Understanding the basics of dermatology
Our skin is the largest organ in our body and makes up 15 per cent of our body’s weight. The top layer or epidermis – which itself comprises several different layers – acts as a barrier preventing irritants and allergens penetrating the body and contributes to the immune function.
At the same time, our skin prevents excessive loss of water and maintains a stable equilibrium inside the body.
The inner layer or dermis is thicker than the epidermis (outer layer) and it’s primary role is to sustain the epidermis as well as cushioning deeper parts of the body from injury and playing a vital role in wound healing.
People with skin problems including eczema, dermatitis, and other inflammatory conditions as well as wounds, including those from surgical procedures, unfortunately have an impaired skin barrier.
And an impaired skin barrier disturbs the ability of the skin to prevent water loss and maintain internal equilibrium – that’s the skin balance.
Skin conditions arising out of a weakened skin barrier like dry skin, eczema and psoriasis or skin wounds, need rapid and effective treatment to help restore the skin barrier to its proper function and reduce pain, inflammation, itching, irritation, infection and skin rashes that can significantly impair a person’s quality of life.
Treatment of skin conditions requires a great deal of care – both in the choice of preparation and its careful use.
For those of us who suffer from skin troubles, understanding the skin condition and the general condition management is really important for our health and wellness. Successful management of skin conditions requires a partnership between the sufferer and the healthcare professional to ensure that skin troubles are managed.
Dermatitis is a general term that describes a skin inflammation. It is a common condition and occurs in many forms. Symptoms include red, itchy, dry skin. The skin may become swollen with a rash over the swelling.
The skin barrier function is impaired if you suffer from dermatitis, causing dryness and facilitating penetration of irritants, allergens, and infections.
As a result, managing dermatitis will vary and it also depends on the key cause and symptoms. If the skin is dry, moisturisers (also called emollients) are used for basic management.
Topical, medical skin treatments are often prescribed by a doctor or healthcare professional, depending on the severity of the condition. The type of topical skin medicine will also depend on the condition, with ointments and other format choices such as medical skin tapes indicated for dry inflamed skin and creams for where the dermatitis is wet, blistering or weeping. Always seek help from a healthcare professional on skin care conditions where the skin barrier has been weakened and you have a skin trouble like dermatitis.
Eczema is sometimes called ‘atopic eczema’ or ‘atopic dermatitis’.
Eczema is a common, chronic, inflammatory skin condition. The main symptom is a very itchy rash which can really affect the quality of life causing lack of ability to concentrate and get a good night’s sleep.
Itchiness is sometimes accompanied by blisters which may break and leak liquid. Over time, the skin can become drier, rougher and develop cracks.
In people with eczema, the top layer of the epidermis (the corneal layer) is damaged by the inflammatory response occurring in the skin. Another possible cause of eczema is when our genes do not work as they should do and this affects the production of the protein, called: filaggrin. We need this smart protein to make the corneal layer in our bodies. A lack of the filaggrin protein causes the epidermis to lose water making it easier for allergens, infections, and irritants to penetrate the skin.
Eczema often affects children but can occur in people of all ages. It is often hereditary. Sometimes eczema gets better with time and may disappear altogether. It often comes and goes in bouts of acute flare-ups.
The National Institute for Health and Care Excellence (NICE)¹ recommends a stepped approach for the management of eczema, tailoring treatment to the severity of the eczema.
Moisturising products (emollients): These are the mainstay of management for eczema. They must be applied generously and frequently. This may help to:
Eczema flare-ups are usually treated with medical creams and ointments prescribed by a doctor or healthcare professional because they can help relieve the itching and inflammation.
PLEASE NOTE: The benefits of a topical skin medicine should always be discussed with the sufferer or in the case of a child, the parents or carers, emphasising that the benefits outweigh any reactions when medical skin treatments are applied appropriately.
Always seek help from a healthcare professional on skin care conditions like eczema.
References
1. National Institute for Health and Care Institute, Atopic eczema in under 12s: diagnosis and management, Published date: 12 December 2007, last accessed 23 April 2021 via: https://www.nice.org.uk/guidance/CG57/chapter/1-Guidance#treatment.
Epithelial tissue forms the covering of all body surfaces, lines body cavities and hollow organs, and is the major tissue in glands.
A wound is a breakdown of the protective function of the skin barrier, the loss of continuity of the epithelial tissue in the skin, with or without loss of underlying tissue and structures such as muscle, bone, and nerves.
A wound follows an injury to the skin, the underlying tissues and/or body organs. It can be caused by anything, from surgery, a cut, a blow, chemicals, extreme heat or cold or disease such as leg or foot ulcers.
There are three phases in wound healing.
Sometimes, the granular tissue grows above the surface of the wound. This is called ‘Proud Flesh’, ‘overgranulation’ or ‘hypergranulation’.
Overgranulation is an excess of granulation tissue, which is more than is required to heal the wound. Such tissue increases the risk of infection and will slow or prevent the migration of epithelial tissue across the top of the wound to allow wound healing.
Always seek help from a healthcare professional on skin care conditions where the skin barrier has been weakened.
Athlete’s foot, also known as tinea pedis, is a fungal infection that affects the upper layer of the skin of the foot, especially when it is warm, moist, and irritated.
The fungus that causes athlete’s foot is called Trichophyton and is commonly found on floors and in clothing.
Trichophyton requires a warm and moist environment to infect the foot, for example, the inside of a shoe.
Athlete’s foot most commonly develops between the toes. It usually causes burning, stinging, redness, and itching. It also causes flaking of the skin in some people. If left untreated it can spread from toe to toe and also to the hands. And the bad news is, anyone can get athlete’s foot.
Athlete’s foot is contagious but can usually be treated with topical antifungal medication (e.g. creams and powders). If the skin becomes very red and sore, a topical treatment containing a medicine, called hydrocortisone may be required. Some antifungal and hydrocortisone preparations are available over the counter. However, if you have a weakened immune system (e.g. you are taking chemotherapy or steroids or are diabetic), you should see a doctor as soon as athlete’s foot develops.
Good foot hygiene is essential. Wash your feet often with clean soapy water and thoroughly dry your feet and in between the toes after washing. Wear fresh cotton socks and change your socks daily. Change shoes often. Always wear pool sandals in swimming pools and gyms.
Ringworm is a common fungal infection of the skin. It is not caused by worms. The main symptom is a red or slivery rash, which may be itchy, swollen, red and dry.
Ringworm can appear anywhere on the body including the scalp (tinea capitis) and groin (jock itch). It is treated with a topical antifungal medication (e.g. cream). If the skin becomes very red and itchy a topical preparation containing hydrocortisone could potentially be useful in treatment. Good hygiene is important. Wash bedding and nightwear frequently.
Topical steroids should be used for a limited time, and only for the inflammation. They have no effect on the infection and used alone can make it worse, so is usually an adjunct to a topical anti-fungal preparation.
Nappy rash is a common irritant dermatitis which affects and is confined to the nappy area. Most babies have it at some point.
Nappies cause the skin to become waterlogged and hold irritants from the faeces and urine causing inflammation.
Soaps, detergents and wearing plastic pants can make the skin more susceptible to nappy rash too. Babies are really the only sufferers of nappy rash but young children wearing plastic pants or coming into contact with other skin irritants (that they may be bathed in), can also cause nappy rash.
Nappy rash is often associated with a fungal infection. Emollient (moisturising) preparations can be used. A preparation containing zinc (e.g. zinc and castor oil) can potentially be soothing. Your pharmacist or healthcare professional will advise you. However, it is important to note that preparations such as emollients will not treat the fungal element of a nappy rash.
Frequent changes of nappies, good nappy changing routine and hygiene are essential. Leaving the baby without nappies for periods of time is also helpful. Where there is secondary fungal and/or bacterial infection, a topical preparation containing an anti-fungal and an antibacterial/antiseptic may be effective.
Remember to break the cycle: Itchy skin can often lead to scratching. Scratching increases inflammation and stimulates nerve fibres, leading to more itching and more scratching. Scratching can cause the skin barrier to break down. This cycle can be broken by use of a topical anti-inflammatory medication to reduce the inflammation in the skin, ease the itching and prevent scratching.
