DRY/SCALY - SKIN/SCALP

See also

Foot skin problems,poor circulation, thrush fungal infection

Common problems

• Eczema: Occurs in atopic individuals /asthma /eczema /hay fever - often in flexures - when weeping/ cracked - often infected.
• Psoriasis: Condition characterised by the eruption of circumscribed, discrete and confluent, reddish, silvery sealed elevation to skin pre-eminently on the elbows, knees, scalp and trunk.
• Fungal skin infection: Impetigo in flexures - athletes foot - natal cleft.
• Fungal skin infection: Ring worm - enlarging scaling patches.
• Fungal skin infection: Seborrheic Dermatitis: Fungal skin infection - in scalp may resemble dandruff, occurs on hairline, folds either side of nose, chest and nappy area.
• (Dry skin: many individuals have dry skin without formal diagnosis).

Danger signs

• Infected eczema associated with staphylococal infection, or impetigo: bright yellow crusts or "scalded skin" - Contact GP.
• Eczema of hands (and feet): Contact dermatitis - usually needs potent steroids if cracking or fissuring or weeping - Contact GP.
• Psoriasis associated with nail pitting and/or joint painlarthritis - refer. Fungal skin infection of feet associated with spreading nail disease -possibly fungal nail infection - Contact GP for nail scrapings.

Notes for children

• Treat aggressively to get skin back to normal then remove therapeutic agents and use simple emollients.

Notes for the elderly

• Many elderly have extremely thin skin, which can be very prone to trauma, Large amounts o regular emollients are often of great benefit.

General advice

• Avoid degreasing agents - eg. reduce bathing, avoid too high water temperature in bath, reduce duration, avoid soap and bath additives (especially foam bath) other than oily emollients.
• In atopics, avoid potential allergens - rarely food - usually contact sensitivity.

Therapy

• Remove scales. Scalp - brush, oil to soften scales, then use product to raise scales, usually a coal tar derivative. Body - tar preparations.
• Hydrocortisone: Topical steroids reduce inflammation.
• Antifungal: Topical preparations are extremely effective.
• Emollient: Soap substitutes, moisturising agents, bath additives.
• Antiseptic: Where superficial second degree infection.

Dictionary

Allergens: antigen.
Antigen: substance that, as a result of coming into contact with appropriate tissues of an animal body, induces a state of sepisitivity and/or resistance to infection or toxic substances after a latent period and which reacts in a demonstrable way with tissues and/or antibody of the sensitized subject in vivo or in vitro.
Atopic: relating to or marked by atopy.
Atopy: type I allergic reaction, specifically one with strong familial tendencies caused by allergens such as pollens, foods and insect venoms.
Emollient: fats and oils, such as lanolin and liquid paraffin, that soothe and soften the skin.
Impetigo: a contagious superficial pyoderma, caused by staphylococci and streptococci that begins with a superficial flaccid vessel which ruptures and forms a thick yellowish crust.
Staphylococcus: a genus of gram-positive bacteria that forms irregular clusters: found on skin, in skin glands on the nasal and other mucous membranes.

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