This chronic skin problem presents as areas with red, scaly skin on different parts of the body. Psoriasis can be inherited or can occur in people who have had an impaired immune system or other immune system problems which can result in the skin cells growing extremely quickly. An impaired immune system can cause an accumulation of harmful substances in the skin such that thick, swollen and scaly areas are formed.
More information about psoriasis:
Psoriasis – Wikipedia
National Psoriasis Foundation
Psoriasis – MedicineNet.com
Q&A: managing dry skin conditions
Psoriasis, eczema, dermatitis & ichthyosis
Is dry skin a common problem?
There are many skin conditions, including psoriasis, eczema/dermatitis and ichthyosis, where dry skin is a major symptom. In the UK 24% of people seek medical advice for skin conditions1 and 30% of people with mild and moderate skin conditions self-medicate1. 20% of children and 10% of adults have eczema, 2-3% have psoriasis and ichthyosis affects one in 250 people1. The incidence of these dry skin conditions is rising.
What causes skin complaints such as eczema and psoriasis?
Eczema and psoriasis are chronic skin conditions with no one cause. They are both inherited skin conditions, so the main cause is genetic. Eczema and psoriasis both have many trigger factors, which are responsible for the flaring of both conditions.
What is the difference between eczema and psoriasis?
Eczema and psoriasis are separate skin conditions, most people have either eczema or psoriasis but a small number of people have both. They are both skin conditions with defects in the immune system and skin barrier; but the immune pathways are different. Eczema affects the skin barrier (startum corneum), as the skin is not able to produce as many fats and oils which results in being less able to retain water. This means the skin, as a protective barrier, is compromised and gaps open up between the skin cells and moisture is lost through the skin from the deeper skin layers. This allows bacteria, irritants and allergens to pass through the skin, which irritates the skin and causes eczema to flare.
In psoriasis the stratum corneum is affected in an opposite way, it is thickened, as the skin replacement process speeds up, taking just a few days to replace skin cells that usually take 21-28 days. This accumulation of skin cells builds up to form raised ‘plaques’ on the skin, which can also be flaky, scaly, red on Caucasian skin, darker patches on darker skin tones.
Eczema and psoriasis can both affect any part of the body, classically eczema is seen on skin creases and psoriasis on outer parts of skin (i.e. elbows, knees, the scalp and lower back), both conditions are itchy.
What aggravates dry skin, eczema or psoriasis?
Common triggers for eczema may include: irritants on the skin including soap, detergent and fragrance; overheating; climate; inhalant allergies including house dust mite, tree/grass pollen. Common triggers for psoriasis may include: injury to the skin; some medications; infection; hormonal changes; and stress or anxiety.
Does the weather have an effect on eczema?
Yes, changes in climate and the weather are common triggers for people with eczema. Hot, sunny weather increases sweating, which can cause more irritation and itching. Cold weather with less humidity causes skin to become drier. Some people find their eczema is better in the summer months, but for others the sun can be a trigger. Moving between different temperatures, from the cold outside to a centrally-heated inside can also be a trigger.
Does age affect dry skin?
For people over the age of 60, dry skin develops as part of the ageing process. If it’s not manged, eczema can develop, especially if the individual has a history of atopic eczema2.
Does childhood eczema eventually go away?
Childhood eczema, also known as atopic eczema (or dermatitis) is very common in childhood – in the UK around 20 per cent of children under 11 years of age develop eczema. Eczema improves in about two-thirds of children but one-third will continue to have it – this is why it cannot be said that children will ‘grow out of eczema’ and it does not, for all ‘eventually go away’. Even if eczema gets better in childhood, it can return during the teenage years or adulthood, sometimes as a different type of eczema.
How should dry skin be managed?
Treating dry skin, generally with emollient skin creams, is key to the prevention and management of common skin conditions. If a dry skin condition flares, topical steroid creams and ointments, in varying strengths, are usually recommended for short-term use confined to the specific area of skin that requires treatment. Steroids are generally prescription-only in the UK and should not be used continuously, as long-term use may cause complications such as thinning skin. Accordingly, managing dry-skin optimally requires longer-term use of emollients, which can be bought online or from pharmacies and/or prescribed by health care professionals.
Can diet have a positive or a negative effect on skin conditions?
A healthy well balanced diet, with plenty of fresh fruit and vegetables and a good daily fluid intake will always have a positive effect on any skin condition. Diet is a huge topic and the public is always very keen for information on diet and skin conditions. Current research has not found a link between diet causing a negative effect on psoriasis, nor does any specific diet show a positive effect on psoriasis. Many parents and adults with eczema question whether food is the cause of eczema. It is true that food can cause allergies, although generally in children under 2 years, and less commonly in older children/adults, though not unheard of. It is important to keep bearing in mind that food is unlikely be the sole trigger for eczema. So the estimation is that approximately 10% of children with severe eczema have food as an aggravating factor, this would be a diagnosed food allergy. If an older child or adult with a skin condition is concerned that diet may be having a negative effect, it is best to keep a food diary for six weeks to try and identify any individual food triggers.
A baby who develops a food allergy will have immediate symptoms of worsening eczema after drinking milk or eating; other signs may include colic, diarrhoea and reflux. It is extremely important to discuss any dietary changes in children under 2 years with a health care professional and obtain a food allergy diagnosis and further help from a dietician.
Do people with eczema have to wear special clothes?
People with eczema have sensitive skin, which is easily irritated. It is recommended that natural fibers, such as viscose, cotton, bamboo and silk be worn next to the skin, rather than man-made fibers or wool. There are some special clothes for eczema, which can be purchased and, in the UK, in very severe cases may be prescribed. These include viscose and silk garments with in-built mittens and feet for babies and young children as well as a range of other garments. These clothes are also useful as a layer next to the skin under synthetic school uniform. Special clothing is also used to prevent damage from the itch-scratch-damage cycle.
Do children with eczema need different products/treatment to adults with eczema?
Essentially products and treatments for children and adults with eczema are the same. Everyone with eczema should use emollients and first-line treatments are topical steroids. The main difference is that the strength of topical steroid should be carefully matched to the age of the patient, severity of eczema and area of the body where the eczema is present. Therefore children are generally treated with mild and moderate topical steroids. There are no differences between emollients for adults and children. If eczema is severe, treatment will be prescribed and supervised by a dermatologist on an individual basis.
What more extreme treatments are there when moisturising alone doesn’t work?
Moisturising is an eczema treatment, which is ongoing and part of daily management to prevent dry skin. Eczema treatment refers to creams or ointments, which are used when eczema is red, sore and itchy – called an eczema flare. The first-line topical treatment for eczema, recommended in NICE and UK dermatology guidelines are topical steroids. These come in four different strengths, mild, moderate, potent and very potent, so are regular treatments apart from the very potent steroid, which may be described as a more extreme treatment. Other treatments, prescribed by dermatologists and generally for adults only (sometimes older children) are phototherapy, immunosuppressant drugs and, in the near future, biologic therapies.
Self-management with emollients
Can dry skin be self-managed?
Dry skin should be self-managed and treated to prevent skin conditions, such as eczema and psoriasis, or to reduce the symptoms of those conditions. Dry skin is a significant symptom, and is the main and constant symptom of eczema/dermatitis, psoriasis and ichthyosis.
What is the itch scratch cycle?
Dry skin is always itchy, which will then be scratched, which results in a flare (red skin) . Constant scratching leads to damage, broken skin, which becomes wet and weepy due to infection. This is known as the itch-scratch-damage-cycle – the first point at stopping this cycle from developing is to keep eczema well moisturised to prevent dry and itchy skin. This dry, flaky and scaly skin is unsightly, and the itch, discomfort plus embarrassment can lead to reduced self-confidence and affect quality of life for many people3.
What is an emollient?
Emollients are the first line therapy for preventing and treating dry skin. An emollient is a moisturising treatment applied directly to the skin to soothe and hydrate it. Emollients are either ‘leave-on emollients’ that come in a variety of formulations including lotions, creams, gel and ointments; or emollient wash products that act as soap substitutes4.
What happens when you don’t keep eczema moisturised?
People with eczema need to keep their skin well moisturised by using emollients at least twice a day. Emollients are used to treat eczema and a good skin care routine, using emollients for both washing and moisturising the skin, soothes, protects and repairs the skin barrier, which can also help reduce itch and eczema flares. If a person with eczema does not moisturise, their skin will be constantly dry and itchy, it could also crack and infection could become a complication. Dry skin is always itchy skin, which is scratched and then damaged, which results in an eczema flare.
How often should eczema sufferers moisturise?
People with eczema should moisturise their skin as often as necessary. As a general rule this for most people with be twice a day; but if the skin is very dry or eczema is sore and uncomfortable due to an eczema flare, several times a day may be necessary.
What differentiates the emollients?
Simple emollients leave an occlusive film on the skin, thereby reducing loss of water from the top layer of the skin (stratum corneum). A simple emollient, which is a cream or lotion, will have a short-lasting effect, so applications may be necessary every two or three hours to rehydrate the skin. Ointments will last longer, around six hours, but will be greasy and messy to use. Emollients like Ganodex, formulated with additional ingredients, provide occlusion and humectant properties, which are longer lasting and cosmetically acceptable.
How should an emollient be chosen?
There are many emollients available. People with dry skin should have the opportunity to make a choice of the most suitable emollient for their skin. This can be daunting and many local prescribing formularies often restrict choice for patients. If a person has information on the type of emollient to choose, they can make an informed choice on the best emollient for preventing and treating their dry skin.
What are the added ingredients for?
An emollient with added ingredients to address all symptoms of dry skin is a good choice. A humectant formulation will help hold water in the skin cells, and compensate for loss of natural moisturising factors seen in common skin conditions and older skin as well as occluding and preventing water loss from skin. Common humectant ingredients to look for in emollients include honey and glycerol, which are in Ganodex, and urea.
What are the beta glucans in Ganodex?
Some emollients contain additional ingredients, for example Ganodex contains beta glucans from Reishi mushrooms, a species that has been used in Chinese medicine for over 2000 years. The beta glucans stimulate immune cells in the skin and adjust the skin’s complex immune system. They can soothe and improve itchy, scaling and irritated skin caused by eczema and psoriasis.
Why chose Ganodex cosmetic skin cream?
Ganodex is an effective cosmetic cream with natural ingredients that is proven to provide relief from itchy, irritated, and scaly skin. Some customers describe the improved confidence as they bring out the best in their skin. Based on feedback and trial data over several years5, over 85% of Ganodex testers or users reported an improvement in their psoriasis, and an even higher proportion with their eczema. The cream is quickly absorbed, has a honey aroma, and is non-greasy after application.
- Schofield J, Grindlay D, Williams H. Skin Conditions in the UK: a Health Care Needs Assessment. Nottingham. Centre of Evidence‐Based Dermatology, University of Nottingham. 2009; 6: 85-88.
- Paul C, Maumus-Robert S, Mazereeuw-Hautier J, Guyen CN, Saudez X, Schmitt AM. Prevalence and risk factors for xerosis in the elderly: a cross-sectional epidemiological study in primary care. 2011;223(3):260-5
- 3 Moncrieff G, Cork M, Lawton S et al. use of emollients in dry-skin conditions: consensus statement. 2013. Clinical and Experimental Dermatology; 38(3):231-8.
- NHS Choices. Emollients. Available from: https://www.nhs.uk/conditions/emollients/ [accessed 26 Jan 2018]
- GlycaNova data on file (2013-2017) including dermatologist studies and TalkHealth 2017 reviews.