Other Skin Conditions

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Psoriasis

Psoriasis is a chronic skin condition that causes red patches with silvery scaling. It tends to affect the scalp, ears, knees and elbows, buttocks, and umbilicus. It may be mild and localized to a small patch in the scalp, or it can be widespread, covering most of the body. The exact cause is unknown, but likely includes genetic factors in addition to a possible trigger such as a strep infection. Patients with psoriasis may have an associated arthritis and are known to be at greater risk to developing cardiovascular disease.

Treatments are based on the severity of the disease, such as the amount of body surface affected, whether there is associated psoriatic arthritis, or whether the disease involves important functional areas. Milder cases are treated with topical steroids and Vitamin D derivatives. More severe cases can be treated with phototherapy, methotrexate and biologic agents (etanercept, adalimumab, ustekinumab, secukinumab), and the novel oral agent apremilast.

Eczema

Some eczema is what is called atopic dermatitis. This is often genetically determined and can be associated with asthma and allergies in the affected person, as well as their family members. The exact cause is unknown, but may involve a gene variation that affects the skin's barrier function and the ability to retain moisture. Skin tends to be dry and more prone to irritation. Bacterial colonization and infections may contribute to the dermatitis. Treatments include emollients to help restore barrier function, topical steroids or immunomodulators such as pimecrolimus to decrease itch and inflammation, and bleach baths and antibiotics to diminish bacterial overgrowth.

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Contact Dermatitis

Some rashes are due to allergy to exposure to chemicals that come into contact with the skin, such as fragrances, preservatives, metals, dyes, and other substances. Even products that are labeled as safe for sensitive skin may include ingredients to which a given individual may be allergic. Allergies often develop over time, and products may change their formulas. Many "natural" products (such as tea tree oil, for example) may be allergenic in certain individuals.

If contact dermatitis is suspected, patch tests can be applied to a standard set of chemicals. This is not the classic prick test as performed by allergists, which tends to assess for trees, pollens, and such. Instead, it screens for agents that may be present in makeups, lotions, and even topical medications. If an allergen is identified and felt to be relevant to the dermatitis, a computerized database will provide a list of topical products that are free of the offending chemical and its related compounds. Successful avoidance of the allergen can clear the dermatitis symptoms and keep them from reappearing.