1. The skin Part 2 24 th June 2013 Dr BK Sinha

2. The Average human body is covered by 1. 5 square feet of skin 2. 10 square feet of skin 3. 15 square feet of skin 4. 20 square feet of skin

3. What causes itching? 1.Itch bugs 2.Itch bodies 3.Itch receptors 4.Itch aliens

4. Eczema = Dermatitis From the Greek origin meaning – To Boil Over

5. So what does it cause? Itch Dry skin Red inflamed skin Sometimes weeping Sometimes infection

6. Atopic dermatitis Affects children Face, back of knees, Front of elbows Irritable and unhappy children

7. Dry eczema Affects older people Very dry itchy and red skin May be all over

8. Contact Dermatitis Can be related to irritation from chemicals, detergents,etc May be allergic

9. Pompholyx Vesicular Eczema ‘ Blebs’ on hands and feet Clear fluid when burst

10. Tests? None usually needed Occasionally Allergy testing Patch tests for contact dermatitis

11. Treatment Main problem is dryness Main treatment is – – MOISTURISE

12. MOISTURISE Creams or ointments as emollients Bath oils Shower gel or soap substitutes Smooth into the skin along the line of hair growth, rather than rubbing in

13. MOISTURISE The greasier the ‘cream’ the better it works, but the messier it is Ointments better for dry skin Use within 3 minutes of bath or shower Use as often as needed Lotions not as effective but less messy Can use lotions daytime and cream or ointment at night

14. Additional treatment Treat inflammation Main treatment - Steroid creams or ointments Use most effective preparation for shortest time possible Perfectly safe as long as some breaks taken Generally mild for face, moderately strong for trunk and very strong for palms and soles

15. How many ‘Finger tips’? Both sides of one hand = One fingertip unit One foot = Two fingertip units One arm= Three fingertip units One leg= Six fingertip units Chest and abdomen = Seven fingertip units Back and Buttocks = Seven fingertip units

16. Other Treatments for Eczema Anti histamine tablets for itching Sometimes steroid tablets but only short term Creams which work on the immune system, e.g., Tacrolimus to avoid side effects from continuous use of steroid creams Occasionally tablets

17. A case on an itchy foot Been itchy for many months Tried some creams but no better

18. Ring worm Very common 10-20 % Treated with creams If widespread, an antibiotic tablet works better

19. Scabies Itchy+++ Especially at night

20. Treatment of scabies Cream all over below neck All contacts Wash all bedding at high setting Rarely tablets

21. Problems with Sun Exposure Sunburn Long term skin damage and ageing Link to some forms of skin cancer

22. But We need the Sun! Lowers blood pressure and that could lower risk of stroke and heart attacks May reduce risk of dementia Main source of Vitamin D Vitamin D needed for »Healthy bones »Healthy teeth »May be Anti-Cancer

23. The Vitamin D story

24. Extent of the Problem 65% don’t get enough vitamin D In the winter and spring 1 in 6 people has a severe deficiency Lack of sun exposure linked to various cancers, diabetes and MS.

25. Responsible Sun Exposure Short daily periods of sun exposure without sunscreen during April to October About 10 to 15 minutes Less than the time it takes to start going red or to burn

26. What else can we do? Eat more oily fish such as salmon and mackerel Consider daily supplement – containing 10 mcg of Vitamin D

27. Key Messages If you have an itch, it could be anything from eczema to scabies The main treatment for eczema is to Moisturise the skin liberally and to use steroid creams sparingly Ringworm is common and treated with creams Scabies is commoner than one would think We can enjoy the Sun – but Responsibly!