There are a number of dry skin conditions which are prone to inflammation, such as plaque psoriasis, guttate psoriasis, atopic eczema, varicose eczema, incontinence-associated dermatitis, hand dermatitis and contact dermatitis (allergic and irritant).
Eczema, or dermatitis, includes a range of related inflammatory dry skin conditions where there is damage to the skin barrier, such as atopic eczema, contact dermatitis and varicose eczema. In all cases the skin is characteristically dry and often inflamed. When the skin is itchy, scratching can cause further damage to the skin and further inflammation.
The causes of the different types of eczema are varied and may include environmental factors. Both genetic and environmental factors are implicated in atopic eczema.
Flare-ups, characterised by areas of hot, red, inflamed skin, are a common feature of atopic eczema which affect part or most of the body. According to the NICE Atopic Eczema in Children Costing Report 2008, children with moderate atopic eczema suffer on average 8.7 flares per year1 and, within this period, mild to moderate atopic eczema patients are likely to have experienced at least one flare requiring a step up in treatment to either a topical corticosteroid or a topical calcineurin inhibitor.
It is important for patients to try to recognise the triggers which may lead to a flare of their eczema.
Common triggers include:-
Psoriasis is a systemic, immune-mediated disorder, characterized by inflammatory skin and joint manifestations. The inflamed ‘salmon pink’ coloured plaques, covered in silvery dry skin scales are characteristic of psoriasis.
NICE acknowledge the widespread use of emollients as part of the management of psoriasis, to moisturise dry skin. This helps to make the skin more comfortable by reducing itching and dryness and reducing the amount of scale. In addition, emollients may have an anti-proliferative effect in psoriasis and may be the only treatment needed in mild psoriasis.2
Emollients will always remain the mainstay of treating dry skin. However, for those whose skin is prone to inflammation, additional intervention may be required through the concomitant use of topical corticosteroids or immunomodulators, either during ‘flares,’ or sometimes for longer, because the severity of their baseline condition is not adequately controlled using emollients alone.
Effective though these agents are, their use may be restricted, especially in the context of long-term use, large areas of skin, sensitive sites of application, and use by vulnerable groups such as children and the elderly.
Combination therapy, typically involving supplementing emollient use with an additional anti‑inflammatory medicine, such as a topical corticosteroid or immunomodulator (also referred to as calcineurin inhibitor), is established standard care.
Topical corticosteroids are available in a variety of different potencies. Patients may sometimes be required to use a range of different strengths of topical corticosteroid when the severity of their skin condition changes, as well as for different parts of the body. It is always important to ensure that patients fully understand their treatment plans.
Combination treatment plans therefore need to be both customised to the differing needs of individual patients and closely monitored by a healthcare professional.
Adex Gel offers a useful treatment option to manage dry skin conditions predisposed to flare-ups.
Adex Gel combines an emollient and anti‑inflammatory action together in a single preparation, offering patients and healthcare professionals a simple and convenient treatment regimen.
Adex Gel can be used routinely in circumstances where ancillary anti-inflammatory action may be beneficial, or intermittently e.g. during flares.
Below is a useful patient resource on dry, inflamed skin which can be downloaded free of charge.
Managing dry, inflamed skin, a guide for patients
The use of other anti‑inflammatory topical treatments for eczema and psoriasis are detailed in the NICE links below.
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