Dermatitis and psoriasis
Treatment for atopic dermatitis and psoriasis: controlling flare-ups, daily skin care and follow-up to space out relapses.
Two chronic conditions, two different treatments
Atopic dermatitis is skin that doesn't hold onto water well and becomes inflamed easily: it itches a lot, turns red and flakes, and usually comes in flare-ups from childhood. Psoriasis is an inflammatory condition in which the skin renews itself too quickly, forming thickened plaques with whitish scale, mainly on the elbows, knees, scalp and lower back.
They're alike in that neither «cures» overnight and both can be well controlled. They're nothing alike in treatment, which is why the first step is working out which one it is.
When to book an appointment
- Itching that interrupts sleep or is already affecting your day.
- Plaques that don't respond to moisturiser, or that always come back in the same place.
- Flare-ups that are becoming more frequent or widespread.
- Lesions on the face, hands or genitals, which need specific treatments.
- Psoriasis with joint pain or swelling: worth assessing.
- Thickened or pitted nails alongside skin lesions.
How we treat it
The plan combines treating the flare-up â topical steroids and other anti-inflammatory skin treatments, and systemic treatment in cases that need it â with maintenance care, which is what really spaces out relapses: daily emollients, suitable soaps, avoiding triggers you already know about. At the appointment you're shown how much to use and for how long, which is where treatments most often fall short.
Follow-up
Reviews are used to adjust treatment: lowering the strength as the skin improves, raising it during a flare-up, and catching in time whether the case needs the next step up. And if something you're in contact with is suspected of keeping the eczema going, a workup is considered with allergy.
Frequently asked questions
Can atopic dermatitis and psoriasis be cured?
They are chronic conditions, so they are not cured in one go, but they are well controlled. The aim is twofold: to settle the flare-up when it appears and to space out relapses with maintenance care. Many people go from having continuous flare-ups to long spells without symptoms.
Are steroid creams dangerous?
Used as directed, no. Problems come from two extremes: applying them for months without supervision or being so afraid of them that they are used at insufficient doses and the flare-up never settles. In the consultation you are told which strength, how much and for how many days.
Is any special diet needed?
There is no diet that cures dermatitis or psoriasis. Cutting out foods on your own usually impoverishes your diet without improving the skin. What does have an influence is daily care with emollients, the right soap, stress and, in psoriasis, tobacco and alcohol.
What is psoriasis and why does it appear?
It is a chronic inflammatory disease in which the skin renews itself too quickly and forms thickened, scaly plaques. There is a genetic predisposition, and flare-ups are triggered by stress, infections, certain medicines, tobacco or alcohol. It is not contagious and it is not caused by poor hygiene.
How can you tell if you have psoriasis?
By well-defined reddish plaques with silvery-white scale, typically on the elbows, knees, scalp and lower back, which may itch. Also by pitted or thickened nails. It is confused with eczema or fungal infections, so the diagnosis is made by the dermatologist on examination and, if necessary, with a biopsy.