The state of our skin is affected by many different things – over-exposure to harsh uv rays, pollution, cigarette smoke, lack of water, caffeine. The list goes on.

Recent studies show that stress also affects our skin state.  Although the link between the brain and the skin is not new the impact stress has on our skin is quite profound.

Here’s something I read in an article one NSTOnline recently.

Universiti Kebangsaan Malaysia clinical psychologist Dr Alvin Ng Lai Oon said the brain-skin connection has been scientifically researched and it is not just a marketing gimmick.

“The skin has not been studied much but in the past 10 years, more has been discovered about how mental state affects skin.

“When you are stressed, the brain releases chemicals that affect the skin biology and when this changes the structure of the skin, it will result in dermatitis, eczema and acne,” he said.

Basically, what happens is stress hormones (adrenaline and cortisol, for example) reduce the immune system of the skin and this imbalance reduces the skin’s ability to repair itself.

“The skin is connected to a central peripheral nervous system with ‘emotional feedback’ so basically what you feel emotionally is connected to your skin.”

Dr Razimah Hanim Abu Zarim, a graduate of Ireland’s Royal College of Surgeons who now runs Ageless Aesthetics, said while it is not conclusive that stress causes skin conditions such as psoriasis and eczema, there are long-time sufferers of these conditions who report that when they are stressed, their conditions become worse.

“Stress may be a trigger and can cause many problems. If you are stressed, you don’t eat properly, have adequate sleep or drink enough water and the effects can be seen on the skin.” He said.

Stress reduces the skins immunity causing inflammatory reactions such as skin bumps and itchiness.  Itchiness results in scratching which compounds the situation.  We all focus on taking care of our skin but perhaps we need to take a look at controlling our stress levels as well.

Nummular Eczema is a chronic dermatitis.  The word nummular comes from the Latin term ‘nummus’ meaning coin. An appropriate name for the condition, as it presents itself as stubborn coin shaped lesions.  The lesions are red, inflamed and scaly.  They are often accompanied by vesicular eruptions or blisters.

Also known as Discoid Eczema

Discoid eczema is the other name which nummular eczema is known as.  In this condition the lesions are usually wide spread on the arms and legs.  They sometimes appear on the trunk and buttocks as well.   As the condition clears the lesions heal from the inner skin layers to the outer.  They look like red rings not unlike ring worm.  It is because of these red rings that nummular eczema also became known as Discoid eczema.

Typical of any eczema the cause of  nummular eczema is unknown and there is no known cure.  It is most common in older people  especially if they have excessively dry skin.  It is worse in the winter season, low humidity, during times of emotional stress and with frequent bathing (ie more than once a day).

Treatment is aimed at decreasing the inflammation and itching whilst healing the lesions.  Cortisone is the preferred cream prescribed by doctors.  Coal tar may be required for stubborn lesions.  Although remission is possible, flare ups will occur if the skin is not kept moisturized and well hydrated.

Nummular Eczema treatment

Although not curable both nummular eczema and its name sake discoid eczema are controllable.  Regular treatment and moisturizing are the key.  Because nummular eczema often covers a large amount of the body a daily bath with a good quality bath oil added is the most effective way to keep the skin moisturized.  I recommend soaking in a warm bath for 15 – 20 minutes each evening.  Pat the skin dry after the bath and rub in any excess bath oil left on the skin.  Bath oils can be applied directly to the skin if the skin is excessively dry.

Immediately after bathing apply your treating cream to the lesions.  It is after the soaking that the skin is at its softest and moistest and the most receptive to the cream.  Use the cream as directed on the packaging and as many times as suggested to aid in the healing of the lesions and skin repair.

Babies and young children often suck their thumb or lick their lips regularly.  This causes saliva to be in constant contact with the lips and surrounding skin.  The saliva often irritates the skin resulting in lip eczema – a dry, irritating rash around the mouth.

The lips become dry, chapped and sore and the skin around the lips becomes inflamed and scaly.  The condition resolves when the habit of thumb sucking or excessively licking the lips is broken.

It’s best to help ease any discomfort by applying a cream to the skin around the lips and on the cheeks to help relieve the itching and inflammation and a lip salve can be applied to the lips.  Once cleared to help prevent recurrence a barrier cream such as petroleum jelly can be applied.

A similar condition can develop in dry climates when the lips become dry and are repeatedly licked to moisten them. The saliva continuously on the external skin surface causes the skin to become dry and irritated.   A change of season and an increase in humidity will resolve the problem.  In the mean time the condition can be treated the same as for lick eczema.

Rosacea is a chronic blood vessel disorder affecting the blood vessels of the face.  The result is a facial rash that appears as red pimple like bumps accompanied by excessive flushing.

So what triggers the condition?

• Diet
• Lifestyle
• Exercise
• Drugs/Medicines
• Emotional changes
• Environmental changes

The triggers of Rosacea are well documented and extensive.  Since Rosacea is the result of the facial blood vessels moving closer to the surface and becoming dilated it stands to reason that anything that will cause further dilatation of the vessels will worsen the condition.

Anxiety, stress and embarrassment will all cause the vessels to dilate.  As will over heating the body.  Saunas, hot rooms, hot and humid weather and high winds will all worsen Rosacea.

The sufferer of Rosacea must be careful when taking medications.  Some drugs are specifically designed to dilate blood vessels whilst others do it as a side effect.  Before starting any new medication whether a prescription or over the counter drug you should check its suitability with your doctor.  Some drugs to be cautious of include steroids, morphine, thyroid medications and vaso dilators (as in those used in cardiac conditions).

Whilst these triggers are easy to identify one of the major triggers – food is not so easy to identify.  Many foods can cause a flare up of Rosacea however the effects of each food are individual.  Not all foods will effect everyone and infact not everyone will be effected by food.

Foods that commonly effect Rosacea include:

• dairy products
• citrus fruits
• cured meats
• peas
• beans
• soy sauce

Food additives found in beer, wine, fruit juice, frozen vegetables and shellfish may also cause problems.  MSG can cause flushing in many people so its effects on the Rosacea sufferer will be more pronounced.

Caffeine also commonly causes a flare-up.  However it is uncertain whether it is the caffeine itself or the temperature of the drink that causes the problem.

Itching and eczema. They seem to go hand in hand, but it’s not just an itch.  It’s an unbearable itch that you just have to scratch…and scratch…and scratch.

The problem is that the more you scratch the itchier it becomes, leading to a vicious cycle known as the scratch itch cycle.

The cause of the scratch itch cycle may be anything ranging from an insect bite, an allergic reaction, tight clothing or dry skin.  Stress and tension will increase the itch.

The nerves at the site of the itch tell the brain that there is an irritation or itch and so you rub or scratch the skin.  This causes small bumps to form on the skin, which are even itchier.  The nerves tell the brain that you have a bigger itch so you scratch more.  And so it goes on until you have unbearable itching and constant scratching.

The end result is thickened skin that is red, sore and broken, leaving it open to potential infection.  The scratching often becomes a habit that may continue after the cause has been removed.

To control the itching, the habit must be ceased for the cycle to be broken.  In very severe cases an oral antihistamine may be required to ease the cycle.  However, often just a conscious effort not to scratch and the application of emollients will ease the itch and sooth the skin sufficiently to allow it to heal.

Dry, flaky, irritated skin

This is what usually comes into the mind of most people when the word Psoriasis is mentioned.  Arthritis is generally not thought of in relation to psoriasis.  But, perhaps it should be.  Up to 20% of people suffering from psoriasis will also develop an arthritis in association with their skin condition.

Similar to rheumatoid arthritis

The symptoms of psoriatic arthritis are similar to those of rheumatoid arthritis, although they are often not as severe.  They include pain, stiffness and swelling in and around a joint, decreased movement, morning stiffness and tiredness.

The likelihood of nail involvement also increases if psoriatic arthritis develops.  80% of people with psoriatic arthritis will report pitting or lifting of the nail, while only 20% of people suffering from psoriasis without arthritic involvement develop nail pitting.

Redness and pain of the eye may also occur in association with this condition.  Psoriatic arthritis is usually seen in the 30 –50 age group and affects both men and women equally.

Difficult to diagnose

The upper joints of the fingers and toes are most commonly affected.  However there may also be some spinal involvement.  Early diagnosis is important to prevent long term damage to the joints and tissues.  This is not always straight forward as diagnosis, especially in the early stages is quite difficult.  Many people have a degree of bone loss by the time the disease is diagnosed.

The relationship between the two is often difficult to determine, as there is no set pattern to be followed.  Symptoms of the two may not always occur at the same time. In fact it is not unusual for the psoriatic arthritis to appear some 10 years after the first signs of psoriasis appear on the skin.  It is also possible for the arthritis symptoms to appear before the skin symptoms develop.

Similarly the severity of the psoriasis rash does not mirror the severity of the associated arthritis and a flare up in one does not indicate a flare up in the other.

Psoriatic arthritis commonly runs in families, so this is one aspect looked at when seeking a diagnosis.  Diagnosis is based on a medical history, physical examination, blood tests, and xrays.  It is the absence of the rheumatoid factor in a blood test that distinguishes psoriatic arthritis from rheumatoid arthritis.

As there is no cure for the condition treatment is aimed at relieving the symptoms.  Many doctors prescribe anti-inflammatory drugs as their preferred treatment.  The use of steroids is not recommended as it may have a detrimental effect on the psoriatic rash causing a flare up on the skin.

Self-help techniques relieve the pain

There are also many self-help techniques available to help control the inflammation and pain.  The application of heat and cold are effective in reducing both pain and inflammation. Regular gentle exercise will also help to reduce joint stiffness and immobility developing.

The possible health risks from using mobile phones have been under scrutiny for some time.  In particular the risk of children who regularly us a mobile phone developing brain tumors.

A few years ago researchers found another health risk resulting from using mobile phones – a risk of developing eczema.  These findings were not made public as there was little or no proof.

Tests carried out by Japanese scientist Dr Hajime Kimata have confirmed these earlier findings that exposure to the microwaves emitted by mobile phones can trigger a reaction in people with skin allergies.

Blood tests have shown that people with eczema or dermatitis have higher levels of chemicals pumped out by their immune system when using a mobile phone causing an allergic reaction.  It would appear that the microwaves are triggering an allergic reaction.

It is believed there are around 50 million mobile phones in use in the UK alone making the safety issue of prolonged use a major concern.

British allergy experts have said that Dr Kimata’s findings are interesting but there is no scientific explanation as to why radiation would increase allergic responses.

“This study adds to the evidence that microwave radiation may do strange things that we don’t quite understand” added Professor Tony Frew, of the Southampton University.

Fact #1
In the course of a life time you will , while sleeping eat 70 assorted insects and 10 spiders.

Fact #2
50 000 cells in your body will have died and been replaced by new cells while you have been reading this sentence.

Fact #3
The most common non contagious disease in the world today is tooth decay.

Fact #4
A person’s entire skin weighs around 4kg (8.75 lb) which is around 7% of the total body weight.

Fact #5
The average person sheds 18kg (39.5 lb) of skin cells in a life time.

Fact #6
Experts predict that 15% of young children suffer from atopic eczema.  It is more common in urban areas than rural, small families than large families and in wealthier families.  The reasons for this are unclear.

Fact #7
Eczema, asthma and hayfever are all; closely related.  They are all atopic conditions with a strong familial basis.  It is estimated that approximately 50% of children with eczema will develop asthma or hayfever.

Fact #8
Psoriasis affects approximately 2 – 4% of the population.  The first symptoms usually appear between the age of 10 – 35 years, although it can appear at any age.

Fact #9
Almost 50% of psoriasis sufferers will experience psoriasis of the fingernails where the nail appears pitted.

Fact #10
About 3% of white adults have psoriasis, however it is uncommon in colored people.  It affects both sexes equally and is rare in small children.

Fact #11
In the last 30 years the number of people with eczema has doubled.

Fact #12
In the UK 1 in 10 people suffer from eczema.  That is 1 in 12 adults and 1 in 8 children.

Fact #13
In the UK eczema costs 288 million pounds every year.  Amazingly one third of this amount is spent by the eczema sufferers themselves on topical treatments – creams, oils, ointments etc.

Fact #14
Occupational dermatitis/eczema, a type of skin inflammation caused by contact with irritant substances used in the workplace is thought to account for over half of the working dayslost in the UK every year.

Fact #15
Studies show that approximately 60% of Americans are deficient in omega 3 and 20% have so little that test methods are unable to detect any in their blood.

The “black box” warning placed on Elidel and Protopic BACK IN 2005 scared patients off using these drugs unnecessarily or so the American Academy of Dermatology (AAD) believe.

Elidel and Protopic are non-steroidal eczema drugs that became available by prescription in 2000 and 2001.  They were heralded as the new miracle treatments for eczema, making steroids a thing of the past.

Recent months have seen much controversy over the use of these drugs as they have been linked to skin cancer and lymphoma.  The Food and Drug Association (FDA) has ruled that both drugs must carry the “black box”, which is the strongest of all safety warnings.

The AAD believes that this warning is unnecessary and will only serve to scare patients and their doctors off using the drugs even when it is their best option of treatment.

AAD spokesperson, Abby Van Voorhees says “The AAD is very disappointed with this ruling by the FDA.  We don’t think the science supports this harsh labeling.   The link to cancer is not proven, and the data shows these medications are quite safe.”

Novartis, the manufacturer of Elidel has been publicly critical of the FDA decision.  Novartis spokesperson, Megan Humphrey stated “We want to make it very, very clear that this action is not substantiated by scientific or clinical evidence…. Based on 21 000 patients in clinical trials, and based on postmarketing use of Elidel in more than 6 million patients, there is no evidence of a causal relationship between Elidel and cancer.”

The FDA has defended their decision stating that there was a real concern for how many scripts for Elidel and Protopic were being written as a first line treatment and for children under 2 years.

The drugs have only ever been approved for adults and children over 2 years and only as a last resort when other treatments have proven unsuccessful.

Norman Fost from the FDA advisory panel said, “A “black box” warning may be excessive, may be overshoot, may be unduly inhibiting (to patients who need the drugs) but it may be that’s the only tool left to stop millions of prescriptions that are inappropriate … that may be the only way to do it.”

Excema is a very common misspelling of the skin condition Eczema.

Eczema has proven to be a very difficult word to spell and can widely vary between:

• excema
• exema
• exma
• eccema
• ezcema
• eczma
• excma
• xma
• xema

All of these variations will be understood, but the correct spelling of the condition is Eczema.