The skin is something we all have, but we often don’t pay much attention to it until something goes wrong.
Then suddenly a small patch of itching becomes the most annoying thing in the world.
You scratch it.
It gets worse.
You put something on it.
It burns.
You scratch again.
And before long, you’re standing in the pharmacy asking:
“What can I put on this?”
The difficulty is that not every itchy, red or dry patch is eczema.
The skin can develop dozens of different conditions, and getting the diagnosis right is half the battle.
Eczema — probably the one I hear about most
Eczema causes dry, itchy, inflamed skin.
It can affect children and adults and can occur anywhere on the body.
Atopic eczema is associated with an overactive immune response and a damaged skin barrier.
In simple terms, the skin isn’t doing as good a job of keeping moisture in and irritants out.
That makes it easier for the skin to become dry, irritated and inflamed. (nhs.uk)
And then comes the scratching.
Itch → scratch → damaged skin → more inflammation → more itch.
Breaking that cycle is a major part of treatment. (nhs.uk)
Moisturiser is not just cosmetic
This is something I regularly try to explain.
For someone with eczema, moisturiser isn’t simply something you use when your skin looks dry.
It is part of the treatment.
Regular emollients help restore the skin barrier and reduce water loss.
They need to be used generously and frequently, even when the skin looks better. (nhs.uk)
There are creams, ointments, lotions and gels.
Generally, ointments are greasier and can be excellent for very dry skin, while lighter creams may be easier to use during the day.
The best moisturiser is often the one the person will actually use consistently. (nhs.uk)
Then there are steroid creams
People sometimes hear the word “steroid” and immediately become frightened.
Used appropriately, topical corticosteroids are highly effective treatments for eczema and other inflammatory skin conditions.
They reduce inflammation and calm the flare.
The important words are used appropriately.
Different steroids have different strengths.
A mild steroid may be suitable for one area of the body, while a stronger preparation may be needed elsewhere or for a severe flare.
Using a potent steroid unnecessarily, particularly on thin skin such as the face or around the eyes, can cause problems including skin thinning.
So don’t assume that stronger automatically means better. (Nice)
Psoriasis is not eczema
This is another common mix-up.
Psoriasis is an inflammatory condition where skin cells are produced much faster than normal.
It often produces well-defined, thickened patches covered with silvery scales.
Common areas include the elbows, knees and scalp, although it can occur anywhere.
It isn’t contagious.
You cannot catch psoriasis from somebody else.
And it isn’t caused by poor hygiene.
Treatment depends on the severity and location and may include topical steroids, vitamin D-related preparations, other topical treatments, phototherapy or systemic medicines for more severe disease.
Modern treatments, including biologic medicines, can be remarkably effective for people with significant psoriasis. (nhs.uk)
Fungal infections are another story
A fungal infection can look like eczema, which is why treating every itchy rash with steroid cream can sometimes make matters worse.
Athlete’s foot is a familiar example.
There may be itching, scaling, cracking and soreness between the toes.
Fungal infections can also affect the groin, body and nails.
Antifungal medicines such as terbinafine or clotrimazole may be used depending on the infection. (nhs.uk)
But if you’re not sure what you’re treating, don’t keep applying different creams and hoping for the best.
Contact dermatitis
Sometimes the problem is simply that something has irritated or sensitised the skin.
Soaps.
Detergents.
Cosmetics.
Hair products.
Perfumes.
Cleaning products.
Metals such as nickel.
This can cause redness, itching, burning and sometimes blistering.
The most important treatment is often identifying and avoiding the trigger.
A cream can calm the inflammation, but if you continue exposing your skin to the substance causing the problem, it will keep coming back. (nhs.uk)
Acne isn’t just a teenage problem
Another misconception is that acne should disappear when you leave school.
It doesn’t always.
Adults can develop acne too, particularly women.
Acne develops when hair follicles become blocked and inflamed.
Hormones, genetics, oil production and bacteria all play a role.
Treatment can include topical benzoyl peroxide, retinoids, azelaic acid and, where appropriate, prescription treatments. (nhs.uk)
And please don’t squeeze everything you see.
It may feel satisfying for five seconds.
The scar can last for years.
Picking and squeezing spots can increase the risk of permanent scarring. (nhs.uk)
When should you see someone?
This is important because not every skin condition belongs in the self-care category.
Get medical advice if a rash is:
Rapidly spreading.
Very painful.
Blistering extensively.
Associated with fever or feeling seriously unwell.
Producing pus or signs of infection.
Not responding to appropriate treatment.
Or simply not looking like anything you’ve had before.
And any new or changing mole, particularly one that changes in size, shape or colour, bleeds or doesn’t heal, deserves proper assessment. (nhs.uk)
What about children?
Children’s skin is particularly sensitive.
Eczema is common in childhood and often improves as children get older, but some continue to have symptoms into adulthood.
Parents sometimes worry about using steroid creams on their children.
That concern is understandable.
But appropriately selected topical steroids, used correctly and for the recommended duration, can be an important part of treating childhood eczema.
Untreated severe eczema can itself cause considerable problems — broken skin, infection, poor sleep and a miserable child.
The answer isn’t to avoid steroids at all costs.
It is to use the right treatment properly. (Nice)
Skin health isn’t just about creams
Your skin is an organ.
It responds to what is happening throughout the body.
Smoking affects skin health.
Excessive sun exposure causes premature ageing and increases skin cancer risk.
Poor nutrition can contribute to some skin and hair problems.
Stress can worsen certain inflammatory conditions.
And scratching can turn a relatively minor problem into a significant one. (nhs.uk)
Good skin care therefore isn’t simply about finding the most expensive moisturiser on the shelf.
My view as a pharmacist
One of the biggest mistakes I see is people treating a skin condition for weeks without ever asking what it actually is.
They buy a cream.
It doesn’t work.
They buy another.
Still no improvement.
Then something stronger.
By the time they seek advice, the original problem may be much harder to recognise.
My advice is simple:
If you don’t know what you’re treating, don’t keep throwing creams at it.
Eczema, psoriasis, fungal infections, contact dermatitis and bacterial infections can look surprisingly similar to an untrained eye.
The right diagnosis leads to the right treatment.
And remember that the skin is not just something covering the rest of you.
It protects you, regulates temperature, prevents water loss and provides a barrier against the outside world. (DBTH Hospitals)
So when your skin starts complaining, it’s worth listening.
Sometimes it needs a little moisturiser.
Sometimes it needs a medicine.
And sometimes it needs a healthcare professional to take a proper look.
Until next time take care of yourself.
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