Eczema & Psoriasis

What are the telltale signs that my rash is eczema?

Eczema is a red rash, usually itchy, scaly and dry, but can also be weepy and be swollen in the acute stages. If the condition is not controlled properly in the early stages, it can lead to thickening of the skin (called lichenification), scratch marks, and pigmentary changes to the skin (lightening or darkening of surrounding skin). Dr Nicole realises how important it is to gain rapid control of eczema in the early stages to prevent the development of any late consequences.

What are the common triggering factors for psoriasis?

There are common trigger factors for psoriasis, and knowing your triggers can help to prevent flare-ups, and bring your psoriasis under control.

Here are some of the common triggers for psoriasis:

Stress, injury to the skin, medications (eg. lithium, beta-blockers such as propranolol, bisoprolol, anti-malarials such as hydroxychloroquine), infections, alcohol and smoking.

Is eczema contagious?

Eczema is not contagious as it is not a skin infection in itself. However, it can be secondarily infected with bacteria or viruses. Some of the key telltales signs for infected eczema are yellow honey-combed crusts on the surface, eczema not responding to usual treatments, and pain associated with the rash. Dr Nicole will perform a thorough assessment and recommend the appropriate treatments for you.

What are the effective treatments out there to control psoriasis?

There are a wide range of effective treatment options available to bring psoriasis under control. They range from prescription creams, phototherapy (UV light therapy), oral medications to injection treatments (biologics).

Dr Nicole realises how important it is to gain rapid, effective control of your psoriasis. Various treatment options can be offered and will be discussed after a thorough skin assessment.

Are all eczema the same?

There are many subtypes of eczema (dermatitis). Here are some of the common subtypes:

• Atopic eczema: commonly present in children with red, scaly or weepy rash on the face and/or creases on the arms and legs
• Irritant contact dermatitis: commonly present with red, scaly rash in the finger webs due to frequent hand-washing or use of harsh chemicals on the skin
• Allergic contact dermatitis: the skin develops an allergic reaction after being in contact with a substance; the common allergens are nickel, perfume, rubber, hair dye and preservatives.
• Seborrheic dermatitis: red, scaly rash commonly on the scalp, eyebrows, creases by the nose, or central chest due to substances produced by malassezia yeasts
• Discoid eczema: round, coin-shaped scaly, red and intensely itchy rash which can affect any parts of the arms, legs or body; this rash sometimes can look like psoriasis
• Stasis/Venous eczema: dry, scaly and red rash on both lower legs, usually with prominent leg veins

Dr Nicole will establish the subtype of eczema for you right from the start, before initiation of the appropriate treatments.

How do I know if my eczema is worsened by food?

In general, it is rare (less than 1 in 10) for eczema to be made worse by food. The most common foods which can trigger eczema symptoms are: cow’s milk, eggs, soya, wheat, fish and nuts.

Immediate food allergy happens within 2 hours of eating the trigger food. Common symptoms are redness, swelling and irritation around the mouth, abdominal pain, vomiting and diarrhoea.

Delayed food allergy happens within 6-24 hours after eating the trigger food. Common symptoms are more intense itching and flare up of eczema. Sometimes, there may also be stomach pains, vomiting and diarrhoea.

A useful way to find out whether certain foods worsen your eczema is to keep a food diary. Record your eczema symptoms, your general well-being and all food and drinks taken daily for a period to pin point any specific trigger.

What are the common triggering factors for eczema?

The key in managing eczema is to know the triggers for your eczema. Knowing your triggers can help to prevent flare-ups, and bring your eczema under control.

Here are some of the common eczema triggers:

Dry skin, stress, irritants (eg. soaps, detergents, bubble baths and body wash), emotional stress, cold or hot weather, allergens (eg. pollen, house dust mites, pet dander, mold), hormonal changes and skin infections.

What are the effective treatments out there to control eczema?

There are currently a wide range of treatments available for eczema, ranging from over-the-counter remedies, prescription creams, phototherapy (UV light treatment), to oral medications.

The key management strategy using prescription creams is to have a tailored treatment regime specifying how frequent, how much and how long these treatments should be used for, how to manage acute flare ups as well as preventing further flare ups.

In the near future, there will be injection treatments (biologics) available to treat severe eczema.

What is an allergy test?

An allergy test can establish whether you are allergic to a substance. There are four main forms of allergy testing:

1. Food challenge test: Essentially, it means that you are given the suspected food allergen in small amounts and gradually increasing the dose in a clinical environment. If there is a suspicion of anaphylaxis with a particular food allergen, the test must be performed in a clinical environment so that any allergic reactions can be managed promptly.
2. Blood tests: The blood tests to test for an allergy is called an IgE or RAST test. It measures the immune reaction produced in your blood against a suspected allergen.
3. Prick testing: Prick testing is carried out by pricking your skin with a small amount of the suspected allergen to see if there is an itchy, red and swollen mark formed on your skin.
4. Patch testing: Patch testing is carried out to see whether your skin develops a delayed reaction, usually a few days after exposure to a specific chemical or substance. A range of common chemicals or substances including the suspected allergens are taped to your skin for 48 hours, and you are monitored for the following 2-3 days to see whether there is a reaction on the skin.

What are the telltale signs that my rash is psoriasis?

Psoriasis tends to present as red, raised, scaly patches or plaques (raised or thickened skin). The red patches or plaques tend to have a clear outline. Psoriasis tends to run in families. About a third of people with psoriasis also has joint pains or swelling (psoriatic arthritis)

There are many subtypes of psoriasis. Here are some of the common subtypes:

• Chronic plaque psoriasis: the commonest type of psoriasis; the plaques are common on the scalp, ears, elbows, knees and back.
• Palmoplantar psoriasis: psoriasis affecting just the palms and soles
• Guttate psoriasis: small plaques of psoriasis affecting the whole body, usually after a throat infection
• Flexural psoriasis: smooth red patches affecting the body folds
• Nail psoriasis: nail changes such as yellowing, thickening, pitting or lifting of the nails
• Sebopsoriasis: affecting the face, ears, chest and scalp

Dr Nicole will establish the subtype of psoriasis for you right from the start, before initiation of any treatments.