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The treatment helps block the chemicals that lead to the immune response. This new treatment has transformed the lives of patients with severe psoriasis in the past decade, says Professor Griffiths. The injections are administered by the patient — just as someone with diabetes injects insulin — once a week or once every 12 weeks, depending on the type of treatment. Four different biological therapies have been approved by the national Institute for health and Care Excellence (nice) and, according to Professor Williams, one more which promises to be even more effective is due for approval within 12 months. Thirty years ago these patients would have been having significant amounts of puva, spending time in hospital and increasing their skin cancer risk — but now we can give them back normal lives, says Professor Griffiths. The drugs are, however, expensive, so dermatologists use them only as a last resort, and come with the possibilities of side-effects such as increased risk of infection, rashes and, in very rare cases, neurological symptoms (such as seizures and inflammation of the nerves of the. Another ground-breaking treatment, a new once-a-day tablet called apremilast, could become available in the uk in the next year. It works by inhibiting an enzyme in immune cells, causing an anti-inflammatory effect.
They are still used today in some centres alongside a treatment called puva, which combines light therapy with psoralen tablets (psoralens are synthetic versions of compounds found in plants that increase the skins sensitivity to uv light). This triggers a chemical reaction that slows down the production of skin cells. But coal tar can be unpleasant to use (it is smelly and can be messy) and puva has been linked with skin cancer. When puva was introduced 40 years ago, the risks hadnt been determined and though it was highly effective, people used it too often, says Professor Griffiths. It engels not only products increased wrinkles and brown spots but also the incidence of skin cancer. Puva is still offered on the nhs but treatments are limited to one a year.
Instead, specialists increasingly favour uv treatment (see laser box) which has a lower risk of skin cancer. Mild cases of psoriasis can now be treated using gels containing vitamin d — which slows the over-active build-up of the top layer of skin — combined with a corticosteroid, which can dampen down the immune response. And for severe cases — particularly where patients also have psoriatic arthritis — regular treatment with new biologic injections can make a significant difference. Moisturiser that makes skin worse, for decades, its been routinely recommended and prescribed by gps as a gentle moisturiser, but using aqueous cream in this way can make skin conditions worse. One study found that 56 per cent of children developed an irritant reaction to it, while many complained that it made their skin sting. There is also some evidence to show it might dry out the skin barrier further, says dermatologist Professor Hywel Williams. It is great as a wash product, but it shouldnt be used as a moisturiser, as it cannot repair your skin.
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Soap is too harsh for eczema sufferers, he says, and avoid any skincare products containing preservatives or washes containing sodium laurel sulphate, which can irritate eczema. Instead, a simple emulsifying ointment from the chemist can be mixed with water as a cream soap and used as a direct application cream, he suggests. Or try dermol Shower Emollient,.65. The experts favourite products: Try avene xeraCalm ad (a range of creams, cleansing oils and lotions for varying degrees of dryness which contains compounds that can help restore the skins barrier from.50 to 35, suggests Dr Anthony bewley, consultant dermatologist at Barts and the. Aveeno moisturising cream,.93, contains oatmeal, which is anti-itch and helps restore the skin barrier, says Dr Nick lowe, a dermatologist and former senior lecturer at University college londons school of medicine. Towie star Jess Wright suffers from psoriasis.
Psoriasis, this skin condition — characterised by raised flaking, itching red patches on various parts of the body — affects around.8 million people in Britain, most of them first affected before their 40th birthday. It is an immune condition that causes the body to produce too many new skin cells. The extra cells accumulate and cluster in red, inflamed patches, thickening the skin, which often has a silvery scale appearance. A virus or infection such as tonsillitis — when the immune system is weakened — can trigger the condition in those with a genetic predisposition, as can a stressful event, says Christopher Griffiths, professor of dermatology at the University of Manchester and a world expert. Around 30 per cent of people with psoriasis get painful joints — sometimes the joint pain comes before the skin condition appears — because the immune system targets the joints, triggering psoriatic arthritis. The old and trusted methods of treating psoriasis are fast falling out of favour and there is new hope on the horizon in the form of a powerful injection and, in a years time, a once-a-day tablet that could halt symptoms in their tracks. For the past 100 years products containing coal tar, a thick, heavy oil with a strong smell have been used for psoriasis.
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However, the rogue genes might never be switched on until the person is exposed to specific environmental triggers, such as low temperatures or low humidity, which dry the skin to the point that brings on eczema. The latest thinking in eczema treatment focuses on protecting the skin barrier first with emollients (moisturising oils, creams and ointments) and then dampening down the immune system (with steroid creams) when red, itchy skin inflammation occurs. However, continuous and over-use of steroid creams can cause skin-thinning — the steroid appears to reduce the production of collagen, a protein that helps supports the top levels of skin. So professor Williams advises judicious use: Once the initial attack phase is under control, we often put people on weekend therapy, using opleiding the creams only on a saturday and Sunday night, he says. This rarely causes skin-thinning and dramatically reduces the number of flare-ups. Specialists are excited by newer topical anti-inflammatory afvallen ointments, called tacrolimus or pimecrolimus, which can be prescribed by your gp and which wont cause skin-thinning. Although Professor Williams says its too early to know if they are safe long term, evidence shows they seem to be highly effective. In extreme cases light therapy (see next page) can help.
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When skin is inflamed it is a sign that inflammatory cells have gathered beneath its surface, explains Dr joanna gach, consultant dermatologist at bmi meriden in coventry and University hospital coventry. These cells stimulate the release histamine - a natural chemical the body produces in response to an allergen which causes the itching. Scratching produces more inflammation, more histamine and more itch. She recommends trying a non-soap cleanser such as Dermol 500 (11.94 from Lloyds pharmacy) and frequent use of preservative and fragrance free emollient creams such as E45 cream, aveeno, cetraben or Olaten (see products below). Never ignore itching skin, warns Dr Gach. In extreme cases it could be a sign of iron deficiency, diabetes, thyroid, kidney or liver disease so always see your gp if the itching persists. Itching can also be caused by a fungal infection - characterised by a flaky round and itchy wound - which can be treated with remedies oral anti-fungal agents. Hives - a raised itchy rash which may be triggered by allergy to insect bites, medications or general anaesthetics or an infection can be treated with antihistamines (in higher doses than those taken for hay fever).
The usual cause is an inherited gene that leads to a deficiency in a protein thats supposed to keep the skin moist and act as its barrier, explains Professor Hywel Williams, director of the centre for evidence-based Dermatology at the University of Nottingham. This deficiency means the skin dries out, becomes itchy and inflamed and — if scratched — red and sore. Other inherited genes can trigger the body to mount an abnormal immune response in the skin to allergens such as house mites or even certain foods. Very often eczema sufferers have to endure a combination of the two: the deficient skin barrier and an abnormal response to allergens. Don't scratch that itch, it'll prolong the agony. Scratching produces more inflammation so must be avoided, doctors warn. While rituals scratching that itch may feel fantastic, it can very often prolong the problem.
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Redness, rashes, bumps and break-outs can be at best embarrassing, and at worst really quite debilitating. But brilliant developments in doctors understanding of how to prevent and treat skin conditions means the outlook for patients is looking much brighter. In verlamd this, the final part of our unique how to beat series, we have worked closely with experts in each field of dermatology to bring you cutting-edge information about your complaint and the newest treatments available. . It could be life-transforming. Scroll down for video, brilliant developments in doctors understanding of how to prevent and treat skin conditions means the outlook for patients is looking much brighter. Eczema, dermatitis (or eczema) affects one in ten adults and one in five children, causing patches of dry, scaly, red and itchy skin. In some cases, an unknown allergy to substances such as perfumes, creams, hair dyes or nickel jewellery can be enough to prompt the body to mount a defence, triggering an inflammatory reaction in the skin. But most eczema is atopic eczema, an inherited condition that is linked to other sensitivities such as hay fever and asthma. The distinctive, red, itchy patches of skin are a sign that your immune system has over-reacted to harmless allergens and has triggered the inflammatory process in its defence.