Dr Kevin McCarroll
Medical Matters
Skin is the largest organ in the human body and its visible appearance often reflects on our health and vitality. If eyes are the window to our souls, so too skin can mirror something deeper about our general health.
We subject our skin to sun, rain, wind, deodorants and perfumes and probably take for granted just how important it is until problems arise. But skin conditions are common and account for about 15% of all consultations with GPs. Furthermore, they can be a source of great social embarassment, anxiety and low self esteem.
The most common skin condition in those aged between 30-60 in Ireland is rosacea otherwise called the ‘Curse of the Celts’. It has a greater incidence in those with fair skin, blue eyes and of Celtic ancestry and is characterised by facial redness, especially around the cheeks and nose and often raised bumps and pimples.
Sensitive
Visible blood vessels may also be present as well as flushing and the skin tends to be sensitive and may feel as if it stings or burns. The eyes are not infrequently involved where there may be irritation, burning and a dry gritty sensation.
Signs are sometimes erroneously attributed to alcohol intake though while not causing the condition it can lead to exacerbations as can sun exposure, hot drinks and spicy food, all of which can increase blood flow to the skin.
While the cause is not clear, a considerable amount of research is being undertaken in rosacea implicating the immune system and skin microflora. In particular, microscopic mites called Demodex which are ubiquitous in normal adults (especially around hair follicles and the skin’s oil glands) are significantly more prevalent in rosacea.
Regular use of SPF 30 cream to reduce UVB skin exposure and minimising hot or spicy foods, alcohol, hot baths and showers can reduce facial flushing. Antibiotic gels and tablets can help by reducing inflammation.
A new cream which actually kills the mite is also available and laser therapy can also be used as a longer lasting treatment of skin redness. Overall, rosacea tends to remit and relapse over periods of months to years though usually burns out in older age.
Eczema is one of the commonest skin problems affecting about 20% of children (where in 80% of cases it first presents). It can also persist into adulthood where it has prevalence of about 10%.
If both parents have eczema, there is an approximate 80% chance that children will also have it and it’s more prevalent in those with asthma or hayfever.
Eczema gives rise to areas of red, dry skin that are often intensely itchy, leading to scratching which can make it worse. There are lots of irritants and allergens that can trigger it including soap, shampoos, detergents, fragrances and house dust mites but often none can be identified.
Soaps and shower gels can dry out the skin by removing natural oils so using moisturisers will help to soothe and rehydrate it and optimise its barrier role against irritants. Clothes that increase skin temperature (especially wools) will aggravate eczema. Using soft cotton materials and anti-dust mite bed covers may help. For flare ups, topical steroid creams work well.
Psoriasis affects about 70,000 people in Ireland with about 15% having a severe form of the disease. It is usually a chronic condition with remissions and flare ups and occurs when the immune system attacks the skin.
This leads to inflammatory, itchy, red patches with a silvery scale. It often affects the elbows, knees, face and scalp or behind the ears which may be the only area of involvement. There are many potential triggers including emotional stress, several medications, cold weather, smoking and alcohol.
Its important to keep the skin well moisturised with non-soap substitutes and avoid scrubbing or using very hot water when washing.
Skin creams that contain cold tar and calcitriol (a vitamin D analogue) are used in mild cases. Phototherapy with special UV lamps under specialist supervision can be used for more moderately severe cases and when topical creams fail. Steroid creams are used for acute flare ups and in difficult cases it will be treated with medications that suppress the immune system.
Seborrheic dermatitis is a type of eczema that often occurs in the scalp giving rise to scales and dandruff but also affects oily areas of the body such as in the face (especially the nose), chest and back. It can occur at any age and gives rise to red areas that may feel itchy and burn and can be exacerabated by cold, soaps and stress.
Topical creams as well as antifungal shampoo for scalp involvement work well.
In general, for many skin conditions, ensuring good daily skin care with moisturisers is important as well as identifying and avoiding potential triggers. If you have any ongoing skin complaints, make sure to get them checked out so you can get the right treatment.
Dr Kevin McCarroll is a Consultant Physician in Geriatric Medicine, St James’s Hospital, Dublin.