Acne

There's a reason it's called "common acne" - nearly everyone suffers from outbreaks of pimples at some point in life.

It starts when greasy secretions from the skin's sebaceous glands plug the tiny openings for hair follicles (plugged pores). If the openings are large, the clogs take the form of blackheads: small, flat spots with centers darkened by exposure to air. If the openings stay small, the clogs take the form of whiteheads: small, closed, flesh-colored bumps. Both types of plugged pores can develop into swollen, tender inflammations or pimples or deeper lumps or nodules. Cysts associated with severe cases of acne (cystic acne) are firm swellings below the skin's surface that become inflamed and sometimes infected.

Although acne remains largely a curse of adolescence, about 20% of all cases occur in adults. Acne commonly starts during puberty between the ages of 10 and 13 and tends to be worse in people with oily skin. Teenage acne usually lasts for five to 10 years, normally going away during the early 20s. It occurs in both sexes, although teenage boys tend to have the most severe cases. Women are more likely than men to have mild to moderate forms into their 30s and beyond.

Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms.

Acne isn't caused by a harmful diet, poor hygiene, or an uncontrolled sex drive. The simple truth is that heredity and hormones are behind most forms of acne. Swearing off chocolate or scrubbing your face 10 times a day won't change your predisposition to this unsightly, sometimes painful, and often embarrassing skin problem.

The Causes

The cause of acne is not fully understood. Though poor hygiene, poor diet, and stress can aggravate acne, they clearly do not cause it.

Hormones.
Common acne in teenagers starts with an increase in hormone production. During puberty, both boys and girls produce high levels of androgens, the male sex hormones that include testosterone. Testosterone signals the body to make more sebum, a waxy substance that helps the skin retain moisture. Androgens also boost the production of keratin, a substance used by the body to make hair and nails.

Bacteria.
Excess sebum clogs the openings to hair follicles -- especially those on the face, neck, chest, and back. Bacteria grow in these clogged follicles. This makes blackheads or whiteheads form on the skin's surface -- a condition called non-inflammatory acne. Sometimes the follicle wall breaks under the pressure of this buildup. When this happens, sebum leaks into nearby tissues and forms a pustule -- this is called inflammatory acne. This can create cysts. Ruptured cysts leave temporary or permanent scars.

Depending on the type of pill, oral contraceptives may trigger acne in some women but suppress it in others. Steroids taken by some bodybuilders and other athletes can also lead to severe outbreaks.

Acne has many subtypes. Acne neonatorum and acne infantum occasionally affect newborns and infants, usually boys. A pimply rash appears on the face but usually clears within weeks with no lasting effect. People who escaped their teen years almost pimple free may develop persistent adult-onset acne as they get older. Despite the normal increase in androgen levels during puberty, some doctors believe that flare-ups of acne have less to do with androgen levels than with how a person's skin responds to an increase in sebum production. The bacteria Propionibacterium acnes and Staphylococcus epidermidis occur naturally in healthy hair follicles. If too many of them accumulate in plugged follicles, they may secrete enzymes that break down sebum and cause inflammation. Some people are simply more sensitive than others to this reaction. Sebum levels that might cause a pimple or two in one person may result in widespread outbreaks -- or even acute cystic acne -- in another person.


Risk factors

Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:

• Teenagers, both in boys and girls
  
• Women and girls, two to seven days before their periods
  
• Pregnant women
  
• People using certain medications, including cortisone
  

Other risk factors include:

• Direct skin exposure to greasy or oily substances, or to certain cosmetics
  
• A family history of acne — if your parents had acne, you're likely to develop it too
  
• Friction or pressure on your skin caused by items such as telephones or cell phones, helmets, tight collars and backpacks
• Foods - it is still to be a controversy about food inducing acnes. It is a very individual reason, when chocolate, nuts, milk or other fatty foods and even eggs can induce acne in several people.

How does acne happen?

There are oil glands on your chest, face and back numbering in the thousands. In fact, between the nose and cheek areas there are as many as two thousand oil glands every square inch. The function of these oil glands is to lubricate the skin by producing oil, or sebum. Oil that is produced in the glands flows through follicles or tiny ducts to the surface of the skin. It usually starts far beneath the surface of the skin. A blemish (or internal lump) begins about 2 to 3 weeks before it appears on your skin's surface. Acne first begins to form in your sebaceous hair follicles. You know this as "pores", the tiny holes on you skin. Deep within each hair follicle, sebaceous glands generate sebum, the oil that keeps your skin soft, moist and pliable. As part of your skin's renewal process the old cells die and are shed off. Normally, this cell shedding process happens gradually, and fresh new skin takes its place.

But sloughing (the process where living tissue is separated from dead skin tissue) is not the same for everyone. Some people shed cells evenly while others don't. The result of uneven sloughing is that dead cells become sticky, clogging together to form a plug, similar to a cork in a bottle. This plug traps oil and bacteria inside the follicle.

The trapped oil begins to form a lump as your skin continues its normal oil production. Your body's natural defense system then sends an army of white blood cells to attack the bacteria. The whole process takes around 2 to 3 weeks, resulting in a pimple.

Clinical Appearances

Acne typically appears on your face, neck, chest, back and shoulders, which are the areas of your skin with the largest number of functional oil glands. Acne can take the following forms:

• Comedones (whiteheads and blackheads). Comedones (kom-uh-DO-neze) are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones are open at the skin surface they're called blackheads because of the dark appearance of the plugs in the hair follicles. When comedones are closed, they're called whiteheads — slightly raised, skin-colored bumps.
  
• Papules. These are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.
  
• Pustules. Similar to papules, pustules are red, tender bumps with white pus at their tips.
  
• Nodules. These are large, solid, painful lumps beneath the surface of the skin. They're formed by the buildup of secretions deep within hair follicles.
  
• Cysts. These are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.
  

    
   


  

Treatment and Prevention

Acne usually isn't a serious medical condition. But you may want to seek medical treatment from a dermatologist for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin. If acne or the scars it may have left are affecting your social relationships or self-esteem, you may also want to ask a dermatologist if your acne can be controlled or if your scars can be diminished.

Treatment
Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four. With most prescription acne treatments, you may not see results for four to eight weeks, and your skin may get worse before it gets better.

Your doctor or dermatologist may recommend a prescription medication you apply to your skin (topical medication) or take by mouth (oral medication). Oral prescription medications for acne should not be used during pregnancy, especially during the first trimester.

Types of acne treatments include:

• Topical treatments. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their active ingredient. These products can be helpful for very mild acne. If your acne doesn't respond to these treatments, you may want to see a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, Renova) and adapalene (Differin) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available. They work by killing excess skin bacteria. Often, a combination of such products is required to achieve optimal results.
  
• Antibiotics. For moderate to severe acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months, and you may need to use them in combination with topical products.
  
• Isotretinoin. For deep cysts, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug. In addition, isotretinoin may increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels.
  
• Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen), have been shown to improve acne in women. However, oral contraceptives may cause other side effects that you'll want to discuss with your doctor.
  
• Laser and light therapy. Laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacterium that causes acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars, so they may be good treatment choices for people with both active acne and acne scars.
  
• Cosmetic procedures. Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures — which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars — are most effective when used in combination with other acne treatments.
  
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Acne scar treatment
Doctors may be able to use certain procedures to diminish scars left by acne. These include fillers, dermabrasion, intense light therapy and laser resurfacing. 

• Soft tissue fillers. Collagen or fat can be injected under the skin and into scars to fill out or stretch the skin, making the scars less noticeable. Results from this acne scar treatment are temporary, so you'd need to repeat the injections periodically.
  
• Dermabrasion. Usually reserved for more severe scarring, dermabrasion involves removing the top layer of skin with a rapidly rotating wire brush. Surface scars may be completely removed and deeper acne scars may appear less noticeable. Dermabrasion may cause pigmentation changes for people with darker skin.
  
• Microdermabrasion. This newer acne scar treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or "polish" the skin's surface. Then, a vacuum tube removes the crystals and skin cells. Because just the surface cells are removed, the skin isn't damaged. However, results are subtle and scars may still be noticeable, even after several sessions.
  
• Laser, light source and radiofrequency treatments. In laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis). As the wound heals, new skin forms. Less intense lasers (nonablative lasers), pulsed light sources and radiofrequency devices don't injure the epidermis. These treatments heat the dermis and cause new skin formation. After several treatments, acne scars may appear less noticeable. This means shorter recovery times, but treatment typically needs to be repeated more often and results are subtle.
  
• Skin surgery. A minor procedure (punch excision) cuts out individual acne scars. Stitches or a skin graft repairs the hole left at the scar site.
  

Prevention

Once your acne improves or clears, you may need to continue your acne medication or other treatment to prevent new acne breakouts. In some cases, you might need to use a topical medication on acne-prone areas, continue taking oral contraceptives or attend ongoing light therapy sessions to keep your skin clear. Talk to your doctor about how you can prevent new eruptions.

You can also prevent new acne breakouts with self-care measures, such as washing your skin with a gentle cleanser and avoiding touching or picking at the problem areas. Other acne prevention tips include:

• Wash acne-prone areas only twice a day. Washing removes excess oil and dead skin cells. But too much washing can irritate the skin. Wash areas daily with a gentle cleanser and use oil-free, water-based skin-care products.
  
• Use an over-the-counter acne cream or gel to help dry excess oil. Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
  
• Avoid heavy foundation makeup. Choose powder cosmetics over cream products because they're less irritating.
  
• Remove makeup before going to bed. Going to sleep with cosmetics on your skin can clog tiny openings of the hair follicles (pores). Also, be sure to throw out old makeup and clean your cosmetic brushes and applicators regularly with soapy water.
  
• Wear loosefitting clothing. Tightfitting clothing traps heat and moisture and can irritate your skin. Also, whenever possible, avoid tightfitting straps, backpacks, helmets or sports equipment to prevent friction against your skin.
  
• Shower after exercising or doing strenuous work. Oil and sweat on your skin can trap dirt and bacteria.

Self-care

You can avoid or control most acne with good basic skin care and the following self-care techniques:
Wash problem areas with a gentle cleanser. Products such as facial scrubs, astringents and masks generally aren't recommended because they tend to irritate skin, which can worsen acne. Excessive washing and scrubbing also can irritate skin. If you tend to develop acne around your hairline, shampoo your hair frequently.

• Try over-the-counter acne lotion to dry excess oil and promote peeling. Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
  
• Avoid irritants. You may want to avoid oily or greasy cosmetics, sunscreens, hair-styling products or acne concealers. Use products labeled "water-based" or "noncomedogenic." For some people, the sun worsens acne. Additionally, some acne medications can make you more susceptible to the sun's rays. Check with your doctor to see if your medication is one of these, and if so, stay out of the sun as much as possible and anytime you have to be in the sun, use sunscreen that doesn't clog your pores.
  
• Watch what touches your face. Keep your hair clean and off your face. Also avoid resting your hands or objects such as telephone receivers on your face. Tight clothing or hats also can pose a problem, especially if you'll be sweating. Sweat, dirt and oils can contribute to acne.
  
• Don't pick or squeeze blemishes. Picking or squeezing can cause infection or scarring. Most acne will clear up without this kind of intervention. If you need aggressive treatment, see your doctor or dermatologist.

Atopic Dermatitis

Atopic dermatitis is a chronic (long-lasting) disease that affects the skin. The word "dermatitis" means inflammation of the skin. "Atopic" refers to diseases that are hereditary, tend to run in families, and often occur together. These diseases include asthma, hay fever, and atopic dermatitis. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling.

Atopic dermatitis most often affects infants and young children, but it can continue into adulthood or first show up later in life. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin often remains dry and easily irritated. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.

How common?

Atopic dermatitis is very common. It affects males and females equally and accounts for 10 to 20 % of all referrals to dermatologists (doctors who specialize in the care and treatment of skin diseases). Atopic dermatitis occurs most often in infants and children and its onset decreases substantially with age. Scientists estimate that 65 percent of patients develop symptoms in the first year of life, and 90 percent develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis.

About 10% of all infants and young children experience symptoms of the disease. Roughly 60 percent of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood. This means that more than 15 million people in the United States have symptoms of the disease.

The Causes

The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever and asthma, which many people with atopic dermatitis also have. In addition, many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma. Although one disorder does not cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis.

In the past, it was thought that atopic dermatitis was caused by an emotional disorder. We now know that emotional factors such as stress can exacerbate, but do not cause the condition.

The Other Predisposition Factors

In addition to irritants and allergens, other factors, such as emotional issues, temperature and climate, and skin infections can affect atopic dermatitis. Although the disease itself is not caused by emotional factors or personality, it can be exacerbated by stress, anger, and frustration. Interpersonal problems or major life changes, such as divorce, job changes, or the death of a loved one, can also make the disease worse. Often, emotional stress seems to prompt a flare of the disease.

Bathing without proper moisturizing afterward is a common factor that triggers a flare of atopic dermatitis. The low humidity of winter or the dry year-round climate of some geographic areas can intensify the disease, as can overheated indoor areas and long or hot baths and showers. Alternately sweating and chilling can induce an attack in some people. Bacterial infections can also prompt or increase the severity of atopic dermatitis. If a patient experiences a sudden onset of illness, the doctor may check for a viral infection (such as herpes simplex) or fungal infection (such as ringworm or athlete's foot).

Is atopic dermatitis contagious?

No. Atopic dermatitis is definitely not contagious; it cannot be passed from one person to another. There is no cause for concern in being around someone with even an active case of atopic dermatitis.

The Symptoms

Symptoms vary from person to person. The most common symptoms are dry, itchy skin, cracks behind the ears, and rashes on the cheeks, arms, and legs. The itchy feeling is an important factor in atopic dermatitis, because scratching and rubbing in response to itching worsen the skin inflammation that is characteristic of this disease. People with atopic dermatitis seem to be more sensitive to itching and feel the need to scratch longer in response. They develop what is referred to as the "itch-scratch" cycle. The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable.

How atopic dermatitis affects the skin can be changed by patterns of scratching and resulting skin infections. Some people with the disease develop red, scaling skin where the immune system in the skin becomes very activated. Others develop thick and leathery skin as a result of constant scratching and rubbing. This condition is called lichenification. Still others develop papules, or small raised bumps, on their skin. When the papules are scratched, they may open (excoriations) and become crusty and infected. The box below lists common skin features of the disease. These conditions can also be found in people without atopic dermatitis or with other types of skin disorders.

Skin Features of Atopic Dermatitis

• Lichenification: thick, leathery skin resulting from constant scratching and rubbing
  
• Papules: small raised bumps that may open when scratched, becoming crusty and infected
  
• Ichthyosis: dry, rectangular scales on the skin
  
• Keratosis pilaris: small, rough bumps, generally on the face, upper arms, and thighs
  
• Hyperlinear palms: increased number of skin creases on the palms
  
• Urticaria: hives (red, raised bumps), often after exposure to an allergen, at the beginning of flares, or after exercise or a hot bath
  
• Cheilitis: inflammation of the skin on and around the lips
  
• Atopic pleat (Dennie-Morgan fold): an extra fold of skin that develops under the eye
  
• Hyperpigmented eyelids: eyelids that have become darker in color from inflammation or hay fever

 

How to treat atopic dermatitis?

Treatment involves a partnership between the doctor and the patient and his or her family members. The doctor will suggest a treatment plan based on the patient's age, symptoms, and general health. The patient and family members play a large role in the success of the treatment plan by carefully following the doctor's instructions. Some of the primary components of treatment programs are described below. Most patients can be successfully managed with proper skin care and lifestyle changes and do not require the more intensive treatments discussed.

The doctor has three main goals in treating atopic dermatitis: healing the skin and keeping it healthy; preventing flares; and treating symptoms when they do occur. Much of caring for the skin involves developing skin care routines, identifying exacerbating factors, and avoiding circumstances that stimulate the skin's immune system and the itch-scratch cycle. It is important for the patient and family members to note any changes in skin condition in response to treatment, and to be persistent in identifying the most effective treatment strategy.

Skin Care
Healing the skin and keeping it healthy are of primary importance both in preventing further damage and enhancing the patient's quality of life. Developing and following a daily skin care routine is critical to preventing recurrent episodes of symptoms. Key factors are proper bathing and the application of lubricants, such as creams or ointments, within 3 minutes of bathing. People with atopic dermatitis should avoid hot or long (more than 10 to 15 minutes) baths and showers. A lukewarm bath helps to cleanse and moisturize the skin without drying it excessively. The doctor may recommend limited use of a mild bar soap or non-soap cleanser because soaps can be drying to the skin. Bath oils are not usually helpful.

Once the bath is finished, the patient should air-dry the skin, or pat it dry gently (avoiding rubbing or brisk drying), and apply a lubricant immediately. Lubrication restores the skin's moisture, increases the rate of healing, and establishes a barrier against further drying and irritation. Several kinds of lubricants can be used. Lotions generally are not the best choice because they have a high water or alcohol content and evaporate quickly. Creams and ointments work better at healing the skin. Tar preparations can be very helpful in healing very dry, lichenified areas. Whatever preparation is chosen, it should be as free of fragrances and chemicals as possible.

Another key to protecting and restoring the skin is taking steps to avoid repeated skin infections. Although it may not be possible to avoid infections altogether, the effects of an infection may be minimized if they are identified and treated early. Patients and their families should learn to recognize the signs of skin infections, including tiny pustules (pus-filled bumps) on the arms and legs, appearance of oozing areas, or crusty yellow blisters. If symptoms of a skin infection develop, the doctor should be consulted to begin treatment as soon as possible.

Treating Atopic Dermatitis in Infants and Children

• Give brief, lukewarm baths.
  
• Apply lubricant immediately following the bath.
  
• Keep child's fingernails filed short.
  
• Select soft cotton fabrics when choosing clothing.
  
• Consider using antihistamines to reduce scratching at night.
  
• Keep the child cool; avoid situations where overheating occurs.
  
• Learn to recognize skin infections and seek treatment promptly.
  
• Attempt to distract the child with activities to keep him or her from scratching.
  

Medications and Phototherapy:
If a recurrence of atopic dermatitis occurs, several methods can be used to treat the symptoms. With proper treatment, most symptoms can be brought under control within 3 weeks. If symptoms fail to respond, this may be due to a flare that is stronger than the medication can handle, a treatment program that is not fully effective for a particular individual, or the presence of trigger factors that were not addressed in the initial treatment program. These factors can include a reaction to a medication, infection, or emotional stress. Continued symptoms may also occur because the patient is not following the treatment program instructions.

Corticosteroid creams and ointments are the most frequently used treatment. Sometimes, over-the-counter preparations are used, but in many cases, the doctor will prescribe a stronger corticosteroid cream or ointment. Occasionally, the base used in certain brands of corticosteroid creams and ointments is irritating for a particular patient and a different brand is required. Side effects of repeated or long-term use of topical corticosteroids can include thinning of the skin, infections, growth suppression (in children), and stretch marks on the skin.

Tacrolimus (Protopic) and pimecrolimus (Elidel) ointments are powerful topical medicated creams (drugs that are applied to the skin) that is used for the treatment of atopic dermatitis. These new drugs are referred to as "immune modulators." They were first used internally to help patients with kidney and liver transplants avoid rejecting the organs they received. They work by suppressing the immune system. When these drugs are used externally to treat the skin, however, they do not weaken or change the body's immune system. Also, unlike topical steroids (cortisone creams), these new medications don't cause thinning of the skin and breaking of superficial blood vessels (atrophy).

Some treatments reduce specific symptoms of the disease. Antibiotics to treat skin infections may be applied directly to the skin in an ointment, but are usually more effective when taken by mouth in pill form. Certain antihistamines that cause drowsiness can reduce nighttime scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose nighttime scratching aggravates the disease. If viral or fungal infections are present, the doctor may also prescribe medications to treat those infections.

Phototherapy is treatment with light that uses ultraviolet A or B light waves, or a combination of both. This treatment can be an effective treatment for mild to moderate dermatitis in older children (over 12 years old) and adults. Photochemotherapy, a combination of ultraviolet light therapy and a drug called psoralen, can also be used in cases that are resistant to phototherapy alone. Possible long-term side effects of this treatment include premature skin aging and skin cancer. If the doctor thinks that phototherapy may be useful in treating the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully.

When other treatments are not effective, the doctor may prescribe systemic corticosteroids; drugs that are taken by mouth or injected into muscle instead of being applied directly to the skin. An example of a commonly prescribed corticosteroid is prednisone. Typically, these medications are used only in resistant cases and are only given for short periods of time. The side effects of systemic corticosteroids can include skin damage, thinned or weakened bones, high blood pressure, high blood sugar, infections, and cataracts. It can be dangerous to suddenly stop taking corticosteroids, so it is very important that the doctor and patient work together in changing the corticosteroid dose.

In adults, immunosuppressive drugs, such as cyclosporine, are also used to treat severe cases of atopic dermatitis that have failed to respond to any other forms of therapy. Immunosuppressive drugs restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others. The side effects of cyclosporine can include high blood pressure, nausea, vomiting, kidney problems, headaches, tingling or numbness, and a possible increased risk of cancer and infections. There is also a risk of relapse after the drug is discontinued. Because of their toxic side effects, systemic corticosteroids and immunosuppressive drugs are used only in severe cases and then for as short a period of time as possible. Patients requiring systemic corticosteroids or immunosuppressive drugs should be referred to a dermatologist or an allergist specializing in the care of atopic dermatitis to help identify trigger factors and alternative therapies.

In rare cases, when no other treatments have been successful, the patient may have to be hospitalized. A 5 to 7 day hospital stay allows intensive skin care treatment and reduces the patient's exposure to irritants, allergens, and the stresses of day-to- day life. Under these conditions, the symptoms usually clear quickly if environmental factors play a role or if the patient is not able to carry out an adequate skin care program at home.

Tips for Working With Your Doctor

• Provide complete, accurate medical information about yourself or your child.
  
• Make a list of your questions and concerns in advance.
  
• Be honest and share your point of view with the doctor.
  
• Ask for clarification or further explanation if you need it.
  
• Talk to other members of the health care team, such as nurses, therapists, or pharmacists.
  
• Don't hesitate to discuss sensitive subjects with your doctor.
  
• Discuss changes to any medical treatment or medications with your doctor before making them.
  

Atopic Dermatitis and Quality of Life

Despite the symptoms caused by atopic dermatitis, it is possible for people with the disorder to maintain a high quality of life. The keys to an improved quality of life are education, awareness, and developing a partnership among the patient, family, and doctor. Good communication is essential for all involved. It is important that the doctor provides understandable information about the disease and its symptoms to the patient and family and demonstrate any treatment measures recommended to ensure that they will be properly carried out.

When a child has atopic dermatitis, the entire family situation may be affected. It is important that families have additional support to help them cope with the stress and frustration associated with the disease. The child may be fussy and difficult, and often is unable to keep from scratching and rubbing the skin. Distracting the child and providing as many activities that keep the hands busy is key, but requires much effort and work on the part of the parents or caregivers. Another issue families face is the social and emotional stress associated with disfigurement caused by atopic dermatitis. The child may face difficulty in school or other social relationships and may need additional support and encouragement from family members.

Adults with atopic dermatitis can enhance their quality of life by caring regularly for their skin and being mindful of other effects of the disease and how to treat them. Adults should develop a skin care regimen as part of their daily routine, which can be adapted as circumstances and skin conditions change. Stress management and relaxation techniques may help decrease the likelihood of flares due to emotional stress. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial. Chronic anxiety and depression may be relieved by short-term psychological therapy.

Recognizing the situations when scratching is most likely to occur may also help. For example, many patients find that they scratch more when they are idle. Structured activity that keeps their hands occupied may prevent further damage to the skin. Occupational counseling also may be helpful to identify or change career goals if a job involves contact with irritants or involves frequent hand washing, such as kitchen work or auto mechanics.

Controlling Atopic Dermatitis

• Prevent scratching or rubbing whenever possible.
  
• Protect skin from excessive moisture, irritants, and rough clothing.
  
• Maintain a cool, stable temperature and consistent humidity levels.
  
• Limit exposure to dust, cigarette smoke, pollens, and animal dander.
  
• Recognize and limit emotional stress.
  

Atopic Dermatitis At A Glance

• Atopic dermatitis is the most common and significant type of eczema.
  
• The skin sensitivity of this disease is inherited.
  
• The patient's skin is "super sensitive" to many irritants.
  
• Dry scaly patches develop in a characteristic distribution.
  
• Itching is intense and scratching hard to resist.
  
• Scratching can cause skin thickening and darkening and lead to bacterial infection.
  
• Extremely dry skin can break down and ooze or weep.
  
• If the itch can be controlled, the rash (which is aggravated by vigorous scratching) can be contained.
  
• ;Treatment of atopic dermatitis is centered around rehydrating the skin with moisturizers and cautious use of topical steroids to reduce inflammation and itching.
  
• Oral antihistamines are often necessary to break the "itch-scratch" cycle.
  
• Since secondary infections can aggravate the rash, topical or oral antibiotics may also be occasionally indicated.
  

Allergic Skin disorders

Our skin is a good barometer of how healthy the body is. A frequent recurrent infection of the skin may indicate that the immunity system is weak. Skin has its own interference with lifestyle in colour and texture. Our skin controls and regulates the water content of the body. It protects body as a covering and works as defence force against infection. It is helpful in activating vitamin D when it is exposed to sunlight. If skin is damaged water content will be lost. Infection will spread resulting in renal shut down and collapse.

When skin or body is confronted with any other foreign substance, our immune system counteracts to withstand any ill effects from that substance. Antigen-antibody reaction will develop to inhibit all the ill effects. If this is excessive and it creates disease like condition then it is called Allergy. So the heightened reaction of the body to external agent is called Allergy. Antigens developed from this reaction attach to blood cells and form mast cells. When this gets contact with allergen, it secretes histamine which is primary chemical conductor and responsible for allergic reactions. When the body has been exposed to the elements known as allergen, which has been previously exposed, allergies form on the body.

Allergies are different types as allergic rhinitis, sinusitis, asthma and allergic skin disorder. All allergies are serious and very uncomfortable. Allergies can be due to any foreign material –natural or artificial.

If any foreign substance enters into the nose, we sneeze. If this occurs continuously as allergy then it is called as allergic Rhinitis. Likewise, if there is any irritation in the skin, body reacts as red itchy swelling initially, which in due course with subsequent exposure leads to allergic skin disorder.

Skin allergy usually subsides by it self, and denotes about the bodies sensitivity. If this is excess it becomes allergic skin disorder.

Skin allergies or Allergic Skin Disorders are a serious and uncomfortable type. Any red, bumpy, scaly itchy, swollen skin can signify an allergic skin condition. This is the result of immune reaction against an irritant. From an overall healthcare the problem of allergy scare is dismissed as minor annoyances without due consideration for diagnosis and treatment. The majority sufferers are females leading to dismissal more readily than if the symptoms were experienced by men. Allergy in some form occurs in all individuals.

SYMPTOMS OF SKIN ALLERGIES

Allergic skin condition can take several forms and are due to various causes. They are:

Urticaria (Hives)

Urticaria is a smooth flat red eruption with white center called Hives. It appears, disappears or reappears suddenly, without leaving any trace. It causes itching, burning and a stinging sensation anywhere in the body. Acuteness may be caused due to scratching, pressure, aggravation on the nerves, exercises or physical exertion, direct exposure to sunlight or cold , metal, pollens, plants, chemicals, oils cream, food as crab, oyster, prawn, tomato, lime and drugs like aspirin, anti inflammatory drugs, BP medicines and pain killers. Hives are a result of histamine acting on the upper layers of skin. Histamine is primary chemical mediator caused due to antigen-antibody reaction.

The urticaria may be as:

• Heat urticaria - allergy caused due to heat
  
• Papular urticaria - allergy caused due to encounter of flies or mites
  
• Solar urticaria - a rare form of hive due to exposure to UV radiation
  
• Cold urticaria - allergy caused due to cold
  
• Pressure urticaria - allergy caused due to tight dresses or any tight situation.
• Angioedema - the rapid swelling (edema) of the skin, mucosa and submucosal tissues.It is a swelling resulting from histamine action on deeper layers of skin and it may or may not occur with hives. It is not red or itchy and mostly affects or occurs in soft tissues such as eye-lids, mouth or genitals. Apart from the common form, mediated by allergy, it has been reported as a side effect of some medications, specifically ACE inhibitors.

  
Dermographism - Physical urticaria                           Angioedema




Urticaria

Allergic Contact Dermatitis

When skin comes in contact with an allergic substance as plants, metals, dyes, rubber products, cosmetics and medications, a reaction starts after 1 to 3 days leading to red, itchy, inflamed skin known as Allergic Contact Dermatitis. It is more painful than itchy when the agent in contact with skin is more concentrated. Cold soaks and compresses can offer a relief. All age groups can be affected by contact dermatitis and potential triggers may be found just about anywhere. The hands and feet are the most common areas for contact dermatitis to occur. Usually, these symptoms will occur only in the areas that actually came into contact with the irritant or allergen.

Sun Rash

Some people have sensitive skin to the sun in spring and summer. For them, exposure to sunlight results in a rash which may recur throughout summer. These are small reddish blisters in areas exposed to sunlight. They are extremely itchy. There is relief only during winter. For young ones it is very recurrent since skin is very weak and it disappears as they get older.

Atopic Dermatatis (Eczema)

Atopic Dermatatis is allergic eczematous condition affecting mostly face, elbows and knees. Itching leads to scales and flakes. In intense cases, oozing will occur if a bacteria or viral infection is introduced by scratching. Common causes are allergens, sweating, overheating, and emotional stress and strain, and diet, irritants in the wool, pets, soaps, and other agents. This is most common in children and individuals with asthma and allergic rhinitis.

  

DIAGNOSIS OF SKIN ALLERGY

A correct diagnosis along with proper therapy instituted early in the course of the disease will minimise frustration. The diagnosis of skin allergy can be made through:

Intestinal irritation-due to foods like crab, oyster, tomato and lime. Food allergies are usually more difficult to determine. Hives can arise 12-24 hours after consuming the food or food additive making it hard to recall what was eaten earlier.
External irritation-due to use of oil and creams, Emotion, Climate changes
Menstrual trouble, Suppressed sweat, Medications.

PREVENTIVE MEASURES FOR SKIN ALLERGY

About half the number of patients with chronic hives will have at least one more episode of hives in their lifetime. The primary treatment for eczema is that the patient should stop scratching and rubbing the rash. If any food is identified allergic it should be eliminated from diet. Use sunscreens for sun protection for photosensitive skin.

TREATMENT

Treatment also includes avoidance of stimulus, desensitization and stress reduction.

In allopathy, usually anti-histamines, nerve inhibitors are used to control allergy. It is temporary and works for only 12- 36 hours. This can be noticed in patients who are in continuous exposure to allergen -- for example-occupational diseases. If patient takes drugs on long term, side effects will also add to problems.

HOMEOPATHIC APPROACH FOR SKIN ALLERGY

The objective of taking treatment is to provide comfort. Homoeopathy provides it without any side-effects. The homoeopathic approach is a natural way to help the body by supporting the body’s own process of healing. It involves the use of extremely diluted substances to heal the body through the release of vital energy. The rule in homeopathy is that “like treats like”. Homoeopath mostly selects the drugs with the aggravating factors like Taking allergic diet, During full moon Intake of liquor, During menses period, During menopause, On undressing, In open air, At night, especially after 12 p.m.

Also homoeo medicines will not shut allergy like switching off, but it desensitises the body to the allergen by improving immunity. Thus it helps patient to live in their circumstances.

The medicines mostly used are – Apis mel, Sulphur, Ledum, Pulsatilla, Sepia, Croton tig, Arg Nit, Nat mur, Ignatia, Urtica urens, Hepa sulf, Dulcamara, Rhus tox, Graphites, Petroleum, Acid sulp, Acid nit, Capsicum, Ars alb, Causticum. These medicines should be taken under the advice and diagnosis of a Homoeopath.