby's skin. Maalox and Mylanta are anti-acids. Urine is acidic. Maalox/Mylanta will help nutralize the acidity.

In summary, sitz bath with baking soda. Pat dry. Leave it open to air for at least 30 minutes. Apply Maalox and let it dry before reaching for a clean diaper.

Simple, home-made, effective remedies. My daughter - if she could remember those days - would agree. (She would also be quite upset if she read this!!)

Romancing-the-soap.com was not created to be a watered-down treatise on dermatology. However, its goal is to help you make informed decisions about self-care, including skin care, by providing you with current, factual information. So, in regards to the products above, here is my personal and professional take….

Etarnecept (Enbrel) and alalimumab (Humira) are perhaps the most popular drugs used to combat psoriasis. They are tumor necrosis factor blockers (TNF). Other TNF drugs include Cimzia for Crohn’s disease, and Remicade. A TNF is a cytokine (chemical substance involved in “communications” between body cells) that plays a role in the process of inflammation (there is Alpha and Beta TNF, but we don’t need to get into that!) In essence, a TNF will interact with a tumor cell and cause its death, a process known as “cytolysis”.

Although many patients report significant improvement of psoriasis when using these drugs, these medications do carry serious risks. They have been implicated in conditions like heart failure, lupus-like symptoms, cytopenia (a reduction in the number of blood cells), malignancies, etc.

I consider them relatively new drugs, whose long-term side effects aren‘t really known, although - as you will read in the following excerpt - reports of serious adverse effects are becoming more frequent. These drugs must be taken continuously to help control psoriasis (think of the cost); yet in many cases they do not work.

As previously mentioned, psoriasis cannot be cured, so please be very suspicious of anyone who claims to have found the “miracle cure”. When the miracle happens, I will definitely let you know!

Ok, here’s the abbreviated report:

On June 5, 2008, the U.S. Food and Drug Administration (FDA) issued a communication outlining a more in-depth investigation of the possible association between injectable medications called tumor necrosis factor (TNF) blockers and the development of lymphoma and other cancers in children and young adults. TNF blockers are used to treat patients with autoimmune conditions such as Juvenile Idiopathic Arthritis (JIA) (formerly Juvenile Rheumatoid Arthritis), Crohn’s disease, rheumatoid arthritis, plaque psoriasis and ankylosing spondylitis.

The FDA is currently investigating approximately 30 reports of cancer in children and young adults submitted via the FDA’s Adverse Event Reporting System over a 10-year interval (1998-April 29, 2008). The reports describe cancers occurring in young adults who began taking TNF blockers when they were age 18 or younger. Approximately 50 percent of the cancers were lymphomas (both Hodgkin’s and non-Hodgkin’s). Other reported cancers included leukemia, melanoma and solid organ cancers.

As a result, the FDA has asked the manufacturers of TNF blockers to provide information about all cases of cancer reported in children taking TNF blockers. They have also contacted medical experts to assess the potential association between TNF blockers and cancers, and to determine if there are children and young adults with JIA and Crohn’s disease who may be at particular risk for developing a lymphoma or other cancer. They are also requiring the manufacturer of the newest TNF blocker, Cimzia, to conduct a 10-year study to assess the long-term risks of the product, including lymphoma and other cancers.

While cancers are known to occur in children and young adults, reports of these events are concerning and long-term studies are necessary to provide definitive answers about whether TNF blockers increase the occurrence of cancers. The FDA has been aware of the possible association between the use of TNF blockers and the development of cancer but believes the potential benefits of the products outweigh the potential risks. Currently, the prescribing information for all four TNF products warns about this possible risk.

Source: http://www.fda.gov/cder/drug/early_comm/TNF_blockers.htm