Transcript The skin Part 2

The skin
Part 2
24th June 2013
Dr BK Sinha
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
What causes itching?
1. Itch bugs
2. Itch bodies
3. Itch receptors
4. Itch aliens
Eczema
• = Dermatitis
• From the Greek origin meaning –
To Boil Over
So what does it cause?
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Itch
Dry skin
Red inflamed skin
Sometimes weeping
Sometimes infection
Atopic dermatitis
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Affects children
Face, back of knees,
Front of elbows
Irritable and unhappy children
Dry eczema
• Affects older people
• Very dry itchy and red skin
• May be all over
Contact Dermatitis
• Can be related to irritation from
chemicals, detergents,etc
• May be allergic
Pompholyx
• ‘Blebs’
on Eczema
• Vesicular
hands and
feet
• Clear fluid
when burst
Tests?
• None usually needed
• Occasionally Allergy testing
• Patch tests for contact
dermatitis
Treatment
• Main problem is dryness
• Main treatment is –
–MOISTURISE
MOISTURISE
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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
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
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
How many ‘Finger tips’?
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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
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
A case on an itchy foot
• Been itchy for many months
• Tried some creams but no better
Ring worm
• Very common
• 10-20 %
• Treated with creams
• If widespread, an antibiotic tablet works better
Scabies
• Itchy+++
• Especially at night
Treatment of scabies
• Cream all over below neck
• All contacts
• Wash all bedding at high setting
• Rarely tablets
Problems with Sun Exposure
• Sunburn
• Long term skin damage and
ageing
• Link to some forms of skin cancer
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
The Vitamin D story
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.
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
What else can we do?
• Eat more oily fish such as salmon and
mackerel
• Consider daily supplement – containing 10
mcg of Vitamin D
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!