Itchy Skin was the topic of a live health chat Dr. Mejia participated in today with Dr. Marta Rendon on the Sun Sentinel Health Chat . It was simultaneously in all the Tribune Co. papers:  The Sun-Sentinel, LA Times, Chicago Tribune, Orlando Sentinel, Baltimore Sun, Hartford Courant.

Some definitions of the different types of skin conditions and diseases for itchy skin are:

Psoriasis (sore-EYE-ah-sis) is a chronic (long-lasting) disease. It develops when a person’s immune system sends faulty signals that tell skin cells to grow too quickly. New skin cells form in days rather than weeks. The body does not shed these excess skin cells. The skin cells pile up on the surface of the skin, causing patches of psoriasis to appear.

Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an irritating acid, a cleaning agent, or other chemical

Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions like Neosporin or Bacitracin

Seborrheic eczema (also called seborrheic dermatitis or seborrhea): is a very common form of mild skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, ears, and occasionally other parts of the body. Often this is also called dandruff in adults or “cradle cap” in infants.

Nummular eczema: coin-shaped (round), isolated patches of irritated skin — most commonly on the arms, back, buttocks, and lower legs — that may be crusted, scaling, and extremely itchy

Neurodermatitis: a very particular type of dermatitis where the person frequently picks at their skin, causing rashes. The underling cause may be a sensitivity or irritation which sets off a cascade of repeated itching and scratching cycles. It may be seen as scratch marks and pick marks on the skin. Sometimes scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) may become intensely irritated when scratched.

Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems and congestion of the leg veins. It may have a darker pigmentation, light-brown, or purplish-red discoloration from the congestion and back up of the blood in the leg veins. It’s sometimes seen more in legs with varicose veins.

Q & A On  Sun Sentinal Health Chat

Dr. Mejia: Psoriasis is the most chronic autoimmune disease in the country, affecting up to 7.5 million Americans – or roughly 2-3 percent of the worldwide population.

The Psoriasis Foundation at www.psoriasis.org is an excellent source of information for all the up to date information research and treatments for psoriasis as well as statistics.
SunSentinel.com Health: Emailed question: Are there any new breakthroughs in the treatment of rosacea and what is the best non-prescription treatment out there? — Rich

Dr. Mejia: Rosacea can be triggered by a variety of foods such as spicy foods, red wines and certain cheeses. In many cases patients are given a list of foods to avoid.

Comment From Gabby: Do you know what causes psoriasis? I first started getting it when I was about 30 years old, mostly on my elbows. I’m now 55.

Dr. Mejia: Psoriasis is a genetic condition affecting 1% of the population.

Comment From Psoriasis Foundation: People with psoriasis are at increased risk for other serious health conditions like heart disease and diabetes. What’s the importance of maintaining overall health in people with psoriasis?

Dr. Mejia: There are several over the counter treatments such as coal tar which have worked well for my patients . Otherwise other topical treatments for itchy skin such as topical steroids are used.

Comment from Johnny: Will we ever reseach enogh to find the causes of eczema and such itchy probles that cause bad skin disorders some of the cures now can be more dangerous than the problem why is it the most effective treatments like lasers treatment so expensive when high tect equipment is really cheap to make.

Dr. Mejia: Johnny. There are many reasons for eczema. The problem is finding the cause. It may be an irritant, and allergy or atopic dermatitis.

I can’t comment on the cost of the equipment. Generally we are not utilizing expensive lasers for eczema. It is more topical therapy and trigger avoidance.

Comment from Randy: I have deep red patches on my legs that get dry and flaky. The creams they give me to get rid of it only temporarily get rid of it.

Dr. Mejia: Eczema on the lower legs can be related to stasis dermatitis or nummular eczema as above. I would also check depending on your age whether you have severe varicose veins.

Comment from Kim: My 5 year old son has excema. The only trigger seems to be our dog. We have been swimming more often recently and his excema seems to be worse; however he is spending more time with our dog. Is chlorine something that could be making it worse. Please advise any tips beyond moisturizer. We use a steroid cream to treat it and I am hesitant to use it too much. Thanks!

Dr. Mejia: Scalp itching in a young kid could be lice, psoriasis or even seborrheic dermatitis although rarer. Some children may also exhibit neurotic itching or obsessive compulsive habits. There is also a condition called trichotillomania of constant hair twirling which can lead to temporary hair loss.

Comment from Randy: It seems more like Nummular eczema primarily on my lower legs.

Dr. Mejia: Randy, unfortunately without a proper exam to diagnose your condition, I could not give you a for sure answer. However, start with good moisturization and possibly over the counter topical hydrocortisone. If things are not improving, definitely see your dermatologist for a proper diagnosis. If you are older, skin cancers can look like eczema. Nummular eczema is typically treated with steroids and moisturization. Try the greasy stuff like aquaphor for really dry skin and itchy skin.

Comment From Psoriasis Foundation: Up to 30 percent of people with psoriasis develop psoriatic arthritis, a related condition causing swelling of the joints. We recommend that people talk with their doctor if they experience joint pain, stiffness or swelling lasting more than 3 days. What symptoms should people look for?

Dr. Mejia: The symptoms of the most common form of psoriatic arthritis affects the tips of the fingers or toes. However, one in five cases of the condition can affect the spine. The least common form of psoriatic arthritis is called “psoriatic arthritis mutilans,” which targets the joints, causing severe destruction.  Most patients typically have joint pain.

SunSentinel.com Health: Emailed question: My son has renal disease and horrible skin. I have seen several dermatologists and have gotten no answers. Are you aware of skin conditions associated with renal failure?

Dr. Mejia: Kyrle disease has been associated with patients with kidney problems. The cause of the disease is unknown. Some cases appear to be idiopathic (no known triggers), or inherited.  What has been found is that Kyrle disease appears to occur more frequently in patients with certain systemic disorders such as Diabetes mellitus , Renal disease (chronic renal failure, albuminuria, elevated serum creatinine, abnormal creatinine clearance, polyuria) , Hepatic abnormalities (alcoholic cirrhosis) , Congestive heart failure . Treatments have included topical steroids and isotretinoin as well as antihistamines.

Comment From Ed: Can topical use of the anti-fungal ketoconazole cause abnormal liver function tests or gynecomastia? If so, how would you treat sebborheic eczema presumably caused by the yeast malassezia?

Dr. Mejia: Lamasil is an antifungal.

Sun-Sentinel.com Health: Emailed question: I have itchy patches on my breast. My doctor has given me Lamisil, which hasn’t worked. I am worried that it could be breast cancer, but are there any other creams I can try before taking more expensive steps to check for cancer. — Anne

Dr. Mejia: I would recommend seeing your dermatologist again for the patches on your breast. You may even want to request a biopsy if you are concerned about a breast cancer. There is a known condition called Pagets disease which is a malignancy of the breast. Pagets typically involves one breast area. When both areas are involved, we tend to think of irritations or allergies from bras. But generally, we do do a biopsy to rule out Pagets disease.

Comment from Amanda: I was diagnosed with eczema when I was 12. Everytime I get an irritated area under control through medications… another spot appears somewhere else. Is this normal?

Comment From Psoriasis Foundation: Getting psoriasis under control is important. The National Psoriasis Foundation can connect you with many resources to help you access medical services and treatments. Check out our Health Insurance Action Center for further assistance/details with insurance issues:http://www.psoriasis.org/NetCommunity/Page.aspx?pid=1269


Comment From Psoriasis Foundation: When is it appropriate to get a second opinion from a dermatologist when you have any disease affecting the skin?

Dr. Mejia: If you  have ANY disease affecting your skin that is not resolviong, I would recommend a second opinion if several treatments have failed. You do not want to miss a skin cancer masquerading as a rash.

Bob Mendiola: Let me ask a question. In rosacea, if you don’t attend to it promptly, can it progress to somethign more serious?

Dr. Mejia: Generally speaking rosacea does not progress to more serious symptoms. However, you do want to have a proper diagnosis. In some cases the facial redness can be a sign of lupus rather than rosacea.

Some patients can develop a disfiguring problem caused rhinophyma. This is typically in patients that have a predisposition to the problem.

Comment From Psoriasis Foundation: How should people prepare for their dermatology appointment? The National Psoriasis Foundation website at www.psoriasis.org has lots of patient resources to get you started.

Dr. Mejia: The best thing is to make a list of all there treatments and to bring any and all medications with them that they have used. Getting advanced records from their prior doctor visits would help.

SunSentinel.com Health: Emailed question: Late last year I accidentally hit my right leg which I believe began a series of rashes and itchy skin all the way up to my buttocks. I was diagnosed with Urticaria and she prescribed triam/cetaphil cream fougera, which didn’t help. Another doctor prescribed prednisone, Tramcinolone Acetonide Cream and Doxepin HL 10 mg, which helped somewhat but I still have itch, rash and discomfort. What can I do? — Helen

Dr. Mejia: A skin biopsy of the rash will always assure a proper diagnosis. If things are not improving, I typically increase the strength of the topical steroid or change it. I also may increase the dosage of antihistamines or try a combination. I may also look for other causes such as allergic contact dermatitis and consider patch testing to rule out allergies. There are also special blood tests to rule out an autoimmune urticarial problem.


Comment From Psoriasis Foundation: With summer coming, people are getting sunburns, scratching on their knees and other “injuries” to the skin. Could you explain what the Koebner effect is? Many people ask us about psoriasis triggers.

Dr. Mejia: The Koebner phenomenon (Koebnerization, isomorphic response) occurs when a new area of psoriasis develops in injured skin. For example, after a surgery, psoriasis may develop around the surgical scar. This phenomenon may also help explain why psoriasis tends to occur on areas of constant low-intensity trauma such as elbows and knees. Koebnerization can occur after non-traumatic skin injury such as a sunburn, or an allergic reaction to a medication. In patients who suffer from dandruff or seborrheic dermatitis of the face and scalp, psoriasis can superimpose itself due to irritation and scratching and a crossover or combination dermatitis known as “sebopsoriasis” develops. Koebnerization is not specific to psoriasis.

Bob Mendiola: Can you tell us. Can itchy skin be a sign of skin cancer?

Dr. Mejia: Yes it can. Rashes can be a sign of skin cancer. Generalized itching or all over can sometimes be a sign of an internal malignancy or a problem with the kidneys or liver. The symptoms of pruritus or itching may differ in patients with lymphoma for example . Pruritus of the nostrils has been associated with brain tumors.

SunSentinel.com Health: Emailed question: How do you treat a dry scalp – MINUS the store bought dandruff shampoo – what if that doesn’t work?

Dr. Mejia: Dry scalp assuming it is seborrhea or psoriasis can be treated with prescription strength shampoos as well as topical steroids.

It would be best seeing your dermatologist for this treatment.

Comment From Psoriasis Foundation: Thank you, Dr. Mejia and Dr. Rendon. We hope to work with you soon at the National Psoriasis Foundation. We appreciate the time you took to answer everyone’s questions and for the information you provided our community about psoriasis.

SunSentinel.com Health: Finally, a transcript of this chat will be available shortly at www.SunSentinel.com/transcript

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