The skinPart 2

24th June 2013Dr BK Sinha

The Average human body is covered by

1. 5 square feet of skin2. 10 square feet of skin3. 15 square feet of skin4. 20 square feet of skin

What causes itching?

1. Itch bugs2. Itch bodies3. Itch receptors4. Itch aliens

Eczema

• = Dermatitis• From the Greek origin meaning –

To Boil Over

So what does it cause?

• Itch• Dry skin• Red inflamed skin• Sometimes weeping• Sometimes infection

Atopic dermatitis

• Affects children• Face, back of knees, • Front of elbows• Irritable and unhappy children

Dry eczema

• Affects older people• Very dry itchy and red skin • May be all over

Contact Dermatitis

• Can be related to irritation from chemicals, detergents,etc

• May be allergic

Pompholyx

• Vesicular Eczema• ‘Blebs’ on hands and feet

• Clear fluid when burst

Tests?

• None usually needed• Occasionally Allergy testing• Patch tests for contact

dermatitis

Treatment

• Main problem is dryness• Main treatment is –

–MOISTURISE

MOISTURISE

• Creams or ointments as emollients• Bath oils• Shower gel or soap substitutes• Smooth into the skin along the line of hair

growth, rather than rubbing in

MOISTURISE• The greasier the ‘cream’ the better it works,

but the messier it is• Ointments better for dry skin• Use within 3 minutes of bath or shower• Use as often as needed• Lotions not as effective but less messy• Can use lotions daytime and cream or

ointment at night

Additional treatment

• Treat inflammation• Main treatment -

Steroid creams or ointments• Use most effective preparation for shortest

time possible• Perfectly safe as long as some breaks taken• Generally mild for face, moderately strong for

trunk and very strong for palms and soles

How many ‘Finger tips’?

• Both sides of one hand = One fingertip unit• One foot = Two fingertip units• One arm = Three fingertip units• One leg = Six fingertip units• Chest and abdomen = Seven fingertip units• Back and Buttocks = Seven fingertip units

Other Treatments for Eczema

• Anti histamine tablets for itching• Sometimes steroid tablets but only short term• Creams which work on the immune system,

e.g., Tacrolimus to avoid side effects from continuous use of steroid creams

• Occasionally tablets

A case on an itchy foot

• Been itchy for many months• Tried some creams but no better

Ring worm

• Very common• 10-20 %

• Treated with creams

• If widespread, an antibiotic tablet works better

Scabies

• Itchy+++• Especially at night

Treatment of scabies

• Cream all over below neck• All contacts• Wash all bedding at high setting• Rarely tablets

Problems with Sun Exposure

• Sunburn• Long term skin damage and

ageing• Link to some forms of skin cancer

But We need the Sun!

• Lowers blood pressure and that could lower risk of stroke and heart attacks

• May reduce risk of dementia• Main source of Vitamin D• Vitamin D needed for

»Healthy bones»Healthy teeth»May be Anti-Cancer

The Vitamin D story

Extent of the Problem

• 65% don’t get enough vitamin D • In the winter and spring 1 in 6 people

has a severe deficiency• Lack of sun exposure linked to

various cancers, diabetes and MS.

Responsible Sun Exposure

• Short daily periods of sun exposure without sunscreen during April to October

• About 10 to 15 minutes • Less than the time it takes to start going red

or to burn

What else can we do?

• Eat more oily fish such as salmon and mackerel

• Consider daily supplement – containing 10 mcg of Vitamin D

Key Messages

• If you have an itch, it could be anything from eczema to scabies

• The main treatment for eczema is to Moisturise the skin liberally and to use steroid creams sparingly

• Ringworm is common and treated with creams• Scabies is commoner than one would think• We can enjoy the Sun – but Responsibly!