My June 2008 column, reviewed eczema and its treatment.This month, I will cover other skin problems.People with psoriasis develop patches of thick red skin covered with silvery scales which typically occur on the scalp, knees, elbows, legs and back.In about 20% of patients, the condition may lead to psoriatic arthritis—a painful inflammation of the joints. Psoria- sis is a disease of the immune system where T cells in the skin release chemical messages that speed up the life cycle of cells, causing them to die and slough off in days rather than weeks. The thick red patches are dead cells.
In 2003, FDA approved a new class of drugs to fight psoriasis. These biologics work by blocking interactions between immune system cells to limit the number of T cells in the skin. Remicade blocks a signal in the immune system that causes inflammation. If the patient has psoriasis on less than 10% of his body, only a topical treatment is prescribed. This topical medicine may include corticosteroid ointments, creams and foams. Another drug is Taclonex, which contains a steroid and a synthetic vitamin D cream to reduce inflammation and scaling and slows the rate of skin cell growth.
Seborrheic dermatitis is a form of eczema that occurs primarily on the face and scalp and in the ears, causing a red rash with yellowish, greasy scales. This disorder is most common in older people and patients with a neurological condition such as Parkinson’s disease. Dermatologists recommend using over-the-counter dandruff shampoos that contain salicylic acid, zinc pyrithione or selenium sulfide.Another recommended procedure is to apply a salicylic acid liquid product to the scalp in the evening, wear a shower cap overnight and use a dandruff shampoo in the morning. A prescription corticosteroid foam will also reduce inflammation and itching.
Yellow Nails, Red Faces
Another malady that older people get is nail fungus—perhaps 50% of people over 50 have this condition. A thickened yellow toenail or fingernail is an indication of a fungus. It occurs after people get athlete’s foot, and then damage the nail, which opens a space between the nail plate and nail bed allowing the fungus to enter. The most effective treatment is an oral antifungal that enters the bloodstream to target the fungus in the nail bed.Topical antifungal products have a difficult time penetrating the nail, but they are sometimes suggested for use after the oral treatment is completed.Of course, you can wait for the fungus to rise out of the bed and get rid of it when you cut your nails.
Rosacea begins as a tendency to flush easily and may progress to small broken blood vessels or spider veins (telangiectasia).
In its most advanced form (inflammatory rosacea), small pus-filled bumps or pustules begin to form giving rosacea its nickname “adult acne.”If left untreated, it may cause the nose to thicken and redden, a malady that afflicted comedian W.C. Fields.The exact cause of this condition, called rhinophyma, is not known, but spicy food, alcohol, exercise and the sun are suspected. Topical antibiotics are prescribed for milder cases.
Azelaic acid, which reduces redness and inflammation, is another popular treatment.More severe cases of rosacea require both topical and oral antibiotics.Physicians say that after four to six weeks of treatment, injured vessels start to close and disappear, and the redness goes away.Laser applications cost $250 to $500 per treatment, and most people need two to three procedures.
Leprosy was once one of the world’s most feared scourges.A 4,000-year-old skeleton, found in India, is the earliest known case of leprosy.This seems to indicate that this bacterial disease was carried from Asia to Europe possibly by Alexander the Great and his troops or by slave ships from India.
Lepers have hard, nodular swellings on the skin that enlarge and spread, accompanied by loss of sensation with eventual paralysis, wasting of muscle, and production of deformities.As dreaded as it is, leprosy is not an easy disease to catch.It is necessary to be in very close contact with a person for months or years in order to be infected.Modern medicine has eliminated the need to isolate lepers. Today, 90% of the global population has immunity to leprosy, which is cured with antibiotics. Nevertheless, there were 200,000 new cases of the disease last year, mostly in Africa and Asia.