Straight, No Chaser: What’s that Rash? Eczema and Psoriasis

Rashes are very frustrating for patients.  They itch, burn, get infected, aren’t pleasant to look at and never go away rapidly enough. Another problem is no one ever seems to know what they are at first, and that causes a big problem because you’re concerned immediately (as you should be) when the rash appears. Unfortunately, in the early stages, most rashes are indistinguishable. In many cases, in order to diagnose them, you’d have to let them evolve and bloom into whatever they’re trying to become, but who has time for that? I remember in medical school, the prevailing wisdom was “If it’s wet, dry it (powder), if it’s dry, wet it (creams, lotions and ointments), and give everybody steroids.” Well, don’t try that at home without your physician’s direction because it’s not universally true, but it sure does seem like hydrocortisone has a lot to do with treating rashes.

Today, I’d like to review two common chronic conditions defined by rashes, and later I’ll do the same with acute presentations of rashes. The thing about eczema and psoriasis is we should know it when we see it, and so should you. By the way, dermatitis is the general term for skin inflammations, and eczema and psoriasis both fall under this category. As such, they have a lot in common, including basic underlying mechanisms (irritation), treatment considerations and a knack at raising frustration levels.

eczema

Eczema (aka atopic dermatitis, which is the most common form of eczema) is a red, dry itchy rash that really is just an inflammatory reaction. If you let it linger, it can become cracked, infected and develop a leather-like consistency. It’s said that you’d develop eczema just by scratching or rubbing your skin long enough, because it’s the damage to the skin that causes the inflammatory reaction that defines eczema. This is why eczema is notoriously called “the itch that rashes”. You’re more likely to have it if you have asthma, have fever or tendencies toward food allergies (or other allergies), but you can get it with pretty much any significant skin irritation. It’s not contagious, but it does run in families.

psoriasis

Psoriasis is another chronic skin condition that is easily recognized. As noted above, that thick scaly, silvery skin (called plaques) results from an overgrowth of skin cells. As with eczema, this condition is a result of inflammation to the skin, in this instance caused by an overreaction of your immune system speeding up the production of skin cells. Psoriatic lesions are most often seen on the elbows, knees and scalp; it can also involve the back, hand and feet (including the nails). Psoriasis tends to flare-up then go into remission, but during those flare-ups, it is very uncomfortable and unsightly.

These are both ‘dry’ rashes, so treatment involves moisturizers, changing habits to include mild soaps, loose fitting clothing, moderate temperature showers (to avoid drying the skin), and when necessary, antihistamines (like Benadryl) and topical steroid creams (like hydrocortisone). Use any medications after consultation with your physician, who may prescribe more exotic treatments such as medications to calm or suppress the body’s immune response or ultraviolet light therapy. Your job is to identify and avoid the irritants that cause the inflammatory reaction (e.g. sweating, scratching, tight-fitting clothing and anything that dries you out). It’s important for you to get these addressed early before the appearance becomes too bothersome for you.

I welcome any questions or comments.

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5 Comments

Filed under Medical Treatment, Skin/Dermatology

5 responses to “Straight, No Chaser: What’s that Rash? Eczema and Psoriasis

  1. Antoine

    I really appreciate this article Dr. Sterling. I went to the doctor about 2 weeks ago about a rash on my hand and arm and was told it was Eczema. I was shocked, as I have never had it before in my 30+ years of living. If possible, could you suggest a OTC med that will not only help the itching, but also help the flaring up? The PA tried to give me some meds that were TOO DANG HIGH and wasn’t covered by Insurance. Thanks and ’06.

    • Hi, Antoine. Head to your local pharmacy and have a conversation with the pharmacist. S/he will be able to recommend an inexpensive OTC topical cream or ointment for you. It will likely be a hydrocortisone preparation. The lower strength OTC preparations are good places to start for mild, new onset eczema. Of course, the best course of action is to follow the advice given by your primary care provider. Perhaps a generic preparation of the same strength product your PA recommended is available. Thanks for the comment and question, and thank you for following Straight, No Chaser.

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