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Red lumps suddenly appear on the skin. They multiply, spill, burn and itch. They are so similar that it is often difficult to determine if they are a symptom of allergies or psoriasis?
Atopic dermatitis (AD) is a severe allergic skin reaction. Psoriasis vulgaris (from Latin psoriasis) is one of the most common dermatological diseases. Both conditions are genetically determined, and the tendency to develop them may (but does not have to) pass from parents to children. Both diseases can manifest themselves at any age. Signs of both are itchy skin lesions similar to those on the body, such as the bend of the knees and elbows. Both diseases cause shame in the “marked” and fear of contagion in outside observers, although both are not contagious! Both are chronic conditions with longer or shorter remissions. Both are incurable and incalculable – you never know when the next throw will happen. In both cases, their causes are unclear, but the factors that cause them and the methods of treatment differ.
Blemishes on the shield
The epidermis – the outermost layer of the skin – is said to be a “living shield” for it. Because he is the first to resist the “blows” of harmful substances with which the skin comes into direct contact or inhaled. Properly functioning epidermis wears out quite quickly and must constantly regenerate in order to fulfill its role. Rebuilding is simple. In the lowest layer of the epidermis, the so-called basal, young cells called keratinocytes are formed. They move gradually through the successive layers of the epidermis: spinous, granular, to the superficial horny. During this journey, they split, deposit keratin (the protein that gives the skin mechanical strength and elasticity), and turn into a stratum corneum. After reaching the stratum corneum, they are dead and fall off – they are exfoliated.
The healthy epidermis renewal cycle usually lasts about 4 weeks. However, in psoriasis patients, the basal layer produces much more keratinocytes, and the process of their keratinization takes only 3–4 days. The first, the so-called psoriatic-type eruption are burning and itchy lumps. They are covered with silvery scales (this is the effect of too quick keratosis), after which blood may appear when scraped. Early lumps measure from a few millimeters to about 2 cm, but they may stick together to form a so-called plaque outbreaks. Depending on the severity of the disease, the color of the papules can vary – from pink to brown-red. Psoriatic lesions most often appear around the elbows, knees, back and head.
Red papules aren’t always a symptom of psoriasis. This is usually the so-called irritation eczema. Its appearance means that some irritant (e.g. a component of a sanitary cleaner) has damaged the natural skin cover and penetrated into its deeper tissues. Everyone has such blemishes, and their number and severity depend on the intensity of the irritant and the length of time it acts on the skin.
The matter becomes more serious if the appearance of pimples in the form of small lumps, blisters (usually in joint bends – e.g. elbows or knees, but also on the face and neck, or all over the body) has been preceded by signs such as flushed (red) spots on skin, its dryness and persistent itching just in places of changes. Such symptoms accompany atopic dermatitis. In this way, the body signals that an agent that it considers an intruder has entered and with which it is fighting. In acute AD conditions, it even happens that the parts of the body affected by inflammation swell, and exudate appears from the eruptions. With chronic atopic dermatitis, the so-called lichenization – that is, impetigo of the skin. It becomes thickened, and the epidermis – similar to psoriasis – begins to peel off intensely. This is why when making a diagnosis without a detailed history and tests, it is difficult to determine whether the skin lesions are a sign of psoriasis or advanced AD.
Where did this sudden change come from?
Atopic dermatitis is often referred to as the “hyper-reactivity” of the skin to sensitizing agents. They can be skin irritants (e.g. soaps, solvents, preservatives, clothes made of wool or plastics, but also rain and wind or our own sweat), inhalation allergens (e.g. dust, cigarette smoke, mold, pollen of grass and trees) , animal hair), microorganisms (e.g. yeasts, dermatophytes), as well as food allergens (most often – egg, milk, nuts, crustaceans and fish, citrus fruits and strawberries). This list shows that allergic eczema on the skin can occur regardless of the route the allergen takes into the body.
Why can some of us eat oranges, and for others this pleasure ends with embarrassing dermatological ailments? The main hypothesis regarding the development of AD is that skin inflammation is caused by various types of immune disorders. For example, when the body overproduces IgE antibodies to fight allergens, it produces just as many different inflammatory proteins; or the inflammatory symptoms are the result of the release of histamine mast cells, which in a healthy body fights infections, and in allergy sufferers causes inflammatory symptoms in various organs, including the skin. Another theory is that atopic dermatitis is influenced by the so-called ectodermal defect – disturbances in the production of ceramides and lipids in the skin make it too dry and easily irritated. But there is also a thesis that atopic dermatitis is a genetic defect of the skin consisting in its excessive tendency to… itch.
Opinions are also divided as to the causes of the sudden rash of psoriasis. Doctors believe that psoriasis is simply inherited, and whether it shows up or not, when it does, and how it develops, depends on non-genetic factors, which are abundant. It is enough to mention that psoriasis can be activated by various infections (e.g. purulent angina, untreated tooth decay, inflammation of the urinary tract, chickenpox, rubella and measles in children, and in adults herpes zoster and infections caused by yeast), internal diseases – e.g. type 2 diabetes or gout, as well as mechanical damage or long-term skin irritation – from pressure on the wrist with a watch strap, through scratches, pricks after vaccinations, to burns (sunburn, boiling water) and surgical scars. Psoriasis may also appear after taking certain medications, e.g. beta-blocking drugs in patients with hypertension, antidepressants, or during hormonal storms – puberty and menopause. More severe forms of psoriasis also appear in people who regularly abuse alcohol, and the exacerbation of skin lesions may also occur after too intensive external treatment.
We find more psoriasis theories in alternative medicine. One of them says that psoriasis is caused by toxins excreted through the skin – the liver, overloaded with a bad diet, cannot keep up with neutralizing them and must find another “outlet”. Another says that psoriasis is a manifestation of immune disorders in the form of excessive stimulation of the epidermis to produce cells. Yet another locates stress, overload with negative emotions as the main factor negatively affecting the immune system. The last thesis is also confirmed by numbers – about 30% of patients claim that their first psoriasis outbreak occurred after prolonged, strong tension caused by e.g. death of a loved one, loss of job, and most patients with psoriasis noticed that they were ashamed of disease, isolation and depression have exacerbated the condition. The disastrous effect of stress on the weakening of the immune system is also confirmed by the fact that it is also listed among the factors initiating the relapses of atopic dermatitis.
Atopic dermatitis – retreats, relapses
Atopic dermatitis appears on its own – as often in the first weeks of a child’s life as it is among adults and the elderly. And the sooner it appears, the worse its course is. Atopic dermatitis is unpredictable – it can start and end in a single eczema, or cause changes throughout the body. Treatment of atopic dermatitis begins with a detailed interview with the patient and specialist tests (skin tests, exposure-provocation tests, blood tests) of the type of allergen (or allergens) and its elimination from the patient’s environment. If the doctor hesitates whether the skin lesions should be considered atopic dermatitis or psoriasis, he asks the patient about the coexistence of other allergic diseases, such as bronchial asthma, seasonal or chronic hay fever or conjunctivitis. However, the lack of contact with an allergic factor may not be enough to recover, because atopic dermatitis is often accompanied by bacterial infections (usually staphylococcus aureus) caused by itching and scratching wounds. In AD, desensitization therapy and non-steroidal drugs are also used, but it is impossible to eliminate AD permanently.
Tedious, long-lasting and with no guarantee of constant improvement is the treatment of equally unpredictable psoriasis. As the causes of the disease are unknown, the therapy is primarily aimed at removing the troublesome, embarrassing symptoms. The first stage is always getting rid of the scales – body ointments and head olives with salicylic acid and warm baths. Then the patient uses ointments with tar, cygnoline or steroids to limit the processes of epidermis multiplication and its abnormal keratosis, as well as a derivative of vitamin D3. Oral medications (from the group of cytostatics and immunosuppressants) are administered with types of psoriasis resistant to other forms of treatment and always under close medical supervision – most of these preparations may, for example, cause congenital abnormalities to the fetus. The most modern and effective therapeutic method of psoriasis are biological drugs (subcutaneous injections once a week or every 2–4 weeks), but this treatment is very expensive (about PLN 20 for six months), and free access to it is limited. Many psoriasis patients benefit from radiation therapy – irradiation with special lamps using different wavelengths of light. Many also praise the beneficial effects of sunbathing on psoriasis lesions.
Common to the treatment of both atopic and psoriatic lesions is the proper care of the skin and epidermis. Washing them daily with non-irritating preparations and intensive moisturizing effectively delay both the potential appearance of the disease and its recurrence.
You can use Konopka ointment for skin care. The preparation contains beeswax, which has an antiseptic and disinfecting effect, and an extract of medical sage leaves with anti-inflammatory properties. Its regular use helps to moisturize the skin and prevents excessive dryness. You can buy Konopka ointment at medonetmarket.pl. It is also a good idea to use a cream designed for the care of atopic and psoriasis skin, eg Atopos cream for atopic dermatitis and psoriasis. It has anti-inflammatory, regenerating and nourishing properties.
Other varieties of psoriasis
Exudative – changes appear only in skin folds (e.g. armpits), they are often wet and ooze. Generalized pustular – one of the most severe varieties of psoriasis, it leads to complications in the work of internal organs, and even death. Skin eruptions are sterile – not caused by bacteria – spots, their appearance is accompanied by fever and poor general condition.
Pustular palms and feet – pimples appear only in these parts of the body. This type of pustular psoriasis returns frequently, but is not life-threatening.
Generalized – a severe form of psoriasis causing profuse dermatitis called erythroderma.
Arthritis – affects the small joints of the hands and feet, joints of the spine and others, sometimes leading to permanent disability. It may be accompanied by extensive plaque lesions scattered throughout the body as well as small eruptions, e.g. on the scalp.
Nail psoriasis – mycosis-like point depressions, longitudinal or transverse furrows, yellow spots showing through the nail.
See also: Skin reveals hidden problems
Types of atopic dermatitis
Eczema type – occurs from early childhood to the end of the second year of life. Characteristic for it are irregular erythematous-exudative foci with small exudative lumps and vesicles that tend to enlarge and crack, and the oozing secretion dries up into yellow or brown-red crusts. They appear most often on the cheeks, forehead, hairy scalp of a child, distal parts of the limbs and torso, less often in the bends of the knee, elbow or wrist joints.
Type of focal or generalized impetigo – appears in the period between 3 and 11 years of age. Patients complain of severe drying of the skin, intense peeling of the epidermis and nagging itching. The outbreaks of lichenization occur most often on the skin in the flexion surfaces of the joints, but sometimes also on more extensive areas of the skin.
Scabies – occurs in adults. The hallmarks are dry skin, itching, diffuse lumps and lichen outbreaks.
The vicious cycle of itching, or how to stop scratching?
The skin lesions arising from atopic dermatitis and psoriasis are often very itchy. Itching causes scratching, which results in the so-called harmless. quirks (damage to the epidermis that heal completely and without scars) and more severe irritations and infections. The latter provoke further itchy lesions. To begin effective treatment, somewhere there is a need to break this itchy vicious cycle. The ban on scratching is ineffective for both children and adults. Some people may know this from their own experience – the longer they stop scratching, the more they scratch themselves when they can’t stand the itch anymore. Therefore, specialists recommend to “break” the wheel when irritation develops (intensive lubrication and moisturizing of the skin) and infections (the use of antibiotics and steroids).
Text: Magdalena Gajda
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