The skin Part 2

1. The skinPart 2 24th June 2013 Dr BK Sinha

2. The Average human body is covered by 1. 5 square feet of skin 2. 10 square feet of skin 3. 15 square feet of skin 4. 20 square feet of skin

3. What causes itching? • Itch bugs • Itch bodies • Itch receptors • Itch aliens

4. Eczema • = Dermatitis • From the Greek origin meaning – To Boil Over

5. So what does it cause? • Itch • Dry skin • Red inflamed skin • Sometimes weeping • Sometimes infection

6. Atopic dermatitis • Affects children • Face, back of knees, • Front of elbows • Irritable and unhappy children

7. Dry eczema • Affects older people • Very dry itchy and red skin • May be all over

8. Contact Dermatitis • Can be related to irritation from chemicals, detergents,etc • May be allergic

9. ‘Blebs’ on hands and feet Clear fluid when burst Pompholyx • Vesicular Eczema

10. Tests? • None usually needed • Occasionally Allergy testing • Patch tests for contact dermatitis

11. Treatment • Main problem is dryness • Main treatment is – • MOISTURISE

12. MOISTURISE • Creams or ointments as emollients • Bath oils • Shower gel or soap substitutes • Smooth into the skin along the line of hair growth, rather than rubbing in

13. MOISTURISE • The greasier the ‘cream’ the better it works, but the messier it is • Ointments better for dry skin • Use within 3 minutes of bath or shower • Use as often as needed • Lotions not as effective but less messy • Can use lotions daytime and cream or ointment at night

14. Additional treatment • Treat inflammation • Main treatment - Steroid creams or ointments • Use most effective preparation for shortest time possible • Perfectly safe as long as some breaks taken • Generally mild for face, moderately strong for trunk and very strong for palms and soles

15. How many ‘Finger tips’? • Both sides of one hand = One fingertip unit • One foot = Two fingertip units • One arm = Three fingertip units • One leg = Six fingertip units • Chest and abdomen = Seven fingertip units • Back and Buttocks = Seven fingertip units

16. Other Treatments for Eczema • Anti histamine tablets for itching • Sometimes steroid tablets but only short term • Creams which work on the immune system, e.g., Tacrolimus to avoid side effects from continuous use of steroid creams • Occasionally tablets

17. A case on an itchy foot • Been itchy for many months • Tried some creams but no better

18. Ring worm • Very common • 10-20 % • Treated with creams • If widespread, an antibiotic tablet works better

19. Scabies • Itchy+++ • Especially at night

20. Treatment of scabies • Cream all over below neck • All contacts • Wash all bedding at high setting • Rarely tablets

21. Problems with Sun Exposure • Sunburn • Long term skin damage and ageing • Link to some forms of skin cancer

22. But We need the Sun! • Lowers blood pressure and that could lower risk of stroke and heart attacks • May reduce risk of dementia • Main source of Vitamin D • Vitamin D needed for • Healthy bones • Healthy teeth • May be Anti-Cancer

23. The Vitamin D story

24. Extent of the Problem • 65% don’t get enough vitamin D • In the winter and spring 1 in 6 people has a severe deficiency • Lack of sun exposure linked to various cancers, diabetes and MS.

25. Responsible Sun Exposure • Short daily periods of sun exposure without sunscreen during April to October • About 10 to 15 minutes • Less than the time it takes to start going red or to burn

26. What else can we do? • Eat more oily fish such as salmon and mackerel • Consider daily supplement – containing 10 mcg of Vitamin D

27. Key Messages • If you have an itch, it could be anything from eczema to scabies • The main treatment for eczema is to Moisturise the skin liberally and to use steroid creams sparingly • Ringworm is common and treated with creams • Scabies is commoner than one would think • We can enjoy the Sun – but Responsibly!