Eczema and psoriasis are two chronic skin conditions that not only can be painful, but also debilitating – leading many patients to feel less attractive and affecting their work and social lives.

The skin is an important barrier that protects us from harmful bacteria, radiation, and even variations in temperature – and damaged skin due to both internal and external factors can cause us to be more susceptible to dangerous elements. 

This is why eczema and psoriasis flareups can lead to more severe complications, and why it is important to treat them as soon as possible upon diagnosis.

In order to do so, this article aims to provide a summarized guide on the diagnosis and treatment of the most common and chronic types of eczema and psoriasis – including advice on how to minimize the onset of a flareup during the circuit breaker period.

What is Eczema

Essentially, eczema is the body’s overactive immune response to an allergy or irritant that causes red, scaly, and itchy patches on the skin.

Otherwise known as “atopic dermatitis” – eczema can appear on the face, neck, upper arms, back, and elbow and knee creases; as well as the back of the hands and feet.

Here are some common symptoms:

• Itchy skin that can sometimes be intense
• Redness
• Dry or flaky skin
• Small blisters that may weep or ooze
• Cracked skin that may bleed
• Leathery, thickened skin that happens after scratching

“The itch that rashes” is another term for eczema; as it is almost always itchy before a rash appears. Although more common in children, eczema affects 1 in 10 adults worldwide. It is also one of the most common skin conditions treated at the National University Hospital and the National Skin Centre in Singapore.

Eczema arises due to genetic and environmental factors –  a family history of eczema; or being exposed to heat, dust, chemicals, food allergies, and other irritants can all trigger a flareup.

The main cause for eczema isn’t always easily identified; however, is vital if you want to appropriately manage and control the condition.

There are more than 10 different types of eczema that all differ in their characteristics, appearance, and severity. The most common types include:

• Atopic Dermatitis (usually develops in childhood, and often develops as scaly patches that are red, inflamed, swollen, and itchy)
• Contact Dermatitis (due to the skin coming into contact with irritants or allergens such as cosmetic products, soaps and detergents, metals found in jewelry, or fragrances in perfumes)
• Seborrheic Dermatitis (affects both babies and adults – although adults suffer from a more chronic and relapsing form. Often develops as yellowish, greasy patches over the oily areas of the body such as the face and back. Commonly seen as scalp dandruff)

People with eczema also lack a protein known as filaggrin – which is important in retaining the skin’s moisture. Without it, the skin loses excessive moisture; making it dry and even more susceptible to infection and injury.

The “itch-scratch cycle” is what doctors call the vicious cycle of scratching, inflammation, and then more itching – causing broken skin and open blisters that can result in a bacterial or viral infection.

Unfortunately, infections do happen – leading to further complications and becoming fatal in rare cases. Eczema herpeticum is a potentially serious condition that causes a sudden, painful widespread flareup with weeping small sores and painful blisters after exposure to the cold sore virus (herpes simplex). It can also cause fatigue, fevers, chills, and possible death and blindness.

In this case, doctors will likely have to prescribe antiviral medication in order to help reduce the severity of the outbreak.

In diagnosing and assessing your condition, your doctor will likely ask you about:

• Any known triggers
• Past medical conditions
• Previous diagnoses, if any
• Previous medications and your response to it

Understanding your triggers is the first step to preventing future flareups; and identifying and actively taking steps to avoid them is just as important as treatment itself.

What is Psoriasis

Psoriasis is a chronic inflammatory skin condition that is characterized by clearly defined, red, and scaly plaques (thickened patches) on the skin.

The immune system plays a key role in psoriasis, where a specific type of white blood cell called T lymphocytes abnormally triggers inflammation in the skin and causes skin cells to rapidly multiply – which is why we often notice elevated and scaly plaques on the surface of the skin.

Appearing most frequently at the scalp, elbows, and knees, here are some symptoms of psoriasis:

• Red or purplish raised patches on the skin
• Silvery scales over plaques
• Dry skin that can crack or bleed
• Burning and stinging sensation that can include itching
• Changes in the nails such as discoloration

Similar to eczema, psoriasis has a genetic and environmental element to it – where a third of people with the condition will have at least one family member affected by the disease. In some cases, psoriasis can also affect the joints in what is known as psoriatic arthritis.

There are 5 types of psoriasis, namely:

• Plaque Psoriasis (makes up more than 80% of cases – well-defined areas of elevated red skin, with a flaky, silver-white buildup on top)
• Guttate Psoriasis (appears as small, pink-colored drops – scales are finer than those seen in plaque psoriasis)
• Inverse Psoriasis (appears as red lesions in skin folds – most commonly found in the armpits, near the genitals, or in abdominal folds)
• Pustular Psoriasis (well-defined, white pustules on the skin that is filled with pus and surrounding red skin)
• Erythrodermic Psoriasis (a rare and severe type that is extremely inflammatory and affects most of the body’s surface – appears as a red, widespread rash over most of the body that is very itchy and painful)

Similar to eczema, severe psoriasis can lead to complications and require immediate medical attention. Moderate to severe forms of psoriasis are diagnosed as those who have more than 10% of their body surface affected at any point of time, or when flareups occur on sensitive areas such as the palms, soles, and face.

Especially for patients with erythrodermic and pustular psoriasis – seeking help from a doctor is essential to help with the pain and alleviating symptoms. 

Once again, identifying your triggers such as injury, stress, and certain lifestyle habits can also help decrease the frequency of psoriasis flareups.

Testing for Eczema and Psoriasis

Due to the similarities of eczema and psoriasis, it can be hard to differentiate between the two if overlapping features are present – but clear communication, a well-trained eye, and biopsy can be utilized to accurately identify your condition, as well as the appropriate treatments available.

Further investigations such as a patch test or blood work may also be considered for certain patients with eczema to eliminate any allergic reactions and figure out your triggers. 

Treating Eczema and Psoriasis

A good proportion of patients with eczema and psoriasis require only topical treatments – the key here is to alleviate the symptoms and prevent a relapse.

The first line of therapy often involves topical medications such as corticosteroids in the form of creams, gels, liquids, sprays, or ointments. It can also come in the form of vitamin D-3 derivatives and coal tar for patients with psoriasis. These range from mild to stronger options, which are prescribed according to the location and severity of your symptoms. These treatments have an anti-inflammatory effect that are helpful in treating acute and chronic flareups.

In a 2014 survey conducted, over 40% of patients experiencing mild psoriasis, 50% with moderate and 40% of the severe form were discontented with the recommended topical therapies¹ as compared to systemic and phototherapy groups.

When topical medications aren’t enough to resolve symptoms ­– phototherapy, systemic medications (cyclosporin, methotrexate, and acitretin for example), and new-class biologics can be utilized to modulate the immune system and treat moderate to severe conditions.

If there is presence of an infection – topical and oral antibiotics can also be prescribed to fight the bacteria and reduce inflammation.

Adhering to a good skincare routine such as regularly applying moisturizers and emollients are useful in keeping the skin hydrated and improving the itch. In a clinical trials of patients using topical corticosteroids – 15% – 47% patients suffering from mild to severe chronic plaque psoriasis showed improvements with the additional use of emollients².

It is important to remember that all treatments come with their list of pros and cons, as well as side effects that work differently on multiple patients. This is why it is vital that you seek help from a professional dermatologist to assess your needs, current condition and treat you accordingly.

Post-Inflammation Hyperpigmentation (PIH) from Eczema and Psoriasis

A common side effect that patients notice after an eczema or psoriasis flareup is post-inflammatory hyperpigmentation (PIH) – which typically happens following inflammation or picking and scratching of your skin during a flareup.

While trying to heal an injury, the body overstimulates melanocytes (pigment-producing cells) in the skin – causing brown or black localized scars to appear.

Majority of these scars will gradually fade on their own overtime, but when that fails to happen – treatments such as topical hydroquinone and other lightening agents such as glycolic acid and vitamin C may be used to improve this. If pigmentation is still persistent – more potent treatments such as chemical peels and lasers for pigmentation can then be considered.

Pico Lasers for Pigmentation

A photoacoustic laser that is FDA-approved – pico lasers are safe to use on all skin types and are the most advanced lasers to help with PIH whilst minimizing the risks of any adverse side effects.

The picoway laser and picosure laser both work differently from traditional lasers due to their unique mechanism of action that allows it to deliver ultra-short picosecond (one trillionth of a second) bursts of energy directly to the skin tissues to break up pigmentation.

As compared to the traditional Q-switch lasers that holds a high risk of side effects such as post-treatment hyperpigmentation and scarring, especially in dark-skinned patients – pico lasers provide safe, predictable, and consistent results. In a 2018 clinical study, Asian patients who were treated with the pico laser saw a low rate of PIH lesions at 4.65%³!

Coming in multiple wavelengths – 532nm, 755nm, 785nm, and 1064nm – this makes pico lasers an extremely versatile treatment that can be fully customized to your skin phototype, needs, and specific condition. 

At our dermatology clinic, we utilize pico lasers to treat PIH from varying causes such as acne, eczema, and psoriasis – supplementing it with a range of topical medications to help lighten and improve the appearance of benign pigmented lesions.

The systems in our clinic also include the picoway resolve and picosure focused lens array that can be used to treat acne scars, pores, and textural irregularities to achieve overall skin rejuvenation.

Key Takeaways

To date, there is no permanent cure for both eczema and psoriasis, although it can be largely controlled and managed with early treatment and prevention to improve the patient’s quality of life.

Because of the similarities between acne, rosacea, psoriasis, eczema, and allergies –finding a knowledgeable and experienced doctor to diagnose your red, dry, and itchy skin is the first important step.   

Dr. Angeline Yong is an experienced dermatologist with over 15 years of medical practice and offers the most innovative and scientifically-based solutions to treat all types of chronic skin conditions. Providing only the best quality care possible to all her patients, contact us today to get started on your personalized treatment plan and care!

Note: Flareups of chronic skin conditions such as pustular psoriasis and eczema herpeticum are extremely time-sensitive and need to be treated immediately. Considered to be an essential treatment – we will still be open during the circuit breaker period; however, we will only be providing essential services that are in line with government requirements.

Please take note that cosmetic treatments will not be offered during this time as we will be focusing solely on medical and surgical treatments that are considered essential. In the meantime, do stay safe and try to keep stress at bay, adhering to a healthy diet and keeping your skin moisturized to avoid a flareup during this period!

References:
1. Callis Duffin K, Yeung H, Takeshita J, et al. Patient satisfaction with treatments for moderate-to-severe plaque psoriasis in clinical practice. The British Journal of Dermatology. 2014;170(3):672-680.
2. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol 2009;60:643–59. doi:10.1016/j.jaad.2008.12.032.
3. Negishi K, Akita H, Matsunaga Y. Prospective study of removing solar lentigines in Asians using a novel dual-wavelength and dual-pulse width picosecond laser. Lasers Surg Med. 2018;50(8):851-858.