Causes in children

The exact cause is unknown. It’s a multifactorial condition and genetic predisposition and environmental triggers play major roles. If you, your child, or any of their siblings have asthma, hayfever, or eczema (known as the ‘Atopic March’) then your child is more likely to develop eczema.
Although some children with eczema also have a food allergy, less than 2 out of 10 children with eczema develop a food allergy. Our current understanding is that eczema comes before the food allergy. The more severe it is, the higher the risk for developing an allergy.

Symptoms

Eczema looks like red, dry patches that can be itchy. Babies rub their feet and scratch as soon as they are undressed and sleeping can be unsettled.
Infected eczema can be weepy, sore and the skin looks swollen. Some children can become unwell if the eczema is very widespread or infected with bacteria or viruses.

Treatment for eczema

There is no eczema that doesn’t improve with topical steroids. When someone tells me that topical steroids don’t work it’s because a) the child doesn’t have eczema, b) they are not using the right topical steroid strength, and c) the eczema is infected.
Emollients are the mainstay for eczema in children and a regular application is needed. Soap-free washes are much more hydrating than bath oils.
It’s important to use the topical steroid appropriate at the correct strength, the correct amount, and the right duration.
Follow up is needed to ensure that eczema doesn’t flare and trigger factors have been identified.

Topical treatments

Emollients that are liked by parents and children are the QV cream and ointment,cerave cream and ointment, cetraben cream and ointment, hydromol ointment, and Epaderm ointment. If too greasy you can substitute them with creams but bear in mind these are less hydrating and may need more regular application.

Soap-free washes are part of the treatment. QV gentle wash is an excellent wash and if there are frequent bacterial skin infections a very good alternative is Octenisan antibacterial wash. Topical steroids such as clobetasone ointment, Betnovate ointment, or combination creams such as betamethasone with fusidic acid or betamethasone with clioquinol can be very effective when used correctly in the correct amount, location, and duration. A dermatologist confident in treating children with eczema can advise you and prescribe these for your child.

Conclusion

Eczema in children affects 1 in 5 in the Western world. It’s a common and treatable condition, which once identified early and correctly managed can change your child’s and family’s life.

If your kid has eczema or any other rash, don’t despair, book an appointment with the leading Consultant Paediatric Dermatologist Dr. Gabriela Petrof on +44(0)2034684884 or +44(0) 2038695134.

The post What is eczema? appeared first on Dr Anastasia Therianou.

It is a term for non-scarring hair loss that can occur at any age, in both men and women. It can also affect children. Symptoms of alopecia areata commonly include the coin-sized bald patches that can appear on the scalp, as well as hair loss from the torso, limbs, eyelashes, eyebrows, pubic hair, and beard. Occasionally, it can involve the whole scalp (alopecia totalis) or even the entire body and scalp (alopecia Universalis).

Does the hair grow back?

While regrowth is not guaranteed, in typical alopecia areata, regrowth occurs over a few months or even years. If the hair loss is relatively minor, as in most cases, full hair regrowth usually occurs spontaneously within a year. But where the hair loss is more extreme, it may not all grow back. When hair regrows can be white, at least initially, and you may get further episodes of alopecia areata. It is unpredictable if you get more flare-ups in the future or not.

Causes of alopecia areata

Experts believe that this kind of hair loss occurs when the immune system attacks the growing hair, causing inflammation. The reasons for this auto-immune condition are not fully understood, although extreme stress appears to be a trigger, and about 20% of sufferers have a family history. There are believed to be several genes that can make an individual more susceptible.

Other contributory factors

Some experts believe there is a wide range of contributing factors that make someone more susceptible to developing alopecia areata. Hormones, allergies, viruses, and even toxins might contribute. Probably several factors combined are involved in the activation of the condition in an individual.

Hair growth cycles

Hair follicle growth occurs in cycles consisting of a long growing phase (anagen), a short transitional phase (catagen), and a short resting phase. At the end of the resting phase, the hair falls out (exogen) and a new hair starts growing in the follicle beginning the cycle again. Hair loss in alopecia areata is a disorder of hair follicle cycling.

Other symptoms of alopecia areata

If you have alopecia areata on the scalp it may be accompanied by a tingling sensation. Another potential symptom is pitted nails, with an appearance like the pin-prick dents in a thimble. The condition tends to start with smooth bald patches without inflammation or scales, although hair loss can be diffused. There may be short, fractured hairs and patches of grey hair in a bald area.

Alopecia areata in men

Along with alopecia areata bald patches appearing on the scalp, men can experience patches of hair loss in their facial hair, as well as the chest and back hair. Male pattern baldness is a gradual thinning of hair on the scalp, whereas hair loss from alopecia areata is patchy in the majority of the patients.

Alopecia areata in women

Some hair thinning is common in around 55 percent of women by the age of 70, and this is known as female pattern baldness. However, alopecia areata can occur at any age. Like with men, it can have a negative impact on self-image, so it’s important to get to the cause and identify appropriate treatments.

What brings about regrowth?

While hair loss can be sudden and develop swiftly, regrowth is slower. Regrowth occurs if the inflammatory response subsides. People with minimal patches often have a full and spontaneous recovery within two years whether or not they receive treatment. But in about 30% the condition persists and becomes more extensive, or they have repeated cycles of hair loss and re-growth.

Possible solutions

Addressing the causes of stress in your life is believed to be of help in bringing about regrowth. If your regrowing hair is slow to return to your normal color, ask your hairdresser about dying it.  And speak to a dermatologist about treatments to speed up regrowth.

Diagnosing alopecia areata

You may be offered a blood test to identify a medical condition related to the thyroid gland that can be associated with alopecia areata. Also, a pull test and a trichoscopy to determine the stage of the shedding process, and rarely a scalp biopsy, where a tiny skin sample is taken to be checked under a microscope, might also be needed. Vitamin D is also being checked, as deficiency has been linked to unresponsive treatment, so it is important to optimize the levels before starting any treatment.

Alopecia areata treatments

There is a range of treatments, but none are effective for everyone, and some sufferers don’t respond to any treatment. Topical steroid ointments, creams, or applications, as well as intralesional injections of steroids, can be useful in localized disease.

Some physicians use oral steroids, but personally, I don’t like using them as many times hair loss can recur after the discontinuation of the treatment. Minoxidil foam may prevent further hair loss and improve hair density, but you’d need to commit to at least six months of using it. Another long-term treatment option is Anthralin, a synthetic tar-like substance.

Contact sensitization treatment is another option and involves creating inflammation at the scalp which helps with this condition. Immunosuppressant tablets such as methotrexate, azathioprine, or cyclosporine can be used in more severe cases.

There also some new treatments, currently under clinical trials (tofacitinib, ruxolitinib, and baricitinib). These are potentially new immunosuppressive tablets for alopecia areata. Furthermore, topical formulations of these medicines are also being studied for their effectiveness in treating alopecia areata

Alopecia areata prognosis

Even in the most severe cases of alopecia totalis and alopecia Universalis, recovery may occur at some future date. According to research, 40% of patients with one bald patch have full hair regrowth within 6 months and 27% of patients with multiple patches of hair loss have full regrowth within a year.

Important factors to consider

Your hair is not just decoration for your head – it is also protection. If you have bald patches remember to use sunblock or a hat to prevent sunburn in strong sunlight. And watch out for low doors, cupboards, and tree branches that can cause nasty scrapes on your bare scalp.

Alopecia areata facts

This skin condition is probably the third most common form of hair loss dermatologists see, and the lifetime risk is two in every 100 people at some point in their lives. It is not contagious and can affect men, women, and children. If you have alopecia areata you are slightly more likely to get other autoimmune conditions like vitiligo, lupus, diabetes, ulcerative colitis, and thyroid disease.

A total cover-up

If you feel self-conscious about your hair loss and are finding that regrowth is taking too long, wearing a wig or hairpiece is always an option. You can find one privately, or ask your consultant to prescribe you one through the NHS (there is some cost involved to you). Your hospital orthotic department will recommend suppliers who are good at assisting people with alopecia areata.

What else can I do?

Hair extensions can help to camouflage the problem, so look for a hairdresser who specializes in this. It is important to avoid too much tension on any hair when this is done because this in turn could cause hair loss, known as traction alopecia. Artificial eyelashes, eyebrow pencils, and eyebrow tattoos can also help you feel better about your appearance.

Find out more about alopecia-areata. If you’re concerned about your hair loss or hair thinning, don’t despair – book a consultation with a hair expert today.

The post Alopecia areata: Causes, Diagnosis, New Treatment appeared first on Dr Anastasia Therianou.

What is psoriasis?

A skin disease that occurs equally in men and women, psoriasis is an autoimmune condition that causes the overproduction of skin, resulting in red and scaly skin and irritation. It can start at any age, but most often develops in adults under 35 years old, affecting men and women equally. Tickle occurs cyclically, with flare-ups followed by periods of ‘remission’. It can look alarming, but it’s not contagious.

Psoriasis types

There are five different types of this disease. The most common type is plaque psoriasis, which causes red, inflamed patches on the skin which are often covered with skin plaques. Guttate psoriasis is common in childhood and causes small pink spots. Pustular psoriasis, more common in adults, causes white, pus-filled blisters and red inflamed skin. Inverse psoriasis causes bright areas of red, shiny, inflamed skin.

Severe tickle

The fifth type is erythrodermic psoriasis and it is both severe and very rare. Often covering large sections of the body, your skin appears sunburned and scales can slough off in large sections. Sufferers may experience fever or become very ill. As this type is life-threatening it’s important to see your GP.

Common symptoms

While it is rarely serious, psoriasis skin can be itchy and uncomfortable and feel like it’s crawling and prickling. In some cases, it is even painful. Where tickle affects hands and feet, you may have rawness with painful cracks that can bleed, affecting walking and use of your hands. Nail psoriasis can be painful if it causes your nail to lift away from the nail bed, and psoriatic arthritis causes pain and swelling in joints.

Causes and triggers

If a family member is or has been affected by tickle you are more likely to suffer from it. Flare-ups can be triggered by a variety of factors including stress, alcohol, skin damage, infections, and even intense sunlight. Some medications, including lithium, beta-blockers, high blood pressure medication, and some malaria treatments can also trigger flare-ups.

Where does psoriasis appear?

Chronic plaque psoriasis, the most common type, tends to appear on knees, between buttocks, on elbows, on the trunk, on the scalp, and behind the ears but may appear in other places on your body like palms and soles of the feet. Guttate psoriasis and pustular psoriasis both appear on the trunk and arms and legs.

Nail psoriasis

Around half of the people who have psoriasis also get a nail psoriasis. This can include salmon pink discoloration under the nail, pitting and ridging of your nail’s surface, and thickening and yellowing of the nails. It can also involve separation of the nail plate from your nail bed and even complete destruction of the nail.

Conditions related to psoriasis

There are a number of serious conditions related to tickle which make tackling the triggering factors important. Moderate to severe tickle increases the risk of heart disease and stroke and the disease can also be associated with diabetes, obesity, venous thromboembolism, high cholesterol, and high blood pressure, as well as inflammatory bowel disease.

What you can do

Once diagnosed by your GP, making certain lifestyle changes will help you to manage your symptoms. Staying a healthy weight, following a balanced diet, and exercising regularly are recommended. If you smoke, now is the time to stop and to avoid excessive alcohol. Find ways to reduce stress and anxiety and discuss any medication that may be having an impact on the condition with your dermatologist.

Treatments

There is no cure for tickle but it can usually be treated and managed very well. In most cases, topical treatments (applied to the surface of the skin) are enough to manage the condition. In more severe cases, phototherapy using ultraviolet light, tablets, or injections are required. There is also evidence that acupuncture can help in some cases.

If psoriasis is becoming a problem for you and you would like to discuss treatment options, arrange to see a dermatologist.

The post What to do if you have psoriasis? appeared first on Dr Anastasia Therianou.

The post Can covid-19 affect our hair? appeared first on Dr Anastasia Therianou.