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Psoriasis and Eczema

Dermatology Associates of Ithaca offers proven treatments for eczema and psoriasis to our patients. Whether your disease is very mild or extremely severe, we will create a customized treatment regimen to address your skin needs.

Frequently Asked Questions (Psoriasis)

Psoriasis, like eczema, is an inflammatory condition of the skin (and potentially other organs) caused by increased activity of the immune system which causes redness, scale, and sometimes itch. Psoriasis is not contagious.  The cause is unclear, but it tends to occur in people who have a family history of psoriasis, who have recently been infected with strep throat, or rarely after starting certain medications.  Symptoms may worsen with exposure to cold temperatures and dry air.  Psoriasis of the skin can be associated with inflammation of the joints which may cause irreversible joint damage; therefore worsening joint pains should be brought to the attention of your dermatology care provider and PCP.  Psoriasis can also be associated with obesity, diabetes, and heart disease, so it is important to let your primary care physician know that you are affected with this condition.

Topical steroids possess anti-inflammatory properties that decrease the redness and flaking of psoriasis.

  • Topical steroids should be applied to affected areas of skin twice a day for 1-2 weeks on, then 1 week off to allow the skin to recover and avoid the long-term use of steroids that can cause skin thinning. After applying topical steroids, apply a layer of moisturizer.
  • Types of topical steroids include:
    • Low potency: Hydrocortisone 1% cream is available over the counter and is safe for areas of thin skin including the face, armpits, and groin, and eyelids (avoiding getting in eyes however)
    • Higher potency: Stronger formulations such as clobetasol, fluocinonide, and triamcinolone may be prescribed for a limited time. Avoid use on the face, armpits, groin, or inner thigh unless specifically instructed to do so (they may produce thinning of the skin if used in these areas).

Topical vitamin D containing creams such as calcipotriene and calcipotriol can be helpful in treating psoriasis. They are particularly helpful when taking a week off from topical steroids, since they do not thin the skin like steroids can, and also in areas of thin skin such as the armpits and groin.

Psoriasis will often improve with exposure to light and light booth treatment with broadband UVB, a well-established psoriasis treatment for patients who have not responded to topical therapy. BBBUVB is a safe treatment that requires short in-office visits three days per week.  It may take at least 6-8 weeks of treatment to see improvement.

Enbrel (etanercept), Humira (adalimumab), Stelara (ustekinumab), and Cosentyx (secukinumab) are injected biologic therapies. They work by decreasing the overactive immune system that causes psoriasis. Particularly for patients with widespread psoriasis, they may be more convenient to use than topical medications or light therapy. However, because they suppress the immune system, biologic medications may put patients at increased risk for infection and rarely, internal cancer. They are also much more expensive than other treatment options and your insurance company may require prior authorization.

Steroid foams, solutions, oils, and lotions can be applied the scalp. In very severe cases, systemic treatments such as Methotrexate or biologic medications can be considered.

Frequently Asked Questions (Eczema)

Eczema (atopic dermatitis) is often known as “the itch that rashes.” This means that itching of the skin is often the first sign of eczema. Scratching causes the skin to become inflamed and more itchy, and the skin becomes red, itchy, and flaky. It can affect any part of the skin and although the cause is unclear, people with a family history of eczema, hay fever, or asthma may be more likely to develop eczema. Dry air such as during wintertime when the heat is on tends to cause the skin to dry out as well and eczema to worsen. Skin that is prone to eczema has difficulty retaining moisture (think of a wall of bricks which is your skin, and the mortar in between the bricks which keeps moisture in—for patients with eczema, this mortar is less effective); thus, it is crucial to moisturize and keep the skin hydrated such as with a humidifier at night.

Moisturizers rehydrate the skin, improving eczema. We recommend applying moisturizers twice a day, including right after showering or bathing in lukewarm water.

  • Use a facial moisturizer with SPF 30 or higher sun block on a daily basis. Ultraviolet rays from the sun are still damaging to the skin, even in the winter.
  • Regular use of a fragrance-free lip balm with sun block is very helpful for chapped lips.
  • When choosing a moisturizer, look for products that are fragrance free, especially if you have sensitive skin. Ointments and creams, such as Cetaphil cream (not lotion), CeraVe cream, or Eucerin, are more effective than lotions.
  • Heavy ointments such as petroleum jelly, Aquaphor or hydrated petrolatum are useful for severely dry areas such as the hands, feet, elbows and knees. Wearing cotton gloves or socks over an ointment on hands or feet at bedtime can help with severe dryness and cracking.

Baths in lukewarm water can help to rehydrate and soothe eczematous skin.

  • Bathe or shower in lukewarm water.  Hot water removes natural oils from your skin, making it dry and itchy.
  • Limit showers to 10-15 minutes.
  • Use mild soaps such as Dove.  Minimize use of soap on areas that tend to get dry such as the arms and legs.
  • Use moisturizing cleaners such as Cetaphil to wash your face.
  • Apply moisturizers immediately after a bath or shower while your skin is still wet.  Putting on a moisturizer will trap the water in the upper layers of your skin, making it less dry and itchy.  Apply any prescription creams or ointments to the affected areas before you apply your moisturizer.
  • Topical steroids possess anti-inflammatory properties that decrease the redness, flaking, and itching resulting from eczema.
  • Topical steroids should be applied to affected areas of skin twice a day for 1-2 weeks on, then 1 week off to allow the skin to recover and avoid the long-term use of steroids that can cause skin thinning. After applying topical steroids, apply a layer of moisturizer.
  • Types of topical steroids include:
    • Low potency: Hydrocortisone 1% cream is available over the counter and is safe for areas of thin skin including the face, armpits, and groin, and eyelids (avoiding getting in eyes however)
    • Higher potency: Stronger formulations such as clobetasol, fluocinonide, and triamcinolone may be prescribed for a limited time. Avoid use on the face, armpits, groin, or inner thigh unless specifically instructed to do so (they may produce thinning of the skin if used in these areas).
  • Protopic and Elidel are helpful second line agents for treatment of eczema in areas of thin skin, or long term treatment of eczema that does not tolerate breaks from steroid use.
  • A mild burning sensation may occur with initial application but should improve over the next week as your skin becomes used to the medication. A think film of the medication should be applied twice daily to affected areas, avoiding open skin, and stopping when skin has improved.
  • The FDA has issued a “Black Box Warning” for these medications since it is unclear whether there may be a link to cancer; however, we are comfortable recommending these medications for use as directed. An excellent resource to read more about this may be found at: http://chicagoeczema.com/resource/protopic-and-elidel

We recommend oral antihistamines such as Benadryl (diphenhydramine) or, if needed, Atarax (hydroxyzine), for controlling itching at night. They can cause drowsiness (and in rare instances, hyperactivity) so we do not recommend driving or operating machinery while taking sedating antihistamines. The dose can be repeated every four hours. If non-sedating antihistamines are needed during the day, Claritin (loratadine), Zyrtec (cetirizine), or Allegra (fexofenadine) may be taken.

Light treatment with broadband UVB phototherapy helps to improve eczema during months when the sun is weaker. Broadband therapy is a safe and effective treatment option for eczema that has not responded to topical therapy, which requires short in-office treatments three days a week.

  • A weekly or twice weekly bleach bath, similar to creating one’s own swimming pool, can be extremely helpful in improving eczema. It works by killing the bacteria on the skin that worsen eczema.
  • Make sure to use lukewarm water, not hot water which can dry out the skin and worsen eczema
  • Instructions:
    • For regular tub: Add 2 tsp bleach (e.g. Clorox) of bleach in one tub
    • For baby tub: Add 1 tablespoon of bleach in baby tub (1 teaspoon per gallon of water)
    • Soak for 10 minutes
    • Thoroughly rinse with lukewarm, fresh water
    • Pat dry with a newly-washed towel (don’t rub, as this will cause eczema to become more itchy)
    • Apply topical steroids if prescribed by your dermatologist
    • Moisturize entire body liberally, then dress in newly-washed pajamas

Severe eczema can be treated with weekly wet wraps, which prevent scratching, rehydrate the skin, and promote absorption of topical steroids so that less medication is needed. We recommend first taking a lukewarm bath or shower, gently patting dry without completely drying out the skin, then applying a thin film of topical steroid to affected areas. Then a thick coat of ointment such as Vaseline can be applied over the entire body. Warm, wet cotton pajamas can then be worn, to promote rehydration overnight. Please make sure to keep your room warm to prevent chilling.

Helpful Links
Bleach Bath
Dry Skin Care
Broadband UVB

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