Eczema Holistic Treatment

Eczema Free Forever Ebook

Rachel Anderson has written an educational ebook that allows readers to not only be extremely informed about the type of eczema they are experiencing, but also shows them simple straight forward steps that can be taken to promote an overall healthier life. Eczema Free Forever is an instantly downloadable eBook in PDF format and it guarantees to cure eczema whether it is mild or severe. Eczema Free Forever is an 80-page guide and it has 7 chapters. The effectiveness of the methods offered in Anderson's book can depend on the determination of the individual. If a choice is made to create a overall healthy lifestyle those readers would have a far greater likelihood of experiencing the sought after results. Read more...

Eczema Free Forever Summary

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4.8 stars out of 22 votes

Contents: 80-page EBook
Author: Rachel Anderson
Official Website: www.eczemafreeyou.com
Price: $29.97

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My Eczema Free Forever Review

Highly Recommended

All of the information that the author discovered has been compiled into a downloadable book so that purchasers of Eczema Free Forever can begin putting the methods it teaches to use as soon as possible.

As a whole, this book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Eczema Vanished

This product was created by Hayley Harragan who is a food and skin dermatologist. She started following the natural ways of treating several health conditions. She was a victim of a flare up skin which motivated her to start looking for natural treatments for the same condition. During this time, she started to research comprehensively about natural home remedies of some skin conditions and she finally got the answer. With time, she ended up getting a life resolution to eczema. This product is a complete multimedia program with all the tricks and tips that can greatly help you combat this condition. The author herself and her son were victims. Since the product has already worked for the creators, am sure it can help you too. She also included her experiences with Eczema on another work known as 'Eczema Free Forever''. With all the tips and tricks shared, you can trust the product to help you deal with eczema. Read more...

Eczema Vanished Summary

Contents: Ebook
Author: Hayley Harragan
Price: $37.00

Atopic eczema

The psychosocial stressors implicated in atopic dermatitis are summarised in Table 2.3. Table 2.3. Psychosocial stress in atopic eczema Atopic dermatitis has been considered a prime example of a Th2 disease mechanism. In atopic dermatitis the presentation of immunoglobulin E (IgE) antigen appears to be one of the fundamental mechanisms intrinsic to the disease. IgE-allergen complex presentation by cutaneous Langerhans cells to circulating and tissue T-cells continue the response, which, in atopy, consists mainly of Th2 cells. There is an increased ratio of Th2 to Th1 cells in atopy leading to the increase in humoral immunity via cytokine IL-4. This induces IgE-producing B-cells and enhanced eosinophil activity via cytokine IL-5 (Leung, 2000 Blauvelt et al., 2003). The induction and maintainance of eosinophils in atopic skin is maintained by Th2 cytokines. These are instrumental in the production of additional chemokines which play a further role in recruiting immune cells to skin....

Evening Primrose

In Germany and the United Kingdom, evening primrose oil is approved for treatment of atopic eczema (4,13). Many other indications have been claimed but remain poorly backed up by clinical studies or controversial results. Therefore, evening primrose oil is usually considered a food supplement in most countries.

Management and Treatment

Removal ofthe tick can be carried out by applying a tight dressing or cloth impregnated with chloroform, petrol, or ether to the tick body. The organism is carefully removed a few minutes later, avoiding the rupture of head and mouth-parts, which can be left behind, into the skin. A careful follow-up and self-surveillance is indicated as systemic illness may start a few days or weeks following the tick bite. Symptoms such as a fever, skin rash, lymph node enlargement, fatigue, and night sweats indicate systemic disease and the patient requires referral to a hospital physician or to a specialist in tropical or travel medicine.

Seaborne Waterborne Conditions

Holiday-makers in tropical seawaters present to local doctors following contact with or traumatic skin injury from jelly fish, coral reefs, anemones, sea-urchins, and venomous fish. A variety of acute clinical pictures manifest as contact eczema, stings, burns, as well as penetrating injuries, whereas vasoactive phenomena represent the common pathogenic mechanism in direct skin poisoning. The returning traveller commonly has postinflammatory lesions characterised by hyperpigmentation and scarring. Chronic eczematous reactions and secondary bacterial infections require specific treatment.

How might stigmatisation be reduced

One approach is to reduce the visibility of a stigmatising mark. There is good evidence that cosmetic surgery (Sarwer et al., 1998) and cosmetic prostheses can help people feel better about themselves and their appearance. With respect to skin conditions, skin camouflage creams can be used to disguise skin blemishes such as scars and vitiligo. Kent (2002) found that clients who consulted the British Red Cross Skin Camouflage Service felt more confident in and exhibited less avoidance of social situations after their appointment than before. Although there was no measure of enacted or felt stigma in that study, qualitative comments indicated that clients were less preoccupied by how others would react to them. Laser treatment can also be helpful for those with port wine stains (Troilius et al., 1998), as is medical treatment for a variety of skin conditions including acne and eczema (Kurwa & Finlay, 1995 Kellett & Gawkrodger, 1999).

Helminthic infections

Ankylostoma duodenale (unlike Necator americanus) may also be contracted by the faeco-oral route. The hookworms of cats and dogs, Ankylostoma braziliense and A. caninum, fail to achieve full maturity in humans but may cause a serpiginous skin rash -cutaneous larva migrans.

Changes in social networks

For some couples, skin disease brings new responsibilities into a relationship and this may be taxing if traditional gender roles become unbalanced (Danoff-Burg & Revenson, 2000). For example, in one affected couple, a wife had to seek employment when her husband was unable to continue his job at a dry cleaner because the steam and chemicals aggravated his eczema. Functional limitations may also lead to changes in a couple's leisure activities for instance, patients with psoriasis receiving psoralen plus ultraviolet light (PUVA) treatment often sacrifice holidays in the sun. If, for the sake of the relationship, partners also forgo valued activities, they too are in danger of becoming isolated through their own loss of freedom. Firstly, by missing out on social interactions that were previously shared and

Cognitivebehavioural therapy

CBT focuses on examining and trying to challenge dysfunctional beliefs and appraisals, which may be implicated in a person's low mood or avoidance of certain situations or behaviours. Consequently, targeting cognitions and maladaptive behaviour are the key areas of CBT interventions for facilitating change. According to this approach, beliefs are considered as hypotheses to be tested rather than assertions to be uncritically accepted. Therapist and client take the role of'investigators' and develop ways to test beliefs, such as 'Others do not like me because of my eczema' or 'I won't be happy anymore because of my vitiligo'. Success at challenging these beliefs involves providing evidence that they are erroneous, and underscored by anxiety and depression (Beck, 1993). CBT has been successfully applied to various skin conditions. For example, Horne et al. (1989) used cognitive-behavioural therapy along with standard medical treatment in treating three patients suffering with atopic...

Psychoanalytic psychotherapy and hypnosis

Patients with urticaria or eczema) are not yet aware of a psychogenic factor in their dermatosis. There are case reports in the literature where the use of psychoanalytic psychotherapy led to marked improvements in skin conditions (Van Moffaert, 1992). Early researchers in psychodermatology experimented with the use of hypnosis (Van Moffaert, 1992). Hypnosis brings about changes in physiological parameters, such as skin conductance, skin temperature and vasomotor reactions all of which can be decisive in the aetiology of skin diseases (Van Moffaert, 1992). Neurodermatitis, chronic urticaria and viral warts are skin diseases with which hypnosis has been successfully used (Barber, 1978).

Validation techniques

Construct validity is determined by examining correlation between QoL scores and demographic factors, and other measures used in parallel. Establishing correlation with other existing methods is possible where obvious comparators exist, for example a new disease-specific measure can be compared in the same population with a wider dermatology-specific measure that is likely to encompass many of the concepts of the new measure. It is less easy where an entirely new aspect of QoL is being established, for example when a method for measuring the family impact of atopic dermatitis in children was first proposed (Lawson et al., 1998).

Epidemiology national surveys

Patients with ichthyosis in Sweden (Ganemo et al., 2004), significant differences of QoL scores were seen between major ichthyosis types. QoL measures can be used sequentially in long-term studies to assess the longer-term impact of disease, as illustrated by the recent study in Australia (Jenner et al., 2004). Patients with atopic dermatitis were assessed in a 1-year prospective study this study highlighted substantial financial and other effects on patients.

Differential Diagnosis of Spongiotic Dermatitis in a Child

A 5-wk-old boy was seen in the dermatology clinic with a diffuse erythematous, scaly eruption that was most extensive on his face, neck and scalp. It was not noticed at birth, but appeared within the first week of life and continued to progress. The clinical differential diagnosis included atopic dermatitis, seborrheic dermatitis, and Langerhans cell histiocytosis. The histologic sections prepared from the biopsy specimen are demonstrated in Fig. 15A,B. The histologic differential diagnosis of a spongiotic process with intraepidermal hematopoietic cells was similar to the clinical differential diagnosis, and included Langerhans cell histocytosis, seborrheic dermatitis, and atopic dermatitis in this patient population. Other entities such as Gianotti-Crosti syndrome and mycosis fungoides were easily eliminated based upon clinical presentation and disease history. A strategic table was developed as is seen in Table 8. The diagnostic stains are depicted in Fig. 16A,B. It is important to...

Vignette K Differential Diagnosis of Mycosis Fungoides

A 72-yr-old man presented to the dermatology clinic with a known 5-yr history of erythematous patches on his proximal trunk and extremities. The patches initially responded to topical steroids, but more recently persisted even with treatment. The differential diagnosis included contact dermatitis, mycosis fungoides, and a drug eruption. Several punch biopsies were performed and are demonstrated in Fig. 21A,B.

The impact of skin disease on the motherchild relationship

In addition, physical contact between a mother and her baby are very important for the developing relationship. If the baby or child has a skin condition which is painful or uncomfortable this may have an impact on the quality of physical contact between the mother and child (Koblenzer, 1990). In some cases, if the treatment requires a lot of skin contact, for example, applying moisturisers or other topical medication, or if the child requires a lot of physical contact to soothe them and reduce their discomfort, this can result in additional physical contact between mother and child, although the quality of this contact may still be affected if the child is uncomfortable and finds the treatment procedures unpleasant. Bick (1986), described the psychoanalytic treatment of a child with eczema and emphasised the importance of the mother's ability to 'contain' the child's discomfort and drew a parallel between this and the mother's role in managing a young infant's behaviour. There are...

Postoperative Wound Care

Laser Wound Healing

As noted before, interpretation of adverse events when continuous wave lasers were employed for cutaneous laser surgery and epidermal necrosis ensued became obscured by the fact that scarring was underreported or redefined and postoperative care was not standardized, not mentioned in the literature or in lectures, and sometimes not given. Second-degree thermal wounds all scar and it is likely that the absence of postoperative dressings over the necrotic wound in early argon laser surgery was responsible for much of the incidence of hypertrophic scars. With proper postoperative dressings and antibacterial ointment the incidence of such scarring dropped to less than 1 (75,77) from a range of 3-16 or more (60,68,71,73,74,178,214,215) (Figs. 1.11 and 1.17). Brauner and Schliftman were early proponents of scrupulous postoperative wound care. Unfortunately, there was an accompanying and unexpected large incidence of contact dermatitis to bacitracin with large areas of coverage (216-218)....

Shwachman Diamond syndrome Clinical features

Shwachman and Bodian and their colleagues first reported this disease independently in 1964. It is now recognized as an autosomal recessive disorder characterized by exocrine pancreatic insufficiency (100 ), bone marrow dysfunction (100 ) and other somatic abnormalities (particularly involving the skeletal system). Signs of pancreatic insufficiency (malabsorption, failure to thrive) are apparent early in infancy (note that the pancreatic function can improve in a subset of Shwachman-Diamond syndrome (SDS) patients by 4 years of age). Other common somatic abnormalities include short stature ( 70 ), protuberant abdomen and an ichthyotic skin rash ( 60 ). Metaphyseal dysostosis is seen on radiographs in 75 of patients. Other abnormalities include hepatomegaly, rib thoracic cage abnormalities, hypertelorism, syndactyly, cleft palate, dental dysplasia, ptosis and skin pigmentation.

Combined immunodeficiency

A number of rare inherited defects significantly compromise both humoral and cellular immunity but do not usually lead to early death from severe infection (Table 22.1). These include defects in CD40 ligand (HIM-1), ataxia telangiectasia (AT) and other defects in DNA repair systems, and the Wiskott-Aldrich syndrome (WAS). A predisposition to cancer, particularly lymphoma, occurs in many of these syndromes. In WAS, the clinical features range from thrombocytopenia alone to a severe disease characterized by recurrent infection, severe eczema and B-cell lymphoma at an early age. Patients with ataxia telangiectasia usually die before the third decade from progressive ataxia and or tumours, often compounded by recurrent infections due to an associated antibody deficiency. The mutated gene (ATM) is involved in cell cycle regulation and also appears to be a tumour suppressor, as it is frequently deleted in prolymphocytic and chronic lymphocytic leukaemia (CLL) cells. Another gene involved in...

Stress and dermatology

As far back as the 19th century, Hillier (1865), in working with eczema, implicated mental excitement, nervous debility and anxiety as the cause of these skin diseases. In 1982, Teshima and colleagues found that emotional stress had the capacity to influence the immune system to a great extent and that this would often manifest in cutaneous illness. They found that the tension in patients could lead to an enhancement of allergic reactions and these allergic patients were shown to improve with relaxation and autogenic training. There were also speculative implications for skin disease with the finding that the function of T-cells and the phagocytosis of macrophages were suppressed by induced stress. Furthermore, evidence of the strong relationship between the skin and the central nervous system (CNS) has been demonstrated by Ortonne and colleagues (1983) who noted that innervation of the CNS often produced blushing, perspiration and pallor.

Obsessivecompulsive disorder

OCD (American Psychiatric Association, 1994) is characterised by recurrent obsessions or compulsions severe enough to be time consuming or cause marked distress or significant impairment. OCD is an anxiety disorder, and some of the compulsive behaviours of OCD may in fact further exacerbate skin disorders that are associated with or exacerbated by anxiety such as atopic dermatitis. Some of the compulsions involve repetitive behaviours such as hand washing, hair plucking, trichotillomania, onychophagia, picking of a minor irregularity in the skin or lesions on the skin and repetitive bathing or scratching (Hatch et al., 1992 Stein & Hollander, 1992 Monti et al., 1998 Calikusu et al., 2003). The patient with OCD feels driven to perform in response to an obsession which, if resisted, produces anxiety. The compulsive scratching of OCD may exacerbate a primary skin disorder such as psoriasis, eczema and other pruritic conditions, or cause flare-ups of acne as in acne excoriee. OCD...

Psychosocial impact of skin diseases

As well as affecting psychosocial functioning, negative psychosocial experiences may also affect the onset and progression of cutaneous conditions. Clinical observations have suggested that stress often precedes the onset or exacerbation of many dermatological conditions that share both psychosomatic and immunological components, such as vitiligo, psoriasis and atopic dermatitis (Koblenzer, 1983 Al-Abadie et al., 1994). For example, emotional distress and stressful life events have been suggested as contributory factors in the onset of vitiligo (Papadopoulos et al., 1998).

Sunrelated Skin Diseases And Cancer

Appearance Kaposi Sarcoma

Many dermatoses may be provoked by exposure to ultraviolet (UV) radiation and they may be acute or chronic. In addition, a number of other dermatoses may be exacerbated by exposure to sunlight these include acne, atopic eczema, dermatomyositis, erythema multiforme, herpes simplex, Darier disease, lichen planus, autoimmune blistering disorders, psoriasis, rosacea, and seborrhoeic dermatitis. Some of the more common problems included in this section are presented in Table 9.4.

The impact of skin conditions on selfesteem

All schools should have anti-bullying policies in place and should have plans to help reduce bullying in school. However, there is considerable variation in how well these are implemented and how proactive schools are in promoting and managing differences within the school. There are some excellent training packages available for teachers from organisations, such as Kidscape, as well as Changing Faces and the National Eczema Society.

The impact of skin disease on the psychological wellbeing of the child and family

There are a large number of studies that have shown that any form of physical illness during childhood increases the risk of psychological difficulties for the child (Lavigne & Faier-Routman, 1992 Wallander & Varni, 1998). There is also evidence from a few studies about the specific impact of a skin disorder on childhood psychological problems. For example, Absolon et al. (1997) found that children with eczema had higher rates of behavioural problems than healthy children. Rates of psychological difficulties are even higher among young people with acne and up to a half of 12-20-year olds with acne have been shown to have psychological or social problems (Smithard et al., 2001). There are now several measures of quality of life for skin conditions that have been developed specifically for children and which help us to access the child's view of the impact of a skin condition on themselves. For example, the Children's Dermatology Life Quality Index (Lewis-Jones & Finlay, 1995)...

Clinical Findings and Diagnosis

Granuloma Annulare The Scalp

Figure 9.18 Tinea corporis in a traveller with atopic eczema. Erythematous polycyclic plaques from fungal infection and hy-popigmented patches on eczematous skin Figure 9.18 Tinea corporis in a traveller with atopic eczema. Erythematous polycyclic plaques from fungal infection and hy-popigmented patches on eczematous skin malleolar regions. Toe-web involvement is commonly bilateral, presenting with erythema, a burning sensation, pruritus and scaling, particularly of the fourth interdigital toe web space. Severe acute forms present with painful erythema and blistering in a similar pattern to that found in cases of acute eczema or pompholix. Patients with a history of atopy are predisposed to superficial infections by dermatophytes, and in these cases erythematous inflammatory fungal lesions coexist with patches of ecze-matous skin (Figure 9.18). Chronic plantar lesions develop asymptomatic large hyperkeratotic plaques and a particular form of toenail infection by T.rubrum manifests...

Difficulties in communication

Secure Attachment Style 'As far as relationships go, my personal opinion is that my partner would have to be comfortable with my skin because it plays such a huge part in my life. Also, being honest and open about things at the beginning of a relationship avoids any embarrassing and nasty surprises further on down the line. I don't expect non-eczema suffers to understand completely the emotions I experience, but I would like them to be a bit compassionate about my condition, especially if I'm going to have a long-term relationship with them' (Female eczema patient).

Major depressive disorder

Depression is encountered in a wide range of other dermatological disorders (Panconesi, 1984 Gupta & Gupta, 1996 Woodruff et al., 1997 Picardi et al., 2000 Gupta & Gupta, 2003 Picardi et al., 2004 Sampogna et al., 2004). Depression may modulate pruritus perception in other pruritic skin disorders such as atopic dermatitis and chronic idiopathic urticaria in addition to psoriasis (Gupta et al., 1994). Higher anxiety and depressive symptoms (Ullman et al., 1977 Hashiro & Okumura, 1998 Kiebert et al., 2002 Zachariae et al., 2004) have been reported in patients with atopic dermatitis. The anxiety may be the feature of an underlying depressive illness in some of these patients. Chronic intractable eczema during childhood may be a sign of a disturbed parent child relationship (Koblenzer & Koblenzer, 1988) however, a major depressive disorder should be ruled out before a disturbance in the family dynamics is implicated (Allen, 1989). Chronic idiopathic urticaria has been...

Potassium Iodide KI Prophylaxis

Additionally, a number of non-thyroidal side effects of iodine have to be mentioned. These may be gastrointestinal (stomach pain, nausea, vomiting, and diarrhea), allergy related (angioedema, arthralgia, eosinophilia, lym-phadenopathy, urticaria), or skin rashes. However, such non-thyroidal side effects are very rare. Extremely rare disorders reported to be caused by excess iodine ingestion include dermatitis herpetiformis (Duhring's disease), iodo-derma tuberosum, and hypocomplementemic vasculitis and myotonia congenita 1 .

Psychological approaches to treatment for dermatological conditions

Increasingly then, within the dermatological literature, attention was given to the therapeutic benefits that might derive from psychological interventions beyond those of standard medical care. Given the close and clear associations between psychological factors and cutaneous conditions, it is not surprising that the effects of such treatment have been investigated. The literature has documented psychological interventions for a number of cutaneous conditions, such as vitiligo, psoriasis, acne and atopic dermatitis, which have been suggested to be as effective for each of these types of disorders as classical medical procedures (Van Moffaert, 1992 Papadopoulos & Bor, 1999). For example, in their review of psychological therapies for the treatment of psoriasis, Winchell and Watts (1998) describe a case in which two psychiatric patients with psoriasis were given a suggestion that imipramine would have beneficial effects on their skin condition. Following this suggestion one of the...

Development of QoL research in dermatology

A 21-question format was suggested in 1970 to record, in a standard way, the impact of skin disease on QoL (Whitmore, 1970). Other suggestions concerning criteria for assessing the impact of permanent skin impairment (Committee, 1970) and systems for wider assessment of disability (Robinson, 1973) were also proposed. The first dermatology disease-specific instrument, the Psoriasis Disability Index (PDI) (Finlay & Kelly, 1985 Kelly & Finlay, 1987) was initially used to assess the impact of hospital admission on disability in patients with psoriasis and has subsequently been used widely (Lewis & Finlay, 2004). The use of validated, standardised general health measures in dermatology, such as the UK Sickness Impact Profile (Finlay et al., 1990) and the Short Form-36 (SF-36) (Nichol et al., 1996) followed in the early 1990s. Several dermatology disease-specific QoL measures for use in acne, psoriasis, atopic dermatitis, alopecia, leg ulcers and others were described during the...

Chemical and physical agents

Dapsone and Salazopyrin (salicylazosulphapyridine) will cause oxidative intravascular haemolysis in normal subjects if taken in high enough dosage. Red cells show the 'bite' abnormality of the chemically damaged cell (Figure 10.5). Heinz bodies may be absent or scanty in patients with an intact spleen. Dapsone is used in the treatment of G6PD-deficient subjects with leprosy and in the treatment of dermatitis herpetiformis, in which functional hyposplenism occurs Heinz bodies appear in the latter case, acute intravascular haemolysis in the former. Leprosy dermatitis herpetiformis

Changes in disease

The catecholamines released in chronic stress appear to have a related effect by inhibiting IL-12 and enhancing IL-10 (Hazko et al., 1998). Paradoxically it has been proposed that the acute stress reaction seen in inflammatory dermatoses, such as psoriasis and eczema, (Dhabar et al., 1996) is induced also by corticos-teroids and catecholamines, which have a particular effect in the acute stress response of inducing enhanced cell-mediated immunity via INF gamma and the cytokine IL-2. Animal studies (Jafarian-Tehrani & Sternberg, 1999) have suggested that the HPA axis response to stress may also be impaired in chronic stress, allowing a susceptibility to autoimmune diseases to emerge. The mechanism is unclear but similar observations in patients with atopic eczema (Buske-Kirschbaum et al., 1997) and rheumatoid disease (Gutierrez et al., 1999) have been recorded.

Malabsorption

Malabsorption of dietary folate occurs in tropical sprue, in gluten-induced enteropathy in children and in adults, when it is associated with dermatitis herpetiformis. In the rare congenital syndrome of selective malabsorption of folate, there is an associated defect of folate transport into the cerebrospinal fluid, and these patients show megaloblastic anaemia, responding to physiological doses of folic acid given parenterally but not orally. These patients also show mental retardation, convulsions and other central nervous system abnormalities. Minor degrees of malabsorption may also occur following jejunal resection or partial gastrectomy, in Crohn's disease and in systemic infections but, in these conditions, if severe deficiency occurs, it is usually largely due to poor nutrition.

Pellagra

Pellagra is caused by a nutritional deficiency of niacin and classically manifests with the triad dermatitis, diarrhoea, and dementia (3Ds). Clinically, it manifests with a remarkable photosensitive rash that may show an ec-zematoid pattern with hyperpigmentation. Most lesions affect the face and neck, and both lower limbs present with signs similar to those found in stasis dermatitis. Eczematoid changes, xerosis, and hyperpigmented Finally, a number of chronic skin conditions, ec-zematous in nature, result in bilateral and remarkably symmetrical hyperpigmented skin patches. A symmetrical rash suggests contact dermatitis, but complex cases involve a vascular deficit secondary to venous hypertension. Psoriasis may also present with a chronic recurrent eczematous picture affecting the heel and medial plantar aspects on both feet.

Measles

Measles is an acute communicable disease which presents with fever, signs of inflammation of the respiratory tract (coryza, cough), and a characteristic skin rash. The presence of punctate lesions (Koplik's spots) on the buccal mucosa may assist diagnosis in the early prodromal phase. Deaths occur mainly from complications such as secondary bacterial infection, with bronchopneumonia and skin sepsis. Post-measles encephalitis occurs in a few cases. The incubation period is usually about 10 days, at which stage the patient presents with the prodromal features of fever and coryza. The skin rash usually appears 3-A days after the onset of symptoms. The aetiological agent is the measles virus.

Disease

The skin is the part of the body which comes into direct contact with the environment and hence it is usually the first part of the body to sustain damage or be exposed to irritant substances. Thus, dermatitis is a fairly common complaint. The symptoms generally begin as itching, sweat retention, increased sensitivity and pain, but lead to swelling, oozing, crusting and scaling, with thickening and hyperpigmentation. Inflammation occurs in response to a number of factors e.g. mechanical, chemical, thermal stimuli, infections or imbalance in the autoregulation processes. All these processes can reduce barrier action and lead to increased permeability of the skin to drugs. Allergic contact dermatitis from drugs is a significant obstacle to the development of transdermal drug delivery systems and various animal models are being investigated to test methods for its prevention23.

Behaviour therapy

Systematic desensitisation is an appropriate technique for the treatment of dermatoses which feature anticipatory anxiety (Van Moffaert, 1992). The fear and apprehension that patients with skin disease may feel about themselves may be challenged by this technique. Through graded exposure, the patient enters situations that they may fear and avoid. The habit-reversal technique is a common strategy used to inhibit scratching and it has been reported to have some success with skin disorders, such as eczema and psoriasis (Ginsburg, 1995). It involves self-monitoring for early signs and situational cues of scratching and practising alternative responses, such as clenching the fists (Ehlers et al., 1995). Relaxation has beneficial effects on skin disorders because it reduces stress levels. It is a useful way to help patients prepare for anxiety-provoking situations or to cope with stressful social predicaments. Relaxation can be used on its own as a means to reduce anxiety or tension or can...

Group therapy

Various approaches, such as social skills training to group therapy have been tried with patients with skin disorders (Robinson et al., 1996). Patients with chronic skin conditions, such as psoriasis or eczema are known to benefit from group therapy and such therapy has increased their confidence in coping with the disease (Ehlers et al., 1995 Seng & Nee, 1997 Fortune et al., 2002).

Therapeutics

There is now a widespread use by pharmaceutical companies of QoL measures as additional outcome measures in clinical trials of new drugs. Recent examples include a study from Germany that demonstrated that use of topical pimecrolimus cream in adults with atopic dermatitis results in major improvement of QoL, as well as in standard clinical parameters (Meurer et al., 2004). Similar improvement was seen in a study from Korea (Won et al., 2004) using topical tacrolimus in adults and children with atopic dermatitis.

Gerry Kent

Since Goffman's seminal work, there have been several collections of essays (e.g. Jones et al., 1984 Heatherton et al., 2000) that cover research on stigma from a general psychological perspective. The aim of this chapter is to review the research on stigma and stigmatisation as it relates to dermatological conditions. The work has been conducted with people with a variety of skin conditions, including vitiligo, psoriasis, port wine stains and eczema. The chapter aims to answer six questions

Conclusion

Psychiatric disorders in the dermatological patient are generally assumed to be secondary to the skin disorder however, in some instances they may be primary and or have a direct impact on the course of the dermatological symptoms. Pruritus severity in psoriasis and atopic dermatitis has been noted to correlate directly with the severity of depressive symptoms in the patient, suggesting that depression may modulate pruritus perception. Depressive disease is one of the most frequently encountered psychiatric disorders in dermatology and may be a feature of a wide range of conditions including psoriasis, acne, chronic idiopathic urticaria and atopic dermatitis. Depressive symptoms may also present as somatic equivalents, for instance cutaneous dysaesthesias for which no physical basis can be identified. Psoriasis and acne have been associated with suicidal ideation and suicide. In psoriasis the frequency of suicidal ideation generally increases with increasing psoriasis severity however...

Clinical Disease

In addition, asymptomatic infection, e.g. travelers, should be actively screened for. Suspicion should be particularly high in an individual with esophageal varices, hepatic enlargement and normal liver function tests (El Rooby, 1985 Raia et al., 1984). Most other etiologies for bleeding varices result in small cirrhotic livers, elevation in transaminases and low serum albumin. Travel history, history of contact with fresh water, skin rash or acute febrile episodes should be specifically elicited. A definitive diagnosis is made by identification of the characteristic schistosome eggs in feces, urine or a biopsy specimen (Feldmeier, 1993). The excretion of eggs may be scanty or absent in the early phase of illness and repetitive examinations are recommended, using the appropriate stool or urine concentration techniques (World Health Organization, 1983 Peters and Kazura, 1987). Parasite eggs may also be absent or in low numbers in patients who present with chronic fibrotic complications...

Penny Titman

Skin disease is very common among children and young people. For example, up to 20 of young children develop eczema and the majority of young people develop some symptoms of acne temporarily during adolescence (McHenry et al., 1995 Smithard et al., 2001). However, there is surprisingly little research on the psychological impact of skin disease in childhood and the focus of most research in paediatric psychology has been on life-threatening conditions, such as cancer. Despite the lack of research, there is widespread acknowledgement of the impact of skin disease on the psychological well-being and quality of life of children, and increasing awareness of the importance of understanding the psychological impact of skin disorders on children and their families (Howlett, 1999). strongly influenced by their peer group and become less dependent on their parents. As a consequence of this, the implications for a child with, for example, severe eczema at the age of 2 years are very different...

Fabrys disease

Although females are heterozygous, they are usually symptomatic and may be as severely affected as males. A skin rash (angiokeratoma) and pain in limbs (acro-paraesthesia) are early symptoms (under 10 years old). In late childhood, reduced sweating, abdominal symptoms and lymphoedema are characteristic. Renal failure, cardiac failure, stroke, epilepsy and CNS sensory organ involvement are later features. Life expectancy is 40-50 years for men and 50-65 years for most women.

Psoriasis

Psoriasis, like atopic eczema, is an inflammatory skin disease with a multifactorial aetiology. It is a chronic, immune-mediated disorder (Kreuger, 1989) associated with significant physical and psychological morbidity. The psychological factors have been summarised by Ginsburg and Link (1989) and instruments have been developed to measure psoriasis-related stress (Wang et al., 1990 Fortune et al., 2002).

Hyposplenism

In some disorders such as sickle cell disease, gluten-induced enteropathy (coeliac syndrome) and dermatitis herpetiformis, hyposplenism occurs frequently it is seen less frequently in Crohn's disease, ulcerative colitis and essential thrombocy-thaemia, and it occurs only occasionally in the other conditions listed in Table 21.2. Congenital absence of the spleen is rare and may be associated with organ transposition and with severe malformations of the heart and lungs.

Eosinophilia

Up to 10 of the travelling population have atopic conditions, such as eczema or asthma, which cause a raised eosinophil count, and some medications such as nonsteroidal anti-inflammatory agents also cause a raised count. A wide variety of nematode and trematode infections produce eosinophilia, particularly during the migratory phases of larvae through the body (Table 12.12). Some of these, such as hookworms, roundworms and Strongyloides spp are universally distributed in the tropics, while other parasitic infections will be suggested by the specific travel history of the patient and by the symptoms and physical findings.

Identity

Variables that identify the presence or absence of the illness Skin diseases can be identified by symptoms such as pain and itching, concretely by signs like sores or bleeding and by the use of abstract labels such as eczema or psoriasis. Identity is important because the meaning and interpretation of a symptom can influence the way the person addresses the symptom. Should a patient erroneously apply the label of skin cancer to a white lesion on their skin, this could precipitate a different response than were they to attribute the lesion as a rash or an injury. This is particularly important in the domain of help-seeking.

Arthropod infections

This is an infection of the skin by the mite, Sarcoptes scabiei. The skin rash typically consists of small papules, vesicles and pustules, characterized by intense pruritus. Another typical feature is the presence of burrows, which are superficial tunnels made by the adult mite. Secondary bacterial infection is common. Lesions occur most frequently in the moist areas of skin, for example the web of the fingers.

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