Sensitive skin

Sensitive skin is not an uncommon problem. It is almost always a problem of facial skin, but can occur anywhere or everywhere on the body. The most common complaint is that facial products start to burn, tingle or sting when applied. The product often needs to be washed off quickly to relieve the sensation.

Sensitive skin is a symptom. It is not a specific disease, like asthma. Therefore, the question to ask when you have sensitive skin is: “What is the underlying condition that is causing the sensitive skin?”

From a purely anatomical or physiological perspective any condition that can disturb the epidermis, which is the top layer of the skin, can lead to a sensitive skin. Nerve fibres terminate in the epidermis, so any condition that disturbs the area around a nerve fibre can result in that nerve fibre becoming too easily stimulated. This over sensitivity of nerve fibres is experienced by the patient as sensitive skin.

The two most common causes of a sensitive skin are Atopic Dermatitis and Irritant Dermatitis.

Atopic Dermatitis is a genetic condition that results in many different signs and symptoms, but a tendency to dryness is perhaps the most common symptom. Dryness leads to an abnormal epidermis, disturbs the environment of the epidermal nerve endings and opens the door for sensitive skin to develop. Because dryness is the primary problem, the cornerstone of the treatment of Atopic Dermatitis is moisturisers and the avoidance of products that can dry the skin even more, like regular soaps and cleansers. Over time, this will improve the epidermis, normalize the area around the nerve fibre and result in less sensitivity. In many patients Atopic Dermatitis only manifests later in life.

Irritant dermatitis is caused by exposure to irritants. These irritants are most often soaps, cleansers, toners and other cosmetic preparations. Very often these products are advertised as mild, natural and non-irritant. The cornerstone of the treatment if Irritant Dermatitis is to avoid the irritant. With complete avoidance of the irritant and other supplementary measures, the skin sensitivity will gradually subside over a period of weeks to months.

Irritant dermatitis can often be superimposed on Atopic dermatitis. The patient with Atopic dermatitis already has an abnormal epidermis and is therefore already much more sensitive to the potential irritant effects of soaps and other cosmetic products. Patients often find it difficult to believe that their facial products or facial cosmetic routine can play a role in their sensitive skin. “Doctor, but I have used those products for years”, is a common explanation for why the facial products cannot possibly play a role. But, it can.

There are two possible explanations why an existing product can suddenly start stinging. Either the person himself/herself has changed or the product ingredients or way of use have changed.

Here are some examples of the “person has changed” scenario:

  • Perhaps an oral medication was started that makes the skin drier. Statins, used to treat elevated cholesterol levels, often leads to dry skin and then increased skin sensitivity.
  • Perhaps the work or home environment changed. Air conditioners can sometimes tip the scale towards dryness.
  • Perhaps a Contact dermatitis has developed. Contact dermatitis is a type of skin allergy that can be investigated by doing an allergy tests, called patch tests.
  • Stress has been showed to influence the epidermis in dramatic ways.
  • The thyroid gland might have become under active, leading to a disturbed epidermis and increased skin sensitivity.
  • The normal ageing process and sun damage leads to increased skin dryness that can then lead to sensitive skin.
  • After the menopause the skin becomes significantly drier and prone to sensitivity

To figure out what exactly tipped the scale towards a sensitive skin and to treat sensitive skin will often require the help of a dermatologist.

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How to eliminate House Dust Mite

House_Dust_MiteThere are many triggers that can cause a flare-up of Atopic eczema. The House Dust Mite is one such trigger.  House Dust Mite lives in the dust found in human and animal habitation.  Not everybody with Atopic eczema will be sensitive to the House Dust Mite, but more than 35% of Atopic eczema patients are sensitive to House Dust Mite. The Atopy Patch test can be used to test for House Dust Mite Allergy.

House Dust Mites feed on pollen, fungi, bacteria and most importantly on the skin flakes shed from humans and animals. These skin flakes concentrate in the creases of bedding and furniture. The number of skin flakes and House Dust Mites found in an area is proportional to the time humans and animals spend in that area. Bedding will therefore contain large numbers of House Dust Mites.

If you want to start a House Dust Mite elimination campaign the places to concentrate your efforts should therefore be those areas where the family spend most of their time.

Before describing the steps needed to contain the House Dust Mite population, please note that the elimination of House Dust Mite is still vastly less important than the regular application of moisturisers.

PREPARATION

  • Completely empty the room, just as if you were moving.
  • Empty and clean all cupboards. If possible, store contents elsewhere and seal the cupboards.
  • Remove carpeting.
  • Replace curtains with metal of wooden blinds that are easy to clean
  • Clean and scrub the woodwork and floors thoroughly to remove all traces of dust.
  • Wipe wood, tile, or linoleum floors with water, wax, or oil.
  • Cement any linoleum to the floor.
  • Keep the doors and windows closed.

MAINTENANCE

  • Clean the room thoroughly and completely once a week.
  • Clean floors, furniture, tops of doors, window frames and sills, etc., with a damp cloth.
  • Carefully vacuum upholstery regularly. Use a special filter in the vacuum.
  • Air the room thoroughly after cleaning

BEDS AND BEDDING

  • Keep only one bed in the bedroom. Most importantly, wrap mattress in a zippered dust-proof or allergen-proof cover. Scrub beds outside the room. If you must have a second bed in the room, prepare it in the same manner.
  • Use only washable materials on the bed. Sheets, blankets, and other bedclothes should be washed frequently in water that is at least 50 degrees Celsius. Lower temperatures will not kill dust mites. If you set your hot water temperature lower, wash items at a laundromat which uses high wash temperatures.
  • Use a synthetic material for bedding. Avoid fuzzy wool blankets or feather- or wool-stuffed pillows.

FURNITURE AND FURNISHINGS

  • Go for the minimalist look on the room.
  • Avoid upholstered furniture.
  • Use only a wooden or metal chair that you can easily clean.

AIR CONTROL

  • Modern air conditioners can reduce the levels of house dust mite in the air.

CHILDREN

  • Keep toys that will accumulate dust out of the child’s bedroom.
  • Avoid stuffed toys
  • Use only washable toys of wood, rubber, metal, or plastic
  • Store toys in a closed toy box or chest

PETS

  • Keep all animals with fur or feathers out of the bedroom. If you are allergic to dust mites, you could also be allergic or develop an allergy to cats, dogs, or other animals.

These steps are extreme, but it is only by eliminating >90% of house dust mites in an area, that you obtain any benefit. If these measures does not help to reduce the severity of your Atopic Eczema, you are most likely not sensitive to House Dust Mite allergens.

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The cause of Atopic Dermatitis

The cause of Atopic DermatitisThe cause of Atopic Dermatitis is impairment of the barrier function of the skin. This impairment is caused by decreased levels of two epidermal compounds: Ceramide and Filagrin. Ceramide is decreased because of a genetically determined increase in an enzyme that breaks down a Ceramide building block. Filagrin is decreased because of under-expression of the gene that govern Filagrin formation.

Once the skin barrier becomes impaired, it becomes more porous and Atopic Dermatitis will start to become visible. This leads to a much more sensitive skin, because it becomes easy for irritants to penetrate into the skin. The skin also becomes more susceptible to infection that can further aggravate this dermatitis.

The goal of treatment in Atopic Dermatitis is therefore to repair the skin barrier function.

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The diagnosis of Atopic dermatitis

Atopic dermatitis cannot be diagnosed with a test, like diabetes for example. Atopic dermatitis can only be diagnosed clinically. That means that in order for you to be diagnosed with Atopic dermatitis your doctor or dermatologist must see certain signs on your skin.

In summary, the major diagnostic features of Atopic Dermatitis are:

  • The typical skin signs
  • a Personal or family history Atopic Dermatitis, Asthma or Hay fever
  • Itching
  • Chronicity of the condition

The typical skin signs of Atopic dermatitis varies with age. In infants the face, scalp, front part of the legs and back part of the arms are most often affected. In adults the disease seems to switch to the opposite side of the limbs where it is the back part of the legs (especially the skin folds behind the knee), the front part of the arms (especially the skin folds at the elbow) and other flexural areas that are characteristically affected. These are not hard-and-fast rules and any area of the skin can be affected.

In addition to the above mentioned major features of Atopic Dermatitis the following minor features can also help in making the diagnosis of Atopic Dermatitis.

  • Xerosis (Skin dryness)
  • Denny-Morgan skin folds. These are prominent skin folds in the lower eyelid.
  • Centro-facial pallor. The skin of the central part of the face appears lighter than the periphery.
  • Peri-orbital darkening. Darkening of the skin around the eyes.
  • Pityriasis alba (a slight powdery-white scaling on the cheeks)
  • Keratosis Pilaris, which can be felt as a roughness on the upper-outer arms especially.
  • a Raised IgE – antibody level on a blood test
  • an Increased number of eosinophils (a type of white blood cell) in the blood
  • Seasonality of the condition
  • a Positive skin prick test to various substances
  • Itching when sweating
  • Prominent skin folds along the front of the neck
  • Prominent dryness on the shins that can have a puzzle-like appearance due to large dry flakes
  • Hand en foot dermatitis
  • Nipple dermatitis
  • Red inflamed eyes
  • Cataracts
  • A sensitivity to wool

Please note that blood tests and skin prick tests cannot be used to diagnose Atopic Dermatitis! They make up just 3 of the minor features of Atopic Dermatitis and are therefore relatively unimportant when it comes to diagnosing Atopic Dermatitis.

It is important to realize that not any single factor alone are diagnostic of Atopic dermatitis. The diagnoses can be made with confidence only if at least 3 of the 4 major features are present together with 3 of the minor features of Atopic Dermatitis.

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I have eczema. I am fed up with applying cream! Now what?

First, relax….

No, eczema can’t be cured. Yes, there is a chance you can have eczema for life. Yes, you might have to apply creams for perhaps the rest of your life! And yes, you do have one of the most frustrating conditions there is.

Please, have your moments of despair, but never, never, never stop using your moisturizers! They are the single most important tool in your eczema treatment toolbox! They are without side effects in most people and can make a major difference to the control of dermatitis by simply keeping skin well hydrated.

Moisturizers are the most important tool in your treatment toolbox

By hydrating your skin the best you can, you will also use less immunosuppressant creams and ointments like corticosteroids, Tacrolimus and Pimecrolimus. Less immunosuppressant medication means there is less chance of getting the side effects of these medications like skin thinning (corticosteroids), infections and even the small unproven possibility of skin cancers (Tacrolimus and Pimecrolimus).

If you do not apply your moisturizers religiously, the whole emphasis of your treatment will start shifting toward immunosuppression. If you were someone who controlled your eczema with emollients and intermittent corticosteroids you will find that you need more corticosteroids. Some people will need treatment with light therapy and a few people might need immunosuppressive tablets. Light therapy raises the chances of skin cancer and most immunosuppressive tablets raises the chances of skin and other cancers.

There are many different emollients on the market. Experiment! Find one you like and stick with it! Use it head-to-toe at least twice a day. Use it even if your skin looks perfect to you. Remember, the goal of using emollients is not only to sooth active eczema, but also to prevent flare-ups from occurring!

Get fed up, feel despair, feel frustrated and then just start applying the emollients again and again…….!

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