The pain of constant itching and scratching for those with skin conditions causes extreme discomfort, and as the weather gets drier, these symptoms can worsen. The array of skin ailments—common rashes, acne, allergic reactions, and the like—and the difficulty of their diagnoses can often lead to the wrong treatments. So, who do you turn to for a reliable diagnosis and the best treatment?
We spoke with Risa M. Jampel, MD, a clinical assistant professor of dermatology at the University of Maryland School of Medicine to learn more about these diseases and the best means of treatment. Dr. Jampel is a board-certified dermatologist, specializing in the study of skin conditions, such as eczema and psoriasis.
What are eczema and psoriasis?
Eczema (atopic dermatitis) and psoriasis are both inflammatory diseases of the skin that are red, itchy, and scaly, although they are two different skin diseases.
Who is more likely to develop these skin conditions?
Eczema usually begins in infancy or early childhood, however there is a late-onset form that can affect adults. It is also more common in cities than in rural areas. Psoriasis can develop in patients from infancy to adulthood, however, most patients develop psoriasis before age 40.
Both of these conditions have a genetic component.
What are some of the symptoms?
With both diseases, most patients experience itching which can be intense and interfere significantly with quality of life. Patients often report dry, itchy, and scaly skin. Psoriasis can also be accompanied by painful arthritis.
How common are they?
These conditions are common and influenced by a complex interaction of environment and genetics. Some studies report that psoriasis affects about 2 percent of the general population, although, in the United States, the number is somewhat higher.
Eczema is reported to affect up to 30 percent of the population depending on age and where you live. It’s actually more common in inner cities.
Is there a time of year when skin conditions are more prevalent?
There are no absolute patterns for what makes eczema worse, as it varies from patient to patient. That being said, many patients with atopic dermatitis experience worse symptoms in the winter when the air is drier. Other patients are also affected by hotter temperatures. Scratching—which can be unavoidable due to the intense itching—will make the rash worse. Eczema is associated with asthma and food allergies but treatment of the two does not cure or remedy the skin condition.
Psoriasis can be worsened by scratching, as well as by certain medications, HIV infection, certain bacterial infections, obesity, and use of alcohol or tobacco.
Stress can be an exacerbating factor for both diseases, as they are a complex interaction of environment and genetic factors.
What innovative treatments do you offer for eczema and psoriasis?
The first concern is always to be sure that we have the correct diagnosis. A visit entails a thorough patient history and exam and, if indicated, tests which may include a biopsy, patch tests, or other diagnostic studies. Once we are sure of the diagnosis, we will make treatment recommendations.
At University of Maryland Dermatology, my colleagues and I offer experience with a wide range of extensive topical and systemic therapies, as well as ultraviolet light (UV) therapy—called phototherapy. UV therapy given in a controlled medical setting (do not go to the tanning salon!) can be extremely effective treatments for both conditions in the appropriate patient.
Phototherapy patients see a noticeable improvement within 1-2 months of steady treatment—twice as fast as using biological drugs.
Lots of over-the-counter products are advertised for these conditions. How effective are they and what do consumers need to look out for?
Most of the over-the-counter products are low-potency corticosteroids or plain moisturizers. Keeping the skin well moisturized is helpful but is not an effective sole treatment for these skin diseases. Be careful with botanicals and “natural products,” as many have fragrances and can aggravate the skin.
What’s the biggest misconception about eczema and psoriasis?
Often, patients think there is something they are doing wrong and that they are causing the disease. We want them to understand that this is a skin disease and requires expert evaluation, treatment, and follow-up, as well as a lot of hard work on the part of the patient (and for children, their parents) to treat these diseases.
Risa M. Jampel, MD